Authors:Jessica L. Maples-Keller; Matthew Price; Sheila Rauch; Maryrose Gerardi; Barbara O. Rothbaum Pages: 147 - 155 Abstract: Publication date: March 2017 Source:Behavior Therapy, Volume 48, Issue 2 Author(s): Jessica L. Maples-Keller, Matthew Price, Sheila Rauch, Maryrose Gerardi, Barbara O. Rothbaum Several cognitive behavioral therapeutic approaches have been demonstrated to be effective in reducing post-traumatic stress disorder (PTSD) symptoms (Foa, Keane, Friedman, & Cohen, 2008). The bulk of PTSD treatment research has relied on pre-post designs, which are limited in their ability to investigate the therapeutic process over time. The present study investigated the relations between PTSD symptom clusters using symptom assessment at pretreatment, midtreatment, and posttreatment using cross-lagged panel design over the course of Virtual Reality Exposure (VRE) treatment. Participants were 156 Iraq and/or Afghanistan veterans who met DSM-IV criteria for PTSD due to military trauma. Using structural equation modeling, the final reexperiencing model demonstrated good fit, χ2(34)=39.95, p =.22; RMSEA=.034, 90% CI: [0.00, 0.07], CFI=.993, and results suggested that reexperiencing at pretreatment demonstrated a significant effect on numbing, avoidance, hyperarousal at midtreatment, and reexperiencing symptoms at midtreatment demonstrate a significant effect on each of the three symptom clusters at posttreatment. These findings suggest that reexperiencing symptoms are indeed a key aspect of the therapeutic process within exposure therapy for PTSD. Additional research examining the impact of reexperiencing-focused intervention strategies on treatment outcomes is warranted.
Authors:Mandy J. Kumpula; Kimberly Z. Pentel; Edna B. Foa; Nicole J. LeBlanc; Eric Bui; Lauren B. McSweeney; Kelly Knowles; Hannah Bosley; Naomi M. Simon; Sheila A.M. Rauch Pages: 156 - 165 Abstract: Publication date: March 2017 Source:Behavior Therapy, Volume 48, Issue 2 Author(s): Mandy J. Kumpula, Kimberly Z. Pentel, Edna B. Foa, Nicole J. LeBlanc, Eric Bui, Lauren B. McSweeney, Kelly Knowles, Hannah Bosley, Naomi M. Simon, Sheila A.M. Rauch Prolonged exposure (PE) effectively reduces negative cognitions about self, world, and self-blame associated with posttraumatic stress disorder (PTSD), with changes in posttraumatic cognitions being associated with reductions in PTSD symptoms (Foa & Rauch, 2004). Further, recent research has demonstrated that cognitive change is a likely mechanism for PTSD symptom reduction in PE (Zalta et al., 2014). The present study examines temporal sequencing of change in three domains of posttraumatic cognitions (i.e., negative cognitions about the self, negative cognitions about the world, and self-blame) and PTSD symptoms during the course of PE. Adult outpatients meeting diagnostic criteria for PTSD were recruited at 4 sites. Participants (N =46) received 8 sessions of PE over 4 to 6weeks. PTSD symptoms and posttraumatic cognitions were assessed at pretreatment and Sessions 2, 4, 6, and 8. PTSD symptom severity and negative cognitions about the self and the world each decreased significantly from pre- to posttreatment, while self-blame cognitions were unchanged. Examination of temporal sequencing of changes during the course of PE via time-lagged mixed effects regression modeling revealed that preceding levels of negative cognitions about the world drove successive severity levels of PTSD symptoms, whereas preceding PTSD symptom severity did not drive subsequent negative cognitions about the world. Reductions in negative cognitions about the self led to subsequent improvement in PTSD. Improvement in PTSD symptoms in prior sessions was related to later reduction in negative cognitions about the self, though the impact of negative cognitions in influencing subsequent symptom change demonstrated a stronger effect. Results support that reductions in negative cognitions about the self and world are mechanisms of change in PE, which may have valuable implications for maximizing treatment effectiveness.
Authors:Adele M. Hayes; Carly Yasinski; Damion Grasso; C. Beth Ready; Elizabeth Alpert; Thomas McCauley; Charles Webb; Esther Deblinger Pages: 166 - 181 Abstract: Publication date: March 2017 Source:Behavior Therapy, Volume 48, Issue 2 Author(s): Adele M. Hayes, Carly Yasinski, Damion Grasso, C. Beth Ready, Elizabeth Alpert, Thomas McCauley, Charles Webb, Esther Deblinger Although there is substantial evidence to support the efficacy of cognitive-behavioral treatments (CBT) for posttraumatic stress disorder (PTSD), there is some debate about how these treatments have their effects. Modern learning theory and cognitive and emotional processing theories highlight the importance of reducing avoidance, facilitating the constructive processing of feared experiences, and strengthening new inhibitory learning. We examined variables thought to be associated with unproductive and constructive processing of traumatic experiences in a sample of 81 youth with elevated PTSD symptoms, who received Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for abuse or traumatic interpersonal loss. Sessions during the trauma narrative phase of TF-CBT were coded for indicators of unproductive processing (overgeneralization, rumination, avoidance) and constructive processing (decentering, accommodation of corrective information), as well as levels of negative emotion. In previous analyses of this trial (Ready et al., 2015), more overgeneralization during the narrative phase predicted less improvement in internalizing symptoms at posttreatment and a worsening of externalizing symptoms over the 12-month follow-up. In contrast, more accommodation predicted improvement in internalizing symptoms and also moderated the negative effects of overgeneralization on internalizing and externalizing symptoms. The current study examined correlates of overgeneralization and accommodation. Overgeneralization was associated with more rumination, less decentering, and more negative emotion, suggesting immersion in trauma-related material. Accommodation was associated with less avoidance and more decentering, suggesting a healthy distance from trauma-related material that might allow for processing and cognitive change. Decentering also predicted improvement in externalizing symptoms at posttreatment. Rumination and avoidance showed important associations with overgeneralization and accommodation, respectively, but did not predict treatment outcomes. This study identifies correlates of overgeneralization and accommodation that might shed light on how these variables relate to unproductive and constructive processing of traumatic experiences.
