Behavior Therapy最新文献

This three-wave longitudinal study of 297 community adults (mean age = 38.66 years, 67% female) examined how anxiety sensitivity and experiential avoidance work together to explain the relation between perfectionism and anxious and depressive symptoms over 2 years. Participants completed measures of self-critical (SC) and personal standards (PS) higher-order dimensions of perfectionism, anxiety sensitivity, experiential avoidance, and anxious and depressive symptoms at Time 1. Participants completed measures of anxiety sensitivity, experiential avoidance, and symptoms again at Time 2 one year later, and symptoms measures again at Time 3 two years after baseline. Moderated mediation analyses showed that for those with higher Time 1 experiential avoidance, Time 1 SC perfectionism was indirectly related to Time 3 anxious arousal symptoms through Time 2 anxiety sensitivity. For those with moderate to higher Time 1 anxiety sensitivity, Time 1 SC perfectionism was indirectly associated with Time 3 general distress and anxious arousal symptoms through Time 2 experiential avoidance. These moderated mediation effects were not found for PS perfectionism. These results support anxiety sensitivity and experiential avoidance as moderating and mediating processes that may be important treatment targets for reducing vulnerability to anxious and depressive symptoms over the longer-term in SC perfectionistic individuals.

Psychometric properties of the Insomnia Severity Index (ISI) were analyzed in U.S. college samples. ISI items and total score with sleep and psychosocial questionnaires were examined in Experiment I. ISI diagnostic accuracy in a clinical sample with and without insomnia was assessed in Experiment II. ISI test–retest validity, confirmatory factor analysis (CFA), and item response theory via graded response model (GRM) were assessed in Experiment III. Results indicated analogous ISI and sleep diary items showed moderate correlations (r₁ = .40; r₂ = .45). The ISI total had weak to strong correlations with other indicators of sleep-related disturbance (rs = .25–.62). The ISI had weak to moderate correlations with psychosocial measures commonly associated with insomnia (rs = .10–.57). The diagnostic accuracy of the ISI was very high (area under the curve [AUC] = .999). Sensitivity and specificity were maximized at a cutoff score ≥ 8. The ISI demonstrated good test–retest reliability (ICC = .87). CFA revealed a three-factor model for two study samples and GRM indicated better ability of the ISI to assess moderate (Sample III) and moderate to high (Sample I) levels of insomnia severity. The ISI demonstrated good psychometric properties and appears generally valid for screening insomnia disorder and assessing insomnia severity in college students. Overlap with psychological symptoms suggests caution while interpreting these constructs independently.

Previous research has shown a relationship between proximal (i.e., close-in-time) emotion experiences and suicidal ideation (SI). Yet, it remains unclear which emotion processes (i.e., the level of the emotion [intensity], how much emotions vary [variability], emotional consistency [inertia], how specific emotions are [differentiation]) and which emotions (i.e., sadness, hopelessness, anger, nervousness, happiness) are most potent predictors of SI. Seventy-seven adolescents (67.5% assigned female at birth) completed daily diaries for 4 weeks after psychiatric hospitalization. Levels of the above-mentioned emotions and frequency of SI were recorded. For each week and each emotion, mean (intensity), standard deviation (variability), autocorrelation (inertia), and intraclass correlation coefficients (ICCs; negative emotion differentiation) were calculated (i.e., four observations/person). Multilevel models examined whether (a) mean intensity, variability, and their interaction; and (b) mean intensity, inertia, and their interaction, were related to mean weekly SI frequency. A separate model examined whether negative emotion differentiation was related to mean weekly SI frequency after adjusting for mean intensity. A significant interaction between mean intensity of anger and variability of anger emerged (B = 0.54, SE = 0.24, p = .023); a positive relationship between mean anger and mean SI frequency was present at moderate or high levels of anger variability but not at its low levels. Mean intensity of most emotions was related to SI frequency in the expected directions. No other statistically significant findings emerged. Results revealed the importance of considering multiple emotion features, their dynamic nature, and their combined effect. Future research should explore mechanisms accounting for anger being related to heightened proximal SI, along with an examination of effective intervention strategies to reduce anger intensity and variability.

