Publications by year
In Press
Farrand P, Greenberg N, Bloomfield T, Watkins E, Mullan E (In Press). Acceptability of a Step 2 psychological therapy service for UK Armed Forces Veterans and family members: a qualitative study. Occupational Medicine
Watkins ER, Grafton B, Weinstein S, MacLeod C (In Press). For ruminators, the emotional future is bound to the emotional past: Heightened ruminative disposition is characterised by increased emotional extrapolation.
Clinical Psychological ScienceAbstract:
For ruminators, the emotional future is bound to the emotional past: Heightened ruminative disposition is characterised by increased emotional extrapolation
Processing mode theory (Watkins, 2008) proposes that rumination is characterized by abstract processing that involves increased thinking about the implications of emotional events, which derives the prediction that heightened ruminative disposition will be associated with elevated emotional extrapolation from current events when formulating future expectancies. To test this, we used a novel Emotional Extrapolation Assessment Task (EEAT) that measured individual differences in the degree to which the emotional tone of initial events influence relative expectancy for subsequent events that are emotionally consistent or inconsistent with this initial event. In Experiment 1, ruminative disposition was associated with increased self-reported expectancy for negative subsequent events relative to positive subsequent events. As predicted, in Experiment 2, heightened ruminative disposition was associated with increased emotional extrapolation, assessed using a comprehension latency performance-based measure.
Abstract.
Buckman JEJ, Saunders R, Cohen ZD, Barnett P, Clarke K, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, et al (In Press). Indicators of Prognosis Independent of Treatment for Adults with Depression in Primary Care, Going Beyond Baseline Symptom-Severity: a Systematic Review and Individual Patient Data Meta-Analysis. SSRN Electronic Journal
Burkhouse KL, Jacobs RH, Peters AT, Ajilore O, Watkins ER, Langenecker SA (In Press). Neural Correlates of Rumination in Adolescents with Remitted Major Depressive Disorder and Healthy Controls. Cognitive, Affective, and Behavioral Neuroscience
Trick LV, Watkins E, Henley W, Gandhi M, Dickens CM (In Press). Perservative negative thinking predicts depression in people with acute coronary syndrome. General Hospital Psychiatry
O'Mahen HA, Tester-Jones M, Karl A, Watkins E (In Press). Rumination in dysphoric mothers negatively affects mother-infant interactions. Journal of Child Psychology and Psychiatry
Dickens CM, Trick LVT, Watkins E (In Press). The association of perserverative negative thinking with depression, anxiety and emotional distress in people with long term conditions: a systematic review. Journal of Psychosomatic Research
2024
Langenecker SA, Westlund Schreiner M, Bessette KL, Roberts H, Thomas L, Dillahunt A, Pocius SL, Feldman DA, Jago D, Farstead B, et al (2024). Rumination-Focused Cognitive Behavioral Therapy Reduces Rumination and Targeted Cross-network Connectivity in Youth with a History of Depression: Replication in a Preregistered Randomized Clinical Trial. Biological Psychiatry Global Open Science, 4(1), 1-10.
2023
Dooley J, Ghezal A, Gilpin T, Hassan Basri H, Humberstone K, Lahdelma A, Misurya P, Marshall E, Watkins E (2023). Assessing the impact of university students’ involvement in the first year of Nurture-U: a national student wellbeing research project.
BMC Research Involvement and EngagementAbstract:
Assessing the impact of university students’ involvement in the first year of Nurture-U: a national student wellbeing research project
Background
Students experience lower levels of wellbeing than the general, age-matched population. A whole-university approach to mental health is encouraged, which must work for individuals from all backgrounds and experiences. Student input is vital in researching and designing these solutions. Nurture-U is a national, large-scale research project exploring better ways to support student wellbeing, with a Student Advisory Group (SAG) that feeds into project decision making. With the first year of the project now completed, we now critically review the processes and effectiveness of the SAG and how well the project is engaging and working with students.
Methods
Assessment of the SAG’s impact on the project, the student advisors, and the researchers was undertaken through a content analysis of team meetings and collection of advisor and researcher feedback using the Patient Engagement Quality Guidance Tool.
Results
142 students worked on different tasks in the first year of the Nurture-U project. The SAG was involved in the project branding and marketing, and in the development and co-design of interventions and tools. They reported a positive experience, with involvement boosting confidence. They felt valued but reported not always knowing whether their input was implemented in final decisions. They also recommended different methods of providing feedback. Researchers found student input beneficial to communicate the viewpoint of a different generation and increase the relevance of the study, but also suggested improvements for communication between the research team and the student group.
Conclusions
This critical reflection of the SAG’s public advisor role in this large-scale research project was important in highlighting what worked well and areas to improve. As the project unfolds, we aim to adapt our methods of student input, increase the transparency of decision-making processes, and in turn increase student-led decision making within the project.
Abstract.
Cranston T, Davy E, Elkhafer K, Jones B, Taylor G, Newbold L, Watkins E (2023). Designing a Single Online Screening and eConsenting System to Maximise Recruitment for Three Concurrent Randomised Controlled Trials of Complex Interventions for Improving Student Mental Health.
Abstract:
Designing a Single Online Screening and eConsenting System to Maximise Recruitment for Three Concurrent Randomised Controlled Trials of Complex Interventions for Improving Student Mental Health
The aim of the NURTURE-U study is to develop and evaluate an acceptable, effective, cohesive system of
whole-university and stepped care student wellbeing and mental health support. This study comprises three
concurrent randomised controlled trials (RCTs) which will evaluate different approaches of support.
Participants will be allocated to a trial based on their screening assessment. Screening, consenting and data
collection is to be conducted online in the form of surveys. A key requirement of the solution is participants’
user experience of the enrolment process (screening and consenting). The participants’ journey, from
screening to baseline completion, should be perceived as a single survey whilst accommodating segregation
of trial data. A system or integrated systems to facilitate this had to be developed.
The defined process allows individuals to enter the screening survey, consent and complete screening
before being, automatically, evaluated for trial eligibility. There are four possible outcomes from the study
screening. If an individual consents to participate in a trial, they then continue to complete the baseline
survey for their allocated trial.
REDCap Academic (RCA) was selected as the solution system, due to its versatility as an EDC system with
survey capabilities and extensive API. Desired features include RCA’s ability to prepopulate (pipe) data from
one survey to another, allowing participants to be seamlessly transferred into an alternative project within
RCA whilst completing a survey.
Four RCA validated projects were created: one screening and one for each of the three trials. Once
participants complete enrolment for a trial, they are automatically transferred to the trial’s baseline survey
without any break in survey flow. This transfer includes piped data, such as screening ID, linking the
screening record to the trial record.
User Acceptance Testing by the study team and students will conclude in August 2022, providing feedback
on student engagement of the system design and user experience, prior to deployment in Autumn 2022.
A single, unified, online screening and consenting system to determine eligibility against multiple trials is an
efficient trial enrolment solution. By negating the need for potential participants to complete multiple
screening surveys for different concurrent trials, it is anticipated that the system will aid recruitment, as well
as reducing burden on both potential participants and trial teams.
Abstract.
Mak WWS, Tong ACY, Fu ACM, Leung IWY, Jung OHC, Watkins ER, Lui WWS (2023). Efficacy of Internet-based rumination-focused cognitive behavioral therapy and mindfulness-based intervention with guided support in reducing risks of depression and anxiety: a randomized controlled trial (Preprint).
Abstract:
Efficacy of Internet-based rumination-focused cognitive behavioral therapy and mindfulness-based intervention with guided support in reducing risks of depression and anxiety: a randomized controlled trial (Preprint)
. BACKGROUND
. Rumination and worry are common risk factors of depression and anxiety. Internet-based transdiagnostic interventions targeting individuals with these specific risks may be an effective way to prevent depression and anxiety.
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. OBJECTIVE
. This study developed and compared the efficacy of two Internet-based transdiagnostic interventions with online guidance to an Internet-based psychoeducation control group in reducing risks and symptoms of depression and anxiety.
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. METHODS
. This three-arm randomized controlled trial compared Internet-based rumination-focused cognitive behavioral therapy (RFCBT), mindfulness-based intervention (MBI), and psychoeducation control (EDU). A total of 256 participants were randomised into one of the three courses and received a 6-module program. Participants’ level of rumination, worry, depressive and anxiety symptoms were assessed at post-intervention (6 weeks), at 3-month and 9-month follow up. Efficacy was tested using Linear Mixed Model analysis.
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. RESULTS
. Results showed similar levels of improvement on all outcomes across the three conditions. Change in rumination differed comparing RFCBT and MBI, where a fluctuation on rumination was noted at 3-month follow up among participants in RFCBT and an absence of long-term effect on was noted among participants in MBI at 9-month follow up.
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. CONCLUSIONS
. All three conditions showed similar reduction in risks and symptoms implied that the two active interventions were not superior to psychoeducation control. The high attrition at follow-ups suggested the need for caution concerning the findings. Future studies should tease apart placebo effect and identify ways to improve adherence.
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. CLINICALTRIAL
. Chinese Clinical Trial Registry (Trial no: ChiCTR-IOR-15006470)
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Abstract.
Edge D, Watkins E, Newbold A, Ehring T, Frost M, Rosenkranz T (2023). Evaluating the effects of a self-help mobile phone application on worry and rumination experienced by young adults: a randomised controlled trial. (Preprint).
Abstract:
Evaluating the effects of a self-help mobile phone application on worry and rumination experienced by young adults: a randomised controlled trial. (Preprint)
. BACKGROUND
. Delivery of preventative interventions via mobile phone applications offers an effective and accessible way to address the global priority of improving the mental health of adolescents and young adults. A proven risk factor for anxiety and depression is elevated worry and rumination, also known as repetitive negative thinking (RNT).
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. OBJECTIVE
. This was a prevention mechanism trial testing whether an RNT-targeting self-help mobile phone application (MyMoodCoach) reduces worry and rumination in young adults residing in the United Kingdom. A secondary objective was to test whether the app reduces symptoms of anxiety and depression and improves well-being.
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. METHODS
. A web-based, single-blind, two-arm parallel-group Randomised Controlled Trial (RCT) was conducted with N=236 people aged between 16 and 24 who self-reported high levels of worry or rumination. Eligible participants were randomised to an active intervention group (usual practice, plus up to 6 weeks of using the RNT-targeting mobile app, n=119) or a waitlist control group (usual practice with no access to the app until after six weeks, n =117). The primary outcome was changes in worry and rumination six weeks after randomisation. Secondary outcomes included changes in well-being and symptoms of anxiety and depression after six weeks and changes on all measures after 12 weeks.
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. RESULTS
. Participants randomly allocated to use the RNT-targeting self-help app showed significantly lower levels of rumination (mean difference -2.92, 95% CI [-5.57, -.28], P =.031, ηp2 =. 02) and worry (mean difference -3.97; 95% CI [-6.21, -1.73], P <.001, ηp2 =. 06) at six-week follow-up, relative to the waitlist control. Similar differences were observed for wellbeing (P <.001), anxiety (P =. 03) and depression (P =. 04). The waitlist control group also showed improvement when given access to the app after six weeks. Improvements observed in the intervention group after 6 weeks of using the app were maintained at the 12-week follow-up point.
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. CONCLUSIONS
. The MyMoodCoach app had a significant positive effect on worry and rumination, well-being, anxiety, and depression in young adults, relative to waitlist controls, providing proof-of-principle that an unguided self-help app can effectively reduce repetitive negative thinking. This app therefore has potential for prevention of anxiety and depression although longer-term effects on incidence need to be directly evaluated.
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. CLINICALTRIAL
. ClinicalTrials.gov, NCT04950257. Registered 6 July 2021 – Retrospectively registered (shortly after start of recruitment), https://www.clinicaltrials.gov/ct2/show/NCT04950257
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. INTERNATIONAL REGISTERED REPORT
. RR2-10.1186/s12888-021-03536-0
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Abstract.
Watkins E, Newbold A, Tester-Jones M, Collins LM, Mostazir M (2023). Investigation of Active Ingredients Within Internet-Delivered Cognitive Behavioral Therapy for Depression: a Randomized Optimization Trial.
JAMA Psychiatry,
80(9), 942-951.
Abstract:
Investigation of Active Ingredients Within Internet-Delivered Cognitive Behavioral Therapy for Depression: a Randomized Optimization Trial.
IMPORTANCE: There is limited understanding of how complex evidence-based psychological interventions such as cognitive behavioral therapy (CBT) for depression work. Identifying active ingredients may help to make therapy more potent, brief, and scalable. OBJECTIVE: to test the individual main effects and interactions of 7 treatment components within internet-delivered CBT for depression to investigate its active ingredients. DESIGN, SETTING, AND PARTICIPANTS: This randomized optimization trial using a 32-condition, balanced, fractional factorial optimization experiment (IMPROVE-2) recruited adults with depression (Patient Health Questionnaire-9 [PHQ-9] score ≥10) from internet advertising and the UK National Health Service Improving Access to Psychological Therapies service. Participants were randomized from July 7, 2015, to March 29, 2017, with follow-up for 6 months after treatment until December 29, 2017. Data were analyzed from July 2018 to April 2023. INTERVENTIONS: Participants were randomized with equal probability to 7 experimental factors within the internet CBT platform, each reflecting the presence vs absence of specific treatment components (activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, absorption, and self-compassion training). MAIN OUTCOMES AND MEASURES: the primary outcome was depression symptoms (PHQ-9 score). Secondary outcomes include anxiety symptoms and work, home, and social functioning. RESULTS: Among 767 participants (mean age [SD] age, 38.5 [11.62] years; range, 18-76 years; 635 women [82.8%]), 506 (66%) completed the 6-month posttreatment follow-up. On average, participants receiving internet-delivered CBT had reduced depression (pre-to-posttreatment difference in PHQ-9 score, -7.79 [90% CI, -8.21 to -7.37]; 6-month follow-up difference in PHQ-9 score, -8.63 [90% CI, -9.04 to -8.22]). A baseline score-adjusted analysis of covariance model using effect-coded intervention variables (-1 or +1) found no main effect on depression symptoms for the presence vs absence of activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, or self-compassion training (posttreatment: largest difference in PHQ-9 score [functional analysis], -0.09 [90% CI, -0.56 to 0.39]; 6-month follow-up: largest difference in PHQ-9 score [relaxation], -0.18 [90% CI, -0.61 to 0.25]). Only absorption training had a significant main effect on depressive symptoms at 6-month follow-up (posttreatment difference in PHQ-9 score, 0.21 [90% CI, -0.27 to 0.68]; 6-month follow-up difference in PHQ-9 score, -0.54, [90% CI, -0.97 to -0.11]). CONCLUSIONS AND RELEVANCE: in this randomized optimization trial, all components of internet-delivered CBT except absorption training did not significantly reduce depression symptoms relative to their absence despite an overall average reduction in symptoms. The findings suggest that treatment benefit from internet-delivered CBT probably accrues from spontaneous remission, factors common to all CBT components (eg, structure, making active plans), and nonspecific therapy factors (eg, positive expectancy), with the possible exception of absorption focused on enhancing direct contact with positive reinforcers. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN24117387.
Abstract.
Author URL.
Westlund Schreiner M, Roberts H, Dillahunt AK, Farstead B, Feldman D, Thomas L, Jacobs RH, Bessette KL, Welsh RC, Watkins ER, et al (2023). Negative association between <scp>non‐suicidal self‐injury</scp> in adolescents and default mode network activation during the distraction blocks of a rumination task.
Suicide and Life-Threatening Behavior,
53(3), 510-521.
Abstract:
Negative association between non‐suicidal self‐injury in adolescents and default mode network activation during the distraction blocks of a rumination task
AbstractIntroductionRumination, or repetitive and habitual negative thinking, is associated with psychopathology and related behaviors in adolescents, including non‐suicidal self‐injury (NSSI). Despite the link between self‐reported rumination and NSSI, there is limited understanding of how rumination is represented at the neurobiological level among youth with NSSI.MethodWe collected neuroimaging and rumination data from 39 adolescents with current or past NSSI and remitted major depression. Participants completed a rumination induction fMRI task, consisting of both rumination and distraction blocks. We examined brain activation associated with total lifetime NSSI in the context of the rumination versus distraction contrast.ResultsLifetime NSSI was associated with a greater discrepancy in activation during rumination relative to distraction conditions in clusters including the precuneus, posterior cingulate, superior, and middle frontal gyrus, and cerebellum.ConclusionDifficulties associated with rumination in adolescents with NSSI may be related to requiring greater cognitive effort to distract from ruminative content in addition to increased attention in the context of ruminative content. Increasing knowledge of neurobiological circuits and nodes associated with rumination and their relationship with NSSI may enable us to better tailor interventions that can facilitate lasting well‐being and neurobiological change.
Abstract.
Buckman JEJ, Cohen ZD, O'Driscoll C, Fried EI, Saunders R, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, et al (2023). Predicting prognosis for adults with depression using individual symptom data: a comparison of modelling approaches.
Psychol Med,
53(2), 408-418.
Abstract:
Predicting prognosis for adults with depression using individual symptom data: a comparison of modelling approaches.
BACKGROUND: This study aimed to develop, validate and compare the performance of models predicting post-treatment outcomes for depressed adults based on pre-treatment data. METHODS: Individual patient data from all six eligible randomised controlled trials were used to develop (k = 3, n = 1722) and test (k = 3, n = 918) nine models. Predictors included depressive and anxiety symptoms, social support, life events and alcohol use. Weighted sum scores were developed using coefficient weights derived from network centrality statistics (models 1-3) and factor loadings from a confirmatory factor analysis (model 4). Unweighted sum score models were tested using elastic net regularised (ENR) and ordinary least squares (OLS) regression (models 5 and 6). Individual items were then included in ENR and OLS (models 7 and 8). All models were compared to one another and to a null model (mean post-baseline Beck Depression Inventory Second Edition (BDI-II) score in the training data: model 9). Primary outcome: BDI-II scores at 3-4 months. RESULTS: Models 1-7 all outperformed the null model and model 8. Model performance was very similar across models 1-6, meaning that differential weights applied to the baseline sum scores had little impact. CONCLUSIONS: Any of the modelling techniques (models 1-7) could be used to inform prognostic predictions for depressed adults with differences in the proportions of patients reaching remission based on the predicted severity of depressive symptoms post-treatment. However, the majority of variance in prognosis remained unexplained. It may be necessary to include a broader range of biopsychosocial variables to better adjudicate between competing models, and to derive models with greater clinical utility for treatment-seeking adults with depression.
Abstract.
Author URL.
Toyomoto R, Sakata M, Yoshida K, Luo Y, Nakagami Y, Uwatoko T, Shimamoto T, Sahker E, Tajika A, Suga H, et al (2023). Prognostic factors and effect modifiers for personalisation of internet-based cognitive behavioural therapy among university students with subthreshold depression: a secondary analysis of a factorial trial.
J Affect Disord,
322, 156-162.
Abstract:
Prognostic factors and effect modifiers for personalisation of internet-based cognitive behavioural therapy among university students with subthreshold depression: a secondary analysis of a factorial trial.
BACKGROUND: Internet-cognitive behavioural therapy (iCBT) for depression can include multiple components. This study explored depressive symptom improvement prognostic factors (PFs) and effect modifiers (EMs) for five common iCBT components including behavioural activation, cognitive restructuring, problem solving, self-monitoring, and assertion training. METHODS: We used data from a factorial trial of iCBT for subthreshold depression among Japanese university students (N = 1093). The primary outcome was the change in PHQ-9 scores at 8 weeks from baseline. Interactions between each component and various baseline characteristics were estimated using a mixed-effects model for repeated measures. We calculated multiplicity-adjusted p-values at 5 % false discovery rate using the Benjamini-Hochberg procedure. RESULTS: After multiplicity adjustment, the baseline PHQ-9 total score emerged as a PF and exercise habits as an EM for self-monitoring (adjusted p-values
Abstract.
Author URL.
Schreiner MW, Miller RH, Jacobsen AM, Crowell SE, Kaufman EA, Farstead B, Feldman DA, Thomas L, Bessette KL, Welsh RC, et al (2023). Rumination Induction Task in fMRI: Test-Retest Reliability in Youth and Potential Mechanisms of Change with Intervention.
medRxivAbstract:
Rumination Induction Task in fMRI: Test-Retest Reliability in Youth and Potential Mechanisms of Change with Intervention.
BACKGROUND: Rumination is a transdiagnostic problem that is common in major depressive disorder (MDD). Rumination Focused Cognitive Behavioral Therapy (RF-CBT) explicitly targets the ruminative habit. This study examined changes in brain activation during a rumination induction task in adolescents with remitted MDD following RF-CBT. We also evaluated the reliability of the rumination task among adolescents who received treatment as usual (TAU). METHOD: Fifty-five adolescents ages 14-17 completed a self-relevant rumination induction fMRI task and were then randomized to either RF-CBT (n = 30) or TAU (n = 25). Participants completed the task a second time either following 10-14 sessions of RF-CBT or the equivalent time delay for the TAU group. We assessed activation change in the RF-CBT group using paired-samples t-tests and reliability by calculating intraclass correlation coefficients (ICCs) of five rumination-related ROIs during each of three blocks for the TAU and RF-CBT groups separately (Rumination Instruction, Rumination Prompt, and Distraction). RESULTS: Following treatment, participants in the RF-CBT group demonstrated an increase in activation of the left precuneus during Rumination Instruction and the left angular and superior temporal gyri during Rumination Prompt ( p <. 01). The TAU group demonstrated fair to excellent reliability ( M =. 52, range =. 27-.86) across most ROIs and task blocks. In contrast, the RF-CBT group demonstrated poor reliability across most ROIs and task blocks ( M =. 21, range = -.19-.69). CONCLUSION: RF-CBT appears to lead to rumination-related brain change. We demonstrated that the rumination induction task has fair to excellent reliability among individuals who do not receive an intervention that explicitly targets the ruminative habit, whereas reliability of this task is largely poor in the context of RF-CBT. This has meaningful implications in longitudinal and intervention studies, particularly when conceptualizing it as an important target for intervention. It also suggests one of many possible mechanisms for why fMRI test-retest reliability can be low that appears unrelated to the methodology itself.
Abstract.
Author URL.
Castro A, Gili M, Visser M, Penninx BWJH, Brouwer IA, Montaño JJ, Pérez-Ara MÁ, García-Toro M, Watkins E, Owens M, et al (2023). Soft Drinks and Symptoms of Depression and Anxiety in Overweight Subjects: a Longitudinal Analysis of an European Cohort.
Nutrients,
15(18), 3865-3865.
Abstract:
Soft Drinks and Symptoms of Depression and Anxiety in Overweight Subjects: a Longitudinal Analysis of an European Cohort
Background: Studies about the association of carbonated/soft drinks, coffee, and tea with depression and anxiety are scarce and inconclusive and little is known about this association in European adults. Our aim was to examine the association between the consumption of these beverages and depressive and anxiety symptom severity. Methods: a total of 941 European overweight adults (mean age, 46.8 years) with subsyndromal depression that participated in the MooDFOOD depression prevention randomized controlled trial (Clinical Trials.gov identifier: NCT2529423; date of the study: from 2014 to 2018) were analyzed. Depressive and anxiety symptom severity and beverage consumption were assessed using multilevel mixed-effects ordinal logistic regression models for each beverage consumption (carbonated/soft drink with sugar, carbonated/soft drink with non-nutritive sweeteners, coffee, and tea) with the three repeated measures of follow-up (baseline and 6 and 12 months). A case report form for participants’ sociodemographic and clinical characteristics, the Food Frequency Questionnaire, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder 7-Item Scale, the MINI International Neuropsychiatric Interview 5.0, the Short Questionnaire to Assess Health-Enhancing Psychical Activity, and the Alcohol Use Disorders Identification Test were the research tools used. Results: Daily consumption of carbonated/soft drinks with sugar was associated with a higher level of anxiety. Trends towards significance were found for associations between both daily consumption of carbonated/soft drinks with sugar and non-nutritive sweeteners and a higher level of depression. No relationship was found between coffee and tea consumption and the level of depression and anxiety. Conclusions: the high and regular consumption of carbonated/soft drink with sugar (amount of consumption: ≥1 unit (200 mL)/day) tended to be associated with higher level of anxiety in a multicountry sample of overweight subjects with subsyndromal depressive symptoms. It is important to point out that further research in this area is essential to provide valuable information about the intake patterns of non-alcoholic beverages and their relationship with affective disorders in the European adult population.
Abstract.
Cohen ZD, DeRubeis RJ, Hayes R, Watkins ER, Lewis G, Byng R, Byford S, Crane C, Kuyken W, Dalgleish T, et al (2023). The Development and Internal Evaluation of a Predictive Model to Identify for Whom Mindfulness-Based Cognitive Therapy Offers Superior Relapse Prevention for Recurrent Depression Versus Maintenance Antidepressant Medication.
CLINICAL PSYCHOLOGICAL SCIENCE,
11(1), 59-76.
Author URL.
Edge D, Watkins ER, Limond J, Mugadza J (2023). The efficacy of self-guided internet and mobile-based interventions for preventing anxiety and depression – a systematic review and meta-analysis. Behaviour Research and Therapy, 164, 104292-104292.
Wallsten D, Norell A, Anniko M, Eriksson O, Lamourín V, Halldin I, Kindbom T, Hesser H, Watkins E, Tillfors M, et al (2023). Treatment of worry and comorbid symptoms within depression, anxiety, and insomnia with a group-based rumination-focused cognitive-behaviour therapy in a primary health care setting: a randomised controlled trial.
Front Psychol,
14Abstract:
Treatment of worry and comorbid symptoms within depression, anxiety, and insomnia with a group-based rumination-focused cognitive-behaviour therapy in a primary health care setting: a randomised controlled trial.
INTRODUCTION: Repetitive negative thinking (RNT) has been described as a maintaining transdiagnostic factor for psychopathology within the areas of depression, anxiety and insomnia. We investigated the effects of rumination-focused cognitive-behaviour therapy (RF-CBT) in a group format at a primary health care centre on symptoms of depression, anxiety, insomnia, RNT, and quality of life. The participants presented clinical symptom levels of worry and at least two disorders among anxiety disorders, major depressive disorder, and insomnia disorder. METHODS: a randomised controlled superiority parallel arm trial was used. 73 participants were included and randomised in pairs to either group-administered RF-CBT or a waiting list condition. The primary outcomes were self-rated worry and transdiagnostic symptoms (depression, anxiety, and insomnia). Intention-to-treat analyses of group differences were conducted using linear mixed models. Adverse side effects and incidents were presented descriptively. RESULTS: Group RF-CBT significantly reduced self-reported insomnia at post-treatment and self-reported insomnia and depression at the 2 month-follow-up, relative to the wait-list control group. There was no significant difference in change in RNT, anxiety, or quality of life. DISCUSSION: the current study suggests that group-administered RF-CBT may be effective for insomnia and potentially effective for depression symptomatology. However, the study was underpowered to detect small and moderate effects and the results should therefore be interpreted with caution.
Abstract.
Author URL.
2022
Rogiers R, Baeken C, Watkins ER, van den Abbeele D, Remue J, de Raedt R, Lemmens GMD (2022). A Psychoeducational CBT-based Group Intervention (“Drop it”) for Repetitive Negative Thinking: Theoretical Concepts and Treatment Processes. International Journal of Group Psychotherapy, 72(3), 257-292.
Umegaki Y, Nakagawa A, Watkins E, Mullan E (2022). A Rumination-Focused Cognitive-Behavioral Therapy Self-Help Program to Reduce Depressive Rumination in High-Ruminating Japanese Female University Students: a Case Series Study.
Cognitive and Behavioral Practice,
29(2), 468-484.
Abstract:
A Rumination-Focused Cognitive-Behavioral Therapy Self-Help Program to Reduce Depressive Rumination in High-Ruminating Japanese Female University Students: a Case Series Study
The present case series reports the preliminary test of a rumination-focused cognitive-behavioral therapy (RFCBT) self-help program to reduce depressive rumination among Japanese female undergraduates. A workbook-type self-help program based on RFCBT was implemented with 39 participants showing a high tendency toward rumination/worry. Data from 30 participants who completed one or more modules were analyzed quantitatively. The results showed significant reductions of rumination, worry, and anxiety at post-intervention. Further, semistructured interviews were conducted with 13 participants who completed the program, and verbatim data were examined using content analysis. The contents found to be useful and difficult differed for each participant and each module. Based on these results, the future implementation and dissemination of RFCBT is discussed.
Abstract.
Hitchcock C, Rudokaite J, Haag C, Patel SD, Smith AJ, Kuhn I, Jermann F, Ma SH, Kuyken W, Williams JM, et al (2022). Autobiographical memory style and clinical outcomes following mindfulness-based cognitive therapy (MBCT): an individual patient data meta-analysis.
Behav Res Ther,
151Abstract:
Autobiographical memory style and clinical outcomes following mindfulness-based cognitive therapy (MBCT): an individual patient data meta-analysis.
The ability to retrieve specific, single-incident autobiographical memories has been consistently posited as a predictor of recurrent depression. Elucidating the role of autobiographical memory specificity in patient-response to depressive treatments may improve treatment efficacy and facilitate use of science-driven interventions. We used recent methodological advances in individual patient data meta-analysis to determine a) whether memory specificity is improved following mindfulness-based cognitive therapy (MBCT), relative to control interventions, and b) whether pre-treatment memory specificity moderates treatment response. All bar one study evaluated MBCT for relapse prevention for depression. Our initial analysis therefore focussed on MBCT datasets only(n = 708), then were repeated including the additional dataset(n = 880). Memory specificity did not significantly differ from baseline to post-treatment for either MBCT and Control interventions. There was no evidence that baseline memory specificity predicted treatment response in terms of symptom-levels, or risk of relapse. Findings raise important questions regarding the role of memory specificity in depressive treatments.
Abstract.
Author URL.
Sakata M, Toyomoto R, Yoshida K, Luo Y, Nakagami Y, Uwatoko T, Shimamoto T, Tajika A, Suga H, Ito H, et al (2022). Components of smartphone cognitive-behavioural therapy for subthreshold depression among 1093 university students: a factorial trial.
Evid Based Ment Health,
25(e1), e18-e25.
Abstract:
Components of smartphone cognitive-behavioural therapy for subthreshold depression among 1093 university students: a factorial trial.
BACKGROUND: Internet-based cognitive-behavioural therapy (iCBT) is effective for subthreshold depression. However, which skills provided in iCBT packages are more effective than others is unclear. Such knowledge can inform construction of more effective and efficient iCBT programmes. OBJECTIVE: to examine the efficacy of five components of iCBT for subthreshold depression. METHODS: We conducted an factorial trial using a smartphone app, randomly allocating presence or absence of five iCBT skills including self-monitoring, behavioural activation (BA), cognitive restructuring (CR), assertiveness training (AT) and problem-solving. Participants were university students with subthreshold depression. The primary outcome was the change on the Patient Health Questionnaire-9 (PHQ-9) from baseline to week 8. Secondary outcomes included changes in CBT skills. FINDINGS: We randomised a total of 1093 participants. In all groups, participants had a significant PHQ-9 reduction from baseline to week 8. Depression reduction was not significantly different between presence or absence of any component, with corresponding standardised mean differences (negative values indicate specific efficacy in favour of the component) ranging between -0.04 (95% CI -0.16 to 0.08) for BA and 0.06 (95% CI -0.06 to 0.18) for AT. Specific CBT skill improvements were noted for CR and AT but not for the others. CONCLUSIONS: There was significant reduction in depression for all participants regardless of the presence and absence of the examined iCBT components. CLINICAL IMPLICATION: We cannot yet make evidence-based recommendations for specific iCBT components. We suggest that future iCBT optimisation research should scrutinise the amount and structure of components to examine. TRIAL REGISTRATION NUMBER: UMINCTR-000031307.
Abstract.
Author URL.
Bear HA, Ayala Nunes L, DeJesus J, Liverpool S, Moltrecht B, Neelakantan L, Harriss E, Watkins E, Fazel M (2022). Determination of Markers of Successful Implementation of Mental Health Apps for Young People: Systematic Review.
Journal of Medical Internet Research,
24(11), e40347-e40347.
Abstract:
Determination of Markers of Successful Implementation of Mental Health Apps for Young People: Systematic Review
. Background
. Smartphone apps have the potential to address some of the current issues facing service provision for young people’s mental health by improving the scalability of evidence-based mental health interventions. However, very few apps have been successfully implemented, and consensus on implementation measurement is lacking.
.
.
. Objective
. This review aims to determine the proportion of evidence-based mental health and well-being apps that have been successfully adopted and sustained in real-world settings. A secondary aim is to establish if key implementation determinants such as coproduction, acceptability, feasibility, appropriateness, and engagement contribute toward successful implementation and longevity.
.
.
. Methods
. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases in 2021 yielded 18,660 results. After full-text screening, 34 articles met the full eligibility criteria, providing data on 29 smartphone apps studied with individuals aged 15 to 25 years.
.
.
. Results
. of 34 studies, only 10 (29%) studies were identified that were evaluating the effectiveness of 8 existing, commercially available mental health apps, and the remaining 24 (71%) studies reported the development and evaluation of 21 newly developed apps, of which 43% (9/21) were available, commercially or otherwise (eg, in mental health services), at the time of enquiry. Most studies addressed some implementation components including adoption, acceptability, appropriateness, feasibility, and engagement. Factors including high cost, funding constraints, and lengthy research processes impeded implementation.
.
.
. Conclusions
. Without addressing common implementation drivers, there is considerable redundancy in the translation of mobile mental health research findings into practice. Studies should embed implementation strategies from the outset of the planned research, build collaborations with partners already working in the field (academic and commercial) to capitalize on existing interventions and platforms, and modify and evaluate them for local contexts or target problems and populations.