Authors:Andrew A. Cooper; Alexander C. Kline; Belinda Graham; Michele Bedard-Gilligan; Patricia G. Mello; Norah C. Feeny; Lori A. Zoellner Pages: 182 - 194 Abstract: Publication date: March 2017 Source:Behavior Therapy, Volume 48, Issue 2 Author(s): Andrew A. Cooper, Alexander C. Kline, Belinda Graham, Michele Bedard-Gilligan, Patricia G. Mello, Norah C. Feeny, Lori A. Zoellner Homework is often viewed as central to prolonged exposure (PE) for posttraumatic stress disorder (PTSD), but its relationship with treatment outcome is not well understood. We evaluated homework type, dose, and patients’ perceptions of helpfulness as predictors of symptom change and posttreatment outcomes in PE. Patients with chronic PTSD received PE in a randomized clinical trial. Independent evaluators assessed PTSD severity at pre- and posttreatment. Patients reported homework adherence and perceived helpfulness at the beginning of each session, separately for in vivo and imaginal exposure assignments. These variables were examined as predictors of change in PTSD symptoms, PTSD remission, and good end-state functioning (GESF; low PTSD, depression, and anxiety) at posttreatment. Higher imaginal homework adherence predicted greater symptom improvement between sessions and across treatment, as well as twice the odds of achieving remission and GESF. Patients who were at least moderately adherent to imaginal homework assignments (two or more times a week) reported more symptom gains than those who were least adherent but did not differ from those who were most adherent. In vivo adherence was not consistently associated with better outcome, perhaps due to heterogeneity in form and function of weekly assignments. Higher ratings of helpfulness of both types of homework predicted greater symptom improvement from pre- to posttreatment and between sessions. Overall, imaginal exposure homework may complement in-session exposures by enhancing key change processes, though perfect adherence is not necessary. Patients’ perceptions of helpfulness may reflect buy-in or perceived match between homework completion and functional impairment. Clinically, in addition to targeting adherence to homework assignments, querying about perceived helpfulness and adjusting assignments appropriately may help augment clinical gains.
Authors:Courtney C. Farmer; Karen S. Mitchell; Kelly Parker-Guilbert; Tara E. Galovski Pages: 195 - 206 Abstract: Publication date: March 2017 Source:Behavior Therapy, Volume 48, Issue 2 Author(s): Courtney C. Farmer, Karen S. Mitchell, Kelly Parker-Guilbert, Tara E. Galovski The contributions of individual therapy elements to the overall efficacy of evidence-based practices for the treatment of posttraumatic stress disorder (PTSD) are not well-understood. This study first examined the extent to which theoretically important treatment components of Cognitive Processing Therapy (CPT; i.e., skill in Socratic questioning; prioritizing assimilation; attention to practice assignments; emphasis on expression of natural affect) were successfully administered across the course of therapy for 68 PTSD-positive survivors of interpersonal trauma. Therapist fidelity in the administration of these four elements was evaluated in 533 taped CPT sessions of study participants included in one of two randomized controlled CPT treatment trials. Second, we examined therapist fidelity to these components as a predictor of session-to-session PTSD and depression symptom change. Third, follow-up analyses examined the influence of high therapist competence for these four components across an entire course of therapy on symptom change from pre- to posttreatment. Results showed consistently high adherence and more variable competence for these four treatment components. There were no significant effects of therapist fidelity on session-to-session symptom change. However, results showed that overall high therapist competence for “skill in Socratic questioning” and “prioritizing assimilation before overaccommodation” were related to greater client improvement in PTSD severity, but “attention to practice assignments” and “emphasis on expression of natural affect” were not. Overall competence ratings for the four components were not significantly associated with improvement in depressive symptoms. Findings contribute to increased understanding of the relationship between the key treatment components of CPT and symptom change.
Authors:Sarah B. Campbell; Keith D. Renshaw; Todd B. Kashdan; Timothy W. Curby; Sarah P. Carter Pages: 222 - 234 Abstract: Publication date: March 2017 Source:Behavior Therapy, Volume 48, Issue 2 Author(s): Sarah B. Campbell, Keith D. Renshaw, Todd B. Kashdan, Timothy W. Curby, Sarah P. Carter Little is known about the role of romantic partner symptom accommodation in PTSD symptom maintenance. To explore the bidirectional associations of posttraumatic stress disorder (PTSD) symptoms and romantic partner symptom accommodation over time, military servicemen (n =64) with symptoms of PTSD and their cohabiting heterosexual civilian romantic partners (n =64) completed a 2-week daily diary study. Cross-lagged, autoregressive models assessed the stability of men’s PTSD symptoms and partners’ accommodation, as well as the prospective associations of earlier PTSD symptoms with later accommodation and vice versa. Analyses used Bayesian estimation to provide point estimates (b) and Credible Intervals (CIs). In all models, PTSD symptoms (total and individual clusters) were highly stable (b =0.91; CI: 0.88-0.95), and accommodation was moderately stable (b =0.48; CI: 0.40-0.54). In all models, earlier PTSD symptoms (total and clusters) were significantly, positively associated with later accommodation (b =0.04; CI: 0.02-0.07). In contrast, earlier accommodation was significantly associated only with later situational avoidance (b =0.02; CI: 0.00-0.07). Thus, PTSD symptoms may lead to subsequent accommodating behaviors in romantic partners, but partner accommodation seems to contribute only to survivors’ future situational avoidance symptoms. The findings reinforce the notion that PTSD symptoms have an impact on relationship behaviors, and that accommodation from partners may sustain avoidant behaviors in particular. Clinicians should attend to romantic partners’ accommodating behaviors when working with survivors.
