Cognitive Therapy and Research最新文献

Abstract

Background/Purpose

Anxiety sensitivity (AS) is a transdiagnostic risk factor for mental health disorders. While its lower order factors – social, physical, and cognitive concerns – and their associations with emotional disorders have been examined independently of each other, research has not fully appreciated that these factors might appear to different degrees in individuals, with psychopathology implications.

Methods

We used cluster analysis to investigate how the lower order AS factors appear in treatment-seekers with high AS and how these manifestations of AS (i.e., the different clusters) are uniquely associated with psychopathology. Participants (N = 154; from two studies) were high AS treatment-seeking adults with anxiety and/or depressive disorders who completed a diagnostic interview and self-report measures of AS and anxiety and depression symptoms.

Results

A four-cluster solution emerged including a Multidimensional cluster (33.8% of the sample) and Social (28.6%), Physical (21.4%), and Cognitive (16.2%) clusters. Validation analyses revealed cross-cluster differences in age, gender, ethnicity, and psychopathology, the latter reflecting known associations between AS and mental health (e.g., depression symptoms were significantly highest in the Cognitive and Multidimensional clusters).

Conclusions

Results provide valuable insight into the heterogeneity of high AS as it appears clinically, with implications for best matching treatment approaches for this population.

Purpose

There has been limited research conducted on the nature and consequences of excessive reassurance seeking in individuals with social anxiety, who tend to worry about the impression they make in evaluative social contexts. We examined the effects of self-reported trait social anxiety, low self-certainty, and engagement in post-event processing on reassurance seeking behaviours.

Methods

The sample consisted of 399 non-clinical undergraduate participants who completed self-report questionnaires in an online pre-registered correlational study.

Results

Partially consistent with our preregistered hypothesis, hierarchical regression analyses revealed that each predictor variable explained unique variance in reassurance seeking behaviours over and above the others, but interaction effects were non-significant for the main outcome variable measuring overall reassurance-seeking. Ancillary analyses revealed a significant three-way interaction between social anxiety symptoms, self-certainty, and post-event processing on engagement in evaluative threat-related reassurance seeking specifically.

Conclusions

Future prospective, naturalistic, and experimental research is needed to verify that evaluative threat-related reassurance seeking in social anxiety may be driven by heightened self-doubt and engagement in post-event processing, which may hinder socially anxious individuals from receiving high-quality support from those in their social network.

Background

Research suggests that exposure therapy delivered in the morning is more successful than delivered in the evening, which is often explained by higher diurnal endogenous cortisol levels. However, this “morning exposure effect” might also be explained by other factors such as sleep or vigilance.

Methods

The current study aimed to disentangle these effects by assessing the impact of video-based exposure therapy delivered in the morning or in the evening, whilst considering pre-exposure sleep quality, vigilance, and cortisol levels. To this end, 80 snake fearful individuals were randomly assigned to receive exposure treatment in the morning or evening.

Results

Contrary to previous findings, groups did not differ in their pre-post and post-follow up decrease of snake anxiety. However, higher vigilance was found to be associated with a greater pre-post and post-follow-up decrease in snake anxiety. Moreover, pre-exposure sleep efficiency moderated the post-follow-up decrease in snake anxiety across groups: In individuals with high pre-exposure sleep efficiency, those receiving exposure in the morning were estimated to show a stronger decrease in snake anxiety than those receiving exposure in the evening. The opposite pattern was found in individuals with low pre-exposure sleep efficiency.

Conclusions

The results of this study illustrate that diurnal effects on exposure therapy might be more complex than previously assumed.

Trial Registration

The study was prospectively preregistered at the German Clinical Trial Register (https://drks.de/search/en/trial/DRKS00016183).

Background

CBASP is a learning acquisition model of psychotherapy and until this present study, has not been systematically dismantled to identify the active ingredient.

Methods

The present investigation is the first formal dismantling pilot-study conducted to date on the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). The two major treatment components of CBASP, Situational Analysis (SA) and the Interpersonal Discrimination Exercise (IDE), were administered alone and with CBASP treatment-as-usual (the combination of both) to determine if there were active ingredients operative in the model. Secondly, we questioned if the dismantling of CBASP should continue in a larger study in an effort to answer the greater dismantling question of whether to administer both SA and IDE separately based on the active ingredient outcomes.

Results

The study did achieve visually inspected differential data patterns across the three groups of the dependent measures. Based on these outcomes, a larger dismantling study seems warranted and is recommended.

Conclusions

We strongly urge that a larger dismantling study using a similar design be conducted in an effort to further the dismantling process of the CBASP model.

Background

Shame is an important emotion in social anxiety disorder (SAD). However, gender differences in shame, as well as the temporal relationship between shame and anxiety in SAD have not been examined. The present study aimed to address these gaps.

Methods

Participants were 88 individuals (44 with SAD and 44 without SAD) who completed a 21-day experience sampling measurement (ESM). Specifically, participants reported on their emotions once a day at random times.

Results

Hierarchical Linear Modeling indicated that individuals with SAD reported significantly more shame compared to individuals without SAD. In addition, women reported significantly more shame compared to men. Importantly, gender differences in shame were more pronounced among individuals with SAD compared to those without SAD. Finally, we found that for individuals without SAD, shame on a given day significantly predicted anxiety on the following day among men but not among women, whereas for individuals with SAD, shame on a given day significantly predicted anxiety on the following day among both men and women.

Conclusions

Our findings suggest that shame may play a role in the maintenance of SAD. In addition, our findings suggest that social anxiety disorder may impact women’s experience of shame more than men’s.

Background

Clinical data are usually analyzed with the assumption that knowledge gathered from group averages applies to the individual. Doing so potentially obscures patients with meaningfully different trajectories of therapeutic change. Needed are “idionomic” methods that first examine idiographic patterns before nomothetic generalizations are made. The objective of this paper is to test whether such an idionomic method leads to different clinical conclusions.

Methods

51 patients completed weekly process measures and symptom severity over a period of eight weeks. Change trajectories were analyzed using a nomothetic approach and an idiographic approach with bottom-up clustering of similar individuals. The outcome was patients’ well-being at post-treatment.

Results

Individuals differed in the extent that underlying processes were linked to symptoms. Average trend lines did not represent the intraindividual changes well. The idionomic approach readily identified subgroups of patients that differentially predicted distal outcomes (well-being).

Conclusions

Relying exclusively on average results may lead to an oversight of intraindividual pathways. Characterizing data first using idiographic approaches led to more refined conclusions, which is clinically useful, scientifically rigorous, and may help advance individualized psychotherapy approaches.

Background

The present study examined the relative roles of approach and avoidance motivation in eating pathology using a multi-method approach combining self-report and physiological measures. The potential effect of internalized ideals and fears was also investigated.

Methods

Fifty-seven undergraduate women completed a picture-viewing task in which they viewed images of women’s bodies (thin and non-thin) and affective images. Self-report ratings of valence and arousal were measured along with physiological indicators of approach (postauricular reflex) and avoidance (startle blink reflex) motivation.

Results

Greater eating pathology was associated with more negative valence ratings of both thin and non-thin images. There was a significant interaction between valence ratings of non-thin bodies and fear of the unattractive self in relation to eating pathology, such that eating pathology was highest in those who rated non-thin images as more unpleasant and internalized fears of being/becoming unattractive. Thin-ideal internalization did not significantly interact with ratings of thin images to predict eating pathology. There were no significant findings when examining physiological data.

Conclusions

Results from self-report measures suggest that eating pathology is associated with avoidant reactions to both thin and non-thin bodies and highlight the importance of internalized appearance-related fears.

Background

Interventions teaching cognitive-behavioral skills feature prominently among evidence-based treatments for emotional disorders. However, the relative impact of interventions that teach one cognitive-behavioral skill in-depth (i.e., an entrée intervention) versus those that provide limited coverage of multiple skills (i.e., a sampler intervention) remains unclear. In this study, we compared these two approaches using unguided single-session internet-based cognitive-behavioral interventions.

Methods

A total of 657 participants living in the U.S. with elevated depressive symptoms were randomly assigned to the entrée, sampler, or no-intervention control conditions. The entrée approach focused in-depth on developing one skill and the sampler condition introduced three skills. Both interventions lasted approximately 30 min. All participants completed measures of depressive symptoms, loneliness, and coping skill use and quality before the intervention and a week after the intervention.

Results

There were no condition differences in change in depressive symptoms, coping skill usage, coping skill quality, or loneliness. Those in the sampler condition were less likely to drop out than those in the entrée condition. In addition, condition differences were moderated by initial depressive symptom severity, such that among the more severely depressed the sampler condition led to greater symptom reduction than the entrée and control conditions.

Conclusions

We did not find overall differences between the entrée, sampler, and control conditions on primary outcomes. Nonetheless, the differences that did emerge suggest offering a variety of skills improves retention and provides greater relief for those with high initial depressive symptom severity in single-session internet-based interventions.

Clinicaltrials.gov ID NCT04643964, registered on 11/12/2020.

Purpose

Research suggests that performance on the Death-Implicit Association Test (D-IAT) converges with explicit indicators of suicide risk (e.g., suicidal ideation, suicidal behaviors). However, the utility of the D-IAT in acute care settings has been questioned given limited studies and inconsistent findings. Additionally, it remains unclear whether the D-IAT incrementally improves the assessment of suicide risk beyond explicit measures.

Method

The present study evaluated the validity of the D-IAT in a large sample of psychiatric inpatients who attempted suicide within the past two years (N = 203; M age = 32.93 [SD = 12.61]; 50.7% female; 63.5% White; 22.7% Hispanic/Latino). The D-IAT was scored three ways: (1) conventional D scoring where positive scores indicate stronger implicit associations with death, (2) dichotomized D scores where participants were categorized based on positive or negative D score, and (3) DD scoring, which is a novel procedure that differentiates self-identification with death (Me-DD) from a lack of identification with life (Not Me-DD).

Results

D and Not Me-DD were weakly associated with suicide cognitions, hopelessness, suicidal ideation, and wishes to live/die and there were corresponding mean differences based on dichotomized D scores. D and Not Me-DD were also weakly correlated with number of lifetime suicide attempts. Me-DD evidenced fewer significant associations than Not Me-DD suggesting that a lack of association with life may be the central component of D scores.

Conclusions

Findings suggest that the D-IAT may not be a useful standalone measure of suicide risk in high-risk populations.