.
.
. Trial Registration
. PROSPERO CRD42021224365; https://tinyurl.com/4umpn85f
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Abstract.
Pechtel P, Harris J, Karl A, Clunies-Ross C, Bower S, Moberly NJ, Pizzagalli DA, Watkins ER (2022). Emerging ecophenotype: reward anticipation is linked to high-risk behaviours after sexual abuse.
Soc Cogn Affect Neurosci,
17(11), 1035-1043.
Abstract:
Emerging ecophenotype: reward anticipation is linked to high-risk behaviours after sexual abuse.
Adolescents frequently engage in high-risk behaviours (HRB) following childhood sexual abuse (CSA). Aberrant reward processes are implicated in HRB, and their underlying fronto-striatal networks are vulnerable to neurodevelopmental changes during adversity representing a promising candidate for understanding links between CSA and HRB. We examined whether fronto-striatal responses during reward anticipation and feedback (i) are altered in depressed adolescents with CSA compared to depressed, non-abused peers and (ii) moderate the relationship between CSA and HRB irrespective of depression. Forty-eight female adolescents {14 with CSA and depression [CSA + major depressive disorder (MDD)]; 17 with MDD but no CSA (MDD); 17 healthy, non-abused controls} completed a monetary reward task during functional magnetic resonance imaging. No differences in fronto-striatal response to reward emerged between CSA + MDD and MDD. Critically, high left nucleus accumbens activation during reward anticipation was associated with greater HRB in CSA + MDD compared to MDD and controls. Low left putamen activation during reward feedback was associated with the absence of HRB in CSA + MDD compared to MDD. Striatal reward responses appear to play a key role in HRB for adolescents with CSA irrespective of depression, providing initial support for a CSA ecophenotype. Such information is pivotal to identify at-risk youth and prevent HRB in adolescents after CSA.
Abstract.
Author URL.
Edge D (2022). Exploring the use of Internet and Mobile based Interventions (IMIs) in Preventing Anxiety and Depression.
Abstract:
Exploring the use of Internet and Mobile based Interventions (IMIs) in Preventing Anxiety and Depression
This is a doctoral thesis comprising a systematic literature review/meta analysis and an empirical paper. The empirical paper was an Randomised Controlled Trial conducted as part of the ECoWeb project (see funding)
SYSTEMATIC LITERATURE REVIEW
The efficacy of self-guided internet and mobile-based interventions (IMIs) for preventing anxiety and depression – a systematic review and meta-analysis
Abstract
Background: Anxiety and depression are highly prevalent mental disorders which are associated with a considerable personal and economic burden. As treatment alone has a minimal impact on prevalence, there is now a growing focus on interventions which may help prevent anxiety and depression. Internet and Mobile based Interventions (IMIs) have been identified as a useful avenue for the delivery of preventative programmes due to their scalability and accessibility. The efficacy of IMIs that do not require additional support from a trained professional (self-guided) in this capacity is yet to be explored.
Method: a systematic search was conducted on the Cochrane Library, PubMed, PsycARTICLES, PsycINFO, OVID, MEDline, PsycEXTRA and SCOPUS databases. Studies were selected according to defined inclusion and exclusion criteria. The primary outcome was evaluating the effect of self-guided IMIs on incidence of anxiety and depression. The secondary outcome was effect on symptom severity.
Results: After identifying and removing duplicates, 3211 studies were screened, 32 of which were eligible for inclusion in the final analysis. Nine studies also reported incidence data (depression = 7, anxiety = 2). The overall Risk Ratios (RR) for incidence of anxiety and depression was. 86 (95% CI [.28, 2.66], p =.79) and. 67 (95% CI [.48. 93], p =.02) respectively. Analysis for 27 studies reporting severity of depressive symptoms revealed a significant posttreatment standardised mean difference (SMD) of. −.27 (95% CI [ −.37, −.17], p <. 001) for self-guided IMI groups relative to controls. A similar result was observed for 29 studies reporting severity of anxiety symptoms with an SMD of -.21 (95% CI [-.31, -.10], p <. 001).
Conclusions: Self-guided IMIs appear to be effective at preventing incidence of depression, though further examination of the data suggests that generalisability of this finding may be limited. While self-guided IMIs also appear effective in reducing symptoms of anxiety and depression, their ability to prevent incidence of anxiety is less clear.
Keywords: Internet, mobile-based, prevention, depression, anxiety, symptoms, incidence
EMPIRICAL STUDY
Evaluating the effects of a self-help mobile phone application on worry and rumination experienced by young adults: a randomised controlled trial.
Abstract
Background: Improving the mental health of adolescents and young adults has been identified as a global priority. As well as preventing poor mental health, this includes the promotion of increased well-being by developing interventions which target known risk factors such as worry and rumination, also known as Repetitive Negative Thinking (RNT).
Objective: the primary objective of this study was to test whether an RNT-targeting self-help mobile phone application (MyMoodCoach) could reduce levels of worry and rumination in young adults currently residing in the United Kingdom. A secondary objective was to test whether the app could achieve similar reductions in symptoms of anxiety and depression, as well as improve well-being.
Methods: a web-based, single blind, two-arm parallel-group Randomised Controlled Trial (RCT) was conducted with N=236 people aged between 16 and 24 who self-reported high levels of either worry or rumination. Participants were recruited via social media adverts and directed to an open website. Eligible participants were randomised to an active intervention group (usual practice, plus up to 6 weeks of using the RNT-targeting mobile app) or a waitlist control group (usual practice with no access to the app). The primary outcome was changes in worry and rumination six weeks after randomisation. Secondary outcomes included changes in well-being and symptoms of anxiety and depression after six weeks and changes on all measures after 12 weeks. The waitlist control group was given access to the app at the six-week follow-up point.
Results: Participants were randomised to access the RNT-targeting app (n = 119) or waitlist control (n = 117). The active treatment arm showed significantly lower levels of rumination (-2.92, 95% CI [-5.57, -.28], p
Abstract.
Marsh LC, Patel S, Hitchcock C, Smith A, So M, Dalgleish T, Armstrong H, Elliott R, Watkins ER, Moulds ML, et al (2022). From basic science to clinical practice: Do Cognitive Behavioural Therapy tasks benefit from enhanced episodic specificity?.
Abstract:
From basic science to clinical practice: Do Cognitive Behavioural Therapy tasks benefit from enhanced episodic specificity?
Individuals with depression typically remember their past in a generalised manner, at the cost of retrieving specific event memories. This may impair engagement with cognitive behavioural therapy (CBT) tasks that use concrete episodic information to challenge maladaptive beliefs, potentially limiting their therapeutic benefit. Study 1 demonstrated that an episodic specificity induction increased detail and specificity of autobiographical memory in people with major depression, relative to control conditions (N=88). We therefore examined whether the induction enhanced the efficacy of CBT tasks that depend on episodic memory – cognitive reappraisal (Study 2, N=30), evidence gathering (Study 2, N=30), and planning behavioural experiments (Study 3, N=30). Across all three tasks, there were no significant differences in emotion- or belief-change between the specificity and control conditions. Although the induction temporarily enhanced specificity in depressed individuals, it did not significantly boost the efficacy of CBT tasks theorised to benefit from the use of specific mnemonic information.
Abstract.
Dunn B (2022). How well do Cognitive Behavioural Therapy and Behavioural Activation for depression repair anhedonia? a secondary analysis of the COBRA randomised controlled trial.
Behaviour Research and TherapyAbstract:
How well do Cognitive Behavioural Therapy and Behavioural Activation for depression repair anhedonia? a secondary analysis of the COBRA randomised controlled trial
A secondary analysis of the COBRA randomized controlled trial was conducted to examine how well Cognitive Behavioural Therapy (CBT) and Behavioural Activation (BA) repair anhedonia. Patients with current major depressive disorder (N = 440) were randomized to receive BA or CBT, and anhedonia and depression outcomes were measured after acute treatment (six months) and at two further follow up intervals (12 and 18 months). Anhedonia was assessed using the Snaith Hamilton Pleasure Scale (SHAPS; a measure of consummatory pleasure). Both CBT and BA led to significant improvements in anhedonia during acute treatment, with no significant difference between treatments. Participants remained above healthy population averages of anhedonia at six months, and there was no further significant improvement in anhedonia at 12-month or 18-month follow up. Greater baseline anhedonia severity predicted reduced repair of depression symptoms and fewer depression-free days across the follow-up period following both BA and CBT. The extent of anhedonia repair was less marked than the extent of depression repair across both treatment arms. These findings demonstrate that CBT and BA are similarly and only partially effective in treating anhedonia. Therefore, both therapies should be further refined or novel treatments should be developed in order better to treat anhedonia.
Abstract.
Stefanovic M, Rosenkranz T, Ehring T, Watkins ER, Takano K (2022). Is a High Association Between Repetitive Negative Thinking and Negative Affect Predictive of Depressive Symptoms? a Clustering Approach for Experience-Sampling Data.
CLINICAL PSYCHOLOGICAL SCIENCE,
10(1), 74-89.
Author URL.
Buckman JEJ, Saunders R, Arundell L-L, Oshinowo ID, Cohen ZD, O'Driscoll C, Barnett P, Stott J, Ambler G, Gilbody S, et al (2022). Life events and treatment prognosis for depression: a systematic review and individual patient data meta-analysis.
J Affect Disord,
299, 298-308.
Abstract:
Life events and treatment prognosis for depression: a systematic review and individual patient data meta-analysis.
OBJECTIVE: to investigate associations between major life events and prognosis independent of treatment type: (1) after adjusting for clinical prognostic factors and socio-demographics; (2) amongst patients with depressive episodes at least six-months long; and (3) patients with a first life-time depressive episode. METHODS: Six RCTs of adults seeking treatment for depression in primary care met eligibility criteria, individual patient data (IPD) were collated from all six (n = 2858). Participants were randomized to any treatment and completed the same baseline assessment of life events, demographics and clinical prognostic factors. Two-stage random effects meta-analyses were conducted. RESULTS: Reporting any major life events was associated with poorer prognosis regardless of treatment type. Controlling for baseline clinical factors, socio-demographics and social support resulted in minimal residual evidence of associations between life events and treatment prognosis. However, removing factors that might mediate the relationships between life events and outcomes reporting: arguments/disputes, problem debt, violent crime, losing one's job, and three or more life events were associated with considerably worse prognoses (percentage difference in 3-4 months depressive symptoms compared to no reported life events =30.3%(95%CI: 18.4-43.3)). CONCLUSIONS: Assessing for clinical prognostic factors, social support, and socio-demographics is likely to be more informative for prognosis than assessing self-reported recent major life events. However, clinicians might find it useful to ask about such events, and if they are still affecting the patient, consider interventions to tackle problems related to those events (e.g. employment support, mediation, or debt advice). Further investigations of the efficacy of such interventions will be important.
Abstract.
Author URL.
Dillahunt A, Feldman D, Thomas L, Farstead B, Frandsen S, Lee S, Pazdera M, Galloway J, Bessette K, Roberts H, et al (2022). P266. The Balloon Analogue Risk Task and Adolescent Self-Injurious Behaviors. Biological Psychiatry, 91(9).
Mollaahmetoglu OM (2022). Repetitive negative thinking as a risk factor for alcohol use disorders and exploring mechanisms of ketamine as a novel treatment.
Abstract:
Repetitive negative thinking as a risk factor for alcohol use disorders and exploring mechanisms of ketamine as a novel treatment
Alcohol use disorder (AUD) is associated with detrimental physical and mental health consequences, as well as societal costs. Repetitive negative thinking (RNT), characterised by recurrent, uncontrollable thoughts on negative themes, is proposed to contribute to AUD by amplifying negative mood which triggers alcohol consumption as a coping mechanism. However, the acute effects of alcohol consumption on RNT have not been empirically examined. Moreover, little is known about the nature of RNT among people with AUD. The first aim of this thesis was to examine the reciprocal relationship between RNT and alcohol consumption. In Chapter 2, I report the acute effects of low or high dose alcohol consumption on state rumination compared to placebo among hazardous and harmful drinkers. These findings indicated that low dose alcohol intake may temporarily terminate ruminative thinking patterns by improving negative mood. In Chapter 3, I explore the subjective experiences of rumination among individuals with AUD. This revealed a self-perpetuating cycle between drinking and rumination, potentially mediated by alcohol focused rumination, negative mood and feelings of shame associated with drinking. Following from this, I examine ketamine combined with psychological therapy as a novel treatment for AUD, and explore potential mechanisms of this treatment. In Chapter 4, I present a systematic review on the evidence base for ketamine treatment for mental health and substance use disorders. This demonstrated that ketamine has the strongest evidence base in depressive disorders, with some evidence of short term decreases in craving and substance use, and increases in abstinence in alcohol and substance use disorders. In Chapter 5, I examine the potential mechanisms of ketamine’s therapeutic effects in AUD, using data from the Ketamine for the Reduction of Alcoholic Relapse (KARE) trial. The results did not support RNT nor the acute subjective effects of ketamine as mediators of treatment effects on abstinence from alcohol. Following from this, in Chapter 6, I present qualitative data from subjective reports of participants from the KARE trial. This indicated a potential role for ketamine induced dissociation and feelings of connectedness in changing their relationship with alcohol. In Chapter 7, I discuss the interpretation and implications of the findings, as well as strengths and limitations of the thesis and suggestions for future research.
Abstract.
Dillahunt AK, Feldman DA, Thomas LR, Farstead BW, Frandsen SB, Lee S, Pazdera M, Galloway J, Bessette KL, Roberts H, et al (2022). Self-Injury in Adolescence is Associated with Greater Behavioral Risk Avoidance, Not Risk-Taking.
Journal of Clinical Medicine,
11(5).
Abstract:
Self-Injury in Adolescence is Associated with Greater Behavioral Risk Avoidance, Not Risk-Taking
Strategies to link impulsivity and self-injurious behaviors (SIBs) show highly variable results, and may differ depending on the impulsivity measure used. To better understand this lack of consistency, we investigated correlations between self-report and behavioral impulsivity, inhibitory control, SIBs, and rumination. We included participants aged 13–17 years with either current or remitted psychopathology who have (n = 31) and who do not have (n = 14) a history of SIBs. Participants completed self-report measures of impulsivity, the Rumination Responsiveness Scale (RRS), and two behavioral measures of impulsivity: the Balloon Analogue Risk Task (BART) and Parametric Go/No-Go (PGNG). Lifetime SIBs were positively associated with self-reported impulsivity, specifically positive and negative urgency. However, individuals with greater lifetime SIBs demonstrated greater risk aversion (lower impulsivity) as measured by the BART, whereas there was no relation between lifetime SIBs and PGNG performance. There was no relation between rumination and behavioral impulsivity, although greater rumination was associated with higher negative urgency. Future research examining the role of SIBs in the context of active versus remitted psychopathology is warranted. Because most adolescents were remitted from major depressive disorder at the time of study, follow-up studies can determine if lower risk-taking may aid individuals with more prior SIBs to achieve and maintain a remitted state.
Abstract.
Chapman N, Browning M, Baghurst D, Hotopf M, Willis D, Haylock S, Zakaria S, Speechley J, Withey J, Brooks E, et al (2022). Setting national research priorities for difficult-to-treat depression in the UK between 2021-2026.
J Glob Health,
12Abstract:
Setting national research priorities for difficult-to-treat depression in the UK between 2021-2026.
BACKGROUND: Difficult-to-treat depression (DTD) presents a substantial health care challenge, with around one-third of people diagnosed with a depressive episode in the UK finding that their symptoms persist following treatment. This study aimed to identify priority research questions (RQs) that could inform the development of new and improved treatments, interventions, and support for people with DTD. METHODS: Using an adapted Child Health and Nutrition Research Initiative (CHNRI) method, this national prioritisation exercise engaged 60 leading researchers and health care professionals in the UK, as well as 25 wider stakeholders with relevant lived experience to produce a ranked list of priority RQs in DTD. The final list of 99 distinct RQs was independently scored by 42 individuals against a list of five criteria: answerability, effectiveness, impact on health, deliverability, and equity. RESULTS: Highly ranked RQs covered a range of novel and existing treatments. The three highest scoring RQs included evaluation of psychological and pharmacological therapies (eg, behavioural activation, and augmentation therapies), as well as social interventions to reduce loneliness or increase support for people with DTD. CONCLUSIONS: This exercise identified and prioritised 99 RQs that could inform future research and funding decisions over the next five years. The results of this research could improve treatment and support for people affected by DTD. It also serves as an example of ways in which the CHNRI method can be adapted in a collaborative manner to provide a more active role for patients, carers, and health care professionals.
Abstract.
Author URL.
Buckman JEJ, Saunders R, Stott J, Cohen ZD, Arundell L-L, Eley TC, Hollon SD, Kendrick T, Ambler G, Watkins E, et al (2022). Socioeconomic Indicators of Treatment Prognosis for Adults with Depression: a Systematic Review and Individual Patient Data Meta-analysis.
JAMA Psychiatry,
79(5), 406-416.
Abstract:
Socioeconomic Indicators of Treatment Prognosis for Adults with Depression: a Systematic Review and Individual Patient Data Meta-analysis.
IMPORTANCE: Socioeconomic factors are associated with the prevalence of depression, but their associations with prognosis are unknown. Understanding this association would aid in the clinical management of depression. OBJECTIVE: to determine whether employment status, financial strain, housing status, and educational attainment inform prognosis for adults treated for depression in primary care, independent of treatment and after accounting for clinical prognostic factors. DATA SOURCES: the Embase, International Pharmaceutical Abstracts, MEDLINE, PsycINFO, and Cochrane (CENTRAL) databases were searched from database inception to October 8, 2021. STUDY SELECTION: Inclusion criteria were as follows: randomized clinical trials that used the Revised Clinical Interview Schedule (CIS-R; the most common comprehensive screening and diagnostic measure of depressive and anxiety symptoms in primary care randomized clinical trials), measured socioeconomic factors at baseline, and sampled patients with unipolar depression who sought treatment for depression from general physicians/practitioners or who scored 12 or more points on the CIS-R. Exclusion criteria included patients with depression secondary to a personality or psychotic disorder or neurologic condition, studies of bipolar or psychotic depression, studies that included children or adolescents, and feasibility studies. Studies were independently assessed against inclusion and exclusion criteria by 2 reviewers. DATA EXTRACTION AND SYNTHESIS: Data were extracted and cleaned by data managers for each included study, further cleaned by multiple reviewers, and cross-checked by study chief investigators. Risk of bias and quality were assessed using the Quality in Prognosis Studies (QUIPS) and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tools, respectively. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses-Individual Participant Data (PRISMA-IPD) reporting guidelines. MAIN OUTCOMES AND MEASURES: Depressive symptoms at 3 to 4 months after baseline. RESULTS: This systematic review and individual patient data meta-analysis identified 9 eligible studies that provided individual patient data for 4864 patients (mean [SD] age, 42.5 (14.0) years; 3279 women [67.4%]). The 2-stage random-effects meta-analysis end point depressive symptom scale scores were 28% (95% CI, 20%-36%) higher for unemployed patients than for employed patients and 18% (95% CI, 6%-30%) lower for patients who were homeowners than for patients living with family or friends, in hostels, or homeless, which were equivalent to 4.2 points (95% CI, 3.6-6.2 points) and 2.9 points (95% CI, 1.1-4.9 points) on the Beck Depression Inventory II, respectively. Financial strain and educational attainment were associated with prognosis independent of treatment, but unlike employment and housing status, there was little evidence of associations after adjusting for clinical prognostic factors. CONCLUSIONS AND RELEVANCE: Results of this systematic review and meta-analysis revealed that unemployment was associated with a poor prognosis whereas home ownership was associated with improved prognosis. These differences were clinically important and independent of the type of treatment received. Interventions that address employment or housing difficulties could improve outcomes for patients with depression.
Abstract.
Author URL.
Dillahunt A, Feldman D, Thomas L, Farstead B, Frandsen S, Lee S, Pazdera M, Galloway J, Bessette K, Roberts H, et al (2022). The Balloon Analogue Risk Task and Adolescent Self-Injurious Behaviors.
Author URL.
Visla A, Stadelmann C, Watkins E, Zinbarg RE, Flueckiger C (2022). The Relation Between Worry and Mental Health in Nonclinical Population and Individuals with Anxiety and Depressive Disorders: a Meta-Analysis.
COGNITIVE THERAPY AND RESEARCH,
46(3), 480-501.
Author URL.
Schreiner MW, Dillahunt A, Bessette K, Frandsen S, Farstead B, Lee S, Feldman D, Thomas L, Pocius S, Roberts H, et al (2022). Variability of Rumination and Distraction-Related Brain Activation Associated with Lifetime Self-Injury in Adolescents.
Author URL.
2021
Saunders R, Cohen ZD, Ambler G, DeRubeis RJ, Wiles N, Kessler D, Gilbody S, Hollon SD, Kendrick T, Watkins E, et al (2021). A Patient Stratification Approach to Identifying the Likelihood of Continued Chronic Depression and Relapse Following Treatment for Depression.
J Pers Med,
11(12).
Abstract:
A Patient Stratification Approach to Identifying the Likelihood of Continued Chronic Depression and Relapse Following Treatment for Depression.
BACKGROUND: Subgrouping methods have the potential to support treatment decision making for patients with depression. Such approaches have not been used to study the continued course of depression or likelihood of relapse following treatment. METHOD: Data from individual participants of seven randomised controlled trials were analysed. Latent profile analysis was used to identify subgroups based on baseline characteristics. Associations between profiles and odds of both continued chronic depression and relapse up to one year post-treatment were explored. Differences in outcomes were investigated within profiles for those treated with antidepressants, psychological therapy, and usual care. RESULTS: Seven profiles were identified; profiles with higher symptom severity and long durations of both anxiety and depression at baseline were at higher risk of relapse and of chronic depression. Members of profile five (likely long durations of depression and anxiety, moderately-severe symptoms, and past antidepressant use) appeared to have better outcomes with psychological therapies: antidepressants vs. psychological therapies (OR (95% CI) for relapse = 2.92 (1.24-6.87), chronic course = 2.27 (1.27-4.06)) and usual care vs. psychological therapies (relapse = 2.51 (1.16-5.40), chronic course = 1.98 (1.16-3.37)). CONCLUSIONS: Profiles at greater risk of poor outcomes could benefit from more intensive treatment and frequent monitoring. Patients in profile five may benefit more from psychological therapies than other treatments.
Abstract.
Author URL.
Hitchcock C, Rudokaite J, Haag C, Patel S, Smith A, Kuhn I, Jermann F, Helen S, Kuyken W, Williams JMG, et al (2021). Autobiographical memory style and clinical outcomes following mindfulness-based cognitive therapy (MBCT): an individual patient data meta-analysis.
Abstract:
Autobiographical memory style and clinical outcomes following mindfulness-based cognitive therapy (MBCT): an individual patient data meta-analysis
The ability to retrieve specific, single-incident autobiographical memories has been consistently posited as a predictor of recurrent depression. Elucidating the role of autobiographical memory specificity in patient-response to depressive treatments may improve treatment efficacy and facilitate use of science-driven interventions. We used recent methodological advances in individual patient data meta-analysis to determine a) whether memory specificity is improved following mindfulness-based cognitive therapy (MBCT), relative to control interventions, and b) whether pre-treatment memory specificity moderates treatment response. All bar one study evaluated MBCT for relapse prevention. Our initial analysis therefore focussed on MBCT datasets only(n=708), then were repeated including the additional dataset(n=880). Memory specificity increased from baseline to post-treatment. This effect did not differ between MBCT and Control interventions. There was no evidence that baseline memory specificity predicted treatment response in terms of symptom-levels, or risk of relapse. Findings raise important questions regarding the role of memory specificity in depressive treatments.
Abstract.
Moeller SB, Kvist V, Jansen JE, Watkins ER (2021). Clinical Case of a Schizotypal Personality Disorder: Rumination-Focused CBT for Anger Rumination.
Journal of Contemporary Psychotherapy,
51(4), 311-321.
Abstract:
Clinical Case of a Schizotypal Personality Disorder: Rumination-Focused CBT for Anger Rumination
Anger dysregulation is part of a broad range of clinical disorders, and as a dynamic risk factor for aggression anger is highly relevant in clinical populations. Problems of anger and reactive aggression are trans-diagnostic and treatments should target the mechanisms involved in problematic anger across disorders. There is empirical evidence that anger rumination is associated with anger as well as aggression. Because rumination-focused CBT (RfCBT) has shown that reduction in rumination seems to be associated with transdiagnostic reductions in symptoms, the present study aimed at extending the applicability of the RfCBT model to target problematic anger in a case of schizotypal personality disorder (SPD). The current study was a clinical case study with a patient suffering from problematic anger and anger rumination, and diagnosed with schizotypal personality disorder (SPD) receiving 25 sessions of rumination-focused CBT (RfCBT) for problematic anger. The primary focus was on anger and anger rumination, which was reduced during therapy, and maintained in the 3 months follow up. Results on the measures of repetitive negative thinking also showed a decrease, however symptoms of depression and anxiety had increased from pre- to post treatment. RfCBT can be applied to a case of SPD with problematic anger, thereby showing proof of concept for a transdiagnostic use of RfCBT and opening up for future research in this area. The applicability of RfCBT to anger problems among patients diagnosed with SPD needs to be replicated in a larger sample of patients diagnosed with SPD/problematic anger and anger rumination.
Abstract.
Vreijling SR, Penninx BWJH, Bot M, Watkins E, Owens M, Kohls E, Hegerl U, Roca M, Gili M, Brouwer IA, et al (2021). Effects of dietary interventions on depressive symptom profiles: results from the MooDFOOD depression prevention study.
Psychol Med,
52(15), 1-10.
Abstract:
Effects of dietary interventions on depressive symptom profiles: results from the MooDFOOD depression prevention study.
BACKGROUND: Dietary interventions did not prevent depression onset nor reduced depressive symptoms in a large multi-center randomized controlled depression prevention study (MooDFOOD) involving overweight adults with subsyndromal depressive symptoms. We conducted follow-up analyses to investigate whether dietary interventions differ in their effects on depressive symptom profiles (mood/cognition; somatic; atypical, energy-related). METHODS: Baseline, 3-, 6-, and 12-month follow-up data from MooDFOOD were used (n = 933). Participants received (1) placebo supplements, (2) food-related behavioral activation (F-BA) therapy with placebo supplements, (3) multi-nutrient supplements (omega-3 fatty acids and a multi-vitamin), or (4) F-BA therapy with multi-nutrient supplements. Depressive symptom profiles were based on the Inventory of Depressive Symptomatology. RESULTS: F-BA therapy was significantly associated with decreased severity of the somatic (B = -0.03, p = 0.014, d = -0.10) and energy-related (B = -0.08, p = 0.001, d = -0.13), but not with the mood/cognition symptom profile, whereas multi-nutrient supplementation was significantly associated with increased severity of the mood/cognition (B = 0.05, p = 0.022, d = 0.09) and the energy-related (B = 0.07, p = 0.002, d = 0.12) but not with the somatic symptom profile. CONCLUSIONS: Differentiating depressive symptom profiles indicated that food-related behavioral interventions are most beneficial to alleviate somatic symptoms and symptoms of the atypical, energy-related profile linked to an immuno-metabolic form of depression, although effect sizes were small. Multi-nutrient supplements are not indicated to reduce depressive symptom profiles. These findings show that attention to clinical heterogeneity in depression is of importance when studying dietary interventions.
Abstract.
Author URL.
O'Loughlin J, Casanova F, Hughes A, Bowden J, Watkins E, Freathy R, Walters R, Howe L, Kuchenbaecker K, Tyrrell J, et al (2021). HIGHER BMI CAUSES LOWER ODDS OF DEPRESSION IN INDIVIDUALS OF EAST ASIAN ANCESTRY.
Author URL.
Owens M, Watkins E, Bot M, Brouwer IA, Roca M, Kohls E, Penninx BWJH, van Grootheest G, Hegerl U, Gili M, et al (2021). Habitual Behavior as a Mediator Between Food-Related Behavioral Activation and Change in Symptoms of Depression in the MooDFOOD Trial.
Clinical Psychological Science,
9(4), 649-665.
Abstract:
Habitual Behavior as a Mediator Between Food-Related Behavioral Activation and Change in Symptoms of Depression in the MooDFOOD Trial
In this study, we tested potential mediators that may explain change in depressive symptoms following exposure to a food-related behavioral activation intervention (F-BA). These included behavioral activation, avoidance and rumination, eating styles, body mass index, and dietary behavior at baseline and 3-month and 12-month follow-up. The trial used a community sample of 1,025 overweight adults with elevated depressive symptoms without current major depression. Participants were randomly assigned to one of four trial arms: either daily nutritional supplements (vs. placebo) alone or in combination with F-BA (vs. no F-BA) over 12 months. Although F-BA did not significantly reduce depressive symptoms (standardized regression coefficient [b] = −0.223, SE = 0.129; p =.084), significant mediators included emotional eating (b = −0.028, SE = 0.014; p =.042) and uncontrolled eating (b = −0.039, SE = 0.016; p =.013), suggesting that learning adaptive responses to emotional and food cues may underlie effects of F-BA on depressive symptoms.
Abstract.
Casanova F, O'Loughlin J, Martin S, Beaumont RN, Wood AR, Watkins ER, Freathy RM, Hagenaars SP, Frayling TM, Yaghootkar H, et al (2021). Higher adiposity and mental health: causal inference using Mendelian randomization.
Hum Mol Genet,
30(24), 2371-2382.
Abstract:
Higher adiposity and mental health: causal inference using Mendelian randomization.
Higher adiposity is an established risk factor for psychiatric diseases including depression and anxiety. The associations between adiposity and depression may be explained by the metabolic consequences and/or by the psychosocial impact of higher adiposity. We performed one- and two- sample Mendelian randomization (MR) in up to 145 668 European participants from the UK Biobank to test for a causal effect of higher adiposity on 10 well-validated mental health and well-being outcomes derived using the Mental Health Questionnaire (MHQ). We used three sets of adiposity genetic instruments: (a) a set of 72 BMI genetic variants, (b) a set of 36 favourable adiposity variants and (c) a set of 38 unfavourable adiposity variants. We additionally tested causal relationships (1) in men and women separately, (2) in a subset of individuals not taking antidepressants and (3) in non-linear MR models. Two-sample MR provided evidence that a genetically determined one standard deviation (1-SD) higher BMI (4.6 kg/m2) was associated with higher odds of current depression [OR: 1.50, 95%CI: 1.15, 1.95] and lower well-being [ß: -0.15, 95%CI: -0.26, -0.04]. Findings were similar when using the metabolically favourable and unfavourable adiposity variants, with higher adiposity associated with higher odds of depression and lower well-being scores. Our study provides further evidence that higher BMI causes higher odds of depression and lowers well-being. Using genetics to separate out metabolic and psychosocial effects, our study suggests that in the absence of adverse metabolic effects higher adiposity remains causal to depression and lowers well-being.
Abstract.
Author URL.
Buckman JEJ, Saunders R, O'Driscoll C, Cohen ZD, Stott J, Ambler G, Gilbody S, Hollon SD, Kendrick T, Watkins E, et al (2021). Is social support pre-treatment associated with prognosis for adults with depression in primary care?.
Acta Psychiatr Scand,
143(5), 392-405.
Abstract:
Is social support pre-treatment associated with prognosis for adults with depression in primary care?
OBJECTIVE: Depressed patients rate social support as important for prognosis, but evidence for a prognostic effect is lacking. We aimed to test the association between social support and prognosis independent of treatment type, and the severity of depression, and other clinical features indicating a more severe illness. METHODS: Individual patient data were collated from all six eligible RCTs (n = 2858) of adults seeking treatment for depression in primary care. Participants were randomized to any treatment and completed the same baseline assessment of social support and clinical severity factors. Two-stage random effects meta-analyses were conducted. RESULTS: Social support was associated with prognosis independent of randomized treatment but effects were smaller when adjusting for depressive symptoms and durations of depression and anxiety, history of antidepressant treatment, and comorbid panic disorder: percentage decrease in depressive symptoms at 3-4 months per z-score increase in social support = -4.14(95%CI: -6.91 to -1.29). Those with a severe lack of social support had considerably worse prognoses than those with no lack of social support: increase in depressive symptoms at 3-4 months = 14.64%(4.25% to 26.06%). CONCLUSIONS: Overall, large differences in social support pre-treatment were associated with differences in prognostic outcomes. Adding the Social Support scale to clinical assessments may be informative, but after adjusting for routinely assessed clinical prognostic factors the differences in prognosis are unlikely to be of a clinically important magnitude. Future studies might investigate more intensive treatments and more regular clinical reviews to mitigate risks of poor prognosis for those reporting a severe lack of social support.
Abstract.
Author URL.
Langenecker S, Roberts H, Jacobs R, Bessette K, Jago D, Thomas L, Pocius S, Dillahunt A, Frandsen S, Schubert B, et al (2021). Mechanisms of Rumination Change in Adolescent Depression (RuMeChange).
Author URL.
Roberts H, Jacobs RH, Bessette KL, Crowell SE, Westlund-Schreiner M, Thomas L, Easter RE, Pocius SL, Dillahunt A, Frandsen S, et al (2021). Mechanisms of rumination change in adolescent depression (RuMeChange): study protocol for a randomised controlled trial of rumination-focused cognitive behavioural therapy to reduce ruminative habit and risk of depressive relapse in high-ruminating adolescents.
BMC Psychiatry,
21(1).
Abstract:
Mechanisms of rumination change in adolescent depression (RuMeChange): study protocol for a randomised controlled trial of rumination-focused cognitive behavioural therapy to reduce ruminative habit and risk of depressive relapse in high-ruminating adolescents.
BACKGROUND: Adolescent-onset depression often results in a chronic and recurrent course, and is associated with worse outcomes relative to adult-onset depression. Targeting habitual depressive rumination, a specific known risk factor for relapse, may improve clinical outcomes for adolescents who have experienced a depressive episode. Randomized controlled trials (RCTs) thus far have demonstrated that rumination-focused cognitive behavioral therapy (RFCBT) reduces depressive symptoms and relapse rates in patients with residual depression and adolescents and young adults with elevated rumination. This was also observed in a pilot RCT of adolescents at risk for depressive relapse. Rumination can be measured at the self-report, behavioral, and neural levels- using patterns of connectivity between the Default Mode Network (DMN) and Cognitive Control Network (CCN). Disrupted connectivity is a putative important mechanism for understanding reduced rumination via RFCBT. A feasibility trial in adolescents found that reductions in connectivity between DMN and CCN regions following RFCBT were correlated with change in rumination and depressive symptoms. METHOD: This is a phase III two-arm, two-stage, RCT of depression prevention. The trial tests whether RFCBT reduces identified risk factors for depressive relapse (rumination, patterns of neural connectivity, and depressive symptoms) in adolescents with partially or fully remitted depression and elevated rumination. In the first stage, RFCBT is compared to treatment as usual within the community. In the second stage, the comparator condition is relaxation therapy. Primary outcomes will be (a) reductions in depressive rumination, assessed using the Rumination Response Scale, and (b) reductions in resting state functional magnetic resonance imaging connectivity of DMN (posterior cingulate cortex) to CCN (inferior frontal gyrus), at 16 weeks post-randomization. Secondary outcomes include change in symptoms of depression following treatment, recurrence of depression over 12 months post-intervention period, and whether engagement with therapy homework (as a dose measure) is related to changes in the primary outcomes. DISCUSSION: RFCBT will be evaluated as a putative preventive therapy to reduce the risk of depressive relapse in adolescents, and influence the identified self-report, behavioral, and neural mechanisms of change. Understanding mechanisms that underlie change in rumination is necessary to improve and further disseminate preventive interventions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03859297 , registered 01 March 2019.
Abstract.
Author URL.
Dogan-Sander E, Baldofski S, Mauche N, Bot M, Brouwer IA, Cabout M, Gili M, van Grootheest G, Hegerl U, Owens M, et al (2021). Overweight and obese individuals with depressive symptoms from the MooDFOOD prevention trial: Role of sociodemographic, somatic health, and weight related factors. Journal of Affective Disorders Reports, 4
Mostazir M, Taylor G, Henley WE, Watkins ER, Taylor RS (2021). Per-Protocol analyses produced larger treatment effect sizes than intention to treat: a meta-epidemiological study.
J Clin Epidemiol,
138, 12-21.
Abstract:
Per-Protocol analyses produced larger treatment effect sizes than intention to treat: a meta-epidemiological study.
OBJECTIVE: to undertake meta-analysis and compare treatment effects estimated by the intention-to-treat (ITT) method and per-protocol (PP) method in randomized controlled trials (RCTs). PP excludes trial participants who are non-adherent to trial protocol in terms of eligibility, interventions, or outcome assessment. STUDY DESIGN AND SETTING: Five high impact journals were searched for all RCTs published between July 2017 to June 2019. Primary outcome was a pooled estimate that quantified the difference between the treatment effects estimated by the two methods. Results are presented as ratio of odds ratios (ROR). Meta-regression was used to explore the association between level of trial protocol non-adherence and treatment effect. Sensitivity analyses compared results with varying within-study correlations and across various study characteristics. RESULTS: Random-effects meta-analysis (N = 156) showed that PP estimates were on average 2% greater compared to the ITT estimates (ROR: 1.02, 95% CI: 1.00-1.04, P = 0.03). The divergence further increased with higher degree of protocol non-adherence. Sensitivity analyses reassured consistent results with various within-study correlations and across various study characteristics. CONCLUSION: There was evidence of larger treatment effect with PP compared to ITT analysis. PP analysis should not be used to assess the impact of protocol non-adherence in RCTs. Instead, in addition to ITT, investigators should consider randomization based casual method such as Complier Average Causal Effect (CACE).
Abstract.
Author URL.
Edge D, Newbold A, Ehring T, Rosenkranz T, Frost M, Watkins ER (2021). Reducing worry and rumination in young adults via a mobile phone app: study protocol of the ECoWeB (Emotional Competence for Well-Being in Young Adults) randomised controlled trial focused on repetitive negative thinking.
BMC Psychiatry,
21(1).
Abstract:
Reducing worry and rumination in young adults via a mobile phone app: study protocol of the ECoWeB (Emotional Competence for Well-Being in Young Adults) randomised controlled trial focused on repetitive negative thinking
Abstract
. Background
. Promoting well-being and preventing poor mental health in young people is a major global priority. Building emotional competence skills via a mobile app may be an effective, scalable and acceptable way to do this. A particular risk factor for anxiety and depression is elevated worry and rumination (repetitive negative thinking, RNT). An app designed to reduce RNT may prevent future incidence of depression and anxiety.
.
. Method/design
. The Emotional Competence for Well-Being in Young Adults study developed an emotional competence app to be tested via randomised controlled trials in a longitudinal prospective cohort. This off-shoot study adapts the app to focus on targeting RNT (worry, rumination), known risk factors for poor mental health. In this study, 16–24 year olds in the UK, who report elevated worry and rumination on standardised questionnaires are randomised to (i) receive the RNT-targeting app immediately for 6 weeks (ii) a waiting list control who receive the app after 6 weeks. In total, the study will aim to recruit 204 participants, with no current diagnosis of major depression, bipolar disorder or psychosis, across the UK. Assessments take place at baseline (pre-randomisation), 6 and 12 weeks post-randomisation. Primary endpoint and outcome for the study is level of rumination assessed on the Rumination Response Styles Questionnaire at 6 weeks. Worry, depressive symptoms, anxiety symptoms and well-being are secondary outcomes. Compliance, adverse events and potentially mediating variables will be carefully monitored.
.
. Discussion
. This trial aims to better understand the benefits of tackling RNT via an mobile phone app intervention in young people. This prevention mechanism trial will establish whether targeting worry and rumination directly via an app provides a feasible approach to prevent depression and anxiety, with scope to become a widescale public health strategy for preventing poor mental health and promoting well-being in young people.
.
. Trial registration
. ClinicalTrials.gov, NCT04950257. Registered 6 July 2021 – Retrospectively registered.
.
Abstract.
Buckman JEJ, Saunders R, Stott J, Arundell L-L, O'Driscoll C, Davies MR, Eley TC, Hollon SD, Kendrick T, Ambler G, et al (2021). Role of age, gender and marital status in prognosis for adults with depression: an individual patient data meta-analysis.
Epidemiol Psychiatr Sci,
30Abstract:
Role of age, gender and marital status in prognosis for adults with depression: an individual patient data meta-analysis.
AIMS: to determine whether age, gender and marital status are associated with prognosis for adults with depression who sought treatment in primary care. METHODS: Medline, Embase, PsycINFO and Cochrane Central were searched from inception to 1st December 2020 for randomised controlled trials (RCTs) of adults seeking treatment for depression from their general practitioners, that used the Revised Clinical Interview Schedule so that there was uniformity in the measurement of clinical prognostic factors, and that reported on age, gender and marital status. Individual participant data were gathered from all nine eligible RCTs (N = 4864). Two-stage random-effects meta-analyses were conducted to ascertain the independent association between: (i) age, (ii) gender and (iii) marital status, and depressive symptoms at 3-4, 6-8, and 9-12 months post-baseline and remission at 3-4 months. Risk of bias was evaluated using QUIPS and quality was assessed using GRADE. PROSPERO registration: CRD42019129512. Pre-registered protocol https://osf.io/e5zup/. RESULTS: There was no evidence of an association between age and prognosis before or after adjusting for depressive 'disorder characteristics' that are associated with prognosis (symptom severity, durations of depression and anxiety, comorbid panic disorderand a history of antidepressant treatment). Difference in mean depressive symptom score at 3-4 months post-baseline per-5-year increase in age = 0(95% CI: -0.02 to 0.02). There was no evidence for a difference in prognoses for men and women at 3-4 months or 9-12 months post-baseline, but men had worse prognoses at 6-8 months (percentage difference in depressive symptoms for men compared to women: 15.08% (95% CI: 4.82 to 26.35)). However, this was largely driven by a single study that contributed data at 6-8 months and not the other time points. Further, there was little evidence for an association after adjusting for depressive 'disorder characteristics' and employment status (12.23% (-1.69 to 28.12)). Participants that were either single (percentage difference in depressive symptoms for single participants: 9.25% (95% CI: 2.78 to 16.13) or no longer married (8.02% (95% CI: 1.31 to 15.18)) had worse prognoses than those that were married, even after adjusting for depressive 'disorder characteristics' and all available confounders. CONCLUSION: Clinicians and researchers will continue to routinely record age and gender, but despite their importance for incidence and prevalence of depression, they appear to offer little information regarding prognosis. Patients that are single or no longer married may be expected to have slightly worse prognoses than those that are married. Ensuring this is recorded routinely alongside depressive 'disorder characteristics' in clinic may be important.
Abstract.
Author URL.
Cohen Z, DeRubeis R, Hayes R, Watkins E, Lewis G, Byng R, Byford S, Crane C, Kuyken W, Dalgleish T, et al (2021). The Development and Internal Evaluation of a Predictive Model to Identify for Whom Mindfulness-Based Cognitive Therapy Offers Superior Relapse Prevention for Recurrent Depression Versus Maintenance Antidepressant Medication.
Author URL.
Mollaahmetoglu OM, Palmer E, Maschauer E, Nolan MC, Stevens T, Carlyle M, Hardy L, Watkins ER, Morgan CJA (2021). The acute effects of alcohol on state rumination in the laboratory.
Psychopharmacology (Berl),
238(6), 1671-1686.
Abstract:
The acute effects of alcohol on state rumination in the laboratory.
RATIONALE: Rumination is a repetitive, negative, self-focused thinking style associated with various forms of psychopathology. Recent studies suggest that rumination increases craving for alcohol and predicts harmful drinking and alcohol-related problems. However, the acute effects of alcohol on rumination have not been previously studied. It is proposed that alcohol may reduce ruminative thinking through decreasing negative mood. OBJECTIVES: in the present study, we aimed to test the previously unexplored effects of acute alcohol consumption on rumination in a hazardous drinking population. METHODS: We conducted a randomised placebo-controlled laboratory study to examine the effect of low (0.4 g kg-1) and high doses (0.8 g kg-1) of alcohol on state rumination compared to placebo. Participants completed a rumination induction task prior to receiving drinks. We then measured state rumination and mood at repeated time points; 30 min, 60 min and 90 min post-drinks consumption. RESULTS: We found a significant decrease in state rumination in the low-dose alcohol group compared to placebo at 30 min post-alcohol consumption, but no difference was observed between the high-dose alcohol and placebo groups. Mediation analysis provided evidence for an indirect effect of alcohol on state rumination through concurrent changes in negative mood. CONCLUSIONS: These findings suggest that acute alcohol consumption can regulate negative mood and concurrently rumination, providing preliminary evidence for the role of rumination in alcohol use disorders. Rumination may be a treatment target in alcohol use disorders.
Abstract.
Author URL.
Buckman JEJ, Saunders R, Cohen ZD, Barnett P, Clarke K, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, et al (2021). The contribution of depressive ‘disorder characteristics’ to determinations of prognosis for adults with depression: an individual patient data meta-analysis.
Psychological Medicine,
51(7), 1068-1081.
Abstract:
The contribution of depressive ‘disorder characteristics’ to determinations of prognosis for adults with depression: an individual patient data meta-analysis
AbstractBackgroundThis study aimed to investigate general factors associated with prognosis regardless of the type of treatment received, for adults with depression in primary care.MethodsWe searched Medline, Embase, PsycINFO and Cochrane Central (inception to 12/01/2020) for RCTs that included the most commonly used comprehensive measure of depressive and anxiety disorder symptoms and diagnoses, in primary care depression RCTs (the Revised Clinical Interview Schedule: CIS-R). Two-stage random-effects meta-analyses were conducted.ResultsTwelve (n = 6024) of thirteen eligible studies (n = 6175) provided individual patient data. There was a 31% (95%CI: 25 to 37) difference in depressive symptoms at 3–4 months per standard deviation increase in baseline depressive symptoms. Four additional factors: the duration of anxiety; duration of depression; comorbid panic disorder; and a history of antidepressant treatment were also independently associated with poorer prognosis. There was evidence that the difference in prognosis when these factors were combined could be of clinical importance. Adding these variables improved the amount of variance explained in 3–4 month depressive symptoms from 16% using depressive symptom severity alone to 27%. Risk of bias (assessed with QUIPS) was low in all studies and quality (assessed with GRADE) was high. Sensitivity analyses did not alter our conclusions.ConclusionsWhen adults seek treatment for depression clinicians should routinely assess for the duration of anxiety, duration of depression, comorbid panic disorder, and a history of antidepressant treatment alongside depressive symptom severity. This could provide clinicians and patients with useful and desired information to elucidate prognosis and aid the clinical management of depression.
Abstract.
O'Driscoll C, Buckman JEJ, Fried EI, Saunders R, Cohen ZD, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, et al (2021). The importance of transdiagnostic symptom level assessment to understanding prognosis for depressed adults: analysis of data from six randomised control trials.
BMC Med,
19(1).
Abstract:
The importance of transdiagnostic symptom level assessment to understanding prognosis for depressed adults: analysis of data from six randomised control trials.
BACKGROUND: Depression is commonly perceived as a single underlying disease with a number of potential treatment options. However, patients with major depression differ dramatically in their symptom presentation and comorbidities, e.g. with anxiety disorders. There are also large variations in treatment outcomes and associations of some anxiety comorbidities with poorer prognoses, but limited understanding as to why, and little information to inform the clinical management of depression. There is a need to improve our understanding of depression, incorporating anxiety comorbidity, and consider the association of a wide range of symptoms with treatment outcomes. METHOD: Individual patient data from six RCTs of depressed patients (total n = 2858) were used to estimate the differential impact symptoms have on outcomes at three post intervention time points using individual items and sum scores. Symptom networks (graphical Gaussian model) were estimated to explore the functional relations among symptoms of depression and anxiety and compare networks for treatment remitters and those with persistent symptoms to identify potential prognostic indicators. RESULTS: Item-level prediction performed similarly to sum scores when predicting outcomes at 3 to 4 months and 6 to 8 months, but outperformed sum scores for 9 to 12 months. Pessimism emerged as the most important predictive symptom (relative to all other symptoms), across these time points. In the network structure at study entry, symptoms clustered into physical symptoms, cognitive symptoms, and anxiety symptoms. Sadness, pessimism, and indecision acted as bridges between communities, with sadness and failure/worthlessness being the most central (i.e. interconnected) symptoms. Connectivity of networks at study entry did not differ for future remitters vs. those with persistent symptoms. CONCLUSION: the relative importance of specific symptoms in association with outcomes and the interactions within the network highlight the value of transdiagnostic assessment and formulation of symptoms to both treatment and prognosis. We discuss the potential for complementary statistical approaches to improve our understanding of psychopathology.
Abstract.
Author URL.
O'Loughlin J, Casanova F, Jones SE, Hagenaars SP, Beaumont RN, Freathy RM, Watkins ER, Vetter C, Rutter MK, Cain SW, et al (2021). Using Mendelian Randomisation methods to understand whether diurnal preference is causally related to mental health.
Mol Psychiatry,
26(11), 6305-6316.
Abstract:
Using Mendelian Randomisation methods to understand whether diurnal preference is causally related to mental health.
Late diurnal preference has been linked to poorer mental health outcomes, but the understanding of the causal role of diurnal preference on mental health and wellbeing is currently limited. Late diurnal preference is often associated with circadian misalignment (a mismatch between the timing of the endogenous circadian system and behavioural rhythms), so that evening people live more frequently against their internal clock. This study aims to quantify the causal contribution of diurnal preference on mental health outcomes, including anxiety, depression and general wellbeing and test the hypothesis that more misaligned individuals have poorer mental health and wellbeing using an actigraphy-based measure of circadian misalignment. Multiple Mendelian Randomisation (MR) approaches were used to test causal pathways between diurnal preference and seven well-validated mental health and wellbeing outcomes in up to 451,025 individuals. In addition, observational analyses tested the association between a novel, objective measure of behavioural misalignment (Composite Phase Deviation, CPD) and seven mental health and wellbeing outcomes. Using genetic instruments identified in the largest GWAS for diurnal preference, we provide robust evidence that early diurnal preference is protective for depression and improves wellbeing. For example, using one-sample MR, a twofold higher genetic liability of morningness was associated with lower odds of depressive symptoms (OR: 0.92, 95% CI: 0.88, 0.97). It is possible that behavioural factors including circadian misalignment may contribute in the chronotype depression relationship, but further work is needed to confirm these findings.
Abstract.
Author URL.
Roberts H, Mostazir M, Moberly NJ, Watkins ER, Adlam A-L (2021). Working memory updating training reduces state repetitive negative thinking: Proof-of-concept for a novel cognitive control training. Behaviour Research and Therapy, 142, 103871-103871.
2020
Owens M, Watkins E, Bot M, Brouwer IA, Roca M, Kohls E, Penninx B, van Grootheest G, Cabout M, Hegerl U, et al (2020). Acceptability and feasibility of two interventions in the MooDFOOD Trial: a food-related depression prevention randomised controlled trial in overweight adults with subsyndromal symptoms of depression.
BMJ Open,
10(9).
Abstract:
Acceptability and feasibility of two interventions in the MooDFOOD Trial: a food-related depression prevention randomised controlled trial in overweight adults with subsyndromal symptoms of depression.
OBJECTIVES: We report on the acceptability, feasibility, dose-response relationship and adherence of two nutritional strategies to improve mood (multinutrient supplements; food-related behavioural activation (F-BA)) studied in a randomised controlled depression prevention trial (the Multi-country cOllaborative project on the rOle of Diet, Food-related behaviour, and Obesity in the prevention of Depression (MooDFOOD) Trial). We also assessed baseline determinants of adherence and assessed whether better adherence resulted in lower depressive symptoms. DESIGN: Randomised controlled trial with a 2×2 factorial design conducted between 2015 and 2017. SETTING: Germany, the Netherlands, UK and Spain. PARTICIPANTS: Community sample of 1025 overweight adults with elevated depressive symptoms without a current episode of major depressive disorder. Main eligibility criteria included age (18-75 years), being overweight or obese, and having at least mild depressive symptoms, shown by a Patient Health Questionnaire Score of ≥5. A total of 76% of the sample was retained at the 12-month follow-up. INTERVENTIONS: Daily nutritional supplements versus pill placebo or an F-BA therapy, delivered in individual and group sessions versus no behavioural intervention over a 1-year period. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome: self-reported acceptability of the interventions. SECONDARY OUTCOMES: adherence and self-reported depressive symptoms. RESULTS: Most participants reported that the F-BA was acceptable (83.61%), feasible to do (65.91%) and would recommend it to a friend (84.57%). Individual F-BA sessions (88.10%) were significantly more often rated as positive than group F-BA sessions (70.17%) and supplements (28.59%). There were statistically significant reductions in depressive symptoms for those who both adhered to the F-BA intervention and had a history of depression (B=-0.08, SE=0.03, p=0.012) versus those who had no history of depression. Supplement intake had no effect on depressive symptoms irrespective of adherence. CONCLUSIONS: F-BA may have scope for development as a depression prevention intervention and public health strategy but further refinement and testing are needed. TRIAL REGISTRATION NUMBER: NCT02529423.
Abstract.
Author URL.
Rosenkranz T, Takano K, Watkins ER, Ehring T (2020). Assessing repetitive negative thinking in daily life: Development of an ecological momentary assessment paradigm.
PLoS One,
15(4).
Abstract:
Assessing repetitive negative thinking in daily life: Development of an ecological momentary assessment paradigm.
Repetitive negative thinking (RNT) is a transdiagnostic process and a promising target for prevention and treatment of mental disorders. RNT is typically assessed via self-report questionnaires with most studies focusing on one type of RNT (i.e. worry or rumination) and one specific disorder (i.e. anxiety or depression). However, responses to such questionnaires may be biased by memory and metacognitive beliefs. Recently, Ecological Momentary Assessment (EMA) has been employed to minimize these biases. This study aims to develop an EMA paradigm to measure RNT as a transdiagnostic process in natural settings. Based on empirical and theoretical considerations, an item pool was created encompassing RNT content and processes. We then (1) tested model fit of a content-related and a process-related model for assessing RNT as an individual difference variable, (2) investigated the reliability and construct validity of the proposed scale(s), and (3) determined the optimal sampling design. One hundred fifty healthy participants aged 18 to 40 years filled out baseline questionnaires on rumination, worry, RNT, symptoms of depression, anxiety, and stress. Participants received 8 semi-random daily prompts assessing RNT over 14 days. After the EMA phase, participants answered questionnaires on depression, anxiety, and stress again. Multilevel confirmatory factor analysis revealed excellent model fit for the process-related model but unsatisfactory fit for the content-related model. Different hybrid models were additionally explored, yielding one model with satisfactory fit. Both the process-related and the hybrid scale showed good reliability and good convergent validity and were significantly associated with symptoms of depression, anxiety, and stress after the EMA phase when controlling for baseline scores. Further analyses found that a sampling design of 5 daily assessments across 10 days yielded the best tradeoff between participant burden and information retained by EMA. In sum, this paper presents a promising paradigm for assessing RNT in daily life.
Abstract.
Author URL.
Pérez-Ara MÁ, Gili M, Visser M, Penninx BWJH, Brouwer IA, Watkins E, Owens M, García-Toro M, Hegerl U, Kohls E, et al (2020). Associations of Non-Alcoholic Beverages with Major Depressive Disorder History and Depressive Symptoms Clusters in a Sample of Overweight Adults.
Nutrients,
12(10), 3202-3202.
Abstract:
Associations of Non-Alcoholic Beverages with Major Depressive Disorder History and Depressive Symptoms Clusters in a Sample of Overweight Adults
Background: Meta-analysis of observational studies concluded that soft drinks may increase the risk of depression, while high consumption of coffee and tea may reduce the risk. Objectives were to explore the associations between the consumption of soft drinks, coffee or tea and: (1) a history of major depressive disorder (MDD) and (2) the severity of depressive symptoms clusters (mood, cognitive and somatic/vegetative symptoms). Methods: Cross-sectional and longitudinal analysis based on baseline and 12-month-follow-up data collected from four countries participating in the European MooDFOOD prevention trial. In total, 941 overweight adults with subsyndromal depressive symptoms aged 18 to 75 years were analyzed. History of MDD, depressive symptoms and beverages intake were assessed. Results: Sugar-sweetened soft drinks were positively related to MDD history rates whereas soft drinks with non-nutritive sweeteners were inversely related for the high vs. low categories of intake. Longitudinal analysis showed no significant associations between beverages and mood, cognitive and somatic/vegetative clusters. Conclusion: Our findings point toward a relationship between soft drinks and past MDD diagnoses depending on how they are sweetened while we found no association with coffee and tea. No significant effects were found between any studied beverages and the depressive symptoms clusters in a sample of overweight adults.
Abstract.
Paans NPG, Bot M, Brouwer IA, Visser M, Gili M, Roca M, Hegerl U, Kohls E, Owens M, Watkins E, et al (2020). Effects of food-related behavioral activation therapy on eating styles, diet quality and body weight change: Results from the MooDFOOD Randomized Clinical Trial.
J Psychosom Res,
137Abstract:
Effects of food-related behavioral activation therapy on eating styles, diet quality and body weight change: Results from the MooDFOOD Randomized Clinical Trial.
OBJECTIVE: Depression and obesity are bi-directionally related, eating styles and diet quality are two important factors associated with both. It remains uncertain if and how these two factors can be modified. Therefore the current study aims to investigate whether food-related behavioral activation therapy (F-BA), targeting mood, dietary habits and food related behavior, can improve eating styles, and diet quality and reduce body weight in adults with overweight or obesity and subsyndromal depressive symptoms. METHODS: Data were derived from the MooDFOOD prevention trial, a 2x2 factorial RCT investigating the effect of nutritional strategies on prevention of depression. Changes in emotional, uncontrolled, and cognitive restrained eating (Three Factor Eating Questionnaire Revised), Mediterranean Diet Score (MDS), and body weight were analyzed among 1025 adults who either received F-BA or no intervention for 12 months. Intervention effect was tested by longitudinal analysis of covariance using mixed model analysis. RESULTS: the F-BA group showed a small decrease in emotional (β=-5.68, p
Abstract.
Author URL.
Watkins ER, Newbold A (2020). Factorial Designs Help to Understand How Psychological Therapy Works.
Front Psychiatry,
11Abstract:
Factorial Designs Help to Understand How Psychological Therapy Works.
A large amount of research time and resources are spent trying to develop or improve psychological therapies. However, treatment development is challenging and time-consuming, and the typical research process followed-a series of standard randomized controlled trials-is inefficient and sub-optimal for answering many important clinical research questions. In other areas of health research, recognition of these challenges has led to the development of sophisticated designs tailored to increase research efficiency and answer more targeted research questions about treatment mechanisms or optimal delivery. However, these innovations have largely not permeated into psychological treatment development research. There is a recognition of the need to understand how treatments work and what their active ingredients might be, and a call for the use of innovative trial designs to support such discovery. One approach to unpack the active ingredients and mechanisms of therapy is the factorial design as exemplified in the Multiphase Optimization Strategy (MOST) approach. The MOST design allows identification of the active components of a complex multi-component intervention (such as CBT) using a sophisticated factorial design, allowing the development of more efficient interventions and elucidating their mechanisms of action. The rationale, design, and potential advantages of this approach will be illustrated with reference to the IMPROVE-2 study, which conducts a fractional factorial design to investigate which elements (e.g. thought challenging, activity scheduling, compassion, relaxation, concreteness, functional analysis) within therapist-supported internet-delivered CBT are most effective at reducing symptoms of depression in 767 adults with major depression. By using this innovative approach, we can first begin to work out what components within the overall treatment package are most efficacious on average allowing us to build an overall more streamlined and potent therapy. This approach also has potential to distinguish the role of specific versus non-specific common treatment components within treatment.
Abstract.
Author URL.
Hvenegaard M, Moeller SB, Poulsen S, Gondan M, Grafton B, Austin SF, Kistrup M, Rosenberg NGK, Howard H, Watkins ER, et al (2020). Group rumination-focused cognitive-behavioural therapy (CBT) v. group CBT for depression: phase II trial.
Psychol Med,
50(1), 11-19.
Abstract:
Group rumination-focused cognitive-behavioural therapy (CBT) v. group CBT for depression: phase II trial.
BACKGROUND: Although cognitive-behavioural therapy (CBT) is an effective treatment for depression, less than half of patients achieve satisfactory symptom reduction during treatment. Targeting known psychopathological processes such as rumination may increase treatment efficacy. The aim of this study was to test whether adding group rumination-focused CBT (RFCBT) that explicitly targets rumination to routine medical management is superior to adding group CBT to routine medical management in treating major depression. METHODS: a total of 131 outpatients with major depression were randomly allocated to 12 sessions group RFCBT v. group CBT, each in addition to routine medical management. The primary outcome was observer-rated symptoms of depression at the end of treatment measured on the Hamilton Rating Scale for Depression. Secondary outcomes were rumination at post-treatment and depressive symptoms at 6 months follow-up (Trial registered: NCT02278224). RESULTS: RFCBT significantly improved observer-rated depressive symptoms (Cohen's d 0.38; 95% CI 0.03-0.73) relative to group CBT at post-treatment on the primary outcome. No post-treatment differences were found in rumination or in depressive symptoms at 6 months follow-up, although these secondary analyses may have been underpowered. CONCLUSIONS: This is the first randomized controlled trial providing evidence of benefits of RFCBT in major depression compared with CBT. Group RFCBT may be a beneficial alternative to group CBT for major depression.
Abstract.
Author URL.
Bessette KL, Jacobs RH, Heleniak C, Peters AT, Welsh RC, Watkins ER, Langenecker SA (2020). Malleability of rumination: an exploratory model of CBT-based plasticity and long-term reduced risk for depressive relapse among youth from a pilot randomized clinical trial. PLOS ONE, 15(6), e0233539-e0233539.
Owens M, Watkins E, Bot M, Brouwer IA, Roca M, Kohls E, Penninx BWJH, van Grootheest G, Hegerl U, Gili M, et al (2020). Nutrition and depression: Summary of findings from the EU‐funded MooDFOOD depression prevention randomised controlled trial and a critical review of the literature.
Nutrition Bulletin,
45(4), 403-414.
Abstract:
Nutrition and depression: Summary of findings from the EU‐funded MooDFOOD depression prevention randomised controlled trial and a critical review of the literature
AbstractThis paper discusses the emerging field of nutritional psychology and provides an update on the now completed EU‐funded MooDFOOD depression prevention randomised controlled trial that assessed the effects of two nutrition‐based interventions for the prevention of depression in overweight or obese adults with at least mild symptoms of depression. We first outline the problem of major depression, the most common form of psychopathology and the largest contributor to global disability, and then give an overview of the connection between nutrition and depression; separating the evidence according to prevention and treatment of depression. The extant literature is reviewed, and we examine the implications for both prevention and treatment. Questions are posed for further research in this emerging and important area.
Abstract.
Newbold A, Warren FC, Taylor RS, Hulme C, Burnett S, Aas B, Botella C, Burkhardt F, Ehring T, Fontaine JRJ, et al (2020). Promotion of mental health in young adults via mobile phone app: study protocol of the ECoWeB (emotional competence for well-being in Young adults) cohort multiple randomised trials.
BMC Psychiatry,
20(1).
Abstract:
Promotion of mental health in young adults via mobile phone app: study protocol of the ECoWeB (emotional competence for well-being in Young adults) cohort multiple randomised trials.
BACKGROUND: Promoting well-being and preventing poor mental health in young people is a major global priority. Building emotional competence (EC) skills via a mobile app may be an effective, scalable and acceptable way to do this. However, few large-scale controlled trials have examined the efficacy of mobile apps in promoting mental health in young people; none have tailored the app to individual profiles. METHOD/DESIGN: the Emotional Competence for Well-Being in Young Adults cohort multiple randomised controlled trial (cmRCT) involves a longitudinal prospective cohort to examine well-being, mental health and EC in 16-22 year olds across 12 months. Within the cohort, eligible participants are entered to either the PREVENT trial (if selected EC scores at baseline within worst-performing quartile) or to the PROMOTE trial (if selected EC scores not within worst-performing quartile). In both trials, participants are randomised (i) to continue with usual practice, repeated assessments and a self-monitoring app; (ii) to additionally receive generic cognitive-behavioural therapy self-help in app; (iii) to additionally receive personalised EC self-help in app. In total, 2142 participants aged 16 to 22 years, with no current or past history of major depression, bipolar disorder or psychosis will be recruited across UK, Germany, Spain, and Belgium. Assessments take place at baseline (pre-randomisation), 1, 3 and 12 months post-randomisation. Primary endpoint and outcome for PREVENT is level of depression symptoms on the Patient Health Questionnaire-9 at 3 months; primary endpoint and outcome for PROMOTE is emotional well-being assessed on the Warwick-Edinburgh Mental Wellbeing Scale at 3 months. Depressive symptoms, anxiety, well-being, health-related quality of life, functioning and cost-effectiveness are secondary outcomes. Compliance, adverse events and potentially mediating variables will be carefully monitored. CONCLUSIONS: the trial aims to provide a better understanding of the causal role of learning EC skills using interventions delivered via mobile phone apps with respect to promoting well-being and preventing poor mental health in young people. This knowledge will be used to develop and disseminate innovative evidence-based, feasible, and effective Mobile-health public health strategies for preventing poor mental health and promoting well-being. TRIAL REGISTRATION: ClinicalTrials.gov ( www.clinicaltrials.org ). Number of identification: NCT04148508 November 2019.
Abstract.
Author URL.
Watkins ER, Roberts H (2020). Reflecting on rumination: Consequences, causes, mechanisms and treatment of rumination.
Behaviour Research and TherapyAbstract:
Reflecting on rumination: Consequences, causes, mechanisms and treatment of rumination
We review research showing that rumination has multiple negative consequences: (a) exacerbating psychopathology by magnifying and prolonging negative mood states, interfering with problem-solving and instrumental behaviour and reducing sensitivity to changing contingencies; (b) acting as a transdiagnostic mental health vulnerability impacting anxiety, depression, psychosis, insomnia, and impulsive behaviours; (c) interfering with therapy and limiting the efficacy of psychological interventions; (d) exacerbating and maintaining physiological stress responses. The mechanisms underlying rumination are examined, and a model (H-EX-A-GO-N – Habit development, EXecutive control, Abstract processing, GOal discrepancies, Negative bias) is proposed to account for the onset and maintenance of rumination. H-EX-A-GO-N outlines how rumination results from dwelling on problematic goals developing into a learnt habit that involves the tendency to process negative information in an abstract way, particularly in the context of poor executive control and negative information-processing biases. These proximal factors integrate experimental evidence to provide a partial answer to the critical question of what maintains rumination. They constitute a pathway by which more distal biological and environmental factors increase the likelihood of rumination developing. Treatments for rumination are reviewed, with preliminary trials suggesting that psychological interventions designed to specifically target these mechanisms may be effective at reducing rumination.
Abstract.
Feldhaus CG, Jacobs RH, Watkins ER, Peters AT, Bessette KL, Langenecker SA (2020). Rumination-Focused Cognitive Behavioral Therapy Decreases Anxiety and Increases Behavioral Activation Among Remitted Adolescents.
JOURNAL OF CHILD AND FAMILY STUDIES,
29(7), 1982-1991.
Author URL.
Moeller SB, Austin SF, Hvenegaard M, Kistrup M, Gran S, Watkins E (2020). Rumination-focused cognitive behaviour therapy for non-responsive chronic depression: an uncontrolled group study.
Behav Cogn Psychother,
48(3), 376-381.
Abstract:
Rumination-focused cognitive behaviour therapy for non-responsive chronic depression: an uncontrolled group study.
BACKGROUND: One-third of patients with depression do not respond satisfactorily to treatment, and approximately 20% of all patients treated for depression develop a chronic depression. One approach to more effective treatment of chronic and treatment-resistant depression is to target rumination - an underlying mechanism implicated in the development and maintenance of depression. AIM: the purpose of this uncontrolled group study was to investigate the feasibility of individual rumination-focused cognitive behavioural therapy (RfCBT) for patients with chronic and treatment-resistant depression. METHOD: a total of 10 patients with chronic and treatment-resistant depression were offered 12-16 individual sessions of RfCBT. The primary outcome was depressive symptoms as measured by Hamilton Depression Scale at pre-, post- and 3-month follow-up. Secondary symptoms measured included self-reported rumination and worry. RESULTS: There was a significant reduction in depressive symptoms (p < 0.05), rumination (p < 0.01) and worry (p < 0.5) from pre- to post-treatment. Half of the participants (n = 5) showed significant reliable change on levels of depressive symptoms post-treatment. The reduction in depressive symptoms, rumination and worry were maintained at follow-up. CONCLUSIONS: RfCBT was associated with significant reductions in depressive symptoms in a small sample with chronic and treatment-resistant depression. Despite limitations of being a small uncontrolled study with limited follow-up, these results are promising in a difficult to treat population. RfCBT warrants further systematic evaluation.
Abstract.
Author URL.
Thesing CS, Milaneschi Y, Bot M, Brouwer IA, Owens M, Hegerl U, Gili M, Roca M, Kohls E, Watkins E, et al (2020). Supplementation-induced increase in circulating omega-3 serum levels is not associated with a reduction in depressive symptoms: Results from the MooDFOOD depression prevention trial.
Depress Anxiety,
37(11), 1079-1088.
Abstract:
Supplementation-induced increase in circulating omega-3 serum levels is not associated with a reduction in depressive symptoms: Results from the MooDFOOD depression prevention trial.
BACKGROUND: There is ambiguity on how omega-3 (n-3) polyunsaturated fatty acids (PUFAs) are associated with depression, and what the temporality of the association might be. The present study aimed to examine whether (intervention-induced changes in) n-3 PUFA levels were associated with (changes in) depressive symptoms. METHODS: Baseline, 6- and 12-month follow-up data on 682 overweight and subclinically depressed persons from four European countries that participated in the MooDFOOD depression prevention randomized controlled trial were used. Participants were allocated to four intervention groups: (a) placebos, (b) placebos and food-related behavioral activation therapy (F-BA), (c) multinutrient supplements (fish oil and multivitamin), and (d) multinutrient supplements and F-BA. Depressive symptoms were measured using the inventory of depressive symptomatology. PUFA levels (µmol/L) were measured using gas chromatography. Analyses were adjusted for sociodemographics, lifestyle, and somatic health. RESULTS: Increases in n-3 PUFA, docosahexaenoic acid, and eicosapentaenoic acid levels over time were significantly larger in the supplement groups than in placebo groups. Change in PUFA levels was not significantly associated with the change in depressive symptoms (β = .002, SE = 0.003, p = .39; β = .003, SE = 0.005, p = .64; β = .005, SE = 0.005, p = .29; β = -.0002, SE = 0.0004, p = .69). Baseline PUFA levels did not modify the intervention effects on depressive symptoms. CONCLUSIONS: in overweight and subclinical depressed persons, multinutrient supplements led to significant increases in n-3 PUFA levels over time, which were not associated with changes in depressive symptoms. Multinutrient supplements do not seem to be an effective preventive strategy in lowering depressive symptoms over time in these at-risk groups.
Abstract.
Author URL.
Farrand P, Woodford J, Coumoundouros C, Svedin F (2020). Supported cognitive-behavioural therapy self-help versus treatment-As-usual for depressed informal caregivers of stroke survivors (CEDArS): Feasibility randomised controlled trial.
Cognitive Behaviour Therapist,
13Abstract:
Supported cognitive-behavioural therapy self-help versus treatment-As-usual for depressed informal caregivers of stroke survivors (CEDArS): Feasibility randomised controlled trial
Demands placed on informal caregivers can result in an increased likelihood of experiencing common mental health difficulties that may affect their ability to undertake the caring role. Currently, however, few evidence-based interventions have been specifically developed for informal caregivers and available interventions are difficult to access. The Improving Access to Psychological Therapies (IAPT) programme aims to improve access to evidence-based psychological therapies for all groups and may therefore present an opportunity to meet informal caregiver needs. Located within the MRC Complex Intervention Framework, a Phase II feasibility randomised controlled trial (RCT) examines key methodological, procedural and clinical uncertainties associated with running a definitive Phase III RCT of an adapted written cognitive behavioural therapy (CBT) self-help intervention for informal caregivers of stroke survivors. Recruitment was low despite different recruitment strategies being adopted, highlighting significant challenges moving towards a Phase III RCT until resolved. Difficulties with study recruitment may reflect wider challenges engaging informal caregivers in psychological interventions and may have implications for IAPT services seeking to improve access for this group. Further attempts to develop a successful recruitment protocol to progress to a Phase III RCT examining effectiveness of the adapted CBT self-help intervention should be encouraged. Key learning aims After reading this article, readers should be able to: (1) Consider key feasibility issues with regard to recruitment and attrition when running a randomised controlled trial of an adapted written cognitive behavioural therapy (CBT) self-help intervention for informal caregivers of stroke survivors.(2) Understand potential barriers experienced by an informal caregiving population to accessing psychological interventions.(3) Appreciate implications for clinical practice to enhance access to IAPT services and low-intensity CBT working with an informal caregiver population.
Abstract.
Cohen ZD, DeRubeis R, Hayes R, Watkins ER, Lewis G, Byng R, Byford S, Crane C, Kuyken W, Dalgleish T, et al (2020). The development and internal evaluation of a predictive model to identify for whom Mindfulness-Based Cognitive Therapy (MBCT) offers superior relapse prevention for recurrent depression versus maintenance antidepressant medication.
Cook L (2020). Web-Based Rumination-Focused Cognitive Behavioural Therapy (i-RFCBT) for High-Ruminating University Students: an examination of feasibility and efficacy.
Abstract:
Web-Based Rumination-Focused Cognitive Behavioural Therapy (i-RFCBT) for High-Ruminating University Students: an examination of feasibility and efficacy
Depression is both highly prevalent and highly impactful in the student population. The aim of the PhD was to assess internet-based rumination-focused cognitive-behavioural therapy (i-RFCBT) as an intervention to reduce the impact of depression in university students.
The intervention was first implemented as a treatment within a university Wellbeing service. An audit of treatment usage and clinical outcomes (N = 82) found the intervention significantly reduced acute depressive and anxious symptoms. Within a case series subsample (N = 26) there were improvements in clinical outcomes as well as significant reductions in rumination, consistent with the hypothesised mechanism of change.
Acute treatment has a limited impact on the disease burden of depression within a population. A greater focus on prevention is identified as a priority. A qualitative study was conducted to investigate the acceptability of i-RFCBT as a preventive intervention.
Having established that the intervention was acceptable, the RESPOND randomised-controlled trial (N = 235) tested whether guided i-RFCBT was an efficacious at preventing the incidence of depression in UK undergraduates with elevated rumination and worry. The trial found that guided i-RFCBT reduced the incidence of a major depressive episode (MDE) over the course of the 12-month follow-up period by 34% relative to usual care, although this difference was not significant. Baseline stress was a significant moderator of the intervention effect, such that participants with higher stress levels experienced a significant benefit of i-RFCBT in reducing the incidence of MDE relative to usual care. Short- to- medium- term improvements in worry, rumination and depressive symptoms were also found.
As guided interventions are limited in terms of scalability, an additional, quasi phase-II pilot feasibility arm was incorporated within the RESPOND trial to test the acceptability and estimate the effect sizes of unguided i-RFCBT. The pattern of effects for unguided i-RFCBT was similar to that of guided i-RFCBT. The clinical implications of the thesis findings are discussed.
Abstract.
Buckman JEJ, Saunders R, Cohen ZD, Clarke K, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, Watkins E, et al (2020). What factors indicate prognosis for adults with depression in primary care? a protocol for meta-analyses of individual patient data using the Dep-GP database.
Wellcome Open Research,
4, 69-69.
Abstract:
What factors indicate prognosis for adults with depression in primary care? a protocol for meta-analyses of individual patient data using the Dep-GP database
Background: Pre-treatment severity is a key indicator of prognosis for those with depression. Knowledge is limited on how best to encompass severity of disorders. A number of non-severity related factors such as social support and life events are also indicators of prognosis. It is not clear whether this holds true after adjusting for pre-treatment severity as a) a depressive symptom scale score, and b) a broader construct encompassing symptom severity and related indicators: “disorder severity”. In order to investigate this, data from the individual participants of clinical trials which have measured a breadth of “disorder severity” related factors are needed. Aims: 1) to assess the association between outcomes for adults seeking treatment for depression and the severity of depression pre-treatment, considered both as i) depressive symptom severity only and ii) “disorder severity” which includes depressive symptom severity and comorbid anxiety, chronicity, history of depression, history of previous treatment, functional impairment and health-related quality of life. 2) to determine whether i) social support, ii) life events, iii) alcohol misuse, and iv) demographic factors (sex, age, ethnicity, marital status, employment status, level of educational attainment, and financial wellbeing) are prognostic indicators of outcomes, independent of baseline “disorder severity” and the type of treatment received. Methods: Databases were searched for randomised clinical trials (RCTs) that recruited adults seeking treatment for depression from their general practitioners and used the same diagnostic and screening instrument to measure severity at baseline – the Revised Clinical Interview Schedule; outcome measures could differ between studies. Chief investigators of all studies meeting inclusion criteria were contacted and individual patient data (IPD) were requested. Conclusions: in total 15 RCTs met inclusion criteria. The Dep-GP database will include the 6271 participants from the 13 studies that provided IPD. This protocol outlines how these data will be analysed. Registration: PROSPERO CRD42019129512 (01/04/2019)
Abstract.
2019
Mostazir M, Taylor RS, Henley W, Watkins E (2019). An overview of statistical methods for handling nonadherence to intervention protocol in randomized control trials: a methodological review.
J Clin Epidemiol,
108, 121-131.
Abstract:
An overview of statistical methods for handling nonadherence to intervention protocol in randomized control trials: a methodological review.
OBJECTIVE: to undertake a methodological review of statistical methods used in randomized controlled trials (RCTs) for handling intervention nonadherence. STUDY DESIGN AND SETTING: Bibliographic databases were searched using predefined search terms. RESULTS: a substantive number of identified studies (56%) were excluded as they only used naive per protocol analysis for handling nonadherence. Our review included 58 articles published between 1991 and 2015. A total of 88 methodological applications were made by these studies. The two most used methods were complier average causal effect (56%) and instrumental variable (23%) predominantly with the use of maximum likelihood (ML) estimators. These alternative applications typically produced treatment effects greater than the intention-to-treat effect but as their standard errors were larger there was no statistical difference between the methods. CONCLUSION: a substantive proportion of RCTs rely on naive per protocol for handling nonadherence. Recent years have seen an increasing number of applications of more appropriate statistical methods, in particular complier average causal effect and instrumental variable methods. However, these later methods rely on strong underlying assumptions that may be vulnerable to violation. More empirical studies are needed that directly compare the usability and performance of different statistical methods for nonadherence in RCTs.
Abstract.
Author URL.
Rosenkranz T, Takano K, Watkins ER, Ehring T (2019). Assessing repetitive negative thinking in daily life: Development of an ecological momentary assessment paradigm.
Abstract:
Assessing repetitive negative thinking in daily life: Development of an ecological momentary assessment paradigm
Repetitive negative thinking (RNT) is a transdiagnostic process and a promising target for prevention and treatment of mental disorders. RNT is typically assessed via self-report ques-tionnaires with most studies focusing on one type of RNT (i.e. worry or rumination) and one specific disorder (i.e. anxiety or depression). However, responses to such questionnaires may be biased by memory and metacognitive beliefs. Recently, Ecological Momentary Assessment (EMA) has been employed to minimize these biases. This study aims to develop an EMA paradigm to measure RNT as a transdiagnostic process in natural settings. Based on empirical and theoretical considerations, an item pool was created encompassing RNT content and processes. We then (1) tested model fit of a content-related and a process-related model for assessing RNT as an individual difference variable, (2) investigated the reliability and construct validity of the proposed scale(s), and (3) determined the optimal sampling design. One hundred fifty healthy participants aged 18 to 40 years filled out baseline questionnaires on rumination, worry, RNT, symptoms of depression, anxiety, and stress. Participants received 8 semi-random daily prompts assessing RNT over 14 days. After the EMA phase, participants answered questionnaires on depression, anxiety, and stress again.Multilevel confirmatory factor analysis revealed excellent model fit for the process-related model but unsatisfactory fit for the content-related model. Different hybrid models were addi-tionally explored, yielding one model with satisfactory fit. Both the process-related and the hybrid scale showed good reliability and good convergent validity and were significantly as-sociated with symptoms of depression, anxiety, and stress after the EMA phase when con-trolling for baseline scores. Further analyses found that a sampling design of 5 daily assess-ments across 10 days yielded the best tradeoff between participant burden and information retained by EMA. In sum, this paper presents a promising paradigm for assessing RNT in daily life.
Abstract.
Baldofski S, Mauche N, Dogan-Sander E, Bot M, Brouwer IA, Paans NPG, Cabout M, Gili M, van Grootheest G, Hegerl U, et al (2019). Depressive Symptom Clusters in Relation to Body Weight Status: Results from Two Large European Multicenter Studies. Frontiers in Psychiatry, 10
Bot M, Brouwer I, Roca M, Kohls E, Penninx B, Watkins ER, van Grootheest G, Cabout M, Hegerl U, Gili M, et al (2019). Effect of Multinutrient Supplementation and Food-Related Behavioral Activation Therapy on Prevention of Major Depressive Disorder Among Overweight or Obese Adults with Subsyndromal Depressive Symptoms. JAMA - Journal of the American Medical Association, 321, 858-868.
Grasso AC, Olthof MR, van Dooren C, Roca M, Gili M, Visser M, Cabout M, Bot M, Penninx BWJH, van Grootheest G, et al (2019). Effect of food-related behavioral activation therapy on food intake and the environmental impact of the diet: results from the MooDFOOD prevention trial.
European Journal of Nutrition,
59(6), 2579-2591.
Abstract:
Effect of food-related behavioral activation therapy on food intake and the environmental impact of the diet: results from the MooDFOOD prevention trial
Abstract
Purpose
Food-based dietary guidelines are proposed to not only improve diet quality, but to also reduce the environmental impact of diets. The aim of our study was to investigate whether food-related behavioral activation therapy (F-BA) applying Mediterranean-style dietary guidelines altered food intake and the environmental impact of the diet in overweight adults with subsyndromal symptoms of depression.
Methods
In total 744 adults who either received the F-BA intervention (F-BA group) or no intervention (control group) for 12 months were included in this analysis. Food intake data were collected through a food frequency questionnaire at baseline and after 6 and 12 months. Greenhouse gas emissions (GHGE), land use (LU), and fossil energy use (FEU) estimates from life-cycle assessments and a weighted score of the three (pReCiPe score) were used to estimate the environmental impact of each individual diet at each timepoint.
Results
The F-BA group reported increased intakes of vegetables (19.7 g/day; 95% CI 7.8–31.6), fruit (23.0 g/day; 9.4–36.6), fish (7.6 g/day; 4.6–10.6), pulses/legumes (4.0 g/day; 1.6–6.5) and whole grains (12.7 g/day; 8.0–17.5), and decreased intake of sweets/extras (− 6.8 g/day; − 10.9 to − 2.8) relative to control group. This effect on food intake resulted in no change in GHGE, LU, and pReCiPe score, but a relative increase in FEU by 1.6 MJ/day (0.8, 2.4).
Conclusions
A shift towards a healthier Mediterranean-style diet does not necessarily result in a diet with reduced environmental impact in a real-life setting.
Trial registration
ClinicalTrials.gov. Number of identification: NCT02529423. August 2015.
Abstract.
Rogiers R, Baeken C, Van den Abbeele D, De Raedt R, Watkins E, Remue J, Colman R, Lemmens G (2019). Group psychoeducation 'drop it' decreases repetitive negative thinking in major depression and generalized anxiety disorder.
Author URL.
Cook L, Mostazir M, Watkins E (2019). Reducing Stress and Preventing Depression (RESPOND): Randomized Controlled Trial of Web-Based Rumination-Focused Cognitive Behavioral Therapy for High-Ruminating University Students.
J Med Internet Res,
21(5).
Abstract:
Reducing Stress and Preventing Depression (RESPOND): Randomized Controlled Trial of Web-Based Rumination-Focused Cognitive Behavioral Therapy for High-Ruminating University Students.
BACKGROUND: Prevention of depression is a priority to reduce its global disease burden. Targeting specific risk factors, such as rumination, may improve prevention. Rumination-focused Cognitive Behavioral Therapy (RFCBT) was developed to specifically target depressive rumination. OBJECTIVE: the primary objective of this study was to test whether guided Web-based RFCBT (i-RFCBT) would prevent the incidence of major depression relative to usual care in UK university students. The secondary objective was to test the feasibility and estimated effect sizes of unguided i-RFCBT. METHODS: to address the primary objective, a phase III randomized controlled trial was designed and powered to compare high risk university students (N=235), selected with elevated worry/rumination, recruited via an open access website in response to circulars within universities and internet advertisements, randomized to receive either guided i-RFCBT (interactive Web-based RFCBT, supported by asynchronous written Web-based support from qualified therapists) or usual care control. To address the secondary objective, participants were also randomized to an adjunct arm of unguided (self-administered) i-RFCBT. The primary outcome was the onset of a major depressive episode over 15 months, assessed with structured diagnostic interviews at 3 (postintervention), 6, and 15 months post randomization, conducted by telephone, blind to the condition. Secondary outcomes of symptoms of depression and anxiety and levels of worry and rumination were self-assessed through questionnaires at baseline and the same follow-up intervals. RESULTS: Participants were randomized to guided i-RFCBT (n=82), unguided i-RFCBT (n=76), or usual care (n=77). Guided i-RFCBT reduced the risk of depression by 34% relative to usual care (hazard ratio [HR] 0.66, 95% CI 0.35 to 1.25; P=.20). Participants with higher levels of baseline stress benefited most from the intervention (HR 0.43, 95% CI 0.21 to 0.87; P=.02). Significant improvements in rumination, worry, and depressive symptoms were found in the short-to-medium term. of the 6 modules, guided participants completed a mean of 3.46 modules (SD 2.25), with 46% (38/82) being compliant (completing ≥4 modules). Similar effect sizes and compliance rates were found for unguided i-RFCBT. CONCLUSIONS: Guided i-RFCBT can reduce the onset of depression in high-risk young people reporting high levels of worry/rumination and stress. The feasibility study argues for formally testing unguided i-RFCBT for prevention: if the observed effect sizes are robustly replicated in a phase III trial, it has potential as a scalable prevention intervention. TRIAL REGISTRATION: ISRCTN Registry ISRCTN12683436; https://www.isrctn.com/ISRCTN12683436 (Archived by WebCite at http://www.webcitation.org/77fqycyBX). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-015-1128-9.
Abstract.
Author URL.
Hitchcock C, Rudokaite J, Patel S, Smith A, Kuhn I, Watkins E, Dalgleish T (2019). Role of autobiographical memory in patient response to cognitive behavioural therapies for depression: protocol of an individual patient data meta-analysis.
BMJ Open,
9(6).
Abstract:
Role of autobiographical memory in patient response to cognitive behavioural therapies for depression: protocol of an individual patient data meta-analysis.
INTRODUCTION: Cognitive behavioural therapies (CBTs) are one of the most effective treatments for major depression. However, ~50% of individuals do not adequately respond to intervention and of those who do remit from a depressive episode, over 50% will experience later relapse. Identification of patient-level factors which moderate treatment response may ultimately help to identify cognitive barriers that could be targeted to improve treatment efficacy. This individual patient data meta-analysis explores one such potential moderator-the ability to retrieve specific, detailed memories of the autobiographical past-as cognitive-based therapeutic techniques draw heavily on the ability to use specific autobiographical information to challenge the dysfunctional beliefs which drive depression. METHODS AND ANALYSIS: We have formed a collaborative network which will contribute known datasets. This will be supplemented by datasets identified through literature searches in Medline, PsycInfo, Web of Science, the Cochrane Central Register of Controlled Trials and WHO trials database between December 2018 and February 2019. Inclusion criteria are delivery of a cognitive or cognitive behavioural therapy for major depression, and measurement of autobiographical memory retrieval at preintervention. Primary outcomes are depressive symptoms and clinician-rated diagnostic status at postintervention, along with autobiographical memory specificity at postintervention. Secondary outcomes will consider each of these variables at follow-up. All analyses will be completed using random-effects models employing restricted maximum likelihood estimation. Risk of bias in included studies will be measured using the Revised Cochrane Risk of Bias Tool. ETHICS AND DISSEMINATION: the findings will be published in a peer-reviewed journal. Study results will contribute to better understanding of the role of autobiographical memory in patient response to CBTs, and may help to inform personalised medicine approaches to treatment of depression. PROSPERO REGISTRATION NUMBER: CRD42018109673.
Abstract.
Author URL.
Buckman JEJ, Saunders R, Cohen ZD, Clarke K, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, Watkins E, et al (2019). What factors indicate prognosis for adults with depression in primary care? a protocol for meta-analyses of individual patient data using the Dep-GP database.
Wellcome Open Research,
4, 69-69.
Abstract:
What factors indicate prognosis for adults with depression in primary care? a protocol for meta-analyses of individual patient data using the Dep-GP database
Background: Pre-treatment severity is a key indicator of prognosis for those with depression. Knowledge is limited on how best to encompass severity of disorders. A number of non-severity related factors such as social support and life events are also indicators of prognosis. It is not clear whether this holds true after adjusting for pre-treatment severity as a) a depressive symptom scale score, and b) a broader construct encompassing symptom severity and related indicators: “disorder severity”. In order to investigate this, data from the individual participants of clinical trials which have measured a breadth of “disorder severity” related factors are needed. Aims: 1) to assess the association between outcomes for adults seeking treatment for depression and the severity of depression pre-treatment, considered both as i) depressive symptom severity only and ii) “disorder severity” which includes depressive symptom severity and comorbid anxiety, chronicity, history of depression, history of previous treatment, functional impairment and health-related quality of life. 2) to determine whether i) social support, ii) life events, iii) alcohol misuse, and iv) demographic factors (sex, age, ethnicity, marital status, employment status, level of educational attainment, and financial wellbeing) are prognostic indicators of outcomes, independent of baseline “disorder severity” and the type of treatment received. Methods: Databases were searched for randomised clinical trials (RCTs) that recruited adults seeking treatment for depression from their general practitioners and used the same diagnostic and screening instrument to measure severity at baseline – the Revised Clinical Interview Schedule; outcome measures could differ between studies. Chief investigators of all studies meeting inclusion criteria were contacted and individual patient data (IPD) were requested. Conclusions: in total 15 RCTs met inclusion criteria. The Dep-GP database will include the 6271 participants from the 13 studies that provided IPD. This protocol outlines how these data will be analysed. Registration: PROSPERO CRD42019129512 (01/04/2019)
Abstract.
2018
Hammen C, Watkins E (2018).
Depression.Abstract:
Depression
Abstract.
Uwatoko T, Luo Y, Sakata M, Kobayashi D, Sakagami Y, Takemoto K, Collins LM, Watkins E, Hollon SD, Wason J, et al (2018). Healthy Campus Trial: a multiphase optimization strategy (MOST) fully factorial trial to optimize the smartphone cognitive behavioral therapy (CBT) app for mental health promotion among university students: study protocol for a randomized controlled trial.
Trials,
19(1).
Abstract:
Healthy Campus Trial: a multiphase optimization strategy (MOST) fully factorial trial to optimize the smartphone cognitive behavioral therapy (CBT) app for mental health promotion among university students: study protocol for a randomized controlled trial.
BACKGROUND: Youth in general and college life in particular are characterized by new educational, vocational, and interpersonal challenges, opportunities, and substantial stress. It is estimated that 30-50% of university students meet criteria for some mental disorder, especially depression, in any given year. The university has traditionally provided many channels to promote students' mental health, but until now only a minority have sought such help, possibly owing to lack of time and/or to stigma related to mental illness. Smartphone-delivered cognitive behavioral therapy (CBT) shows promise for its accessibility and effectiveness. However, its most effective components and for whom it is more (or less) effective are not known. METHODS/DESIGN: Based on the multiphase optimization strategy framework, this study is a parallel-group, multicenter, open, fully factorial trial examining five smartphone-delivered CBT components (self-monitoring, cognitive restructuring, behavioral activation, assertion training, and problem solving) among university students with elevated distress, defined as scoring 5 or more on the Patient Health Questionnaire-9 (PHQ-9). The primary outcome is change in PHQ-9 scores from baseline to week 8. We will estimate specific efficacy of the five components and their interactions through the mixed-effects repeated-measures analysis and propose the most effective and efficacious combinations of components. Effect modification by selected baseline characteristics will be examined in exploratory analyses. DISCUSSION: the highly efficient experimental design will allow identification of the most effective components and the most efficient combinations thereof among the five components of smartphone CBT for university students. Pragmatically, the findings will help make the most efficacious CBT package accessible to a large number of distressed university students at reduced cost; theoretically, they will shed light on the underlying mechanisms of CBT and help further advance CBT for depression. TRIAL REGISTRATION: UMIN, CTR-000031307. Registered on February 14, 2018.
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Author URL.
Farrand P, Jeffs A, Bloomfield T, Greenberg N, Watkins E, Mullan E (2018). Mental health service acceptability for the armed forces veteran community.
Occup Med (Lond),
68(6), 391-398.
Abstract:
Mental health service acceptability for the armed forces veteran community.
BACKGROUND: Despite developments in mental health services for armed forces veterans and family members, barriers to access associated with poor levels of acceptability regarding service provision remain. Adapting a Step 2 mental health service based on low-intensity cognitive behavioural therapy (CBT) interventions to represent a familiar context and meet the needs of the armed forces veteran community may serve to enhance acceptability and reduce help-seeking barriers. AIMS: to examine acceptability of a Step 2 low-intensity CBT mental health service adapted for armed forces veterans and family members provided by a UK Armed Forces charity. METHODS: Qualitative study using individual semi-structured interviews with armed forces veterans and family members of those injured or becoming unwell while serving in the British Armed Forces. Data analysis was undertaken using thematic alongside disconfirming case analysis. RESULTS: Adapting a Step 2 mental health service for armed forces veterans and family members enhanced acceptability and promoted help-seeking. Wider delivery characteristics associated with Step 2 mental health services within the Improving Access to Psychological Therapies (IAPT) programme also contributed to service acceptability. However, limitations of Step 2 mental health service provision were also identified. CONCLUSION: a Step 2 mental health service adapted for armed forces veterans and family members enhances acceptability and may potentially overcome help-seeking barriers. However, concerns remain regarding ways to accommodate the treatment of post-traumatic stress disorder and provide support for family members.
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Author URL.
Wild J, El-Salahi S, Tyson G, Lorenz H, Pariante CM, Danese A, Tsiachristas A, Watkins E, Middleton B, Blaber A, et al (2018). Preventing PTSD, depression and associated health problems in student paramedics: Protocol for PREVENT-PTSD, a randomised controlled trial of supported online cognitive training for resilience versus alternative online training and standard practice.
BMJ Open,
8(12).
Abstract:
Preventing PTSD, depression and associated health problems in student paramedics: Protocol for PREVENT-PTSD, a randomised controlled trial of supported online cognitive training for resilience versus alternative online training and standard practice
Introduction Emergency workers dedicate their lives to promoting public health and safety, yet suffer higher rates of post-traumatic stress disorder (PTSD) and major depression (MD) compared with the general population. They also suffer an associated increased risk for physical health problems, which may be linked to specific immunological and endocrine markers or changes in relevant markers. Poor physical and mental health is costly to organisations, the National Health Service and society. Existing interventions aimed at reducing risk of mental ill health in this population are not very successful. More effective preventative interventions are urgently needed. We first conducted a large-scale prospective study of newly recruited student paramedics, identifying two cognitive factors (rumination and resilience appraisals) that predicted episodes of PTSD and MD over a 2-year period. We then developed internet-delivered cognitive training for resilience (iCT-R), a supported online intervention, to modify cognitive predictors. This protocol is for a randomised controlled trial to evaluate the efficacy of the resilience intervention. Methods and analysis 570 student paramedics will be recruited from participating universities. They will be randomly allocated to iCT-R or to supported online training of an alternative, widely available intervention or to training-as-usual. Follow-up will occur after the intervention/standard practice period and at 6, 12 and 24 months. Primary outcomes include rates of PTSD and MD and subsydnromal PTSD and MD, measured by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fifth edition, the Patient-Health Questionnaire-9 and the Post-traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Secondary outcomes include measures of resilience, rumination, anxiety, psychological distress, well-being, salivary cortisol, plasma levels of C-reactive protein, smoking and alcohol use, weight gain, sleep problems, health-related quality of life, health resource utilisation and productivity. Ethics and dissemination the Medical Sciences Inter-Divisional Research Ethics Committee at the University of Oxford granted approval, reference: R44116/RE001. The results will be published in a peer-reviewed journal. Access to raw data and participant information will be available only to members of the research team. Trial registration number ISRCTN16493616; Pre-results.
Abstract.
Paans NPG, Bot M, Brouwer IA, Visser M, Roca M, Kohls E, Watkins E, Penninx BWJH (2018). The association between depression and eating styles in four European countries: the MooDFOOD prevention study.
J Psychosom Res,
108, 85-92.
Abstract:
The association between depression and eating styles in four European countries: the MooDFOOD prevention study.
OBJECTIVE: Depression, one of the most prevalent and disabling disorders in Europe, is thought to be associated with unhealthy eating styles. As prevalence of depression and eating styles potentially differ across Europe, the current study aimed to investigate in a large, European sample, the associations of history of major depressive disorder and depression severity with unhealthy eating styles. METHODS: Baseline data of the MooDFOOD prevention study was used. The current analysis included 990 participants of four European countries (The Netherlands, United Kingdom, Germany, Spain). Analyses of Covariance and linear regression analyses were performed with depression history or depression severity as determinants, and emotional, uncontrolled, and cognitive restrained eating (Three Factor Eating Questionnaire Revised, 18 item) as outcomes. RESULTS: Depression history and severity were associated with more emotional and uncontrolled eating and with less cognitive restrained eating. Mood, somatic, and cognitive symptom clusters were also associated with more emotional and uncontrolled eating, and with less cognitive restrained eating. The somatic depressive symptoms "increased appetite" and "increased weight" were more strongly associated to unhealthy eating styles compared to other symptoms. No differences in associations between depression and unhealthy eating were found between European countries. CONCLUSION: Our results suggest that depression is related to more unhealthy eating styles. Diminishing unhealthy eating styles in subthreshold depressed persons could potentially reduce adverse health consequences like weight gain, unhealthy dietary patterns and weight-related diseases. It is also possible that interventions that decrease depressive symptoms can lead to a decrease in unhealthy eating styles.
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Author URL.
Woodford J, Farrand P, Watkins ER, Lewellyn DJ (2018). ”I Don’t Believe in Leading a Life of My Own, I Lead His Life”: a Qualitative Investigation of Difficulties Experienced by Informal Caregivers of Stroke Survivors Experiencing Depressive and Anxious Symptoms.
Clinical Gerontologist,
41(4), 293-307.
Abstract:
”I Don’t Believe in Leading a Life of My Own, I Lead His Life”: a Qualitative Investigation of Difficulties Experienced by Informal Caregivers of Stroke Survivors Experiencing Depressive and Anxious Symptoms
Objectives: Health and social care services are increasingly reliant on informal caregivers to provide long-term support to stroke survivors. However, caregiving is associated with elevated levels of depression and anxiety in the caregiver that may also negatively impact stroke survivor recovery. This qualitative study aims to understand the specific difficulties experienced by caregivers experiencing elevated symptoms of anxiety and depression. Methods: Nineteen semi-structured interviews were conducted with caregivers experiencing elevated levels of depression and anxiety, with a thematic analysis approach adopted for analysis. Results: Analysis revealed three main themes: Difficulties adapting to the caring role; Uncertainty; and Lack of support. Conclusions: Caregivers experienced significant difficulties adapting to changes and losses associated with becoming a caregiver, such as giving up roles and goals of importance and value. Such difficulties persisted into the long-term and were coupled with feelings of hopelessness and worry. Difficulties were further exacerbated by social isolation, lack of information and poor long-term health and social care support. Clinical Implications: a greater understanding of difficulties experienced by depressed and anxious caregivers may inform the development of psychological support targeting difficulties unique to the caring role. Improving caregiver mental health may also result in health benefits for stroke survivors themselves.
Abstract.
2017
Stange J, Bessette K, Jenkins L, Burkhouse K, Peters A, Feldhaus C, Crane N, Ajilore O, Watkins E, Langenecker S, et al (2017). Attenuated Intrinsic Connectivity within Cognitive Control Network among Individuals with Remitted Depression is Associated with Cognitive Control Deficits and Negative Cognitive Styles.
Author URL.
Stange JP, Bessette KL, Jenkins LM, Peters AT, Feldhaus C, Crane NA, Ajilore O, Jacobs RH, Watkins ER, Langenecker SA, et al (2017). Attenuated intrinsic connectivity within cognitive control network among individuals with remitted depression: Temporal stability and association with negative cognitive styles.
Hum Brain Mapp,
38(6), 2939-2954.
Abstract:
Attenuated intrinsic connectivity within cognitive control network among individuals with remitted depression: Temporal stability and association with negative cognitive styles.
Many individuals with major depressive disorder (MDD) experience cognitive dysfunction including impaired cognitive control and negative cognitive styles. Functional connectivity magnetic resonance imaging studies of individuals with current MDD have documented altered resting-state connectivity within the default-mode network and across networks. However, no studies to date have evaluated the extent to which impaired connectivity within the cognitive control network (CCN) may be present in remitted MDD (rMDD), nor have studies examined the temporal stability of such attenuation over time. This represents a major gap in understanding stable, trait-like depression risk phenotypes. In this study, resting-state functional connectivity data were collected from 52 unmedicated young adults with rMDD and 47 demographically matched healthy controls, using three bilateral seeds in the CCN (dorsolateral prefrontal cortex, inferior parietal lobule, and dorsal anterior cingulate cortex). Mean connectivity within the entire CCN was attenuated among individuals with rMDD, was stable and reliable over time, and was most pronounced with the right dorsolateral prefrontal cortex and right inferior parietal lobule, results that were corroborated by supplemental independent component analysis. Attenuated connectivity in rMDD appeared to be specific to the CCN as opposed to representing attenuated within-network coherence in other networks (e.g. default-mode, salience). In addition, attenuated connectivity within the CCN mediated relationships between rMDD status and cognitive risk factors for depression, including ruminative brooding, pessimistic attributional style, and negative automatic thoughts. Given that these cognitive markers are known predictors of relapse, these results suggest that attenuated connectivity within the CCN could represent a biomarker for trait phenotypes of depression risk. Hum Brain Mapp 38:2939-2954, 2017. © 2017 Wiley Periodicals, Inc.
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Author URL.
Richards DA, Rhodes S, Ekers D, McMillan D, Taylor RS, Byford S, Barrett B, Finning K, Ganguli P, Warren F, et al (2017). Cost and Outcome of BehaviouRal Activation (COBRA): a randomised controlled trial of behavioural activation versus cognitive-behavioural therapy for depression.
Health Technol Assess,
21(46), 1-366.
Abstract:
Cost and Outcome of BehaviouRal Activation (COBRA): a randomised controlled trial of behavioural activation versus cognitive-behavioural therapy for depression.
BACKGROUND: Depression is a common, debilitating and costly disorder. The best-evidenced psychological therapy - cognitive-behavioural therapy (CBT) - is complex and costly. A simpler therapy, behavioural activation (BA), may be an effective alternative. OBJECTIVES: to determine the clinical effectiveness and cost-effectiveness of BA compared with CBT for depressed adults at 12 and 18 months' follow-up, and to investigate the processes of treatments. DESIGN: Randomised controlled, non-inferiority trial stratified by depression severity, antidepressant use and recruitment site, with embedded process evaluation; and randomisation by remote computer-generated allocation. SETTING: Three community mental health services in England. PARTICIPANTS: Adults aged ≥ 18 years with major depressive disorder (MDD) recruited from primary care and psychological therapy services. INTERVENTIONS: BA delivered by NHS junior mental health workers (MHWs); CBT by NHS psychological therapists. OUTCOMES: Primary: depression severity (as measured via the Patient Health Questionnaire-9; PHQ-9) at 12 months. Secondary: MDD status; number of depression-free days; anxiety (as measured via the Generalised Anxiety Disorder-7); health-related quality of life (as measured via the Short Form questionnaire-36 items) at 6, 12 and 18 months; and PHQ-9 at 6 and 18 months, all collected by assessors blinded to treatment allocation. Non-inferiority margin was 1.9 PHQ-9 points. We undertook intention-to-treat (ITT) and per protocol (PP) analyses. We explored cost-effectiveness by collecting direct treatment and other health- and social-care costs and calculating quality-adjusted life-years (QALYs) using the EuroQol-5 Dimensions, three-level version, at 18 months. RESULTS: We recruited 440 participants (BA, n = 221; CBT, n = 219); 175 (79%) BA and 189 (86%) CBT participants provided ITT data and 135 (61%) BA and 151 (69%) CBT participants provided PP data. At 12 months we found that BA was non-inferior to CBT {ITT: CBT 8.4 PHQ-9 points [standard deviation (SD) 7.5 PHQ-9 points], BA 8.4 PHQ-9 points (SD 7.0 PHQ-9 points), mean difference 0.1 PHQ-9 points, 95% confidence interval (CI) -1.3 to 1.5 PHQ-9 points, p = 0.89; PP: CBT 7.9 PHQ-9 points (SD 7.3 PHQ-9 points), BA 7.8 PHQ-9 points (SD 6.5 PHQ-9 points), mean difference 0.0 PHQ-9 points, 95% CI -1.5 to 1.6 PHQ-9 points, p = 0.99}. We found no differences in secondary outcomes. We found a significant difference in mean intervention costs (BA, £975; CBT, £1235; p
Abstract.
Author URL.
Finning K, Richards DA, Moore L, Ekers D, McMillan D, Farrand PA, O'Mahen HA, Watkins ER, Wright KA, Fletcher E, et al (2017). Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a qualitative process evaluation.
BMJ Open,
7(4).
Abstract:
Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a qualitative process evaluation.
OBJECTIVE: to explore participant views on acceptability, mechanisms of change and impact of behavioural activation (BA) delivered by junior mental health workers (MHWs) versus cognitive behavioural therapy (CBT) delivered by professional psychotherapists. DESIGN: Semistructured qualitative interviews analysed using a framework approach. PARTICIPANTS: 36 participants with major depressive disorder purposively sampled from a randomised controlled trial of BA versus CBT (the COBRA trial). SETTING: Primary care psychological therapies services in Devon, Durham and Leeds, UK. RESULTS: Elements of therapy considered to be beneficial included its length and regularity, the opportunity to learn and not dwelling on the past. Homework was an important, although challenging aspect of treatment. Therapists were perceived as experts who played an important role in treatment. For some participants the most important element of therapy was having someone to talk to, but for others the specific factors associated with BA and CBT were crucial, with behavioural change considered important for participants in both treatments, and cognitive change unsurprisingly discussed more by those receiving CBT. Both therapies were considered to have a positive impact on symptoms of depression and other areas of life including feelings about themselves, self-care, work and relationships. Barriers to therapy included work, family life and emotional challenges. A subset (n=2) of BA participants commented that therapy felt too simple, and MHWs could be perceived as inexperienced. Many participants saw therapy as a learning experience, providing them with tools to take away, with work on relapse prevention essential. CONCLUSIONS: Despite barriers for some participants, BA and CBT were perceived to have many benefits, to have brought about cognitive and behavioural change and to produce improvements in many domains of participants' lives. To optimise the delivery of BA, inexperienced junior MHWs should be supported through good quality training and ongoing supervision. TRIAL REGISTRATION NUMBER: ISRCTN27473954, 09/12/2011.
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Author URL.
Southworth F, Grafton B, MacLeod C, Watkins E (2017). Heightened ruminative disposition is associated with impaired attentional disengagement from negative relative to positive information: support for the "impaired disengagement" hypothesis.
Cogn Emot,
31(3), 422-434.
Abstract:
Heightened ruminative disposition is associated with impaired attentional disengagement from negative relative to positive information: support for the "impaired disengagement" hypothesis.
Information processing accounts of rumination propose that impaired attentional disengagement from negative information may underpin heightened disposition to experience ruminative brooding in response to negative mood. The present study examined the relationship between individual differences in ruminative disposition and selective attention, using a paradigm capable of distinguishing between biases in the engagement and disengagement of attention. Results showed that higher dispositional ruminative brooding, as measured by both the brooding subscale of the RRS and an in-vivo assessment of ruminative disposition, was associated with greater relative impairment disengaging attention from negative compared to positive stimuli. These findings thus provide support for the "impaired disengagement" account of ruminative brooding.
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Author URL.
Ricarte JJ, Ros L, Latorre JM, Watkins E (2017). Mapping autobiographical memory in schizophrenia: Clinical implications.
Clin Psychol Rev,
51, 96-108.
Abstract:
Mapping autobiographical memory in schizophrenia: Clinical implications.
Increasing evidence suggests that impaired autobiographical memory (AM) mechanisms may be associated with the onset and maintenance of psychopathology. However, there is not yet a comprehensive review of the components of autobiographical memory in schizophrenic patients. The first aim of this review is a synthesis of evidence about the functioning of AM in schizophrenic patients. The main autobiographical elements reviewed in schizophrenic patients include the study of overgeneral memory (form); self-defining memories (contents); consciousness during the process of retrieval (awareness), and the abnormal early reminiscence bump (distribution). AM impairments have been involved in the clinical diagnosis and prognosis of other psychopathologies, especially depression. The second aim is to examine potential parallels between the mechanisms responsible for the onset and maintenance of disturbed AM in other clinical diagnosis and the mechanisms of disturbed autobiographical memory functioning in schizophrenic patients. Cognitive therapies for schizophrenic patients are increasingly demanded. The third aim is the suggestion of key elements for the adaptation of components of autobiographical recall in cognitive therapies for the treatment of symptoms and consequences of schizophrenia.
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Author URL.
Topper M, Emmelkamp PMG, Watkins E, Ehring T (2017). Prevention of anxiety disorders and depression by targeting excessive worry and rumination in adolescents and young adults: a randomized controlled trial.
Behaviour Research and Therapy,
90, 123-136.
Abstract:
Prevention of anxiety disorders and depression by targeting excessive worry and rumination in adolescents and young adults: a randomized controlled trial
Background This randomized controlled trial evaluated the efficacy of a preventive intervention for anxiety disorders and depression by targeting excessive levels of repetitive negative thinking (RNT; worry and rumination) in adolescents and young adults. Methods Participants (N = 251, 83.7% female) showing elevated levels of RNT were randomly allocated to a 6-week cognitive-behavioral training delivered in a group, via the internet, or to a waitlist control condition. Self-report measures were collected at pre-intervention, post-intervention, 3 m and 12 m follow-up. Results Both versions of the preventive intervention significantly reduced RNT (d = 0.53 to 0.89), and symptom levels of anxiety and depression (d = 0.36 to 0.72). Effects were maintained until 12 m follow-up. The interventions resulted in a significantly lower 12 m prevalence rate of depression (group intervention: 15.3%, internet intervention: 14.7%) and generalized anxiety disorder (group intervention: 18.0%, internet intervention: 16.0%), compared to the waitlist (32.4% and 42.2%, respectively). Mediation analyses demonstrated that reductions in RNT mediated the effect of the interventions on the prevalence of depression and generalized anxiety disorder. Conclusions Results provide evidence for the efficacy of this preventive intervention targeting RNT and support a selective prevention approach that specifically targets a known risk factor to prevent multiple disorders.
Abstract.
O'Shea L, Watkins E, Farrand P (2017). Psychological interventions for the treatment of depression, anxiety, alcohol misuse or anger in armed forces veterans and their families: systematic review and meta-analysis protocol.
Syst Rev,
6(1).
Abstract:
Psychological interventions for the treatment of depression, anxiety, alcohol misuse or anger in armed forces veterans and their families: systematic review and meta-analysis protocol.
BACKGROUND: Evidence highlights a high prevalence of common mental health disorders in armed forces veterans and their families, with depression, anxiety, alcohol misuse and anger being more common than PTSD. This paper presents a protocol for a systematic review and meta-analysis to identify existing randomised controlled trial (RCT) research testing the effectiveness of psychological interventions for these difficulties in armed forces veterans and their family members. METHODS: Electronic databases (CENTRAL, PsycInfo, MEDLINE, CINAHL, the Cochrane Register of Clinical Trials, EMBASE and ASSIA) will be searched to identify suitable studies for inclusion in the review supplemented by forward and backward reference checking, grey literature searches and contact with subject authors. Research including armed forces veterans and their family members will be included in the review with research including serving personnel or individuals under the age of 18 being excluded. Few RCTs examining the treatment of depression, anxiety, alcohol misuse or anger exist in armed forces veterans to date. The primary outcome will be symptomatic change following intervention for these difficulties. The secondary outcomes will include methodological aspects of interest such as discharge type and recruitment setting if data permits. In the event that the number of studies identified is too low to undertake a meta-analysis, a narrative review will be conducted. Quality assessment will be undertaken using the Cochrane Collaboration Tool and Cochran's Q statistic calculated to test for heterogeneity as suggested by the Cochrane handbook. DISCUSSION: the review will examine the findings of existing intervention research for depression, anxiety, alcohol misuse or anger in armed forces veterans and their families, along with any effect sizes that may exist. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016036676.
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Author URL.
Watkins E (2017). Targeted psychological interventions may prevent depression in children and adolescents.
Evid Based Ment Health,
20(2).
Author URL.
Freeman D, Sheaves B, Goodwin GM, Yu L-M, Nickless A, Harrison PJ, Emsley R, Luik AI, Foster RG, Wadekar V, et al (2017). The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis.
Lancet Psychiatry,
4(10), 749-758.
Abstract:
The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis.
BACKGROUND: Sleep difficulties might be a contributory causal factor in the occurrence of mental health problems. If this is true, improving sleep should benefit psychological health. We aimed to determine whether treating insomnia leads to a reduction in paranoia and hallucinations. METHODS: We did this single-blind, randomised controlled trial (OASIS) at 26 UK universities. University students with insomnia were randomly assigned (1:1) with simple randomisation to receive digital cognitive behavioural therapy (CBT) for insomnia or usual care, and the research team were masked to the treatment. Online assessments took place at weeks 0, 3, 10 (end of therapy), and 22. The primary outcome measures were for insomnia, paranoia, and hallucinatory experiences. We did intention-to-treat analyses. The trial is registered with the ISRCTN registry, number ISRCTN61272251. FINDINGS: Between March 5, 2015, and Feb 17, 2016, we randomly assigned 3755 participants to receive digital CBT for insomnia (n=1891) or usual practice (n=1864). Compared with usual practice, the sleep intervention at 10 weeks reduced insomnia (adjusted difference 4·78, 95% CI 4·29 to 5·26, Cohen's d=1·11; p
Abstract.
Author URL.
2016
Ricarte Trives JJ, Navarro Bravo B, Latorre Postigo JM, Ros Segura L, Watkins E (2016). Age and Gender Differences in Emotion Regulation Strategies: Autobiographical Memory, Rumination, Problem Solving and Distraction.
Span J Psychol,
19Abstract:
Age and Gender Differences in Emotion Regulation Strategies: Autobiographical Memory, Rumination, Problem Solving and Distraction.
Our study tested the hypothesis that older adults and men use more adaptive emotion regulatory strategies but fewer negative emotion regulatory strategies than younger adults and women. In addition, we tested the hypothesis that rumination acts as a mediator variable for the effect of age and gender on depression scores. Differences in rumination, problem solving, distraction, autobiographical recall and depression were assessed in a group of young adults (18-29 years) compared to a group of older adults (50-76 years). The older group used more problem solving and distraction strategies when in a depressed state than their younger counterparts (ps. 06). Ordinary least squares regression analyses with bootstrapping showed that rumination mediated the association between age, gender and depression scores. These results suggest that older adults and men select more adaptive strategies to regulate emotions than young adults and women with rumination acting as a significant mediator variable in the association between age, gender, and depression.
Abstract.
Author URL.
Richards DA, Ekers D, McMillan D, Taylor RS, Byford S, Warren FC, Barrett B, Farrand PA, Gilbody S, Kuyken W, et al (2016). Cost and Outcome of Behavioural Activation versus
Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial. Lancet
Roberts H, Watkins ER, Wills AJ (2016). Does Rumination Cause “Inhibitory” Deficits?.
Psychopathology Review,
a4(3), 341-376.
Abstract:
Does Rumination Cause “Inhibitory” Deficits?
Inhibitory processes have been implicated in depressive rumination. Inhibitory deficits may cause difficulties in disengaging from ruminative content (e.g. Joormann, 2005), or rumination may constitute a working memory load, causing deficits in inhibitory control (e.g. Hertel, 2004). These hypotheses have different implications for the treatment of depression. We conducted a systematic review of existing evidence, and conclude that most studies do not unambiguously measure inhibition. The majority of published evidence is correlational, and thus supports neither causal direction. No published experimental studies have investigated the inhibitory deficit -? rumination causal direction, and only six have investigated the rumination -? inhibitory deficit hypothesis. In two of these studies the dependent variable has low construct validity. One study reported no effect of rumination on interference, and three did not control for mood effects. There is need for carefully designed experimental research that has the potential to investigate these proposed causal mechanisms.
Abstract.
Southworth F, Grafton B, MacLeod C, Watkins ER (2016). Heightened ruminative disposition is associated with impaired attentional disengagement from negative relative to positive information: Support for the “impaired disengagement” hypothesis.
Cognition and Emotion(4 Jan 2016 online).
Abstract:
Heightened ruminative disposition is associated with impaired attentional disengagement from negative relative to positive information: Support for the “impaired disengagement” hypothesis
Information processing accounts of rumination have suggested that impaired disengagement of attention from negative information may underpin heightened disposition to experience ruminative brooding in response to negative mood. The present study examined the relationship between individual differences in ruminative disposition and selective attention, using a paradigm capable of distinguishing between biases in the engagement and disengagement of attention. Results found that higher dispositional ruminative brooding, as measured by both the brooding subscale of the RRS and an in-vivo assessment of dispositional ruminative brooding, was associated with greater relative impairment disengaging attention from negative compared to positive stimuli. These findings thus provide support for the “impaired disengagement” account of ruminative brooding.
Abstract.
Watkins E, Newbold A, Tester-Jones M, Javaid M, Cadman J, Collins LM, Graham J, Mostazir M (2016). Implementing multifactorial psychotherapy research in online virtual environments (IMPROVE-2): study protocol for a phase III trial of the MOST randomized component selection method for internet cognitive-behavioural therapy for depression.
BMC Psychiatry,
16(1).
Abstract:
Implementing multifactorial psychotherapy research in online virtual environments (IMPROVE-2): study protocol for a phase III trial of the MOST randomized component selection method for internet cognitive-behavioural therapy for depression.
BACKGROUND: Depression is a global health challenge. Although there are effective psychological and pharmaceutical interventions, our best treatments achieve remission rates less than 1/3 and limited sustained recovery. Underpinning this efficacy gap is limited understanding of how complex psychological interventions for depression work. Recent reviews have argued that the active ingredients of therapy need to be identified so that therapy can be made briefer, more potent, and to improve scalability. This in turn requires the use of rigorous study designs that test the presence or absence of individual therapeutic elements, rather than standard comparative randomised controlled trials. One such approach is the Multiphase Optimization Strategy, which uses efficient experimentation such as factorial designs to identify active factors in complex interventions. This approach has been successfully applied to behavioural health but not yet to mental health interventions. METHODS/DESIGN: a Phase III randomised, single-blind balanced fractional factorial trial, based in England and conducted on the internet, randomized at the level of the patient, will investigate the active ingredients of internet cognitive-behavioural therapy (CBT) for depression. Adults with depression (operationalized as PHQ-9 score ≥ 10), recruited directly from the internet and from an UK National Health Service Improving Access to Psychological Therapies service, will be randomized across seven experimental factors, each reflecting the presence versus absence of specific treatment components (activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, absorption, self-compassion training) using a 32-condition balanced fractional factorial design (2IV7-2). The primary outcome is symptoms of depression (PHQ-9) at 12 weeks. Secondary outcomes include symptoms of anxiety and process measures related to hypothesized mechanisms. DISCUSSION: Better understanding of the active ingredients of efficacious therapies, such as CBT, is necessary in order to improve and further disseminate these interventions. This study is the first application of a component selection experiment to psychological interventions in depression and will enable us to determine the main effect of each treatment component and its relative efficacy, and cast light on underlying mechanisms, so that we can systematically enhance internet CBT. TRIAL REGISTRATION: Current Controlled Trials ISRCTN24117387. Registered 26 August 2014.
Abstract.
Author URL.
Roca M, Kohls E, Gili M, Watkins E, Owens M, Hegerl U, van Grootheest G, Bot M, Cabout M, Brouwer IA, et al (2016). Prevention of depression through nutritional strategies in high-risk persons: rationale and design of the MooDFOOD prevention trial.
BMC Psychiatry,
16Abstract:
Prevention of depression through nutritional strategies in high-risk persons: rationale and design of the MooDFOOD prevention trial.
BACKGROUND: Obesity and depression are two prevalent conditions that are costly to individuals and society. The bidirectional association of obesity with depression, in which unhealthy dietary patterns may play an important role, has been well established. Few experimental studies have been conducted to investigate whether supplementing specific nutrients or improving diet and food-related behaviors can prevent depression in overweight persons. METHOD/DESIGN: the MooDFOOD prevention trial examines the feasibility and effectiveness of two different nutritional strategies [multi-nutrient supplementation and food-related behavioral change therapy (FBC)] to prevent depression in individuals who are overweight and have elevated depressive symptoms but who are not currently or in the last 6 months meeting criteria for an episode of major depressive disorder (MDD). The randomized controlled prevention trial has a two-by-two factorial design: participants are randomized to daily multi-nutrient supplement (omega-3 fatty acids, calcium, selenium, B-11 vitamin and D-3 vitamin) versus placebo, and/or FBC therapy sessions versus usual care. Interventions last 12 months. In total 1000 participants aged 18-75 years with body mass index between 25-40 kg/m(2) and with a Patient Health Questionnaire-9 score ≥ 5 will be recruited at four study sites in four European countries. Baseline and follow-up assessments take place at 0, 3, 6, and 12 months. Primary endpoint is the onset of an episode of MDD, assessed according to DSM-IV based criteria using the MINI 5.0 interview. Depressive symptoms, anxiety, food and eating behavior, physical activity and health related quality of life are secondary outcomes. During the intervention, compliance, adverse events and potentially mediating variables are carefully monitored. DISCUSSION: the trial aims to provide a better understanding of the causal role of specific nutrients, overall diet, and food-related behavior change with respect to the incidence of MDD episodes. This knowledge will be used to develop and disseminate innovative evidence-based, feasible, and effective nutritional public health strategies for the prevention of clinical depression. TRIAL REGISTRATION: ClinicalTrials.gov. Number of identification: NCT02529423. August 2015.
Abstract.
Author URL.
Watkins ER, Cook L (2016). RESPOND (REducing Stress and Preventing Depression): comparing guided internet-based rumination focused cognitive behavioural therapy (i-RFCBT) versus a no-intervention control to prevent depression in high ruminating young adults, with adjunct assessment of the feasibility of unguided i-RFBCT: Study protocol for a phase III randomised-controlled trial.
Trials,
17Abstract:
RESPOND (REducing Stress and Preventing Depression): comparing guided internet-based rumination focused cognitive behavioural therapy (i-RFCBT) versus a no-intervention control to prevent depression in high ruminating young adults, with adjunct assessment of the feasibility of unguided i-RFBCT: Study protocol for a phase III randomised-controlled trial
Background: Depression is a global health challenge. Prevention is highlighted as a priority to reduce its prevalence. Although there are effective preventive interventions, efficacy and coverage can be improved. One proposed means to increase efficacy is by targeting interventions at specific risk factors, such as rumination. Rumination-focused CBT (RFCBT) was developed to specifically target depressive rumination, and reduces acute depressive symptoms and relapse for patients with residual depression in a randomised-controlled trial. Preliminary findings from a Dutch randomised prevention trial in 251 high-risk 15-22-year-olds selected with elevated worry and rumination found that both supported internet-RFBCT and group-delivered RFCBT equally reduced depressive symptoms and onset of depressive cases over 1 year, relative to no-intervention control.
Methods/design: a Phase III randomised controlled trial following the MRC Complex Interventions Framework, to extend the Dutch trial in the UK, with the addition of diagnostic interviews, primarily testing whether guided internet-RFCBT reduces onset of depression relative to no-intervention control. High risk young adults (aged 18-24), selected with elevated worry/rumination, recruited through universities and internet advertisement, will be randomised to receive either guided internet-RFCBT, supported by clinical psychologists or mental health paraprofessionals, or no-intervention control. As an adjunct arm, participants are also randomised to unguided internet-RFCBT self-help, in order to provide an initial test of the feasibility and effect size of this intervention. While participants are also randomised to unguided internet-RFCBT, the trial was designed and powered as a Phase III trial comparing guided internet-RFCBT versus no-intervention control. In the comparison between these two arms, the primary outcomes are: a) onset of major depressive episode over a 12-month period, assessed with Structured Clinical Interview for Diagnosis 3 months (post-intervention), 6 months and 15 months after randomisation. Secondary outcomes will be collected on: incidence of generalized anxiety disorder, symptoms of depression and anxiety; levels of worry and rumination, measured at baseline and the same follow-up intervals. In relation to the pilot investigation of unguided internet-RFCBT (adjunct intervention arm), we will assess the feasibility and acceptability of data collection procedures, levels of attrition, effect size and acceptability of the unguided internet-RFCBT intervention.
Discussion: Widespread implementation is necessary for effective prevention, suggesting that the internet may be a valuable mode of delivery. Previous research suggests guided internet-RFCBT reduces incidence rates relative to controls. We are also interested in developing and evaluating an unguided version to potentially increase availability and reduce costs.
Trial Registration: Current Controlled Trials ISRCTN12683436. Date of registration: 27/10/2014
Key Words: Randomised Controlled Trial; Cognitive Behavioural Therapy (CBT); Rumination; Depression; Prevention; Internet-Delivery
Abstract.
Grafton B, Southworth F, Watkins E, MacLeod C (2016). Stuck in a sad place: Biased attentional disengagement in rumination.
Emotion,
16(1), 63-72.
Abstract:
Stuck in a sad place: Biased attentional disengagement in rumination.
Previous research has demonstrated that heightened ruminative disposition is characterized by an attentional bias to depressogenic information at 1,000-ms exposure durations. However, it is unknown whether this attentional bias reflects facilitated attentional engagement with depressogenic information, or impaired attentional disengagement from such information. The present study was designed to address this question. In keeping with recent theoretical proposals, our findings demonstrate that heightened ruminative disposition is associated only with impaired attentional disengagement from depressogenic information, and does not involve facilitated attentional engagement with such information. In addition to resolving this key issue, the present study provided converging support for the previous claim that rumination-linked attentional bias is specific to depressogenic information, and also lends weight to the contention that rumination-linked attentional bias may be evident only when controlled attentional processing is readily permitted by using stimulus exposure durations of 1,000 ms. We discuss the theoretical implications of these findings and highlight key issues for future research.
Abstract.
Author URL.
Jacobs RH, Watkins ER, Peters AT, Feldhaus CG, Barba A, Carbray J, Langenecker SA (2016). Targeting Ruminative Thinking in Adolescents at Risk for Depressive Relapse: Rumination-Focused Cognitive Behavior Therapy in a Pilot Randomized Controlled Trial with Resting State fMRI. PLoS One
Trick L, Watkins E, Dickens C (2016). The role of perseverative negative thinking in predicting depression in people with coronary heart disease: Preliminary findings of a prospective cohort study.
JOURNAL OF PSYCHOSOMATIC RESEARCH,
85, 83-84.
Author URL.
2015
Watkins ER (2015). An alternative transdiagnostic mechanistic approach to affective disorders illustrated with research from clinical psychology.
Emotion ReviewAbstract:
An alternative transdiagnostic mechanistic approach to affective disorders illustrated with research from clinical psychology
Current psychiatric classification adopts a disorder-focused diagnostic approach, as exemplified within ICD-11 and DSM-V. Although this approach has improved reliability of categorisation, its validity and utility has been questioned (Harvey et al. 2004; Insel et al. 2009; Sanislow et al. 2010). Limitations include high co-morbidity between supposedly distinct disorders, heterogeneity within diagnoses, limited treatment efficacy, and similarities across disorders in aetiology, latent symptom structure, and underlying biology. There is also evidence of transdiagnostic cognitive-behavioural processes (Harvey et al. 2004). An alternative approach is therefore to focus on fundamental underlying mechanisms of psychopathology rather than observed symptom clusters. This paper considers the possible benefits, hurdles, and steps towards implementation of this transdiagnostic mechanistic approach, using the example of repetitive negative thought.
Abstract.
Kuyken W, Hayes R, Barrett B, Byng R, Dalgleish T, Kessler D, Lewis G, Watkins E, Brejcha C, Cardy J, et al (2015). Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial.
The LancetAbstract:
Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial
Background: Individuals with a history of recurrent depression have a high risk of repeated depressive relapse or recurrence. Maintenance antidepressants for at least 2 years is the current recommended treatment, but many individuals are interested in alternatives to medication. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce risk of relapse or recurrence compared with usual care, but has not yet been compared with maintenance antidepressant treatment in a definitive trial. We aimed to see whether MBCT with support to taper or discontinue antidepressant treatment (MBCT-TS) was superior to maintenance antidepressants for prevention of depressive relapse or recurrence over 24 months. Methods: in this single-blind, parallel, group randomised controlled trial (PREVENT), we recruited adult patients with three or more previous major depressive episodes and on a therapeutic dose of maintenance antidepressants, from primary care general practices in urban and rural settings in the UK. Participants were randomly assigned to either MBCT-TS or maintenance antidepressants (in a 1:1 ratio) with a computer-generated random number sequence with stratification by centre and symptomatic status. Participants were aware of treatment allocation and research assessors were masked to treatment allocation. The primary outcome was time to relapse or recurrence of depression, with patients followed up at five separate intervals during the 24-month study period. The primary analysis was based on the principle of intention to treat. The trial is registered with Current Controlled Trials, ISRCTN26666654. Findings: Between March 23, 2010, and Oct 21, 2011, we assessed 2188 participants for eligibility and recruited 424 patients from 95 general practices. 212 patients were randomly assigned to MBCT-TS and 212 to maintenance antidepressants. The time to relapse or recurrence of depression did not differ between MBCT-TS and maintenance antidepressants over 24 months (hazard ratio 0·89, 95% CI 0·67-1·18; p=0·43), nor did the number of serious adverse events. Five adverse events were reported, including two deaths, in each of the MBCT-TS and maintenance antidepressants groups. No adverse events were attributable to the interventions or the trial. Interpretation: We found no evidence that MBCT-TS is superior to maintenance antidepressant treatment for the prevention of depressive relapse in individuals at risk for depressive relapse or recurrence. Both treatments were associated with enduring positive outcomes in terms of relapse or recurrence, residual depressive symptoms, and quality of life. Funding: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme, and NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.
Abstract.
De Raedt R, Hertel PT, Watkins ER (2015). Mechanisms of repetitive thinking: Introduction to the special series.
Clinical Psychological Science,
3(4), 568-573.
Abstract:
Mechanisms of repetitive thinking: Introduction to the special series
Repetitive thinking about negative experience, such as worry and rumination, is increasingly recognized as a transdiagnostic process underlying various forms of psychopathology including anxiety and depression. Recent theoretical models have emphasized the role of impaired attentional control and the habitual nature of negative biases in the development and maintenance of pathological repetitive thought. In this introduction, we provide a brief overview of these theories and of how the articles in the special series provide experimental evidence concerning these basic mechanisms underlying rumination and worry, and their relation to clinical dysfunction. Together the research summarized in these articles instantiates these theoretical frameworks and provides convergent evidence confirming the value of adopting a transdiagnostic approach that focuses directly on fundamental mechanisms of psychopathology, instead of on diagnostic criteria.
Abstract.
Watkins E (2015). Overgeneral autobiographical memories and their relationship to rumination.
Author URL.
Watkins E (2015). Psychological treatment of depressive rumination.
Current Opinion in Psychology,
4, 32-36.
Abstract:
Psychological treatment of depressive rumination
Depressive rumination is the tendency to repeatedly dwell on the causes and meanings of negative symptoms, feelings, and problems. It has been robustly implicated as an important mechanism in the onset and maintenance of depression, and has recently been proposed as a potential therapy target to improve treatment efficacy. I describe emerging trial research on psychological therapies that target rumination, which provides encouraging preliminary evidence that rumination-focused interventions may enhance treatment outcome, although key limitations are noted, including the lack of a definitive comparison to existing therapies. Recent advances in cognitive bias modification that implicate cognitive biases in the maintenance of rumination are highlighted as indicating that this approach has potential to treat rumination.
Abstract.
Hvenegaard M, Watkins ER, Poulsen S, Rosenberg NK, Gondan M, Grafton B, Austin SF, Howard H, Moeller SB (2015). Rumination-focused cognitive behaviour therapy vs. cognitive behaviour therapy for depression: study protocol for a randomised controlled superiority trial.
Trials,
16Abstract:
Rumination-focused cognitive behaviour therapy vs. cognitive behaviour therapy for depression: study protocol for a randomised controlled superiority trial.
BACKGROUND: Cognitive behavioural therapy is an effective treatment for depression. However, one third of the patients do not respond satisfactorily, and relapse rates of around 30 % within the first post-treatment year were reported in a recent meta-analysis. In total, 30-50 % of remitted patients present with residual symptoms by the end of treatment. A common residual symptom is rumination, a process of recurrent negative thinking and dwelling on negative affect. Rumination has been demonstrated as a major factor in vulnerability to depression, predicting the onset, severity, and duration of future depression. Rumination-focused cognitive behavioural therapy is a psychotherapeutic treatment targeting rumination. Because rumination plays a major role in the initiation and maintenance of depression, targeting rumination with rumination-focused cognitive behavioural therapy may be more effective in treating depression and reducing relapse than standard cognitive behavioural therapy. METHOD/DESIGN: This study is a two-arm pragmatic randomised controlled superiority trial comparing the effectiveness of group-based rumination-focused cognitive behaviour therapy with the effectiveness of group-based cognitive behavioural therapy for treatment of depression. One hundred twenty-eight patients with depression will be recruited from and given treatment in an outpatient service at a psychiatric hospital in Denmark. Our primary outcome will be severity of depressive symptoms (Hamilton Rating Scale for Depression) at completion of treatment. Secondary outcomes will be level of rumination, worry, anxiety, quality of life, behavioural activation, experimental measures of cognitive flexibility, and emotional attentional bias. A 6-month follow-up is planned and will include the primary outcome measure and assessment of relapse. DISCUSSION: the clinical outcome of this trial may guide clinicians to decide on the merits of including rumination-focused cognitive behavioural therapy in the treatment of depression in outpatient services. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02278224 , registered 28 Oct. 2014.
Abstract.
Author URL.
Tester-Jones M, O'Mahen HA, Karl A, Watkins ER (2015). The Impact of Maternal Characteristics, Infant Temperament and Contextual Factors on Maternal Responsiveness to Infant. Infant Behavior and Development(40), 1-11.
Trick L, Watkins E, Dickens C (2015). The association of perseverative negative thinking with negative affect in long term conditions: a systematic review.
JOURNAL OF PSYCHOSOMATIC RESEARCH,
78(6), 627-628.
Author URL.
Kuyken W, Hayes R, Barrett B, Byng R, Dalgleish T, Kessler D, Lewis G, Watkins E, Morant N, Taylor RS, et al (2015). The effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse/recurrence: results of a randomised controlled trial (the PREVENT study).
Health Technol Assess,
19(73), 1-124.
Abstract:
The effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse/recurrence: results of a randomised controlled trial (the PREVENT study).
BACKGROUND: Individuals with a history of recurrent depression have a high risk of repeated depressive relapse/recurrence. Maintenance antidepressant medication (m-ADM) for at least 2 years is the current recommended treatment, but many individuals are interested in alternatives to m-ADM. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce the risk of relapse/recurrence compared with usual care but has not yet been compared with m-ADM in a definitive trial. OBJECTIVES: to establish whether MBCT with support to taper and/or discontinue antidepressant medication (MBCT-TS) is superior to and more cost-effective than an approach of m-ADM in a primary care setting for patients with a history of recurrent depression followed up over a 2-year period in terms of preventing depressive relapse/recurrence. Secondary aims examined MBCT's acceptability and mechanism of action. DESIGN: Single-blind, parallel, individual randomised controlled trial. SETTING: UK general practices. PARTICIPANTS: Adult patients with a diagnosis of recurrent depression and who were taking m-ADM. INTERVENTIONS: Participants were randomised to MBCT-TS or m-ADM with stratification by centre and symptomatic status. Outcome data were collected blind to treatment allocation and the primary analysis was based on the principle of intention to treat. Process studies using quantitative and qualitative methods examined MBCT's acceptability and mechanism of action. MAIN OUTCOMES MEASURES: the primary outcome measure was time to relapse/recurrence of depression. At each follow-up the following secondary outcomes were recorded: number of depression-free days, residual depressive symptoms, quality of life, health-related quality of life and psychiatric and medical comorbidities. RESULTS: in total, 212 patients were randomised to MBCT-TS and 212 to m-ADM. The primary analysis did not find any evidence that MBCT-TS was superior to m-ADM in terms of the primary outcome of time to depressive relapse/recurrence over 24 months [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.67 to 1.18] or for any of the secondary outcomes. Cost-effectiveness analysis did not support the hypothesis that MBCT-TS is more cost-effective than m-ADM in terms of either relapse/recurrence or quality-adjusted life-years. In planned subgroup analyses, a significant interaction was found between treatment group and reported childhood abuse (HR 1.89, 95% CI 1.06 to 3.38), with delayed time to relapse/recurrence for MBCT-TS participants with a more abusive childhood compared with those with a less abusive history. Although changes in mindfulness were specific to MBCT (and not m-ADM), they did not predict outcome in terms of relapse/recurrence at 24 months. In terms of acceptability, the qualitative analyses suggest that many people have views about (dis)/continuing their ADM, which can serve as a facilitator or a barrier to taking part in a trial that requires either continuation for 2 years or discontinuation. CONCLUSIONS: There is no support for the hypothesis that MBCT-TS is superior to m-ADM in preventing depressive relapse/recurrence among individuals at risk for depressive relapse/recurrence. Both treatments appear to confer protection against relapse/recurrence. There is an indication that MBCT may be most indicated for individuals at greatest risk of relapse/recurrence. It is important to characterise those most at risk and carefully establish if and why MBCT may be most indicated for this group. TRIAL REGISTRATION: Current Controlled Trials ISRCTN26666654. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula and will be published in full in Health Technology Assessment; Vol. 19, No. 73. See the NIHR Journals Library website for further project information.
Abstract.
Author URL.
2014
Watkins ER, Nolen-Hoeksema S (2014). A habit-goal framework of depressive rumination.
J Abnorm Psychol,
123(1), 24-34.
Abstract:
A habit-goal framework of depressive rumination.
Rumination has been robustly implicated in the onset and maintenance of depression. However, despite empirically well-supported theories of the consequences of trait rumination (response styles theory; Nolen-Hoeksema, 1991), and of the processes underlying state episodes of goal-oriented repetitive thought (control theory; Martin & Tesser, 1989, 1996), the relationship between these theories remains unresolved. Further, less theoretical and clinical attention has been paid to the maintenance and treatment of trait depressive rumination. We propose that conceptualizing rumination as a mental habit (Hertel, 2004) helps to address these issues. Elaborating on this account, we propose a framework linking the response styles and control theories via a theoretical approach to the relationship between habits and goals (Wood & Neal, 2007). In this model, with repetition in the same context, episodes of self-focused repetitive thought triggered by goal discrepancies can become habitual, through a process of automatic association between the behavioral response (i.e. repetitive thinking) and any context that occurs repeatedly with performance of the behavior (e.g. physical location, mood), and in which the repetitive thought is contingent on the stimulus context. When the contingent response involves a passive focus on negative content and abstract construal, the habit of depressive rumination is acquired. Such habitual rumination is cued by context independent of goals and is resistant to change. This habit framework has clear treatment implications and generates novel testable predictions.
Abstract.
Author URL.
Rhodes S, Richards DA, Ekers D, McMillan D, Byford S, Farrand PA, Gilbody S, Hollon SD, Kuyken W, Martell C, et al (2014). Cost and outcome of behavioural activation versus cognitive behaviour therapy for depression (COBRA): study protocol for a randomised controlled trial.
Trials,
15Abstract:
Cost and outcome of behavioural activation versus cognitive behaviour therapy for depression (COBRA): study protocol for a randomised controlled trial.
BACKGROUND: Cognitive behaviour therapy (CBT) is an effective treatment for depression. However, CBT is a complex therapy that requires highly trained and qualified practitioners, and its scalability is therefore limited by the costs of training and employing sufficient therapists to meet demand. Behavioural activation (BA) is a psychological treatment for depression that may be an effective alternative to CBT and, because it is simpler, might also be delivered by less highly trained and specialised mental health workers. METHODS/DESIGN: COBRA is a two-arm, non-inferiority, patient-level randomised controlled trial, including clinical, economic, and process evaluations comparing CBT delivered by highly trained professional therapists to BA delivered by junior professional or para-professional mental health workers to establish whether the clinical effectiveness of BA is non-inferior to CBT and if BA is cost effective compared to CBT. Four hundred and forty patients with major depressive disorder will be recruited through screening in primary care. We will analyse for non-inferiority in per-protocol and intention-to-treat populations. Our primary outcome will be severity of depression symptoms (Patient Health Questionnaire-9) at 12 months follow-up. Secondary outcomes will be clinically significant change and severity of depression at 18 months, and anxiety (General Anxiety Disorder-7 questionnaire) and health-related quality of life (Short-Form Health Survey-36) at 12 and 18 months. Our economic evaluation will take the United Kingdom National Health Service/Personal Social Services perspective to include costs of the interventions, health and social care services used, plus productivity losses. Cost-effectiveness will explored in terms of quality-adjusted life years using the EuroQol-5D measure of health-related quality of life. DISCUSSION: the clinical and economic outcomes of this trial will provide the evidence to help policy makers, clinicians and guideline developers decide on the merits of including BA as a first-line treatment of depression. TRIAL REGISTRATION: Current Controlled Trials ISRCTN27473954.
Abstract.
Author URL.
Topper M, Emmelkamp PMG, Watkins E, Ehring T (2014). Development and assessment of brief versions of the Penn State Worry Questionnaire and the Ruminative Response Scale.
Br J Clin Psychol,
53(4), 402-421.
Abstract:
Development and assessment of brief versions of the Penn State Worry Questionnaire and the Ruminative Response Scale.
OBJECTIVES: Worry and depressive rumination have been found to be involved in the onset and maintenance of a range of psychological disorders. The development of brief screening measures for excessive worry and depressive rumination is therefore desirable to facilitate the assessment of worry and rumination in prevention and treatment settings where routine administration of full questionnaires is not practical due to time-related constraints. DESIGN AND METHODS: Using the Penn State Worry Questionnaire (PSWQ) and the Ruminative Response Scale (RRS) as gold standard starting points, brief versions of these measures were developed in a large sample of adolescents (N = 1,952) and results were cross-validated in two independent samples (N = 1,954; N = 457). RESULTS: the brief versions demonstrated acceptable to high internal consistency (brief PSWQ: α =. 84-.91; brief RRS: α =. 78-.81) and correlated highly with the full questionnaires (brief PSWQ: r =. 91-.94; brief RRS: r =. 88-.91). In addition, they showed high sensitivity (brief PSWQ:. 90-.92; brief RRS:. 90-.93), and high specificity (brief PSWQ:. 88-.90; brief RRS:. 80-.87) to detect excessive worry and rumination. The validity of the brief measures was further supported by demonstrating that the brief measures showed similar differences in scores between males and females as the full measures as well as substantial relationships to other measures of repetitive negative thinking and symptom measures of anxiety and depression. Finally, the brief measures predicted future symptoms of anxiety and depression. CONCLUSIONS: the brief versions of the PSWQ and RRS are time-efficient and valid instruments for the screening of worry and depressive rumination. Their use in clinical practice is recommended to inform treatment and/or to select individuals at risk for development of psychological disorders who may benefit from preventive interventions.
Abstract.
Author URL.
Griffith E, Kuyken W, Watkins E, Jones A (2014). Do Females with Bulimia Nervosa and Eating Disorder Not Otherwise Specified Have Selective Memory Biases?.
Behavioural and Cognitive PsychotherapyAbstract:
Do Females with Bulimia Nervosa and Eating Disorder Not Otherwise Specified Have Selective Memory Biases?
Background: the cognitive model suggests memory biases for weight/shape and food related information could be important in the maintenance of eating disorders. Aims: the current study aims to evaluate this and extend previous research by (a) including females with eating disorder not otherwise specified (EDNOS) as a discreet group; (b) considering whether levels of hunger and the pleasantness of the stimulus words are important in word recall. Method: the study includes three groups of females, 16 with bulimia nervosa, 18 with EDNOS and 17 non-dieting general population controls. All participants completed a self-referential encoding and memory recall task. Results: a main effect of word type (p <. 01) with no group by word type interaction or between group difference was found. A priori contrasts indicated that both eating disorder groups recalled significantly more weight/shape and food words compared to all other word categories (p <. 01) compared to the control group; with no significant difference found between the eating disorder groups. In relation to the recall of food words, no significant differences were found between groups for levels of hunger. Both eating disorder groups rated the negative weight/shape (p <. 01), negative food (p <. 01) and neutral body words (p <. 01) as more unpleasant than the control group. Conclusions: the implications for cognitive theory and future research are discussed. Copyright © British Association for Behavioural and Cognitive Psychotherapies 2014.
Abstract.
Bertolino LB, Olaithe M, Tan S, Watkins ER, Bucks RS (2014). Greater general repetitive negative thinking directly predicts more severe insomnia in males: in females it is all about depression.
Author URL.
Kingston REF, Watkins ER, Nolen-Hoeksema S (2014). Investigating Functional Properties of Depressive Rumination: Insight and Avoidance.
JOURNAL OF EXPERIMENTAL PSYCHOPATHOLOGY,
5(3), 244-258.
Author URL.
Woodford J, Farrand P, Watkins ER, Richards DA, Llewellyn DJ (2014). Supported cognitive-behavioural self-help versus treatment-as-usual for depressed informal carers of stroke survivors (CEDArS): study protocol for a feasibility randomized controlled trial.
Trials,
157Abstract:
Supported cognitive-behavioural self-help versus treatment-as-usual for depressed informal carers of stroke survivors (CEDArS): study protocol for a feasibility randomized controlled trial
Background
Increased life expectancy has resulted in a greater provision of informal care within the community for patients with chronic physical health conditions. Informal carers are at greater risk of poor mental health, with one in three informal carers of stroke survivors experiencing depression. However, currently no psychological treatments tailored to the unique needs of depressed informal carers of stroke survivors exist. Furthermore, informal carers of stroke survivors experience a number of barriers to attending traditional face-to-face psychological services, such as lack of time and the demands of the caring role. The increased flexibility associated with supported cognitive behavioral therapy self-help (CBTsh), such as the ability for support to be provided by telephone, email, or face-to-face, alongside shorter support sessions, may help overcome such barriers to access. CBTsh, tailored to depressed informal carers of stroke survivors may represent an effective and acceptable solution.
Methods
This study is a Phase II (feasibility) randomized controlled trial (RCT) following guidance in the MRC Complex Interventions Research Methods Framework. We will randomize a sample of depressed informal carers of stroke survivors to receive CBT self-help supported by mental health paraprofessionals, or treatment-as-usual. Consistent with the objectives of assessing the feasibility of trial design and procedures for a potential larger scale trial we will measure the following outcomes: a) feasibility of patient recruitment (recruitment and refusal rates); (b) feasibility and acceptability of data collection procedures; (c) levels of attrition; (d) likely intervention effect size; (e) variability in number, length and frequency of support sessions estimated to bring about recovery; and (f) acceptability of the intervention. Additionally, we will collect data on the diagnosis of depression, symptoms of depression and anxiety, functional impairment, carer burden, quality of life, and stroke survivor mobility skill, self-care and functional ability, measured at four and six months post-randomization.
Discussion
This study will provide important information for the feasibility and design of a Phase III (effectiveness) trial in the future. If the intervention is identified to be feasible, effective, and acceptable, a written CBTsh intervention for informal carers of stroke survivors, supported by mental health paraprofessionals, could represent a cost-effective model of care.
Trial registration: Current Controlled Trials ISRCTN63590486.
Abstract.
Author URL.
Trick L, Watkins E, Dickens C (2014). The association between perseverative negative cognitive processes and negative affect in people with long term conditions: a protocol for systematic review and meta-analysis.
Syst Rev,
3Abstract:
The association between perseverative negative cognitive processes and negative affect in people with long term conditions: a protocol for systematic review and meta-analysis.
BACKGROUND: Depression is common in people with long term conditions (LTCs) and is associated with worse medical outcomes. Understanding the mechanisms underpinning this relationship could help predict who is at increased risk of adverse medical outcomes, and lead to the development of novel interventions. Perseverative negative cognitive processes, such as worry and rumination, involve repetitive and frequent thoughts about oneself and one's concerns. These processes have been associated with negative affect, and also adverse medical outcomes. The results of prospective studies, which would allow causal inferences to be drawn, are more equivocal however. Furthermore, the majority of studies have been conducted in physically healthy individuals, and we do not know to what extent these findings will generalise to people with LTCs. METHODS/DESIGN: Electronic databases will be searched using a search strategy including controlled vocabulary and text words related to perseverative negative cognitive processes (such as worry and rumination) and negative affect (including depression and anxiety). Records will be hand-searched for terms related to LTCs. Citation and bibliography searching will be conducted, and authors of included studies will be contacted to identify unpublished studies. Studies will be included if they contain a standardised measure of the prospective association between perseverative negative cognitive processes and negative affect, or vice versa, in people with LTCs. Narrative and meta-analytic methods will be used to synthesize the data collected. DISCUSSION: This review will identify and synthesise studies of the prospective association between perseverative negative cognitive processes and negative affect among people with LTCs. The findings will help to identify whether worry and rumination could cause depression and anxiety in people with LTCs, and might indicate whether perseverative negative cognitive processes are appropriate targets for treatment.
Abstract.
Author URL.
Kuyken W, Byford S, Byng R, Dalgleish T, Lewis G, Taylor R, Watkins ER, Hayes R, Lanham P, Kessler D, et al (2014). Update to the study protocol for a randomized controlled trial comparing mindfulness-based cognitive therapy with maintenance anti-depressant treatment depressive relapse/recurrence: the PREVENT trial.
Trials,
15Abstract:
Update to the study protocol for a randomized controlled trial comparing mindfulness-based cognitive therapy with maintenance anti-depressant treatment depressive relapse/recurrence: the PREVENT trial.
BACKGROUND: Depression is a common and distressing mental health problem that is responsible for significant individual disability and cost to society. Medication and psychological therapies are effective for treating depression and maintenance anti-depressants (m-ADM) can prevent relapse. However, individuals with depression often express a wish for psychological help that can help them recover from depression in the long-term. A recently developed treatment, mindfulness-based cognitive therapy (MBCT), shows potential as a brief group program for people with recurring depression.This trial asks the policy research question; is MBCT with support to taper/discontinue antidepressant medication (MBCT-TS) superior to m-ADM in terms of: a primary outcome of preventing depressive relapse/recurrence over 24 months; and secondary outcomes of (a) depression free days, (b) residual depressive symptoms, (c) antidepressant medication (ADM) usage, (d) psychiatric and medical co-morbidity, (e) quality of life, and (f) cost effectiveness? an explanatory research question also asks whether an increase in mindfulness skills is the key mechanism of change.The design is a single-blind, parallel randomized controlled trial examining MBCT-TS versus m-ADM with an embedded process study. To answer the main policy research question the proposed trial compares MBCT-TS with m-ADM for patients with recurrent depression. Four hundred and twenty patients with recurrent major depressive disorder in full or partial remission will be recruited through primary care. RESULTS: Depressive relapse/recurrence over two years is the primary outcome variable. Analyses will be conducted following CONSORT standards and overseen by the trial's Data Monitoring and Safety Committee. Initial analyses will be conducted on an intention-to-treat basis, with subsequent analyses being per protocol. The explanatory question will be addressed in two mutually informative ways: quantitative measurement of potential mediating variables pre- and post-treatment and a qualitative study of service users' views and experiences. CONCLUSIONS: If the results of our exploratory trial are extended to this definitive trial, MBCT-TS will be established as an alternative approach to maintenance antidepressants for people with a history of recurrent depression. The process studies will provide evidence about the effective components which can be used to improve MBCT and inform theory as well as other therapeutic approaches. TRIAL REGISTRATION: Trial registered 7 May 2009; ISRCTN26666654.
Abstract.
Author URL.
Douilliez C, Heeren A, Lefevre N, Watkins E, Barnard P, Philippot P (2014). Validation of the French version of a questionnaire assessing the constructive and unconstructive repetitive thoughts.
CANADIAN JOURNAL OF BEHAVIOURAL SCIENCE-REVUE CANADIENNE DES SCIENCES DU COMPORTEMENT,
46(2), 185-192.
Author URL.
Douilliez C, Heeren A, Lefèvre N, Watkins E, Barnard P, Philippot P (2014). Validation of the French version of a questionnaire that evaluates constructive and non-constructive repetitive thoughts.
Canadian Journal of Behavioural Science,
46(2), 185-192.
Abstract:
Validation of the French version of a questionnaire that evaluates constructive and non-constructive repetitive thoughts
This article presents the adaptation and the validation of a short self-report questionnaire assessing repetitive thinking, the Mini Cambridge-Exeter Repetitive Thought Scale (Mini-CERTS). This 16 item scale evaluates two dimensions of repetitive thinking: "concrete, experiential thinking" (CET) and "abstract, analytical thinking" (AAT) that may have constructive and unconstructive consequences. A large sample of adult volunteers (n = 247) filled in the Mini-CERTS. Subsamples also responded to depression, anxiety and general symptomatology questionnaires as well as to a concurrent measure, the Ruminative Response Scale. Confirmatory factor analysis ascertained the two-dimension structure of the questionnaire. Correlational analyses evidenced differentiated patterns of relation between CET and AAT and anxiety, depression and general symptomatology scales. AAT was correlated to the brooding scale of the RRS but there was no relation between CET and both scales of the RRS. Preliminary data suggest that the Mini-CERTS is sensitive to clinical status and treatment. © 2012 Canadian Psychological Association.
Abstract.
Bassanini A, Caselli G, Fiore F, Ruggiero GM, Sassaroli S, Watkins ER (2014). Why "why" seems better than "how". Processes underlining repetitive thinking in an Italian non-clinical sample.
Personality and Individual Differences,
64, 18-23.
Abstract:
Why "why" seems better than "how". Processes underlining repetitive thinking in an Italian non-clinical sample
Given the evidence for the dysfunctional effects of rumination, the fundamental question remains: why depressed patients continue to ruminate over long periods of time? Watkins has shown that unconstructive repetitive thought is focused on "why", aiming at detecting the personal reasons of negative events. This strategy leads people to find evaluative answers of personal inadequacy or negativity of the world. The research aims at (a) test the hypotheses that why RT is significantly correlated to negative mood, even when controlling for depressive symptoms; (b) test whether non-clinical participants really tend to prefer the "how" RT, when coping with an unexpected negative event of everyday life; this results would suggest that the "how" style is more functional than the "why" style (c) exploring beliefs that may guide the choice between the "how" or the "why" modes; (d) investigate the influence of a previous choice on the subsequent thinking style. 212 participants have been recruited. We include questionnaires about rumination and depression and 8 vignette describing negative unexpected situations, followed by three tasks. The results confirm the detrimental role of why focused repetitive thinking on mood state and show a significant influence of a "why tendency". © 2014 Elsevier Ltd.
Abstract.
2013
Kingston REF, Watkins ER, O'Mahen HA (2013). An Integrated Examination of Risk Factors for Repetitive Negative Thought.
JOURNAL OF EXPERIMENTAL PSYCHOPATHOLOGY,
4(2), 161-181.
Author URL.
Schaich A, Watkins ER, Ehring T (2013). Can concreteness training buffer against the negative effects of rumination on PTSD? an experimental analogue study.
J Behav Ther Exp Psychiatry,
44(4), 396-403.
Abstract:
Can concreteness training buffer against the negative effects of rumination on PTSD? an experimental analogue study.
BACKGROUND AND OBJECTIVES: Trauma-related rumination has been found to be an important maintaining factor for PTSD. On the background of the processing mode account of ruminative thinking, this study tested whether the relationship between rumination and analogue PTSD symptoms can be modified by training participants in a concrete mode of processing. METHODS: Healthy participants were trained in either an abstract or a concrete style of processing. Afterwards, they watched a stressful film. The interactive effect of training condition and trait rumination on intrusive memories of the film was examined. RESULTS: Following abstract training, a positive relationship between trait rumination and intrusive memories of the film emerged. As hypothesized, this relationship disappeared following concrete training. LIMITATIONS: include the lack of a no-training control group and the analogue paradigm used. CONCLUSIONS: the study provides preliminary evidence that the relationship between trait rumination and analogue PTSD symptoms can be modified. If replicated in future studies, it may be promising to examine the value of concreteness training for prevention and/or treatment of PTSD.
Abstract.
Author URL.
Watkins ER (2013). Cognitive mechanisms involved in therapeutic change for depression Reducing abstraction and increasing concreteness.
Author URL.
Watkins ER (2013). Cognitive mechanisms involved in therapeutic change for depression: Reducing abstraction and increasing concreteness. In (Ed)
Changing Emotions, 195-201.
Abstract:
Cognitive mechanisms involved in therapeutic change for depression: Reducing abstraction and increasing concreteness
Abstract.
Roberts H, Watkins ER, Wills AJ (2013). Cueing an unresolved personal goal causes persistent ruminative self-focus: an experimental evaluation of control theories of rumination.
J Behav Ther Exp Psychiatry,
44(4), 449-455.
Abstract:
Cueing an unresolved personal goal causes persistent ruminative self-focus: an experimental evaluation of control theories of rumination.
BACKGROUND AND OBJECTIVES: Control theory predicts that the detection of goal discrepancies initiates ruminative self-focus (Martin & Tesser, 1996). Despite the breadth of applications and interest in control theory, there is a lack of experimental evidence evaluating this prediction. The present study provided the first experimental test of this prediction. METHODS: We examined uninstructed state rumination in response to the cueing of resolved and unresolved goals in a non-clinical population using a novel measure of online rumination. RESULTS: Consistent with control theory, cueing an unresolved goal resulted in significantly greater recurrent intrusive ruminative thoughts than cueing a resolved goal. Individual differences in trait rumination moderated the impact of the goal cueing task on the extent of state rumination: individuals who had a stronger tendency to habitually ruminate were more susceptible to the effects of cueing goal discrepancies. LIMITATIONS: the findings await replication in a clinically depressed sample where there is greater variability and higher levels of trait rumination. CONCLUSIONS: These results indicate that control theories of goal pursuit provide a valuable framework for understanding the circumstances that trigger state rumination. Additionally, our measure of uninstructed online state rumination was found to be a valid and sensitive index of the extent and temporal course of state rumination, indicating its value for further investigating the proximal causes of state rumination.
Abstract.
Author URL.
Hammen C, Watkins E (2013).
Depression, second edition.Abstract:
Depression, second edition
Abstract.
Watson LA, Berntsen D, Kuyken W, Watkins ER (2013). Involuntary and voluntary autobiographical memory specificity as a function of depression.
J Behav Ther Exp Psychiatry,
44(1), 7-13.
Abstract:
Involuntary and voluntary autobiographical memory specificity as a function of depression.
BACKGROUND AND OBJECTIVES: This study tests the hypothesis derived from the CaR-FA-X model (Capture and Rumination, Functional Avoidance and Executive Function model, Williams et al. 2007), that depressed individuals will be less specific during voluntary than involuntary autobiographical memory retrieval and looks at the relative contributions of rumination, avoidance and executive function to memory specificity. METHODS: Twenty depressed and twenty never depressed individuals completed a memory diary, recording 10 involuntary and 10 voluntary autobiographical memories. Psychiatric status (assessed with the Structured Clinical Interview for DSM-IV, SCID-1), psychopathology, rumination, avoidance and executive function were assessed prior to completion of the memory diary. RESULTS: Both groups were more specific during involuntary than voluntary memory retrieval. No overall group differences were identified. However, when non-remitted depressed participants were compared to partially remitted and never depressed participants the expected interaction was identified; non-remitted depressed individuals were less specific during voluntary, but not during involuntary recall. Consistent with theory, negative correlations between memory specificity, rumination and avoidance were also present. LIMITATIONS: the study presents an important yet preliminary finding which warrants further replication with a larger sample size. CONCLUSIONS: the findings provide support for a number of models of autobiographical memory retrieval in particular the CaR-FA-X model of memory specificity.
Abstract.
Author URL.
Gaté MA, Watkins ER, Simmons JG, Byrne ML, Schwartz OS, Whittle S, Sheeber LB, Allen NB (2013). Maternal parenting behaviors and adolescent depression: the mediating role of rumination.
J Clin Child Adolesc Psychol,
42(3), 348-357.
Abstract:
Maternal parenting behaviors and adolescent depression: the mediating role of rumination.
Substantial evidence suggests that rumination is an important vulnerability factor for adolescent depression. Despite this, few studies have examined environmental risk factors that might lead to rumination and, subsequently, depression in adolescence. This study examined the hypothesis that an adverse family environment is a risk factor for rumination, such that the tendency to ruminate mediates the longitudinal association between a negative family environment and adolescent depressive symptoms. It also investigated adolescent gender as a moderator of the relationship between family environment and adolescent rumination. Participants were 163 mother-adolescent dyads. Adolescents provided self-reports of depressive symptoms and rumination across three waves of data collection (approximately at ages 12, 15, and 17 years). Family environment was measured via observational assessment of the frequency of positive and aggressive parenting behaviors during laboratory-based interactions completed by mother-adolescent dyads, collected during the first wave. A bootstrap analysis revealed a significant indirect effect of low levels of positive maternal behavior on adolescent depressive symptoms via adolescent rumination, suggesting that rumination might mediate the relationship between low levels of positive maternal behavior and depressive symptoms for girls. This study highlights the importance of positive parenting behaviors as a possible protective factor against the development of adolescent rumination and, subsequently, depressive symptoms. One effective preventive approach to improving adolescent mental health may be providing parents with psychoeducation concerning the importance of pleasant and affirming interactions with their children.
Abstract.
Author URL.
Watkins ER, Moulds ML (2013). Repetitive thought: Rumination in complicated grief. In (Ed) Complicated Grief: Scientific Foundations for Health Care Professionals, 162-175.
Caselli G, Gemelli A, Querci S, Lugli AM, Canfora F, Annovi C, Rebecchi D, Ruggiero GM, Sassaroli S, Spada MM, et al (2013). The effect of rumination on craving across the continuum of drinking behaviour.
Addict Behav,
38(12), 2879-2883.
Abstract:
The effect of rumination on craving across the continuum of drinking behaviour.
BACKGROUND: Rumination is an abstract, persistent, and repetitive thinking style that can be adopted to control negative affect. Recent studies have suggested the role of rumination as direct or indirect cognitive predictor of craving experience in alcohol-related problems. AIMS: the goal of this study was to explore the effect of rumination induction on craving across the continuum of drinking behaviour. METHODS: Participants of three groups of alcohol-dependent drinkers (N=26), problem drinkers (N=26) and social drinkers (N=29) were randomly allocated to two thinking manipulation tasks: distraction versus rumination. Craving was measured before and after manipulation and after a resting phase. RESULTS: Findings showed that rumination had a significant effect on increasing craving in alcohol-dependent drinkers, relative to distraction, but not in problem and social drinkers. This effect was independent of baseline depression and rumination and was maintained across the resting phase. CONCLUSIONS: Rumination showed a direct causal impact on craving that is specific for a population of alcohol-dependent drinkers.
Abstract.
Author URL.
McEvoy PM, Watson H, Watkins ER, Nathan P (2013). The relationship between worry, rumination, and comorbidity: evidence for repetitive negative thinking as a transdiagnostic construct.
J Affect Disord,
151(1), 313-320.
Abstract:
The relationship between worry, rumination, and comorbidity: evidence for repetitive negative thinking as a transdiagnostic construct.
BACKGROUND: Repetitive negative thinking (RNT) increases vulnerability to multiple anxiety and depressive disorders and, as a common risk factor, elevated RNT may account for the high levels of comorbidity observed between emotional disorders. The aims of this study were to (a) compare two common forms of RNT (worry and rumination) across individuals with non-comorbid anxiety or depressive disorders, and (b) to examine the relationship between RNT and comorbidity. METHODS: a structured diagnostic interview and measures of rumination, worry, anxiety, and depression were completed by a large clinical sample with an anxiety disorder or depression (N=513) presenting at a community mental health clinic. RESULTS: Patients without (n=212) and with (n=301) comorbid diagnoses did not generally differ across the principal diagnosis groups (depression, generalised anxiety disorder, social anxiety disorder, panic disorder) on worry or rumination. As predicted, comorbidity was associated with a higher level of RNT. LIMITATIONS: Cross-sectional design precluded causal conclusions and findings may not generalize to excluded anxiety disorders. CONCLUSIONS: Consistent with the transdiagnostic hypothesis, RNT was associated with a range of anxiety disorders and depression and with comorbidity for those with a principal depressive disorder, supporting recent evidence that RNT is a transdiagnostic process. The presence of RNT, specifically worry and rumination, should be assessed and treated regardless of diagnostic profile. Future research may show that both pure and comorbid depressed or anxious patients receive incremental benefit from transdiagnostic protocols developed to treat core pathological processes of RNT traditionally associated with separate disorders.
Abstract.
Author URL.
2012
Galfin JM, Watkins ER, Harlow T (2012). A brief guided self-help intervention for psychological distress in palliative care patients: a randomised controlled trial.
Palliat Med,
26(3), 197-205.
Abstract:
A brief guided self-help intervention for psychological distress in palliative care patients: a randomised controlled trial.
BACKGROUND: Previous findings implicated rumination (recurrent dwelling on abstract concerns) in elevated psychological distress in palliative patients. We hypothesised that reducing rumination may be important in addressing psychological distress in palliative care. AIM: This study tested the prediction that a brief guided self-help technique targeting abstract rumination would reduce psychological distress in palliative patients. DESIGN: a randomised controlled trial evaluated 4 weeks of guided self-help that involved patients practising thinking more concretely by recalling specific and vivid memories of when they were completely absorbed in an activity or scene. Participants completed a combination of standardised questionnaires to assess anxiety, depression, and quality of life. SETTING/PARTICIPANTS: Palliative care patients who were reporting clinically significant psychological distress, whilst also physically well enough to take part in the trial were recruited from hospices in Devon and Somerset and randomised to either a treatment condition (n = 19) receiving 4 weeks of guided self-help, or a waiting-list control condition (n = 15) receiving treatment as usual. RESULTS: As predicted, the palliative patients receiving the intervention reported significantly greater reductions in anxiety than the waiting-list controls (F(1,23) = 20.55, p < 0.001, partial η (2) = 0.47). However, no significant effect was found on depression or quality of life. CONCLUSION: the findings suggest that a brief guided self-help intervention based on concreteness training can be effective in addressing anxiety in palliative care.
Abstract.
Author URL.
Watkins, E.R. Beck, A.T. (2012). Cognitive-behavioural therapy for mood disorders. In Gabbard G, Beck J, Holmes J (Eds.) Concise Oxford Textbook of Psychotherapy, Oxford: Oxford University Press.
Galfin JM, Watkins ER (2012). Construal level, rumination, and psychological distress in palliative care.
Psychooncology,
21(6), 680-683.
Abstract:
Construal level, rumination, and psychological distress in palliative care.
BACKGROUND: Patients with a life-limiting illness, such as cancer, and their carers experience elevated psychological distress. However, the psychological mechanisms underpinning distress in palliative care have been little studied. Recent theories predict that individuals who experience increased uncertainty in the context of ongoing difficulties, such as palliative patients and their carers, will (a) think more abstractly; (b) ruminate more; and (c) be more distressed. METHODS: Palliative patients (n = 36, 90% with cancer), their carers (n = 29), and age-matched controls (n = 30) completed standardized questionnaires to assess anxiety, depression, and rumination, and open-ended interviews to identify their concerns and idiosyncratic levels of rumination. Concerns were analyzed linguistically for level of abstraction. RESULTS: As predicted, (i) palliative patients and carers reported significantly more uncertainty, rumination, and abstract thinking than controls; (ii) uncertainty, abstractness, and rumination were associated with psychological distress. CONCLUSIONS: Abstraction and rumination are psychological mechanism potentially involved in increased psychological distress in palliative care.
Abstract.
Author URL.
Bradley, B. Watkins E (2012). Depression - treatment. In Lindsay S, Powell G (Eds.) The Handbook of Clinical Adult Psychology (3 rd Edition), Routledge.
Watkins ER, Taylor RS, Byng R, Baeyens C, Read R, Pearson K, Watson L (2012). Guided self-help concreteness training as an intervention for major depression in primary care: a Phase II randomized controlled trial.
Psychological Medicine,
42(7), 1359-1371.
Abstract:
Guided self-help concreteness training as an intervention for major depression in primary care: a Phase II randomized controlled trial
Background the development of widely accessible, effective psychological interventions for depression is a priority. This randomized trial provides the first controlled data on an innovative cognitive bias modification (CBM) training guided self-help intervention for depression.Method One hundred and twenty-one consecutively recruited participants meeting criteria for current major depression were randomly allocated to treatment as usual (TAU) or to TAU plus concreteness training (CNT) guided self-help or to TAU plus relaxation training (RT) guided self-help. CNT involved repeated practice at mental exercises designed to switch patients from an unhelpful abstract thinking habit to a helpful concrete thinking habit, thereby targeting depressogenic cognitive processes (rumination, overgeneralization).Results the addition of CNT to TAU significantly improved depressive symptoms at post-treatment [mean difference on the Hamilton Rating Scale for Depression (HAMD) 4.28, 95% confidence interval (CI) 1.29-7.26], 3-and 6-month follow-ups, and for rumination and overgeneralization post-treatment. There was no difference in the reduction of symptoms between CNT and RT (mean difference on the HAMD 1.98, 95% CI â̂'1.14 to 5.11), although CNT significantly reduced rumination and overgeneralization relative to RT post-treatment, suggesting a specific benefit on these cognitive processes.Conclusions This study provides preliminary evidence that CNT guided self-help may be a useful addition to TAU in treating major depression in primary care, although the effect was not significantly different from an existing active treatment (RT) matched for structural and common factors. Because of its relative brevity and distinct format, it may have value as an additional innovative approach to increase the accessibility of treatment choices for depression. © 2011 Cambridge University Press.
Abstract.
Watkins ER, Taylor RS, Byng R, Baeyens C, Read R, Pearson K, Watson L (2012). Guided self-help concreteness training as an intervention for major depression in primary care: a Phase II randomized controlled trial.
Psychol Med,
42(7), 1359-1371.
Abstract:
Guided self-help concreteness training as an intervention for major depression in primary care: a Phase II randomized controlled trial.
BACKGROUND: the development of widely accessible, effective psychological interventions for depression is a priority. This randomized trial provides the first controlled data on an innovative cognitive bias modification (CBM) training guided self-help intervention for depression. METHOD: One hundred and twenty-one consecutively recruited participants meeting criteria for current major depression were randomly allocated to treatment as usual (TAU) or to TAU plus concreteness training (CNT) guided self-help or to TAU plus relaxation training (RT) guided self-help. CNT involved repeated practice at mental exercises designed to switch patients from an unhelpful abstract thinking habit to a helpful concrete thinking habit, thereby targeting depressogenic cognitive processes (rumination, overgeneralization). RESULTS: the addition of CNT to TAU significantly improved depressive symptoms at post-treatment [mean difference on the Hamilton Rating Scale for Depression (HAMD) 4.28, 95% confidence interval (CI) 1.29-7.26], 3- and 6-month follow-ups, and for rumination and overgeneralization post-treatment. There was no difference in the reduction of symptoms between CNT and RT (mean difference on the HAMD 1.98, 95% CI -1.14 to 5.11), although CNT significantly reduced rumination and overgeneralization relative to RT post-treatment, suggesting a specific benefit on these cognitive processes. CONCLUSIONS: This study provides preliminary evidence that CNT guided self-help may be a useful addition to TAU in treating major depression in primary care, although the effect was not significantly different from an existing active treatment (RT) matched for structural and common factors. Because of its relative brevity and distinct format, it may have value as an additional innovative approach to increase the accessibility of treatment choices for depression.
Abstract.
Author URL.
Watkins ER, Moberly NJ (2012). Process versus purpose mindsets influence emotional response to failure.
Behaviour Research and TherapyAbstract:
Process versus purpose mindsets influence emotional response to failure
Three studies are reported showing that emotional responses to stress can be modified by systematic prior practice in adopting particular processing modes. Participants were induced to think in abstract or concrete modes before being exposed to a failure experience. In Experiment 1, two dimensions within the abstract-concrete distinction were manipulated as participants imagined emotional scenarios: process (how) versus purpose (why), and specific-unique versus generic-prototypical knowledge. The process versus purpose dimension causally influenced subsequent emotional reactivity but the specific-unique versus generic-prototypical dimension did not. In Experiment 2, the process versus purpose dimension was uniquely manipulated using a neutral procedural priming manipulation (Freitas et al. 2004) prior to the failure. Relative to practice at adopting the purpose mindset, practice at adopting the process mindset reduced subsequent emotional reactivity to the failure task. In Experiment 3, the specific-unique versus generic-prototypical dimension alone was manipulated by adapting Neumann and Philippot’s (2007) and Vrielynck and Philippot’s (2009) paradigm such that participants recalled specific autobiographical memories with a focus on unique details versus prototypical elements. There was no effect of the manipulation on subsequent emotional reactivity. These findings provide convergent evidence consistent with the hypothesis that the active element within level-of-abstraction that influences emotional reactivity is the extent of process versus purpose processing, consistent with action identification theory.
Abstract.
Watson LA, Berntsen D, Kuyken W, Watkins ER (2012). The characteristics of involuntary and voluntary autobiographical memories in depressed and never depressed individuals.
Conscious Cogn,
21(3), 1382-1392.
Abstract:
The characteristics of involuntary and voluntary autobiographical memories in depressed and never depressed individuals.
This study compares involuntary and voluntary autobiographical memories in depressed and never depressed individuals. Twenty depressed and twenty never depressed individuals completed a memory diary; recording their reactions to 10 involuntary and 10 voluntary memories over 14-30 days. Psychiatric status (Structured Clinical Interview for DSM-IV, SCID-1), psychopathology, rumination and avoidance were assessed. For both groups, involuntary memories more frequently lead to strong reactions than voluntarily memories. For both modes of retrieval, depressed individuals reported more frequent negative reactions than never depressed individuals and rated memories as more central to identity with higher levels of rumination and avoidance. Depressed individuals retrieved both positive and negative memories during involuntary retrieval. These findings support the view that involuntary memory retrieval represents a basic mode of retrieval during healthy and disordered cognition, and that during depression, both involuntary and voluntary memories are central to identity and associated with rumination and avoidance.
Abstract.
Author URL.
Watkins ER, Grafton B, MacLeod C (2012). The ups and downs of cognitive bias: dissociating the attentional characteristics of positive and negative affectivity.
Journal of Cognitive Psychology,
24, 33-53.
Abstract:
The ups and downs of cognitive bias: dissociating the attentional characteristics of positive and negative affectivity.
Despite considerable past interest in distinguishing the patterns of attentional bias that characterise vulnerability to anxiety and to depression, little research has yet sought to delineate the attentional correlates of two affective dimensions that differentially contribute to these alternative forms of emotional vulnerability—negative and positive affectivity. In the present study, we employ a novel variant of the attentional probe task to examine selective attentional engagement with, and disengagement from, negative words, in participants whose heightened emotional vulnerability reflects either elevated negative affectivity, or attenuated positive affectivity. Elevated negative affectivity was found to be associated with both increased attentional engagement with, and impaired attentional disengagement from, negative information, especially when this was anxiety relevant. In contrast, attenuated positive affectivity was associated with facilitated attentional disengagement from negative information, especially when this was depression relevant. We discuss how this new insight into the attentional characteristics of negative and positive affectivity may serve to illuminate the basis of previously observed discrepancies between the patterns of attentional selectivity observed in anxious and in depressed participants.
Abstract.
2011
Watkins ER, Nolen-Hoeksema S (2011). A Heuristic for Transdiagnostic Models of Psychopathology: Explaining Multifinality and Divergent Trajectories.
Perspectives in Psychological Science,
6, 589-609.
Abstract:
A Heuristic for Transdiagnostic Models of Psychopathology: Explaining Multifinality and Divergent Trajectories
Transdiagnostic models of psychopathology are increasingly prominent because they focus on fundamental processes underlying multiple disorders, help to explain comorbidity among disorders, and may lead to more effective assessment and treatment of disorders. Current transdiagnostic models, however, have difficulty simultaneously explaining the mechanisms by which a transdiagnostic risk factor leads to multiple disorders (i.e. multifinality) and why one individual with a particular transdiagnostic risk factor develops one set of symptoms while another with the same transdiagnostic risk factor develops another set of symptoms (i.e. divergent trajectories). In this article, we propose a heuristic for developing transdiagnostic models that can guide theorists in explicating how a transdiagnostic risk factor results in both multifinality and divergent trajectories. We also (a) describe different levels of transdiagnostic factors and their relative theoretical and clinical usefulness, (b) suggest the types of mechanisms by which factors at 1 level may be related to factors at other levels, and (c) suggest the types of moderating factors that may determine whether a transdiagnostic factor leads to certain specific disorders or symptoms and not others. We illustrate this heuristic using research on rumination, a process for which there is evidence it is a transdiagnostic risk factor.
Abstract.
Watkins ER, Galfin JM, Harlow T (2011). An evaluation of a training programme to teach a brief guided self-help psychological intervention to hospice staff.
International Journal of Palliative Nursing,
17, 197-205.
Abstract:
An evaluation of a training programme to teach a brief guided self-help psychological intervention to hospice staff
Aims: a recent trial demonstrated that a brief guided self-help intervention reduces anxiety in palliative patients. This study investigated whether training palliative nurses to deliver a guided self-help intervention would improve their routine management of psychological distress. Design: a randomized controlled cluster trial compared a team of nurses who attended training (n=5) with a team allocated to a no-training control condition (n=5) on self-reported behaviour and confidence in addressing psychological distress. Ratings of patient psychological distress at routine clinical assessments were also examined pre- and post-training to assess the impact of training on patient distress. Results: As predicted, patients cared for by the trained team demonstrated a significantly greater reduction in distress post-training than patients cared for by the untrained team. However, there was no significant difference in self-reported behaviour and confidence. Conclusion: These findings suggest that brief workshop-based training improves clinical outcomes on psychological distress and may be a means to increase the accessibility of effective psychological interventions in palliative care.
Abstract.
Watkins E (2011). Dysregulation in level of goal and action identification across psychological disorders.
Clin Psychol Rev,
31(2), 260-278.
Abstract:
Dysregulation in level of goal and action identification across psychological disorders.
Goals, events, and actions can be mentally represented within a hierarchical framework that ranges from more abstract to more concrete levels of identification. A more abstract level of identification involves general, superordinate, and decontextualized mental representations that convey the meaning of goals, events, and actions, "why" an action is performed, and its purpose, ends, and consequences. A more concrete level of identification involves specific and subordinate mental representations that include contextual details of goals, events, and actions, and the specific "how" details of an action. This review considers three lines of evidence for considering that dysregulation of level of goal/action identification may be a transdiagnostic process. First, there is evidence that different levels of identification have distinct functional consequences and that in non-clinical samples level of goal/action identification appears to be regulated in a flexible and adaptive way to match the level of goal/action identification to circumstances. Second, there is evidence that level of goal/action identification causally influences symptoms and processes involved in psychological disorders, including emotional response, repetitive thought, impulsivity, problem solving and procrastination. Third, there is evidence that the level of goal/action identification is biased and/or dysregulated in certain psychological disorders, with a bias towards more abstract identification for negative events in depression, GAD, PTSD, and social anxiety.
Abstract.
Author URL.
Pearson KA, Watkins ER, Mullan EG (2011). Rejection sensitivity prospectively predicts increased rumination.
Behav Res Ther,
49(10), 597-605.
Abstract:
Rejection sensitivity prospectively predicts increased rumination.
Converging research findings indicate that rumination is correlated with a specific maladaptive interpersonal style encapsulating submissive (overly-accommodating, non-assertive and self-sacrificing) behaviours, and an attachment orientation characterised by rejection sensitivity. This study examined the prospective longitudinal relationship between rumination, the submissive interpersonal style, and rejection sensitivity by comparing two alternative hypotheses: (a) the submissive interpersonal style and rejection sensitivity prospectively predict increased rumination; (b) rumination prospectively predicts the submissive interpersonal style and rejection sensitivity. Currently depressed (n = 22), previously depressed (n = 42) and never depressed (n = 28) individuals completed self-report measures assessing depressive rumination and key psychosocial measures of interpersonal style and behaviours, at baseline and again six months later. Baseline rejection sensitivity prospectively predicted increased rumination six months later, after statistically controlling for baseline rumination, gender and depression. Baseline rumination did not predict the submissive interpersonal style or rejection sensitivity. The results provide a first step towards delineating a potential casual relationship between rejection sensitivity and rumination, and suggest the potential value of clinical assessment and intervention for both rejection sensitivity and rumination in individuals who present with either difficulty.
Abstract.
Author URL.
Watkins ER, Mullan E, Wingrove J, Rimes K, Steiner H, Bathurst N, Eastman R, Scott J (2011). Rumination-focused cognitive-behavioural therapy for residual depression: phase II randomised controlled trial.
Br J Psychiatry,
199(4), 317-322.
Abstract:
Rumination-focused cognitive-behavioural therapy for residual depression: phase II randomised controlled trial.
BACKGROUND: About 20% of major depressive episodes become chronic and medication-refractory and also appear to be less responsive to standard cognitive-behavioural therapy (CBT). AIMS: to test whether CBT developed from behavioural activation principles that explicitly and exclusively targets depressive rumination enhances treatment as usual (TAU) in reducing residual depression. METHOD: Forty-two consecutively recruited participants meeting criteria for medication-refractory residual depression were randomly allocated to TAU v. TAU plus up to 12 sessions of individual rumination-focused CBT. The trial has been registered (ISRCTN22782150). RESULTS: Adding rumination-focused CBT to TAU significantly improved residual symptoms and remission rates. Treatment effects were mediated by change in rumination. CONCLUSIONS: This is the first randomised controlled trial providing evidence of benefits of rumination-focused CBT in persistent depression. Although suggesting the internal validity of rumination-focused CBT for residual depression, the trial lacked an attentional control group so cannot test whether the effects were as a result of the specific content of rumination-focused CBT v. non-specific therapy effects.
Abstract.
Author URL.
Watkins ER, Moberly NJ, Moulds MJ (2011). When the Ends Outweigh the Means: Mood and Level-of-construal in Depression.
Cognition and Emotion,
7, 1214-1227.
Abstract:
When the Ends Outweigh the Means: Mood and Level-of-construal in Depression
Research in healthy controls has found that mood influences cognitive processing via level of action identification: happy moods are associated with global and abstract processing; sad moods are associated with local and concrete processing. However, this pattern seems inconsistent with the high level of abstract processing observed in depressed patients, leading Watkins (2008, 2010) to hypothesise that the association between mood and level of goal/action identification is impaired in depression. We tested this hypothesis by measuring level of identification on the Behavioural Identification Form after happy and sad mood inductions in never-depressed controls and currently depressed patients. Participants used increasingly concrete action identifications as they became sadder and less happy, but this effect was moderated by depression status. Consistent with Watkins' (2008) hypothesis, increases in sad mood and decreases in happiness were associated with shifts towards the use of more concrete action identifications in never-depressed individuals, but not in depressed patients. These findings suggest that the putatively adaptive association between mood and level of identification is impaired in major depression.
Abstract.
Watkins ER, Moberly NJ, Moulds ML (2011). When the ends outweigh the means: mood and level of identification in depression.
Cogn Emot,
25(7), 1214-1227.
Abstract:
When the ends outweigh the means: mood and level of identification in depression.
Research in healthy controls has found that mood influences cognitive processing via level of action identification: happy moods are associated with global and abstract processing; sad moods are associated with local and concrete processing. However, this pattern seems inconsistent with the high level of abstract processing observed in depressed patients, leading Watkins (2008, 2010) to hypothesise that the association between mood and level of goal/action identification is impaired in depression. We tested this hypothesis by measuring level of identification on the Behavioural Identification Form after happy and sad mood inductions in never-depressed controls and currently depressed patients. Participants used increasingly concrete action identifications as they became sadder and less happy, but this effect was moderated by depression status. Consistent with Watkins' (2008) hypothesis, increases in sad mood and decreases in happiness were associated with shifts towards the use of more concrete action identifications in never-depressed individuals, but not in depressed patients. These findings suggest that the putatively adaptive association between mood and level of identification is impaired in major depression.
Abstract.
Author URL.
2010
Kuyken W, Watkins E, Holden E, White K, Taylor RS, Byford S, Evans A, Radford S, Teasdale JD, Dalgleish T, et al (2010). How does mindfulness-based cognitive therapy work?.
Behav Res Ther,
48(11), 1105-1112.
Abstract:
How does mindfulness-based cognitive therapy work?
Mindfulness-based cognitive therapy (MBCT) is an efficacious psychosocial intervention for recurrent depression (Kuyken et al. 2008; Ma & Teasdale, 2004; Teasdale et al. 2000). To date, no compelling research addresses MBCT's mechanisms of change. This study determines whether MBCT's treatment effects are mediated by enhancement of mindfulness and self-compassion across treatment, and/or by alterations in post-treatment cognitive reactivity. The study was embedded in a randomized controlled trial comparing MBCT with maintenance antidepressants (mADM) with 15-month follow-up (Kuyken et al. 2008). Mindfulness and self-compassion were assessed before and after MBCT treatment (or at equivalent time points in the mADM group). Post-treatment reactivity was assessed one month after the MBCT group sessions or at the equivalent time point in the mADM group. One hundred and twenty-three patients with ≥3 prior depressive episodes, and successfully treated with antidepressants, were randomized either to mADM or MBCT. The MBCT arm involved participation in MBCT, a group-based psychosocial intervention that teaches mindfulness skills, and discontinuation of ADM. The mADM arm involved maintenance on a therapeutic ADM dose for the duration of follow-up. Interviewer-administered outcome measures assessed depressive symptoms and relapse/recurrence across 15-month follow-up. Mindfulness and self-compassion were measured using self-report questionnaire. Cognitive reactivity was operationalized as change in depressive thinking during a laboratory mood induction. MBCT's effects were mediated by enhancement of mindfulness and self-compassion across treatment. MBCT also changed the nature of the relationship between post-treatment cognitive reactivity and outcome. Greater reactivity predicted worse outcome for mADM participants but this relationship was not evident in the MBCT group. MBCT's treatment effects are mediated by augmented self-compassion and mindfulness, along with a decoupling of the relationship between reactivity of depressive thinking and poor outcome. This decoupling is associated with the cultivation of self-compassion across treatment.
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Author URL.
Watkins ER (2010). Level of construal, mind wandering, and repetitive thought: Reply to McVay and Kane (2010).
Psychol Bull,
136(2), 198-201.
Abstract:
Level of construal, mind wandering, and repetitive thought: Reply to McVay and Kane (2010).
In this reply to the comment of McVay and Kane (2010), I consider their argument concerning how Watkins's (2008) elaborated control theory informs their perspective on the role of executive control in mind wandering. I argue that although in a number of places the elaborated control theory is consistent with the perspective of McVay and Kane that mind wandering represents a failure of executive control, their account makes a number of claims that are not articulated in the elaborated control theory-most notably, the hypothesis that level of construal moderates entry of thoughts into awareness. Moreover, the relevant literature suggests that the relationship between level of construal and executive control may be more complex, and may be determined by multiple factors beyond those proposed in this executive-control failure account of mind wandering. Finally, the implications of this model of mind wandering for understanding repetitive thought in general are considered, and it is proposed that examining level of executive control as a further moderating variable within elaborated control theory may be of value. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
Abstract.
Moberly NJ, Watkins ER (2010). Negative affect and ruminative self-focus during everyday goal pursuit.
Cogn Emot,
24(4), 729-739.
Abstract:
Negative affect and ruminative self-focus during everyday goal pursuit.
Models of self-regulation propose that negative affect is generated when progress towards goals is perceived to be inadequate. Similarly, ruminative thinking is hypothesised to be triggered by unattained goals (Martin & Tesser, 1996). We conducted an experience-sampling study in which participants recorded their negative affect, ruminative self-focus, and goal appraisals eight times daily for one week. Negative affect and ruminative self-focus were each associated with low levels of goal success and (with the exception of sadness) high levels of goal importance. As predicted, the combination of low goal success and high goal importance was associated with the highest levels of negative affect, and this interaction was marginally significant for ruminative self-focus. Decomposition of the ruminative self-focus measure revealed that the success by importance interaction was significantly associated with focus on problems but not focus on feelings. Findings did not differ for individuals reporting high versus low levels of depressive symptoms or trait rumination. These results suggest that self-regulatory models of goal pursuit provide a useful explanatory framework for the study of affect and ruminative thinking in everyday life.
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Author URL.
Galfin JM, Watkins ER, Harlow T (2010). Psychological distress and rumination in palliative care patients and their caregivers.
J Palliat Med,
13(11), 1345-1348.
Abstract:
Psychological distress and rumination in palliative care patients and their caregivers.
BACKGROUND: This study is the first to explore how rumination or recurrent dwelling may contribute to psychological distress in palliative care. We hypothesised that rumination is important in palliative care because: (1) rumination is triggered by significant life events; (2) the diagnosis of a life-limiting illness means the reevaluation of a number of personal goals, which may become unattainable, and, thereby, lead to rumination; (3) palliative care patients and caregivers report a number of existential concerns, which in their style and content are characteristic of rumination. METHODS: This study adopted a cross-sectional design, comparing samples of palliative care patients (n = 36), their caregivers (n = 29), and an age-matched control group (n = 30). Participants completed a combination of standardized questionnaires to assess their levels of anxiety, depression, and rumination, and open-ended interviews to identify the concerns they were ruminating on and their idiosyncratic experience of rumination. RESULTS: As predicted, palliative care patients and their caregivers reported significantly more psychological distress than the control group. Palliative care patients and their caregivers also reported significantly more rumination on existential concerns (e.g. about the future) than the control group. The frequency of existential concerns and measures of rumination reported by participants positively correlated with increased psychological distress. CONCLUSION: the results support the importance of addressing rumination on existential concerns in palliative care because of its association with psychological distress. Rumination was identified as a mechanism that may be important in addressing psychological distress in palliative care.
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Author URL.
Watkins ER, Pearson KA, Mullan EG, Moberly NJ (2010). Psychosocial correlates of depressive rumination.
Behaviour Research and Therapy,
48, 784-791.
Abstract:
Psychosocial correlates of depressive rumination
The study examined the relationship between brooding, the maladaptive sub-component of depressive rumination, an important cognitive mechanism implicated in the aetiology of depression, and a range of depressogenic psychosocial factors, including insecure attachment styles and maladaptive interpersonal behaviours. It was hypothesised that brooding (but not the more adaptive reflection component) is associated with an attachment pattern characterised by fear of rejection, and an interpersonal style characterised by submissiveness. Currently depressed (n = 29), previously depressed (n = 42) and never-depressed (n = 32) adults completed self-report measures assessing depressive symptoms, rumination (brooding and reflection), attachment orientation and maladaptive interpersonal behaviours. The study hypotheses were partially supported: After controlling for gender and depressive symptoms, brooding was significantly associated with one indicator of underlying rejection concerns (rejection sensitivity, p =. 05), but was not associated with another indicator of underlying rejection concerns (anxious attachment style) or with avoidant attachment style. After controlling for depressive symptoms, brooding was uniquely associated with the submissive interpersonal style (p <. 01). Brooding was not correlated with needy or cold interpersonal styles after controlling for depressive symptoms.
Abstract.
Kuyken W, Byford S, Byng R, Dalgleish T, Lewis G, Taylor R, Watkins ER, Hayes R, Lanham P, Kessler D, et al (2010). Study protocol for a randomized controlled trial comparing mindfulness-based cognitive therapy with maintenance anti-depressant treatment in the prevention of depressive relapse/recurrence: the PREVENT trial.
Trials,
11Abstract:
Study protocol for a randomized controlled trial comparing mindfulness-based cognitive therapy with maintenance anti-depressant treatment in the prevention of depressive relapse/recurrence: the PREVENT trial.
BACKGROUND: Depression is a common and distressing mental health problem that is responsible for significant individual disability and cost to society. Medication and psychological therapies are effective for treating depression and maintenance anti-depressants (m-ADM) can prevent relapse. However, individuals with depression often express a wish for psychological help that can help them recover from depression in the long-term. We need to develop psychological therapies that prevent depressive relapse/recurrence. A recently developed treatment, Mindfulness-based Cognitive Therapy (MBCT, see http://www.mbct.co.uk) shows potential as a brief group programme for people with recurring depression. In two studies it has been shown to halve the rates of depression recurring compared to usual care.This trial asks the policy research question, is MBCT superior to m-ADM in terms of: a primary outcome of preventing depressive relapse/recurrence over 24 months; and, secondary outcomes of (a) depression free days, (b) residual depressive symptoms, (c) antidepressant (ADM) usage, (d) psychiatric and medical co-morbidity, (e) quality of life, and (f) cost effectiveness? an explanatory research question asks is an increase in mindfulness skills the key mechanism of change? METHODS/DESIGN: the design is a single blind, parallel RCT examining MBCT vs. m-ADM with an embedded process study. To answer the main policy research question the proposed trial compares MBCT plus ADM-tapering with m-ADM for patients with recurrent depression. Four hundred and twenty patients with recurrent major depressive disorder in full or partial remission will be recruited through primary care. Depressive relapse/recurrence over two years is the primary outcome variable. The explanatory question will be addressed in two mutually informative ways: quantitative measurement of potential mediating variables pre/post-treatment and a qualitative study of service users' views and experiences. DISCUSSION: If the results of our exploratory trial are extended to this definitive trial, MBCT will be established as an alternative approach to maintenance anti-depressants for people with a history of recurrent depression. The process studies will provide evidence about the effective components which can be used to improve MBCT and inform theory as well as other therapeutic approaches. TRIAL REGISTRATION NUMBER: ISRCTN26666654.
Abstract.
Author URL.
Pearson KA, Watkins ER, Mullan EG (2010). Submissive interpersonal style mediates the effect of brooding on future depressive symptoms.
Behav Res Ther,
48(10), 966-973.
Abstract:
Submissive interpersonal style mediates the effect of brooding on future depressive symptoms.
Theoretical models and empirical evidence suggest that brooding, the maladaptive sub-component of depressive rumination, is associated with a sub-set of depressogenic interpersonal difficulties characterised by submissive interpersonal behaviours and rejection sensitivity. This study tested whether these cognitive and interpersonal vulnerability factors independently predicted future depression and investigated their interdependence in predicting depression. A heterogeneous adult sample completed self-report measures assessing depressive symptoms, brooding, reflection, rejection sensitivity and maladaptive interpersonal behaviours, at baseline and six months later. When examined separately, brooding and an interpersonal component reflecting submissive, (overly-accommodating, non-assertive, and self-sacrificing) interpersonal behaviours each prospectively predicted increased depressive symptoms six months later, after controlling for baseline depressive symptoms and gender. When examined together, the submissive interpersonal style but not brooding predicted depression, indicating that this maladaptive interpersonal style may mediate the effect of brooding on future depression. Thus, the effects of brooding on depression may in part depend on its association with an interpersonal style characterised by submissiveness.
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Author URL.
Pearson KA, Watkins ER, Kuyken W, Mullan EG (2010). The psychosocial context of depressive rumination: ruminative brooding predicts diminished relationship satisfaction in individuals with a history of past major depression.
Br J Clin Psychol,
49(Pt 2), 275-280.
Abstract:
The psychosocial context of depressive rumination: ruminative brooding predicts diminished relationship satisfaction in individuals with a history of past major depression.
OBJECTIVE: to test the hypothesis that rumination contributes to poor social functioning by examining whether ruminative brooding predicts subsequent relationship satisfaction in individuals with a history of major depression. METHOD: Participants (N=57) were interviewed to assess depressive symptoms and completed self-report measures of brooding and relationship satisfaction, at intake into the study (Time 1) and 3 months later (Time 2). RESULTS: Brooding was related concurrently to relationship satisfaction at Time 2 (p
Abstract.
Author URL.
2009
Vassilopoulos SP, Watkins ER (2009). Adaptive and maladaptive self-focus: a pilot extension study with individuals high and low in fear of negative evaluation.
Behav Ther,
40(2), 181-189.
Abstract:
Adaptive and maladaptive self-focus: a pilot extension study with individuals high and low in fear of negative evaluation.
Previous research in depressed participants has supported the differentiation of self-focus into distinct modes of self-attention with distinct functional effects. In particular, Rimes and Watkins (2005) investigated the effects of self-focused rumination on overgeneral thinking and found that analytical, evaluative self-focus increased global negative self-judgments, whereas self-focus low in analytical thinking decreased such judgments in depressed participants. Given that self-focused attention and rumination have been implicated in the maintenance of social anxiety, the present study investigated the effects of these two distinct forms of self-focused attention on global negative self-judgments in an analogue sample for social anxiety (high and low fear of negative evaluation, FNE). Individuals high and low in FNE (n=41 per group) were randomly allocated to analytic (abstract, evaluative) or experiential (concrete, process-focused) self-focused manipulations. As predicted, in high FNE individuals, the experiential self-focus condition decreased ratings of the self as worthless and incompetent pre- to post-manipulation, whereas the analytical self-focus condition maintained such negative self-judgments. Analytical and experiential self-focus did not differ in their effects on mood. The results suggest that an experiential mode of self-focused rumination may be adaptive in social anxiety.
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Author URL.
Mansell W, Harvey A, Watkins E, Shafran R (2009). Conceptual foundations of the transdiagnostic approach to CBT.
Journal of Cognitive Psychotherapy,
23(1), 6-19.
Abstract:
Conceptual foundations of the transdiagnostic approach to CBT
This article defines and explains the transdiagnostic approach to cognitive-behavioral therapy (CBT) and elaborates on its conceptual foundations and implications for research and practice. We argue that the approach has good philosophical, historical, pragmatic, and empirical foundations. We distinguish between transdiagnostic approaches based on multiple processes that are universally applied (e.g. Harvey, Watkins, Mansell, & Shafran, 2004), multiple processes limited in the range of disorders covered (e.g. Fairburn, Cooper, & Shafran, 2003), symptom-based accounts (e.g. Persons, 1986), and universal single process accounts (e.g. experiential avoidance, self-absorption). We summarize existing evidence and identify key issues relating to the methodology of future research on the transdiagnostic approach. The article concludes by highlighting the great potential benefits of the approach and highlights significant practical, political, and scientific obstacles to putting it into practice on a large scale. © 2009 Springer Publishing Company.
Abstract.
Watkins ER, Moberly NJ (2009). Concreteness training reduces dysphoria: a pilot proof-of-principle study.
Behav Res Ther,
47(1), 48-53.
Abstract:
Concreteness training reduces dysphoria: a pilot proof-of-principle study.
We hypothesized that a tendency towards abstract, general and decontextualized processing is a cognitive distortion that causally contributes to symptoms of depression. This hypothesis predicts that training dysphoric individuals to become more concrete and specific in their thinking would reduce depressive symptoms. To test this prediction, participants with stable dysphoria (scoring > or =14 on BDI-II at 2 consecutive weekly assessments) were randomly allocated in an additive design either to an active intervention control consisting of relaxation training or relaxation training plus concreteness training. Concreteness training involved repeated mental exercises designed to encourage more concrete and specific thinking about emotional events. Both interventions involved a training session and then repeated daily use of compact disc recordings for 7 days. Relaxation training plus concreteness training resulted in significantly greater decreases in depressive symptoms and marginally significantly greater decreases in state rumination than relaxation training alone. These findings suggest the potential value of concreteness training as a guided self-help intervention for mild-to-moderate depressive symptoms.
Abstract.
Author URL.
Watkins ER, Baeyens CB, Read R (2009). Concreteness training reduces dysphoria: proof-of-principle for repeated cognitive bias modification in depression.
J Abnorm Psychol,
118(1), 55-64.
Abstract:
Concreteness training reduces dysphoria: proof-of-principle for repeated cognitive bias modification in depression.
A tendency toward abstract and overgeneral processing is a cognitive bias hypothesized to causally contribute to symptoms of depression. This hypothesis predicts that training dysphoric individuals to become more concrete and specific in their thinking would reduce depressive symptoms. To test this prediction, 60 participants with dysphoria were randomly allocated either to (a) concreteness training; (b) bogus concreteness training, matched with concreteness training for treatment rationale, experimenter contact, and treatment duration but without active engagement in concrete thinking; (c) a waiting-list, no training control. Concreteness training resulted in significantly greater decreases in depressive symptoms and significantly greater increases in concrete thinking than the waiting-list and the bogus training control, and significantly greater decreases in rumination than the waiting-list control. These findings suggest that concreteness training has potential as a guided self-help intervention for mild-to-moderate depressive symptoms.
Abstract.
Watkins ER (2009). Depressive Rumination and Co-Morbidity: Evidence for Brooding as a Transdiagnostic Process.
J Ration Emot Cogn Behav Ther,
27(3), 160-175.
Abstract:
Depressive Rumination and Co-Morbidity: Evidence for Brooding as a Transdiagnostic Process.
A sample of 116 patients with unipolar mood disorders referred to a specialist research clinic were assessed to investigate (a) whether rumination is a transdiagnostic process that is related to co-morbid Axis I and II symptoms and diagnosis in depressed patients; (b) whether common findings in the depressive rumination literature could be replicated in a recurrent depressed sample. Consistent with the transdiagnostic hypothesis, rumination was positively associated with both depression and anxiety, brooding was related to co-morbid obsessive-compulsive disorder and generalized anxiety disorder, and rumination was associated with traits associated with borderline personality disorder, most notably self-report of unstable relationships and inconsistent sense of self. As predicted, rumination was equivalent in currently depressed and formerly depressed patients, suggesting that rumination is not simply dependent on mood state or clinical status. As predicted, the brooding subtype most strongly correlated with depressed and anxious symptoms, consistent with previous observations that brooding is the more maladaptive form of rumination. As predicted, rumination was associated with reports of sexual abuse. Inconsistent with previous findings, there was no gender difference in rumination.
Abstract.
Author URL.
Watkins ER (2009). Depressive rumination: Investigating mechanisms to improve cognitive behavioural treatments.
Cognitive Behaviour Therapy,
38(SUPPL.1), 8-14.
Abstract:
Depressive rumination: Investigating mechanisms to improve cognitive behavioural treatments
Rumination has been identified as a core process in the development and maintenance of depression. Treatments targeting ruminative processes may, therefore, be particularly helpful for treating chronic and recurrent depression. The development of such treatments requires translational research that marries clinical trials, process-outcome research, and basic experimental research that investigates the mechanisms underpinning pathological rumination. For example, a program of experimental research has demonstrated that there are distinct processing modes during rumination that have distinct functional effects for the consequences of rumination on a range of clinically relevant cognitive and emotional processes: an adaptive style characterized by more concrete, specific processing and a maladaptive style characterized by abstract, overgeneral processing. Based on this experimental work, two new treatments for depression have been developed and evaluated: (a) rumination-focused cognitive therapy, an individual-based face-to-face therapy, which has encouraging results in the treatment of residual depression in an extended case series and a pilot randomized controlled trial; and (b) concreteness training, a facilitated self-help intervention intended to increase specificity of processing in patients with depression, which has beneficial findings in a proof-of-principle study in a dysphoric population. These findings indicate the potential value of process-outcome research (a) explicitly targeting identified vulnerability processes and (b) developing interventions informed by research into basic mechanisms. © 2009 Taylor & Francis.
Abstract.
Watkins ER (2009). Depressive rumination: investigating mechanisms to improve cognitive behavioural treatments.
Cogn Behav Ther,
38 Suppl 1(S1), 8-14.
Abstract:
Depressive rumination: investigating mechanisms to improve cognitive behavioural treatments.
Rumination has been identified as a core process in the development and maintenance of depression. Treatments targeting ruminative processes may, therefore, be particularly helpful for treating chronic and recurrent depression. The development of such treatments requires translational research that marries clinical trials, process-outcome research, and basic experimental research that investigates the mechanisms underpinning pathological rumination. For example, a program of experimental research has demonstrated that there are distinct processing modes during rumination that have distinct functional effects for the consequences of rumination on a range of clinically relevant cognitive and emotional processes: an adaptive style characterized by more concrete, specific processing and a maladaptive style characterized by abstract, overgeneral processing. Based on this experimental work, two new treatments for depression have been developed and evaluated: (a) rumination-focused cognitive therapy, an individual-based face-to-face therapy, which has encouraging results in the treatment of residual depression in an extended case series and a pilot randomized controlled trial; and (b) concreteness training, a facilitated self-help intervention intended to increase specificity of processing in patients with depression, which has beneficial findings in a proof-of-principle study in a dysphoric population. These findings indicate the potential value of process-outcome research (a) explicitly targeting identified vulnerability processes and (b) developing interventions informed by research into basic mechanisms.
Abstract.
Author URL.
Watkins ER, Moulds ML (2009). Thought Control Strategies, Thought Suppression, and Rumination in Depression.
INTERNATIONAL JOURNAL OF COGNITIVE THERAPY,
2(3), 235-251.
Author URL.
2008
Mansell W, Harvey A, Watkins ER, Shafran R (2008). Cognitive Behavioral Processes Across Psychological Disorders: a Review of the Utility and Validity of the Transdiagnostic Approach.
INTERNATIONAL JOURNAL OF COGNITIVE THERAPY,
1(3), 181-191.
Author URL.
Watkins ER (2008). Constructive and unconstructive repetitive thought.
Psychol Bull,
134(2), 163-206.
Abstract:
Constructive and unconstructive repetitive thought.
The author reviews research showing that repetitive thought (RT) can have constructive or unconstructive consequences. The main unconstructive consequences of RT are (a) depression, (b) anxiety, and (c) difficulties in physical health. The main constructive consequences of RT are (a) recovery from upsetting and traumatic events, (b) adaptive preparation and anticipatory planning, (c) recovery from depression, and (d) uptake of health-promoting behaviors. Several potential principles accounting for these distinct consequences of RT are identified within this review: (a) the valence of thought content, (b) the intrapersonal and situational context in which RT occurs, and (c) the level of construal (abstract vs. concrete processing) adopted during RT. of the existing models of RT, it is proposed that an elaborated version of the control theory account provides the best theoretical framework to account for its distinct consequences.
Abstract.
Author URL.
Watkins, E.R. Williams, W.H. (2008). Depressive Rumination reduces specificity of Autobiographical Memory Recall in Acquired Brain Injury. Journal of the International Neuropsychological Society, 14(1), 63-70.
Jacoby N, Brewin CR, Watkins E (2008). Effects of contextual questions on experimentally induced dysphoria.
Cognition and Emotion,
22(4), 753-760.
Abstract:
Effects of contextual questions on experimentally induced dysphoria
In a replication and extension of Watkins, Teasdale, and Williams (2003), a scrambled sentences paradigm was used to test whether prompting contextual processing of negative cognitive primes would limit the activation of dysphoric mood. Participants were divided into two groups and, after a dysphoric mood induction procedure, were asked to unscramble sentences that either did or did not emphasise the contextual aspects of moods. Consistent with Watkins et al. participants' despondency decreased significantly more in the contextual group than in the neutral group. This effect could not be accounted for by variations in the way sentences were unscrambled.
Abstract.
Kuyken W, Byford S, Taylor RS, Watkins E, Holden E, White K, Barrett B, Byng R, Evans A, Mullan E, et al (2008). Mindfulness-based cognitive therapy to prevent relapse in recurrent depression.
J Consult Clin Psychol,
76(6), 966-978.
Abstract:
Mindfulness-based cognitive therapy to prevent relapse in recurrent depression.
For people at risk of depressive relapse, mindfulness-based cognitive therapy (MBCT) has an additive benefit to usual care (H. F. Coelho, P. H. Canter, & E. Ernst, 2007). This study asked if, among patients with recurrent depression who are treated with antidepressant medication (ADM), MBCT is comparable to treatment with maintenance ADM (m-ADM) in (a) depressive relapse prevention, (b) key secondary outcomes, and (c) cost effectiveness. The study design was a parallel 2-group randomized controlled trial comparing those on m-ADM (N = 62) with those receiving MBCT plus support to taper/discontinue antidepressants (N = 61). Relapse/recurrence rates over 15-month follow-ups in MBCT were 47%, compared with 60% in the m-ADM group (hazard ratio = 0.63; 95% confidence interval: 0.39 to 1.04). MBCT was more effective than m-ADM in reducing residual depressive symptoms and psychiatric comorbidity and in improving quality of life in the physical and psychological domains. There was no difference in average annual cost between the 2 groups. Rates of ADM usage in the MBCT group was significantly reduced, and 46 patients (75%) completely discontinued their ADM. For patients treated with ADM, MBCT may provide an alternative approach for relapse prevention.
Abstract.
Raes F, Watkins ER, Williams JMG, Hermans D (2008). Non-ruminative processing reduces overgeneral autobiographical memory retrieval in students.
Behav Res Ther,
46(6), 748-756.
Abstract:
Non-ruminative processing reduces overgeneral autobiographical memory retrieval in students.
It has been suggested that overgeneral memory (OGM) represents a vulnerability marker for depression [Williams, J. M. G. Barnhofer, T. Crane, C. Hermans, D. Raes, F. Watkins, E. et al. (2007). Autobiographical memory specificity and emotional disorder. Psychological Bulletin, 133, 122-148]. One important underlying mechanism involved is rumination [e.g. Watkins, E. & Teasdale, J. D. (2001). Rumination and overgeneral memory in depression: Effects of self-focus and analytic thinking. Journal of Abnormal Psychology, 110, 353-357; Watkins, E. & Teasdale, J. D. (2004). Adaptive and maladaptive self-focus in depression. Journal of Affective Disorders, 82, 1-8]. It is as yet unclear to what extent the relationship between rumination and OGM also applies to nonclinical groups. The present study investigated this relationship in a nonclinical student sample, using an innovative sentence completion procedure to assess OGM. As hypothesized, the experimental induction of a concrete, process-focused (or non-ruminative) thinking style (n=102) led to less OGMs as compared to the experimental induction of an abstract, evaluative (or ruminative) thinking style (n=93). The present results add to the accumulating body of evidence that abstract, evaluative (or ruminative) thinking is a crucial underlying process of OGM, and expand prior literature by extending this idea to nonclinical individuals and by using a new procedure to assess OGM.
Abstract.
Author URL.
Watkins E, Moberly NJ, Moulds ML (2008). Processing mode causally influences emotional reactivity: Distinct effects of abstract versus concrete construal on emotional response.
Emotion,
8(3), 364-378.
Abstract:
Processing mode causally influences emotional reactivity: Distinct effects of abstract versus concrete construal on emotional response
Three studies are reported showing that emotional responses to stress can be modified by systematic prior practice in adopting particular processing modes. Participants were induced to think about positive and negative scenarios in a mode either characteristic of or inconsistent with the abstract-evaluative mind-set observed in depressive rumination, via explicit instructions (Experiments 1 and 2) and via implicit induction of interpretative biases (Experiment 3), before being exposed to a failure experience. In all three studies, participants trained into the mode antithetical to depressive rumination demonstrated less emotional reactivity following failure than participants trained into the mode consistent with depressive rumination. These findings provide evidence consistent with the hypothesis that processing mode modifies emotional reactivity and support the processing-mode theory of rumination.
Abstract.
Ehring T, Watkins ER (2008). Repetitive Negative Thinking as a Transdiagnostic Process.
INTERNATIONAL JOURNAL OF COGNITIVE THERAPY,
1(3), 192-205.
Author URL.
Moberly NJ, Watkins ER (2008). Ruminative self-focus and negative affect: an experience sampling study.
J Abnorm Psychol,
117(2), 314-323.
Abstract:
Ruminative self-focus and negative affect: an experience sampling study.
The authors conducted an experience sampling study to investigate the relationship between momentary ruminative self-focus and negative affect. Ninety-three adults recorded these variables at quasi-random intervals 8 times daily for 1 week. Scores on questionnaire measures of dispositional rumination were associated with mean levels of momentary ruminative self-focus over the experience sampling week. Concurrently, momentary ruminative self-focus was positively associated with negative affect. Cross-lagged analyses revealed that whereas ruminative self-focus predicted negative affect at a subsequent occasion, negative affect also predicted ruminative self-focus at a subsequent occasion. Decomposition of the dispositional rumination measure suggested that brooding, but not reflective pondering, was associated with higher mean levels of negative affect. Though broadly consistent with Nolen-Hoeksema's (1991) response styles theory, these results suggest that a reciprocal relationship exists between ruminative self-focus and negative affect.
Abstract.
Author URL.
Moberly NJ, Watkins ER (2008). Ruminative self-focus, negative life events, and negative affect.
Behav Res Ther,
46(9), 1034-1039.
Abstract:
Ruminative self-focus, negative life events, and negative affect.
Ruminative thinking is believed to exacerbate the psychological distress that follows stressful life events. An experience-sampling study was conducted in which participants recorded negative life events, ruminative self-focus, and negative affect eight times daily over one week. Occasions when participants reported a negative event were marked by higher levels of negative affect. Additionally, negative events were prospectively associated with higher levels of negative affect at the next sampling occasion, and this relationship was partially mediated by momentary ruminative self-focus. Depressive symptoms were associated with more frequent negative events, but not with increased reactivity to negative events. Trait rumination was associated with reports of more severe negative events and increased reactivity to negative events. These results suggest that the extent to which a person engages in ruminative self-focus after everyday stressors is an important determinant of the degree of distress experienced after such events. Further, dispositional measures of rumination predict mood reactivity to everyday stressors in a non-clinical sample.
Abstract.
Author URL.
2007
Watkins ER, Barnhofer T, Crane C, Dalgleish T (2007). Autobiographical memory specificity and emotional disorder. Psychological Bulletin, 133(1), 122-148.
Watkins, E. (2007). Depression- investigation. In Lindsay S, Powell G (Eds.) The Handbook of Clinical Adult Psychology (3 rd Edition), Routledge.
Watkins E, Moulds ML (2007). Reduced concreteness of rumination in depression: a pilot study.
Personality and Individual Differences,
43(6), 1386-1395.
Abstract:
Reduced concreteness of rumination in depression: a pilot study
We hypothesized that the reduced concreteness theory of worry (Stöber & Borkovec, 2002) would be applicable to negative recurrent thinking in general, including depressive rumination. To test this prediction, the current study compared the concreteness of problem descriptions of currently depressed (n = 30), recovered depressed (n = 29) and never-depressed (n = 30) individuals. Participants provided open-ended descriptions of two current major problems about which they repeatedly dwell. Blind ratings demonstrated reduced concreteness of the problem descriptions and associated perceived consequences reported by the depressed group relative to the recovered depressed and control groups, which did not differ from each other. These findings are consistent with the hypothesis that recurrent thinking in depression involves reduced concreteness, paralleling the findings in GAD. © 2007 Elsevier Ltd. All rights reserved.
Abstract.
Perkins, N. Williams, J.M.G. Golden, J. Watkins ER (2007). Reduced specificity of autobiographical memory and depression: the role of executive control.
Journal of Experimental Psychology: GeneralAbstract:
Reduced specificity of autobiographical memory and depression: the role of executive control.
.It has been widely established that depressed mood states and clinical depression, as well as a range of other psychiatric disorders, are associated with a relative difficulty in accessing specific autobiographical information in response to emotion-related cue words on an Autobiographical Memory Test (AMT; J. M. G. Williams & K. Broadbent, 1986). In 8 studies the authors examined the extent to which this relationship is a function of impaired executive control associated with these mood states and clinical disorders. Studies 1–4 demonstrated that performance on the AMT is associated with performance on measures of executive control, independent of depressed mood. Furthermore, Study 1 showed that executive control (as measured by verbal fluency) mediated the relationship between both depressed mood and a clinical diagnosis of eating disorder and AMT performance. Using a stratified sample in Study 5, the authors confirmed the positive association between depressed mood and impaired performance on the AMT. Studies 6–8 involved experimental manipulations of the parameters of the AMT designed to further indicate that reduced executive control is to a significant extent driving the relationship between depressed mood and AMT performance. The potential role of executive control in accounting for other aspects of the AMT literature is discussed.
Abstract.
Moulds, M. Watkins E (2007). Revealing negative thinking in recovered depression. Behaviour Research and Therapy
Watkins ER, Moulds M (2007). Revealing negative thinking in recovered major depression: a preliminary investigation.
Behav Res Ther,
45(12), 3069-3076.
Abstract:
Revealing negative thinking in recovered major depression: a preliminary investigation.
Previous research suggests that formerly dysphoric individuals engage in effortful strategies (e.g. thought suppression) that may mask underlying depressive thinking. The addition of a cognitive load, such as recalling a 6-digit number, which interferes with effortful mental control, reveals depressive thinking in formerly dysphoric individuals. This preliminary study tested whether this effect of cognitive load on revealing negative thinking generalizes to formerly clinically depressed patients. Currently depressed patients, recovered depressed patients and never-depressed patients unscrambled sentences that could form either positive or negative statements, after random allocation to either cognitive load or no cognitive load conditions. The number of negative statements unscrambled was used as an index of negative thinking. Without a load, recovered depressed patients did not differ from never-depressed controls: both groups completed fewer negative statements than currently depressed patients. However, the cognitive load increased negative statements in the recovered depressed group, making them resemble the currently depressed group more than the never-depressed group. These preliminary findings extend previous demonstrations of cognitive load unmasking negative thinking in dysphoric students to a clinical population, suggesting that formerly depressed patients utilize effortful strategies to minimize the report of negative thinking, which is undermined by the addition of a cognitive load.
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Watkins E, Scott J, Wingrove J, Rimes K, Bathurst N, Steiner H, Kennell-Webb S, Moulds M, Malliaris Y (2007). Rumination-focused cognitive behaviour therapy for residual depression: a case series.
Behav Res Ther,
45(9), 2144-2154.
Abstract:
Rumination-focused cognitive behaviour therapy for residual depression: a case series.
The treatment of chronic and recurrent depression is a priority for the development of new interventions. The maintenance of residual symptoms following acute treatment for depression is a risk factor for both chronic depression and further relapse/recurrence. This open case series provides the first data on a cognitive-behavioural treatment for residual depression that explicitly targets depressive rumination. Rumination has been identified as a key factor in the onset and maintenance of depression, which is found to remain elevated following remission from depression. Fourteen consecutively recruited participants meeting criteria for medication--refractory residual depression [Paykel, E.S. Scott, J. Teasdale, J.D. Johnson, A.L. Garland, A. Moore, R. et al. 1999. Prevention of relapse in residual depression by cognitive therapy--a controlled trial. Archives of General Psychiatry 56, 829-835] were treated individually for up to 12 weekly 60-min sessions. Treatment specifically focused on switching patients from less helpful to more helpful styles of thinking through the use of functional analysis, experiential/imagery exercises and behavioural experiments. Treatment produced significant improvements in depressive symptoms, rumination and co-morbid disorders: 71% responded (50% reduction on Hamilton Depression Rating Scale) and 50% achieved full remission. Treating depressive rumination appears to yield generalised improvement in depression and co-morbidity. This study provides preliminary evidence that rumination-focused CBT may be an efficacious treatment for medication--refractory residual depression.
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2006
Malliaris Y, Watkins E, Scott J (2006). Intrusive memories in residual unipolar depression: a test of Brewin's schema activation hypothesis.
JOURNAL OF AFFECTIVE DISORDERS,
91, S100-S100.
Author URL.
Moberly NJ, Watkins ER (2006). Processing mode influences the relationship between trait rumination and emotional vulnerability.
Behav Ther,
37(3), 281-291.
Abstract:
Processing mode influences the relationship between trait rumination and emotional vulnerability.
Watkins (2004) found that the mode of processing adopted during expressive writing following a failure influenced emotional recovery from the failure as a function of level of trait rumination. At higher levels of trait rumination, negative mood 12 hours after the failure was greater, but only in an abstract, evaluative writing condition and not in a concrete, process-focused condition. The current study examined whether this interaction of trait rumination with processing mode would generalize to emotional vulnerability to a subsequent negative stressor. Participants repeatedly focused on both positive and negative scenarios in either a concrete, process-focused or an abstract, evaluative mode, before a failure experience. As predicted, after the failure experience, higher levels of trait rumination were associated with lower levels of positive affect, but only for participants in the abstract, evaluative condition and not for participants in the concrete, process-focused condition. This finding is consistent with processing mode influencing the relationship between trait rumination and emotional vulnerability.
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2005
Watkins E, Moulds M, Mackintosh B (2005). Comparisons between rumination and worry in a non-clinical population.
Behav Res Ther,
43(12), 1577-1585.
Abstract:
Comparisons between rumination and worry in a non-clinical population.
Major depression is characterised by ruminative thinking whilst worry is considered central in generalised anxiety disorder (GAD). However, not only do these two forms of repetitive negative thinking regularly co-occur in the same individual but similarities between worry and rumination are apparent. Adapting a methodology developed by Langlois et al. (Behav. Res. Therapy 38 (2000) 157-173), this study directly compared worry and rumination in a non-clinical population across a series of variables drawn from current models (appraisal, general descriptors and emotional reactions). Each of 149 female volunteers, with a wide range of age and backgrounds, identified a ruminative thought and a different worry and subsequently evaluated them using the Cognitive Intrusion Questionnaire. Significant within-subject differences were revealed on seven variables: chronicity, unpleasantness, reality of problem, future orientation, past orientation, feelings of worry and insecurity. There were no differences found between worry and rumination on appraisals and strategies, consistent with accounts that propose that worry and rumination share the same processes but involve different content (Cognitive Ther. Res. 24 (2000) 671-688).
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Author URL.
Moulds, M. Mackintosh, B. Watkins E (2005). Differences and similarities between rumination and worry in a non-clinical population. Behaviour Research and Therapy
Watkins ER, Moulds M (2005). Distinct modes of ruminative self-focus: Impact of abstract versus concrete rumination on problem solving in depression. Emotion, 5(3), 319-328.
Watkins, E.R. Scott, J. (2005). Intrusive memories in residual unipolar depression: a test of Brewin's schema activation hypothesis. Journal of Affective Disorders, 91, S100-S100 Sul 1.
Hayward, P. Watkins, E.R. Wright, K. (2005). Outcome of a two-year follow-up of a cognitive therapy of relapse prevention in bipolar disorder. \r. American Journal of Psychiatry
Moulds, M. Watkins E (2005). Positive Beliefs about Rumination in Depression- a replication and extension. Personality and Individual Differences, 39(1), 73-82.
Watkins, E.R. Ramponi, C. (2005). Reducing specificity of autobiographical memory in non-clinical participants: the role of rumination and schematic models. Cognition and Emotion, 20, 328-350.
Lam DH, Hayward P, Watkins ER, Wright K, Sham P (2005). Relapse prevention in patients with bipolar disorder: cognitive therapy outcome after 2 years.
Am J Psychiatry,
162(2), 324-329.
Abstract:
Relapse prevention in patients with bipolar disorder: cognitive therapy outcome after 2 years.
OBJECTIVE: in a previous randomized controlled study, the authors reported significant beneficial effects of cognitive therapy for relapse prevention in bipolar disorder patients up to 1 year. This study reports additional 18-month follow-up data and presents an overview of the effect of therapy over 30 months. METHOD: Patients with DSM-IV bipolar I disorder (N=103) suffering from frequent relapses were randomly assigned into a cognitive therapy plus medication group or a control condition of medication only. Independent raters, who were blind to patient group status, assessed patients at 6-month intervals. RESULTS: over 30 months, the cognitive therapy group had significantly better outcome in terms of time to relapse. However, the effect of relapse prevention was mainly in the first year. The cognitive therapy group also spent 110 fewer days (95% CI=32 to 189) in bipolar episodes out of a total of 900 for the whole 30 months and 54 fewer days (95% CI=3 to 105) in bipolar episodes out of a total of 450 for the last 18 months. Multivariate analyses of variance showed that over the last 18 months, the cognitive therapy group exhibited significantly better mood ratings, social functioning, coping with bipolar prodromes, and dysfunctional goal attainment cognition. CONCLUSIONS: Patients in the cognitive therapy group had significantly fewer days in bipolar episodes after the effect of medication compliance was controlled. However, the results showed that cognitive therapy had no significant effect in relapse reduction over the last 18 months of the study period. Further studies should explore the effect of booster sessions or maintenance therapy.
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Watkins, E.R. Holden, E. Cook, W. (2005). Rumination in Adolescents at Risk for Depression. Journal of Affective Disorders, 96, 39-47.
Watkins, E.R. (2005). The effects of self-focused rumination on global negative self-judgements in depression. Behaviour Research and Therapy
Watkins, E. (2005). Worry and Rumination: Recurrent Negative Thinking and Affective Disorders. Progress in Neurology and Psychiatry, 9, 28-32.
2004
Watkins, E.R. (2004). Adaptive and Maladaptive Ruminative self-focus during Emotional Processing. Behaviour Research and Therapy, 42, 1037-1052.
Teasdale, J.D. Watkins ER (2004). Adaptive and Maladaptive Self-focus in Depression. Journal of Affective Disorders, 82, 1-8.
Watkins, E.R. (2004). Appraisals and Strategies Associated with Rumination and Worry. Personality and Individual Differences, 37, 679-694.
Watkins, E.R. (2004). Brief psychotherapies for depression: current status. Current Opinion in Psychiatry, 17, 3-7.
Watkins, E. Mansell, W. Shafran, R. (2004). Cognitive behavioural processes across psychological disorders: a transdiagnostic approach to research and treatment., Oxford University Press.
Watkins, E.R. (2004). Rumination and future thinking in depression. British Journal of Clinical Psychology, 43, 129-142.
2003
Watkins ER, Bright J, Hayward P, Lam D (2003). A randomised controlled study of cognitive therapy for relapse prevention for bipolar affective disorder - Outcome of the first year. Archives of General Psychiatry, 60(2), 145-152.
Watkins, E.R. (2003). Combining cognitive therapy with medication in bipolar disorder. Advances in Psychiatric Treatment, 9, 110-116.
Watkins E, Teasdale JD, Williams RM (2003). Contextual questions prevent mood primes from maintaining experimentally induced dysphoria.
Cognition and Emotion,
17(3), 455-475.
Abstract:
Contextual questions prevent mood primes from maintaining experimentally induced dysphoria
We investigated the effects of questions designed to increase a wider awareness of the context in which moods occur on mood-maintaining primes in induced dysphoria. These questions were incorporated, with the primes (negative Velten mood induction statements) into a scrambled sentence task. In Study 1, contextual questions produced a significantly greater reduction in despondency compared to control questions. Study 2 replicated this finding and also demonstrated that contextual questions reduced corrugator EMG response to repeated despondency-inducing statements. The results indicate that contextual questions can prevent negative primes from maintaining depressed mood, consistent with Brewin's (1989) suggestion that one mechanism of psychotherapy is reducing the activation of situationally accessible negative representations.
Abstract.
Watkins E (2003). Depression in Context: Strategies for Guided Action.
BEHAVIOURAL AND COGNITIVE PSYCHOTHERAPY,
31(2), 227-228.
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Watkins E (2003). Excessive Appetites: a Psychological View of the Addictions, 2nd edition.
BEHAVIOURAL AND COGNITIVE PSYCHOTHERAPY,
31(2), 221-222.
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Swain, S. Widmer, S. Watkins, E. (2003). The development and beta-test of a computer-therapy program for anxiety and depression: hurdles and lessons. Computers in Human Behaviour, 19, 277-289.
Watkins E (2003). Understanding suicidal behaviour. The suicidal process approach to research, treatment and prevention.
BRITISH JOURNAL OF CLINICAL PSYCHOLOGY,
42, 219-219.
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2002
Watkins E (2002). Cognitive Therapy for Bipolar Disorder: a Therapist's Guide to Concepts, Method and Practice.
BEHAVIOURAL AND COGNITIVE PSYCHOTHERAPY,
30(1), 121-122.
Author URL.
Mason, A. Watkins E (2002). Mood as Input and Rumination. Personality and Individual Differences, 32, 577-587.
Watkins E (2002). Overcoming Depression: a Self-Help Guide Using Cognitive Behavioural Techniques.
BEHAVIOURAL AND COGNITIVE PSYCHOTHERAPY,
30(2), 247-248.
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Baracaia, S. Watkins E (2002). Rumination and Social Problem-Solving in Depression. Behaviour Research and Therapy, 40, 1179-1189.
Brown, R.G. Watkins ER (2002). Rumination and executive function in depression: an experimental study. Journal of Neurology, Neurosurgery and Psychiatry, 72(3), 400-402.
Watkins ER, Teasdale JD (2002). Rumination and overgeneral memory in depression: effects of self-focus and analytic thinking. Journal of Abnormal Psychology, 110(2), 353-357.
2001
Howard, R. Hobson, A. Aziz, Q. Watkins E (2001). Feeling the Blues in Functional Gut Pain: Manipulating mood state influences the threshold for oesophageal pain. Gastroenterology, 120(5).
Howard, R. Hobson, A. Aziz, Q. Watkins E (2001). Feeling the Blues in Functional Gut Pain: Manipulating mood state influences the threshold for oesophageal pain. Gut, 48
Watkins E, Howard R, Hobson A, Aziz Q (2001). Feeling the blues in functional gut pain: Manipulating mood state influences the perception of esophageal pain.
GASTROENTEROLOGY,
120(5), A639-A639.
Author URL.
Watkins E, Teasdale JD (2001). Rumination and overgeneral memory in depression: Effects of self-focus and analytic thinking.
JOURNAL OF ABNORMAL PSYCHOLOGY,
110(2), 353-357.
Author URL.
Watkins E (2001). The New Handbook of Cognitive Therapy Techniques.
BEHAVIOURAL AND COGNITIVE PSYCHOTHERAPY,
29(3), 386-387.
Author URL.
Watkins E (2001). Treating Complex Cases: the Cognitive Behavioural Approach.
BEHAVIOURAL AND COGNITIVE PSYCHOTHERAPY,
29(3), 387-388.
Author URL.
Baracaia, S. Watkins E (2001). Why do people ruminate in dysphoric moods?. Personality and Individual Differences, 30, 723-734.
2000
Watkins E, Teasdale JD, Williams RM (2000). Decentring and distraction reduce overgeneral autobiographical memory in depression.
Psychol Med,
30(4), 911-920.
Abstract:
Decentring and distraction reduce overgeneral autobiographical memory in depression.
BACKGROUND: Increased recall of categorical autobiographical memories is a phenomenon unique to depression and post-traumatic stress disorder, and is associated with a poor prognosis for depression. Although the elevated recall of categorical memories does not change on remission from depression, recent findings suggest that overgeneral memory may be reduced by cognitive interventions and maintained by rumination. This study tested whether cognitive manipulations could influence the recall of categorical memories in dysphoric participants. METHODS: Forty-eight dysphoric and depressed participants were randomly allocated to rumination or distraction conditions. Before and after the manipulation, participants completed the Autobiographical Memory Test, a standard measure of overgeneral memory. Participants were then randomized to either a 'decentring' question (Socratic questions designed to facilitate viewing moods within a wider perspective) or a control question condition, before completing the Autobiographical Memory Test again. RESULTS: Distraction produced significantly greater decreases in the proportion of memories retrieved that were categorical than rumination. Decentring questions produced significantly greater decreases in the proportion of memories retrieved that were categorical than control questions, with this effect independent of the prior manipulation. CONCLUSIONS: Elevated categorical memory in depression is more modifiable than has been previously assumed; it may reflect the dynamic maintenance of a cognitive style that can be interrupted by brief cognitive interventions.
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Watkins E, Elliott S, Stanhope N, Button J, Williams R, Brown J (2000). Meeting the needs for psychological treatment of people with common mental disorders: an exploratory study.
Journal of Mental Health,
9(4), 445-456.
Abstract:
Meeting the needs for psychological treatment of people with common mental disorders: an exploratory study
This paper describes the limited availability of resources for common mental disorders and the unmet need for treatment for both anxiety and depression. A specific focus is to consider whether a self-referral approach to Stress can be adapted to meet the unmet need for treatment of people with depression. Results indicate that the take-up for a self-referral Depression workshop is much lower than that for the Stress workshops, particularly between the enquiry and the Introductory Talk stage. Additionally, those who came to the Introductory Talks for the Depression workshops were very similar to psychology service referrals. Over 90% had previously been to see their GP, been diagnosed and referred on to the specialist mental health services. It was concluded that the self-referral mechanism was not successful in meeting the unmet needs of those with depression who had not been previously referred. Suggestions are made about improving take-up and engagement for this group.
Abstract.
1998
Williams, R.M. (1998). The efficacy of cognitive-behavioural therapy. In Checkley S, Watkins, E (Eds.) In: the Management of Depression, Oxford:.
1997
Watkins E (1997). Attention and emotion: a clinical perspective - Wells,A, Matthews,G.
BEHAVIOUR RESEARCH AND THERAPY,
35(3), 277-278.
Author URL.