Authors:Steffany J. Fredman; J. Gayle Beck; Philippe Shnaider; Yunying Le; Nicole D. Pukay-Martin; Kimberly Z. Pentel; Candice M. Monson; Naomi M. Simon; Luana Marques Pages: 235 - 246 Abstract: Publication date: March 2017 Source:Behavior Therapy, Volume 48, Issue 2 Author(s): Steffany J. Fredman, J. Gayle Beck, Philippe Shnaider, Yunying Le, Nicole D. Pukay-Martin, Kimberly Z. Pentel, Candice M. Monson, Naomi M. Simon, Luana Marques There are well-documented associations between posttraumatic stress disorder (PTSD) symptoms and intimate relationship impairments, including dysfunctional communication at times of relationship conflict. To date, the extant research on the associations between PTSD symptom severity and conflict communication has been cross-sectional and focused on military and veteran couples. No published work has evaluated the extent to which PTSD symptom severity and communication at times of relationship conflict influence each other over time or in civilian samples. The current study examined the prospective bidirectional associations between PTSD symptom severity and dyadic conflict communication in a sample of 114 severe motor vehicle accident (MVA) survivors in a committed intimate relationship at the time of the accident. PTSD symptom severity and dyadic conflict communication were assessed at 4 and 16weeks post-MVA, and prospective associations were examined using path analysis. Total PTSD symptom severity at 4weeks prospectively predicted greater dysfunctional communication at 16weeks post-MVA but not vice versa. Examination at the level of PTSD symptom clusters revealed that effortful avoidance at 4weeks prospectively predicted greater dysfunctional communication at 16weeks, whereas dysfunctional communication 4weeks after the MVA predicted more severe emotional numbing at 16weeks. Findings highlight the role of PTSD symptoms in contributing to dysfunctional communication and the importance of considering PTSD symptom clusters separately when investigating the dynamic interplay between PTSD symptoms and relationship functioning over time, particularly during the early posttrauma period. Clinical implications for the prevention of chronic PTSD and associated relationship problems are discussed.
Authors:Lynne M. Knobloch-Fedders; Catherine Caska-Wallace; Timothy W. Smith; Keith Renshaw Pages: 247 - 261 Abstract: Publication date: March 2017 Source:Behavior Therapy, Volume 48, Issue 2 Author(s): Lynne M. Knobloch-Fedders, Catherine Caska-Wallace, Timothy W. Smith, Keith Renshaw This study evaluated interpersonal behavior differences among male military service members with and without PTSD and their female partners. Couples (N = 64) completed a 17-minute videotaped conflict discussion, and their interaction behavior was coded using the circumplex-based Structural Analysis of Social Behavior model (SASB; Benjamin, 1979, 1987, 2000). Within couples, the behavior of partners was very similar. Compared to military couples without PTSD, couples with PTSD displayed more interpersonal hostility and control. Couples with PTSD also exhibited more sulking, blaming, and controlling behavior, and less affirming and connecting behavior, than couples without PTSD. Results advance our understanding of the relational impacts of PTSD on military service members and their partners, and underscore the value of couple-based interventions for PTSD in the context of relationship distress.
Authors:Michelle C. Acosta; Kyle Possemato; Stephen A. Maisto; Lisa A. Marsch; Kimberly Barrie; Larry Lantinga; Chunki Fong; Haiyi Xie; Michael Grabinski; Andrew Rosenblum Pages: 262 - 276 Abstract: Publication date: March 2017 Source:Behavior Therapy, Volume 48, Issue 2 Author(s): Michelle C. Acosta, Kyle Possemato, Stephen A. Maisto, Lisa A. Marsch, Kimberly Barrie, Larry Lantinga, Chunki Fong, Haiyi Xie, Michael Grabinski, Andrew Rosenblum Veterans from conflicts such as the wars in Iraq and Afghanistan commonly return with behavioral health problems, including posttraumatic stress disorder (PTSD) and hazardous or harmful substance use. Unfortunately, many veterans experience significant barriers to receiving evidence-based treatment, including poor treatment motivation, concerns about stigma, and lack of access to appropriate care. To address this need, the current study developed and evaluated a web-based self-management intervention based on cognitive behavioral therapy (CBT), targeting PTSD symptoms and hazardous substance use in a group of symptomatic combat veterans enrolled in VA primary care. Veterans with PTSD/subthreshold PTSD and hazardous substance use were randomized to primary care treatment as usual (TAU; n = 81) or to TAU plus a web-based CBT intervention called Thinking Forward (n = 81). Thinking Forward consisted of 24 sections (approximately 20 minutes each), accessible over 12 weeks. Participants completed baseline and 4-, 8-, 12-, 16-, and 24-week follow-up assessments. Three primary outcomes of PTSD, alcohol and other drug use, and quality of life were examined. Significant treatment effects were found for heavy drinking, but not for PTSD or quality of life. The effect of the intervention on heavy drinking was mediated by intervening increases in coping, social support, self-efficacy, and hope for the future. These results demonstrate the promise of a web-based, self-management intervention for difficult-to-engage OEF/OIF veterans with behavioral health and substance use concerns.
Authors:Joyce Weeland; Rabia R. Chhangur; Danielle van der Giessen; Walter Matthys; Bram Orobio de Castro; Geertjan Overbeek Pages: 1 - 18 Abstract: Publication date: January 2017 Source:Behavior Therapy, Volume 48, Issue 1 Author(s): Joyce Weeland, Rabia R. Chhangur, Danielle van der Giessen, Walter Matthys, Bram Orobio de Castro, Geertjan Overbeek We tested the effectiveness of the preventive behavioral parent training (BPT) program, The Incredible Years (IY), and the independent effects of previously suggested sociodemographic and intervention-based moderator variables (i.e., initial severity of externalizing problem behavior, child gender, social economic status, family composition, and number of sessions parents attended), in a large-scale randomized controlled trial. Questionnaire and observation data from 387 parents and children ages 4–8 years (M age = 6.21, SD = 1.33, 55.30% boys) across pretest, posttest, and 4-month follow-up were analyzed, using full intention-to-treat analyses and correcting for multiple testing. IY was successful in decreasing parent-reported child externalizing behavior (Cohen’s d = 0.20 at posttest, d = 0.08 at follow-up), increasing parent-reported (d = 0.49, d = 0.45) and observed (d = 0.06, d = 0.02) positive parenting behavior, and decreasing parent-reported negative parenting behavior (d = 0.29, d = 0.25). No intervention effects were found for reported and observed child prosocial behavior, observed child externalizing behavior, and observed negative parenting behavior. Out of 40 tested moderation effects (i.e., 8 Outcomes × 5 Moderators), only three significant moderation effects appeared. Thus, no systematic evidence emerged for moderation of IY effects. The present multi-informant trial demonstrated that many previously suggested moderators might not be as potent in differentiating BPT effects as once thought.
Authors:Stephen S. O’Connor; Katherine Anne Comtois; David C. Atkins; Amanda H. Kerbrat Pages: 45 - 55 Abstract: Publication date: January 2017 Source:Behavior Therapy, Volume 48, Issue 1 Author(s): Stephen S. O’Connor, Katherine Anne Comtois, David C. Atkins, Amanda H. Kerbrat While previous studies have examined motivational aspects of self-directed violence, few studies have included specific motivations in predictive models for future suicide attempts. The current study utilized a sample of 160 individuals treated in an acute emergency setting following a suicide attempt who completed an interview battery that included an assessment of functional aspects of the index suicide attempt. A follow-up interview was conducted at 6 months to ascertain subsequent suicide attempts. The functional domains of suicide attempts were labeled as reduction-of-distress, communication, perceived better alternative to living, and self-loathing. Above and beyond other known risk factors, including history and highest lethality of previous self-injury, suicide attempts that served a communication function (OR = 0.18, p = .02, CI = 0.04, 0.73) and higher ratings of clinical dysfunction (OR = 3.41, p = .05, CI = 1.02, 11.36) were associated with a significant reduction in likelihood to engage in a suicide attempt during the 6-month follow-up window. Including the perceived effectiveness of the index suicide attempt in getting one’s needs met strengthened the overall model predicting a suicide attempt in the follow-up window and was an independent risk factor above and beyond other variables in the model OR = 1.75, p = .04, CI = 1.02, 3.01). Assessment of functional aspects of suicide attempt is feasible and may improve formulation of risk in a population where typical risk factors for suicide are ubiquitous.
Authors:Michelle G. Newman; Nicholas C. Jacobson; Thane M. Erickson; Aaron J. Fisher Pages: 56 - 68 Abstract: Publication date: January 2017 Source:Behavior Therapy, Volume 48, Issue 1 Author(s): Michelle G. Newman, Nicholas C. Jacobson, Thane M. Erickson, Aaron J. Fisher Objective: We examined dimensional interpersonal problems as moderators of cognitive behavioral therapy (CBT) versus its components (cognitive therapy [CT] and behavioral therapy [BT]). We predicted that people with generalized anxiety disorder (GAD) whose interpersonal problems reflected more dominance and intrusiveness would respond best to a relaxation-based BT compared to CT or CBT, based on studies showing that people with personality features associated with a need for autonomy respond best to treatments that are more experiential, concrete, and self-directed compared to therapies involving abstract analysis of one’s problems (e.g., containing CT). Method: This was a secondary analysis of Borkovec, Newman, Pincus, and Lytle (2002). Forty-seven participants with principal diagnoses of GAD were assigned randomly to combined CBT (n = 16), CT (n = 15), or BT (n = 16). Results: As predicted, compared to participants with less intrusiveness, those with dimensionally more intrusiveness responded with greater GAD symptom reduction to BT than to CBT at posttreatment and greater change to BT than to CT or CBT across all follow-up points. Similarly, those with more dominance responded better to BT compared to CT and CBT at all follow-up points. Additionally, being overly nurturant at baseline was associated with GAD symptoms at baseline, post, and all follow-up time-points regardless of therapy condition. Conclusions: Generally anxious individuals with domineering and intrusive problems associated with higher need for control may respond better to experiential behavioral interventions than to cognitive interventions, which may be perceived as a direct challenge of their perceptions.
Authors:Rumen Manolov; Mariola Moeyaert Pages: 97 - 114 Abstract: Publication date: January 2017 Source:Behavior Therapy, Volume 48, Issue 1 Author(s): Rumen Manolov, Mariola Moeyaert The current paper responds to the need to provide guidance to applied single-case researchers regarding the possibilities of data analysis. The amount of available single-case data analytical techniques has been growing during recent years and a general overview, comparing the possibilities of these techniques, is missing. Such an overview is provided that refers to techniques that yield results in terms of a raw or standardized difference and procedures related to regression analysis, as well as nonoverlap and percentage change indices. The comparison is provided in terms of the type of quantification provided, data features taken into account, conditions in which the techniques are appropriate, possibilities for meta-analysis, and evidence available on their performance. Moreover, we provide a set of recommendations for choosing appropriate analysis techniques, pointing at specific situations (aims, types of data, researchers’ resources) and the data analytical techniques that are most appropriate in these situations. The recommendations are contextualized using a variety of published single-case data sets in order to illustrate a range of realistic situations that researchers have faced and may face in their investigations.