Bulimia nervosa (BN) is characterized by recurrent loss of control over eating (LOC) and inappropriate compensatory behaviors. Although cognitive-behavioral therapy (CBT) is efficacious for BN, many patients continue to experience symptoms at posttreatment. One potential driver of this low treatment response may be low mood, which maintains BN symptoms through negative reinforcement. Thus, it is important to understand how mood changes over enhanced cognitive-behavioral therapy (CBT-E) and whether these changes are associated with improved treatment outcomes. Participants (N = 56) with BN-spectrum eating disorders (EDs) received 16 sessions of the focused version of CBT-E. The Eating Disorder Examination (EDE) was used to measure ED symptoms (global ED pathology, frequency of binge episodes, and compensatory behaviors) at pre- and posttreatment. Latent growth mixture modeling (LGMM) of affective ratings via digital self-monitoring identified latent growth classes. Kruskal–Wallis H tests examined the effect of trajectory of change in mood on pre- to posttreatment symptom change. LGMM yielded a four-class model that best fit the data representing distinct mood trajectories over the course of treatment: (a) highest baseline mood, linear improving; (b) moderate baseline mood, stable; (c) moderate baseline mood, quadratic worsening; and (d) lowest baseline mood, quadratic improving. Participants who demonstrated worsening mood over treatment (i.e., individuals in the “moderate baseline mood, quadratic worsening” class) had significantly higher EDE global scores at posttreatment and follow-up compared to participants with stable mood across treatment. Change in LOC eating frequency and compensatory behaviors across treatment did not significantly differ by mood class. The main effect of mood class or interaction effect between time and mood class on objective binge episodes, subjective binge episodes, and compensatory behaviors was not significant. There were no significant differences in global ED pathology at either posttreatment or follow-up for any other class comparisons. These results suggest that certain trajectories of change in mood during treatment are particularly associated with change in pre- to posttreatment EDE global score. If replicated, our findings could suggest that future iterations of CBT-E should target mood early in treatment in order to maximize reductions in global eating pathology.

Emotion dysregulation is a central process implicated in the genesis and maintenance of obsessive-compulsive disorder (OCD). However, past research on OCD has examined emotion regulation with a trait-level approach, thereby neglecting important situational and temporal dynamics. The present study is the first one to examine moment-to-moment emotion regulation in individuals with OCD. A 6-day ecological momentary assessment was used to assess affect, emotion regulation strategies, perceived effectiveness of emotion regulation strategies, and acceptance of emotional experiences in n = 72 individuals with OCD and n = 54 psychologically healthy controls. As expected, individuals with OCD reported more negative and less positive affect. Group differences in positive (but not negative) affect did remain significant when controlling for baseline depression. Furthermore, the OCD group reported to use a higher momentary number of avoidance-oriented regulation strategies and less perceived effectiveness of emotion regulation, even when controlling for current symptoms and negative affect or baseline depression scores. Further, irrespective of group, more momentary negative affect amplified use of avoidance-oriented strategies and diminished perceived effectiveness and emotional acceptance. Contrary to expectations, these effects were not more pronounced in the OCD group. Possible explanations for unexpected findings and implications for future research, particularly regarding more holistic emotion regulation treatments, are discussed.

The current study evaluated knowledge of and attitudes toward guided self-help (GSH) among clinicians who use evidence-based practices to treat one or more of the following: panic disorder, major depressive disorder, bulimia nervosa, binge-eating disorder, and generalized anxiety disorder. A total of 153 of 256 individuals recruited online and at professional conferences were eligible. This study assessed prior experience with and knowledge of GSH, as well as hypothetical use with a mock patient. Less than 20% of clinicians had ever used GSH, and fewer had used it as a stand-alone treatment. Given a mock patient reporting moderate symptoms, clinicians indicated a 53.62% likelihood that they would use GSH. Exploratory analyses indicated that hypothetical use was predicted by prior use of GSH as well as the Openness subscale of the Evidence-Based Practice Attitude Scale. Study findings suggest that clinicians using evidence-based practices do not uniformly know of or endorse the use of GSH. Lack of training in GSH was one of the most frequently endorsed barriers to implementing GSH in clinical practice (n = 99, 64%). These findings have implications for the use of therapy formats that scale evidence-based treatments in the United States.