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. 2015 Feb;124(1):38-53.
doi: 10.1037/abn0000031.

A two-factor model of relapse/recurrence vulnerability in unipolar depression

Norman A S Farb  1 , Julie A Irving  2 , Adam K Anderson  3 , Zindel V Segal  4
Affiliations

A two-factor model of relapse/recurrence vulnerability in unipolar depression

Norman A S Farb et al. J Abnorm Psychol. 2015 Feb.

Abstract

The substantial health burden associated with major depressive disorder (MDD) is a product of both its high prevalence and the significant risk of relapse, recurrence, and chronicity. Establishing recurrence vulnerability factors (VFs) could improve the long-term management of MDD by identifying the need for further intervention in seemingly recovered patients. We present a model of sensitization in depression vulnerability, with an emphasis on the integration of behavioral and neural systems accounts. Evidence suggests that VFs fall into 2 categories: dysphoric attention and dysphoric elaboration. Dysphoric attention is driven by fixation on negative life events, and is characterized behaviorally by reduced executive control, and neurally by elevated activity in the brain's salience network. Dysphoric elaboration is driven by rumination that promotes overgeneral self- and contextual appraisals, and is characterized behaviorally by dysfunctional attitudes, and neurally by elevated connectivity within normally distinct prefrontal brain networks. Although few prospective VF studies exist from which to catalogue a definitive neurobehavioral account, extant data support the value of the proposed 2-factor model. Measuring the continued presence of these 2 VFs during recovery may more accurately identify remitted patients who would benefit from targeted prophylactic intervention.

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Conflict of interest statement

With regards to the current manuscript, authors NASF, JAI, and AKA have no economic or commercial conflicts of interest to disclose. ZVF discloses commercial interest in Mindfulness-Based Cogntiive Therapy (MBCT), which is mentioned as a therapeutic intervention in the text. ZVF receives commercial support in the form of royalties for the MBCT clinical manual, as well as for leading MBCT facilitator training courses.

Figures

Figure 1
Figure 1
Introducing the two-factor model of depression vulnerability. Subjective experience is presented in each rounded rectangle, reflecting the dynamic process of sensitization over time. Experience is constituted by both positive (+) and negative (−) events, which are dynamically modified by cognition. Weak associations are illustrated as dotted lines and strong associations by solid lines.
Figure 2
Figure 2
A schematic of the 3 intrinsically-connected networks associated with depression vulnerability. Dysphoric attention is characterized by increased salience network (SLN) and reduced executive network (EXN) activity. Prolonged attention to dysphoric content may promote dysphoric elaboration, co-opting EXN function into habitual self-evaluation and elaboration characteristic of the default mode network (DMN). Dysphoric elaboration may in turn create dysphoric expectations, biasing selection and maintaining dysphoric attention.
See this image and copyright information in PMC

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