Authors:Lisa Hopfinger; Matthias Berking; Claudi L.H. Bockting; David D. Ebert Abstract: Publication date: Available online 11 March 2017 Source:Behavior Therapy Author(s): Lisa Hopfinger, Matthias Berking, Claudi L.H. Bockting, David D. Ebert Relapse following response in psychotherapy for Major Depressive Disorder (MDD) is a major concern. Emotion regulation (ER) has been discussed as a putative emerging and maintaining factor for depression. The purpose of the present study was to examine whether ER protects against recurrence of depression over and above residual symptoms of depression following inpatient care for MDD. ER skills (ERSQ-ES) and depression (HEALTH-49) were assessed in 193 patients with MDD (age, M=47.4, SD= 9.6, 75.1% female, 100% Caucasian) at treatment discontinuation, 3- and 12-month after treatment. Multiple hierarchical regressions were used to examine general and specific ER as predictors of depressive symptoms at follow ups. Higher general ER predicted lower depression over and beyond residual symptoms of depression at 3-month among treatment responders but not among treatment non-responders. With regard to specific ER skills, readiness to confront and acceptance of undesired emotions predicted lower depressive symptoms beyond residual symptoms of depression twelve months, respectively three- and twelve months after treatment. Findings of the present study indicate that targeting general ER might be more important for remitted and less important for non-remitted patients. Enhancing ER should hence be realized in a sequential treatment design, in which a continuation phase treatment with a specific focus on ER directly follows, once patients sufficiently responded to treatment. Acceptance of undesired emotion and readiness to confront situations that cue these emotions appear to be particularly important for protecting against recurrence of depression. Future research should clarify whether findings can be generalized to outpatient care.
Authors:Katherine L. Dixon-Gordon; Brianna J. Turner; M. Zachary Rosenthal; Alexander L. Chapman Abstract: Publication date: Available online 11 March 2017 Source:Behavior Therapy Author(s): Katherine L. Dixon-Gordon, Brianna J. Turner, M. Zachary Rosenthal, Alexander L. Chapman Difficulties with emotion regulation are central to borderline personality disorder (BPD). Recent research suggests that avoidance of emotions in general, and emotion suppression specifically, may be commonly used among those who meet criteria for the disorder. Contemporary behavioral interventions for BPD incorporate cognitive and behavioral skills to increase emotional experiencing and acceptance while decreasing behaviors that function to escape or avoid from emotions. Few studies, however, have experimentally examined the effects of instructed emotion suppression and acceptance in BPD. The present study examined the effects of instructed use of different emotion regulation strategies on emotions, psychophysiology, and behavior in BPD. Participants with BPD, major depressive disorder (MDD), and non-psychiatric controls (N = 193) were randomly assigned to either suppress or accept emotions during an audio recording of a social rejection scenario, and completed a behavioral measure of distress tolerance. BPD participants exhibited greater heart rate variability in the acceptance (versus suppression) condition; this pattern was not evident within the other groups. These results suggest that deliberate use of acceptance-based emotion regulation strategies may have unique physiological effects among individuals with BPD.
Authors:Amit Lazarov; Rany Abend; Shiran Seidner; Daniel S. Pine; Yair Bar-Haim Abstract: Publication date: Available online 11 March 2017 Source:Behavior Therapy Author(s): Amit Lazarov, Rany Abend, Shiran Seidner, Daniel S. Pine, Yair Bar-Haim Current attention bias modification (ABM) procedures are designed to implicitly train attention away from threatening stimuli with the hope of reducing stress reactivity and anxiety symptoms. However, the mechanisms underlying effective ABM delivery are not well understood, with awareness of the training contingency suggested as one possible factor contributing to ABM efficacy. Here, 45 high-anxious participants were trained to divert attention away from threat in two ABM sessions. They were randomly assigned to one of three training protocols: an implicit protocol, comprised of two standard implicit ABM training sessions; an explicit protocol, comprised of two sessions with explicit instruction as to the attention training contingency; and an implicit-explicit protocol, in which participants were not informed of the training contingency in the first ABM session and informed of it at the start of the second session. We examined learning processes and stress reactivity following a stress-induction task. Results indicate that relative to implicit instructions, explicit instructions led to stronger learning during the first training session. Following rest, the explicit and implicit groups exhibited consolidation-related improvement in performance whereas no such improvement was noted for the implicit-explicit group. Finally, although stress reactivity was reduced after training, contingency awareness did not yield a differential effect on stress reactivity measured using both self-reports and skin conductance, within and across sessions. These results suggest that explicit ABM administration leads to greater initial learning during the training protocol while not differing from standard implicit administration in terms of offline learning and stress reactivity.
Authors:Sandra Weineland Strandskov; Ata Ghaderi; Hedvig Andersson; Nicole Parmskog; Emelie Hjort; Anna Svanberg Wärn; Maria Jannert; Gerhard Andersson Abstract: Publication date: Available online 2 March 2017 Source:Behavior Therapy Author(s): Sandra Weineland Strandskov, Ata Ghaderi, Hedvig Andersson, Nicole Parmskog, Emelie Hjort, Anna Svanberg Wärn, Maria Jannert, Gerhard Andersson Objectives This is the first trial to investigate the outcome of tailored and ACT-influenced, cognitive behavioral Internet treatment for eating disorder psychopathology, and the relation between knowledge acquisition and outcome. Design Randomized controlled design, with computer-based allocation to treatment or waiting list control group. Participants Participants were recruited via advertisements in social media and newspapers in Sweden. Participants fulfilling the criteria for bulimia nervosa (BN), or Eating Disorder Not Otherwise Specified (EDNOS), with a BMI above 17.5, were enrolled in the study (N = 92). Intervention The treatment group received an Internet-based, ACT-influenced CBT intervention, developed by the authors, for eating disorders. The treatment lasted eight weeks, and was adapted to the participant's individual needs. A clinician provided support. Main outcome measures Eating disorder symptoms and body shape dissatisfaction. Results Intent-to-treat analysis showed that the treatment group (n = 46) improved significantly on eating disorder symptoms and body dissatisfaction, compared with the waiting list control group (n = 46), with small to moderate effect sizes (between group effects, d = 0.35-0.64). More than a third of the participants in the treatment group (36.6%), compared to 7.1% in the waiting list control condition, made clinically significant improvements. Results showed a significant increase in knowledge in the treatment group compared to the waiting list control group (between group effect, d = 1.12), but we found no significant correlations between knowledge acquisition and outcome (r = -0.27 to – r = 0.23). Conclusion The results provide preliminary support for Internet based, tailored, and ACT-influenced treatment, based on CBT for participants with eating disorder psychopathology. Trial registration Clinical Trials NCT02700620.
Authors:Andrea N. Niles; Amanda G. Loerinc; Jennifer L. Krull; Peter Roy-Byrne; Greer Sullivan; Cathy Sherbourne; Alexander Bystritsky; Michelle G. Craske Abstract: Publication date: Available online 23 February 2017 Source:Behavior Therapy Author(s): Andrea N. Niles, Amanda G. Loerinc, Jennifer L. Krull, Peter Roy-Byrne, Greer Sullivan, Cathy Sherbourne, Alexander Bystritsky, Michelle G. Craske Objective There has been increasing recognition of the value of personalized medicine where the most effective treatment is selected based on individual characteristics. This study used a new method to identify a composite moderator of response to evidence-based anxiety treatment (CALM) compared to Usual Care. Method Eight hundred seventy-six patients diagnosed with one or multiple anxiety disorders were assigned to CALM or Usual Care. Using the method proposed by Kraemer (2013), thirty-five possible moderators were examined for individual effect sizes then entered into a forward-stepwise regression model predicting differential treatment response. K-fold cross validation was used to identify the number of variables to include in the final moderator. Results Ten variables were selected for a final composite moderator. The composite moderator effect size (r = .20) was twice as large as the strongest individual moderator effect size (r = .10). Although on average patients benefitted more from CALM, 19% of patients had equal or greater treatment response in Usual Care. The effect size for the CALM intervention increased from d = .34 to d = .54 when accounting for the moderator. Conclusions Findings support the utility of composite moderators. Results were used to develop a program that allows mental health professionals to prescribe treatment for anxiety based on baseline characteristics (http://anxiety.psych.ucla.edu/treatmatch.html).
Authors:Jessica L. Hamilton; Taylor A. Burke; Jonathan P. Stange; Evan M. Kleiman; Liza M. Rubenstein; Kate A. Scopelliti; Lyn Y. Abramson; Lauren B. Alloy Abstract: Publication date: Available online 8 February 2017 Source:Behavior Therapy Author(s): Jessica L. Hamilton, Taylor A. Burke, Jonathan P. Stange, Evan M. Kleiman, Liza M. Rubenstein, Kate A. Scopelliti, Lyn Y. Abramson, Lauren B. Alloy Positive and negative trait affect and emotion regulatory strategies have received considerable attention in the literature as predictors of psychopathology. However, it remains unclear whether individuals’ trait affect is associated with responses to state positive affect (positive rumination and dampening) or negative affect (ruminative brooding), or whether these affective experiences contribute to negative or positive interpersonal event generation. Among 304 late adolescents, path analyses indicated that individuals with higher trait negative affect utilized dampening and brooding rumination responses, whereas those with higher trait positive affect engaged in rumination on positive affect. Further, there were indirect relationships between trait negative affect and fewer positive and negative interpersonal events via dampening, and between trait positive affect and greater positive and negative interpersonal events via positive rumination. These findings suggest that individuals’ trait negative and positive affect may be associated with increased utilization of emotion regulation strategies for managing these affects, which may contribute to the occurrence of positive and negative events in interpersonal relationships.
Authors:Eyal Kalanthroff; Avishai Henik; Helen Blair Simpson; Doron Todder; Gideon E. Anholt Abstract: Publication date: Available online 23 January 2017 Source:Behavior Therapy Author(s): Eyal Kalanthroff, Avishai Henik, Helen Blair Simpson, Doron Todder, Gideon E. Anholt Task control is an executive control mechanism that facilitates goal-directed task selection by suppressing irrelevant automatic “stimulus-driven” behaviors. In the current study, we test the hypothesis that less efficient task control in individuals diagnosed with obsessive-compulsive disorder (OCD) is associated with OCD symptoms, and specifically, with the inability to inhibit unwanted behaviors in OCD. Thirty-five healthy controls, thirty participants with OCD, and twenty-six participants with generalized anxiety disorder (GAD) completed the object-interference (OI) task to measure task control, the stop-signal task to measure response inhibition, and the arrow-flanker task to evaluate executive abilities not contingent upon task control. OCD patients, but not GAD patients or healthy controls, exhibited impaired performance on the OI task. The deficit in task control, but not in response inhibition, correlated with OCD symptom severity. We suggest that reduced task control may be one of the neurocognitive processes that underlie the inability to inhibit unwanted behaviors in OCD.
Authors:Mary E. Oglesby; Norman B. Schmidt Abstract: Publication date: Available online 22 January 2017 Source:Behavior Therapy Author(s): Mary E. Oglesby, Norman B. Schmidt Intolerance of uncertainty (IU) has been proposed as an important transdiagnostic variable within mood- and anxiety-related disorders. The extant literature has suggested that individuals high in IU interpret uncertainty more negatively. Furthermore, theoretical models of IU posit that those elevated in IU may experience an uncertain threat as more anxiety-provoking than a certain threat. However, no research to date has experimentally manipulated the certainty of an impending threat while utilizing an in vivo stressor. In the current study, undergraduate participants (N = 79) were randomized to one of two conditions: certain threat (participants were told that later on in the study they would give a 3-minute speech) or uncertain threat (participants were told that later on in the study they would flip a coin to determine whether or not they would give a 3-minute speech). Participants also completed self-report questionnaires measuring their baseline state anxiety, baseline trait IU, and pre-speech state anxiety. Results indicated that trait IU was associated with greater state anticipatory anxiety when the prospect of giving a speech was made uncertain (i.e., uncertain condition). Further, findings indicated no significant difference in anticipatory state anxiety among individuals high in IU when comparing an uncertain versus certain threat (i.e., uncertain and certain threat conditions, respectively). Furthermore, results found no significant interaction between condition and trait IU when predicting state anticipatory anxiety. This investigation is the first to test a crucial component of IU theory while utilizing an ecologically valid paradigm. Results of the present study are discussed in terms of theoretical models of IU and directions for future work.
Authors:Sarah B. Campbell; Marketa Krenek; Tracy L. Simpson Abstract: Publication date: Available online 14 January 2017 Source:Behavior Therapy Author(s): Sarah B. Campbell, Marketa Krenek, Tracy L. Simpson Research has documented discrepancies between daily and retrospective reports of psychological symptoms in a variety of conditions. A limited number of studies have assessed these discrepancies in samples of individuals with posttraumatic stress disorder (PTSD), with even less research addressing potential covariates that may influence such discrepancies. In the current study, 65 individuals with co-occurring PTSD and alcohol use disorder (AUD) completed daily assessments of their PTSD symptoms for one month, followed by a standard retrospective report of PTSD over the same month. Initial analyses explored the mean levels of daily and retrospective PTSD symptoms, while multilevel models assessed the level of agreement between daily and retrospective reports and the role of demographic variables and comorbid psychopathology (e.g., depression) or substance use (e.g., alcohol use) in moderating the association of daily and retrospective reports. Results showed that retrospective reports of arousal and avoidance symptoms were weakly related to daily reports of these symptoms, while reports of re-experiencing and numbing symptoms showed better agreement. Intra-individual alcohol consumption also moderated associations of re-experiencing and avoidance symptoms, such that on days individuals drank more, their daily reports resembled their retrospective reports less well. Future research should explore the degree to which these results generalize to non-dually-diagnosed samples, as well as the role such reporting discrepancies may play in PTSD treatment.
Authors:Carolyn B. Becker Abstract: Publication date: Available online 12 January 2017 Source:Behavior Therapy Author(s): Carolyn B. Becker Although members of the Association for Behavioral and Cognitive Therapies have made significant strides towards the collective goals outlined in our mission statement, we routinely acknowledge that our ability to develop empirically supported treatments exceeds our success in improving dissemination and implementation of said interventions. Further, as noted by Kazdin and Blase (2011), even if we succeeded in having every clinician world-wide administer our best treatments with excellent competency, we still would be unsuccessful in markedly impacting the worldwide burden of mental illness because most treatments require intensive labor by expensive providers. To this end, Kazdin and Blase and others call for increased use of alternative strategies. Examples include: increased attention towards prevention; use of lower-cost, simplified interventions; task-shifting; train-the-trainer models; community participatory research methodology, and identification of novel funding sources. The Body Project is an empirically supported, cognitive dissonance-based prevention intervention that targets body image, a well-established risk factor for eating disorders, negative affect, unhealthy weight control behaviors, smoking behavior, and decreased physical activity. Supported by a global village of researchers, community activists, and organizational partners, the Body Project and is currently being implemented in 125 countries. The aim of this paper is to share lessons our team has learned in taking a prevention intervention from early testing to widespread implementation and connect these back to broader conversations occurring in our field regarding the importance of scalability and new directions in improving global mental health.
Authors:Georgina Krebs; Lorena Fernández de la Cruz; Benedetta Monzani; Laura Bowyer; Martin Anson; Jacinda Cadman; Isobel Heyman; Cynthia Turner; David Veale; David Mataix-Cols Abstract: Publication date: Available online 10 January 2017 Source:Behavior Therapy Author(s): Georgina Krebs, Lorena Fernández de la Cruz, Benedetta Monzani, Laura Bowyer, Martin Anson, Jacinda Cadman, Isobel Heyman, Cynthia Turner, David Veale, David Mataix-Cols Emerging evidence suggests that cognitive-behavior therapy (CBT) is an efficacious treatment for adolescent body dysmorphic disorder (BDD) in the short-term, but longer-term outcomes remain unknown. The current study aimed to follow-up a group of adolescents who had originally participated in a randomized controlled trial of CBT for BDD to determine whether treatment gains were maintained. Twenty-six adolescents (mean age = 16.2, SD = 1.6) with a primary diagnosis of BDD received a course of developmentally tailored CBT and were followed up over 12 months. Participants were assessed at baseline, mid-treatment, post-treatment, two-, six-, and 12-month follow-up. The primary outcome measure was the clinician-rated Yale-Brown Obsessive-Compulsive Scale Modified for BDD. Secondary outcomes included measures of insight, depression, quality of life, and global functioning. BDD symptoms decreased significantly from pre- to post-treatment and remained stable over the 12-month follow-up. At this time-point, 50% of participants were classified as responders and 23% as remitters. Participants remained significantly improved on all secondary outcomes at 12-month follow-up. Neither baseline insight nor baseline depression predicted long-term outcomes. The positive effects of CBT appear to be durable up to 12-month follow-up. However, the majority of patients remained symptomatic and vulnerable to a range of risks at 12-month follow-up, indicating that longer-term monitoring is advisable in this population. Future research should focus on enhancing the efficacy of CBT in order to improve long-term outcomes.
Authors:Emma Bruehlman-Senecal; Adrian Aguilera; Stephen M. Schueller Abstract: Publication date: Available online 9 January 2017 Source:Behavior Therapy Author(s): Emma Bruehlman-Senecal, Adrian Aguilera, Stephen M. Schueller Objective Psychotherapy non-attendance is a costly and pervasive problem. While prior research has identified stable patient-level predictors of attendance, far less is known about dynamic (i.e., time-varying) factors. Identifying dynamic predictors can clarify how clinical states relate to psychotherapy attendance and inform effective “just-in-time” interventions to promote attendance. The present study examines whether daily mood, as measured by responses to automated mobile phone-based text messages, prospectively predicts attendance in group cognitive-behavioral therapy (CBT) for depression. Method Fifty-six Spanish-speaking Latino patients with elevated depressive symptoms (46 women, mean age = 50.92 years, SD = 10.90 years), enrolled in a manualized program of group CBT, received daily automated mood-monitoring text messages. Patients’ daily mood ratings, message response rate, and delay in responding were recorded. Results Patients’ self-reported mood the day prior to a scheduled psychotherapy session significantly predicted attendance, even after controlling for patients’ prior attendance history and age (OR = 1.33, 95% CI [1.04, 1.70], p = .02). Positive mood corresponded to a greater likelihood of attendance. Conclusions Our results demonstrate the clinical utility of automated mood-monitoring text messages in predicting attendance. These results underscore the value of text messaging, and other mobile technologies, as adjuncts to psychotherapy. Future work should explore the use of such monitoring to guide interventions to increase attendance, and ultimately the efficacy of psychotherapy.
Authors:Timothy B. Baker; Stevens S. Smith; Daniel M. Bolt; Wei-Yin Loh; Robin Mermelstein; Michael C. Fiore; Megan E. Piper; Linda M. Collins Abstract: Publication date: Available online 7 January 2017 Source:Behavior Therapy Author(s): Timothy B. Baker, Stevens S. Smith, Daniel M. Bolt, Wei-Yin Loh, Robin Mermelstein, Michael C. Fiore, Megan E. Piper, Linda M. Collins Factorial experiments have rarely been used in the development or evaluation of clinical interventions. However, factorial designs offer advantages over randomized controlled trial designs, the latter being much more frequently used in such research. Factorial designs are highly efficient (permitting evaluation of multiple intervention components with good statistical power) and present the opportunity to detect interactions amongst intervention components. Such advantages have led methodologists to advocate for the greater use of factorial designs in research on clinical interventions (Collins, Dziak, & Li, 2009). However, researchers considering the use of such designs in clinical research face a series of choices that have consequential implications for the interpretability and value of the experimental results. These choices include: whether to use a factorial design, selection of the number and type of factors to include, how to address the compatibility of the different factors included, whether and how to avoid confounds between the type and number of interventions a participant receives, and how to interpret interactions. The use of factorial designs in clinical intervention research poses choices that differ from those typically considered in randomized clinical trial designs. However, the great information yield of the former encourages clinical researchers’ increased and careful execution of such designs.
Authors:Lori Eisner; David Eddie; Rebecca Harley; Michelle Jacobo; Andrew A. Nierenberg; Thilo Deckersbach Abstract: Publication date: Available online 6 January 2017 Source:Behavior Therapy Author(s): Lori Eisner, David Eddie, Rebecca Harley, Michelle Jacobo, Andrew A. Nierenberg, Thilo Deckersbach There is growing evidence that the capacity for emotion regulation is compromised in individuals with bipolar disorder. Dialectical behavior therapy (DBT), an empirically supported treatment that specifically targets emotion dysregulation, may be an effective adjunct treatment for improving emotion regulation and residual mood symptoms in patients with bipolar disorder. In this open, proof of concept pilot study, 37 participants engaged in a 12-week DBT group skills training program, learning mindfulness, emotion regulation, and distress tolerance skills. Repeated measures mixed models revealed skill acquisition in the areas of mindfulness, emotion regulation and distress tolerance, as well as improved psychological well-being and decreased emotion reactivity. The results of this study support a burgeoning literature that DBT is a feasible adjunct intervention for patients with bipolar disorder.
Authors:Benjamin G. Shapero; Rachel B. Weiss; Taylor A. Burke; Elaine M. Boland; Lyn Y. Abramson; Lauren B. Alloy Abstract: Publication date: Available online 26 December 2016 Source:Behavior Therapy Author(s): Benjamin G. Shapero, Rachel B. Weiss, Taylor A. Burke, Elaine M. Boland, Lyn Y. Abramson, Lauren B. Alloy Most theoretical frameworks regarding the role of life stress in bipolar disorders (BD) do not incorporate the possibility of a changing relationship between psychosocial context and episode initiation across the course of the disorder. The kindling hypothesis theorizes that over the longitudinal course of recurrent affective disorders, the relationship between major life stressors and episode initiation declines (Post, 1992). The present study aimed to test an extension of the kindling hypothesis in BD by examining the effect of early life adversity on the relationship between proximal life events and prospectively assessed mood episodes. Data from 145 bipolar participants (59.3% female, 75.2% Caucasian, and mean age of 20.19 years; SD = 1.75 years) were collected as part of the Temple-Wisconsin Longitudinal Investigation of Bipolar Spectrum Project (112 Bipolar II; 33 Cyclothymic disorder). Participants completed a self-report measure of early adversity at baseline and interview-assessed mood episodes and life events at regular four-month follow-ups. Results indicate that early childhood adversity sensitized bipolar participants to the effects of recent stressors only for depressive episodes and not hypomanic episodes within BD. This was particularly the case with minor negative events. The current study extends prior research examining the kindling model in BD using a methodologically rigorous assessment of life stressors and mood episode occurrence. Clinicians should assess experiences of early adversity in individuals with BD as it may impact reactivity to developing depressive episodes in response to future stressors.
Authors:Nena Stadelmaier; Kamel Gana; Yaël Saada; Odile Duguey-Cachey; Bruno Quintard Abstract: Publication date: Available online 13 December 2016 Source:Behavior Therapy Author(s): Nena Stadelmaier, Kamel Gana, