In the 40 years since Aaron Beck first proposed his cognitive model of depression, the elements of this model--biased attention, biased processing, biased thoughts and rumination, biased memory, and dysfunctional attitudes and schemas--have been consistently linked with the onset and maintenance of depression. Although numerous studies have examined the neural mechanisms that underlie the cognitive aspects of depression, their findings have not been integrated with Beck's cognitive model. In this Review, we identify the functional and structural neurobiological architecture of Beck's cognitive model of depression. Although the mechanisms underlying each element of the model differ, in general the negative cognitive biases in depression are facilitated by increased influence from subcortical emotion processing regions combined with attenuated top-down cognitive control.

Background Depression is associated with immense suffering and costs, and many patients receive inadequate care, often because of the limited availability of treatment. Web-based treatments may play an increasingly important role in closing this gap between demand and supply. We developed the integrative, Web-based program Deprexis, which covers therapeutic approaches such as behavioral activation, cognitive restructuring, mindfulness/acceptance exercises, and social skills training.Objective To evaluate the effectiveness of the Web-based intervention in a randomized controlled trial.Methods There were 396 adults recruited via Internet depression forums in Germany, and they were randomly assigned in an 80:20 weighted randomization sequence to either 9 weeks of immediate-program-access as an add-on to treatment-as-usual (N = 320), or to a 9-week delayed-access plus treatment-as-usual condition (N = 76). At pre- and post-treatment and 6-month follow-up, we measured depression (Beck Depression Inventory) as the primary outcome measure and social functioning (Work and Social Adjustment Scale) as the secondary outcome measure. Completer analyses and intention-to-treat analyses were performed.Results Of 396 participants, 216 (55%) completed the post-measurement 9 weeks later. Available case analyses revealed a significant reduction in depression severity (BDI), Cohen’s d = .64 (CI 95% = 0.33 - 0.94), and significant improvement in social functioning (WSA), Cohen’s d = .64, 95% (CI 95% = 0.33 - 0.95). These improvements were maintained at 6-month follow-up. Intention-to-treat analyses confirmed significant effects on depression and social functioning improvements (BDI: Cohen’s d = .30, CI 95% = 0.05 - 0.55; WSA: Cohen’s d = .36, CI 95% = 0.10 - 0.61). Moreover, a much higher percentage of patients in the intervention group experienced a significant reduction of depression symptoms (BDI: odds ratio [OR] = 6.8, CI 95% = 2.90 - 18.19) and recovered more often (OR = 17.3, 95% CI 2.3 - 130). More than 80% of the users felt subjectively that the program had been helpful.Conclusions This integrative, Web-based intervention was effective in reducing symptoms of depression and in improving social functioning. Findings suggest that the program could serve as an adjunctive or stand-alone treatment tool for patients suffering from symptoms of depression.Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 64953693; http://www.controlled-trials.com/ISRCTN64953693/64953693 (Archived by WebCite at http://www.webcitation.org/5ggzvTJPD)

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Depressed individuals display biased attention for emotional information when stimuli are presented for relatively "long" (e.g., 1 second) durations. The current study examined whether attentional biases are sustained over a much longer period. Specifically, clinically depressed and never depressed young adults simultaneously viewed images from four emotion categories (sad, threat, positive, neutral) for 30 seconds while line of visual gaze was assessed. Depressed individuals spent significantly more time viewing dysphoric images and less time viewing positive images than their never depressed counterparts. Time course analyses indicated that these biases were maintained over the course of the trial. Results suggest that depressed participants' attentional biases for dysphoric information are sustained for relatively long periods even when other emotional stimuli are present. Mood congruent information-processing biases appear to be a robust feature of depression and may have an important role in the maintenance of the disorder. KeywordsCognitive bias; information processing; depression maintenance; attention; eye movements Cognitive theories of depression postulate that depressed individuals are characterized by negative biases in information processing (e.g., Beck, 1976). In general, these models propose that biases in attention, perception, and memory serve to maintain a major depressive episode. In regard to attention, depressed individuals are expected to selectively attend to negative stimuli and filter out positive stimuli. This bias, in turn, is thought to contribute to the maintenance of the disorder.Numerous studies of attentional biases in depression have been conducted. Despite initial null findings (e.g., Mogg, Bradley, Williams, & Mathews 1993;MacLeod, Mathews, & Tata, 1986), more recent work has documented an association between depression and biased attention. For instance, Gotlib et al. (2004) reported an attentional bias for sad facial expressions in a clinically depressed sample using a dot probe task (Gotlib, Krasnoperova, Yue, & Joorman, 2004). Gotlib et al. (2004) and Joormann and Gotlib (2007) subsequently replicated this finding. Caseras, Garner, Bradley, and Mogg (2007) provided further evidence that dysphoric individuals maintained their gaze longer on negative pictures than non-dysphoric people.Correspondence concerning this article should be addressed to Christopher G. Beevers, Department of Psychology, The University of Texas at Austin, 1 University Station, A8000, Austin, TX 78712. E-mail: beevers@psy.utexas.edu. Jennifer L. Kellough is now at the Department of Psychology, University of Southern California.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production proc...

Significant shifts or discontinuities in symptom course can mark points of transition and reveal important change processes. The authors investigated 2 patterns of change in depression-the rapid early response and a transient period of apparent worsening that the authors call a depression spike. Participants were 29 patients diagnosed with major depressive disorder who enrolled in an open trial of an exposure-based cognitive therapy. Hierarchical linear modeling revealed an overall cubic shape of symptom change and that both the rapid response and spike patterns predicted lower posttreatment depression. Patients wrote weekly narratives about their depression. Early narratives of rapid responders were coded as having more hope than those of nonrapid responders. The narratives of patients with a depression spike had more cognitive-emotional processing during this period of arousal than those without a spike. Findings are discussed in the context of cognitive-emotional processing theories in depression and anxiety disorders.

Experiencing depression symptoms, even at mild to moderate levels, is associated with maladaptive outcomes for adolescents. We used network analysis to evaluate which symptoms (and associations between symptoms) are most central to adolescent depression. Participants were part of a large, diverse community sample (N = 1,409) of adolescents between 13 and 19 years of age. Network analysis was used to identify the most central symptoms (nodes) and associations between symptoms (edges) assessed by the Children's Depression Inventory. We also evaluated these centrality indicators for network robustness using stability and accuracy tests, associated symptom centrality with mean levels of symptoms, and examined potential differences between the structure and connectivity of depression networks in boys and girls. The most central symptoms in the network were self-hatred, loneliness, sadness, and pessimism. The strongest associations between symptoms were sadness-crying, anhedonia-school dislike, sadness-loneliness, school work difficulty-school performance decrement, self-hatred-negative body image, sleep disturbance-fatigue, and self-deprecation-self-blame. The network was robust to stability and accuracy tests. Notably, symptom centrality and mean levels of symptoms were not associated. Boys and girls' networks did not differ in levels of connectivity, though the link between body image and self-hatred was stronger in girls than boys. Self-hatred, loneliness, sadness, and pessimism were the most central symptoms in adolescent depression networks, suggesting that these symptoms (and associations between symptoms) should be prioritized in theoretical models of adolescent depression and could also serve as important treatment targets for adolescent depression interventions.

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Background: Studies have shown that certain Internet interventions can help alleviate depression. However, many such interventions contain personal support elements, making it difficult to ascertain whether the program or the support drives the effects. Studies are needed to investigate whether Internet interventions contribute to symptom reduction even when they are delivered without personal support, and even among severely depressed individuals who often receive other forms of treatment. Objective: This randomized controlled trial aimed to examine the effect of an Internet intervention that was deployed without personal support ("Deprexis") among adults with initially severe depression symptoms. Methods: Adults recruited from a range of sources who had exceeded the threshold for severe depression (PHQ-9 ≥ 15) in a pre-screening assessment and met inclusion criteria were randomized (N = 163) to the intervention (3 months program access; n = 78) or care-as-usual/waitlist control (n = 85). A diagnostic screening interview was administered by telephone at baseline to all participants. Online assessments were administered at baseline, 3 months (post-treatment), and 6 months (follow-up). The main outcome was the Patient Health Questionnaire (PHQ-9) between baseline and post-treatment. Results: Eighty-two percent of randomized participants were reached for the post-treatment assessment. Results for the intention-to-treat (ITT) sample showed significant intervention effects on depression reduction between baseline and post-treatment (linear mixed model [MM], F 1,155.6 = 9.00, p b .01, for the time by condition interaction), with a medium between-group effect size, Cohen's d = 0.57 (95% CI: 0.22-0.92). Group differences in depression severity at follow-up were marginally significant in the ITT sample, t (119) = 1.83, p = 0.07, and smaller than at post-treatment (PHQ-9, d = 0.33, 95% CI: −0.03-0.69). The number needed to treat (NNT) at post-treatment was 5, with 38% of participants in the intervention group achieving response (at least 50% PHQ-9 symptom change, plus post-treatment score b 10), compared to 17% in the control group, p b 0.01. Effects on secondary outcomes, including anxiety, health-related quality of life, and somatic symptoms, were not significant, with the exception of significant effects on anxiety reduction in PP analyses. Early ratings of program Internet Interventions 2 (2015) 48-59 ⁎ Corresponding author atInternet Interventions j o u r n a l h o m e p a g e : w w w . i n v e n t -j o u r n a l . c o m / helpfulness/alliance (after 3 weeks) predicted pre-post depression reduction, controlling for baseline severity and early symptom change. Conclusions: These results replicate and extend previous findings by showing that Deprexis can facilitate symptomatic improvement over 3 months and, perhaps to a lesser degree, up until 6 months among adults with initially severe depression.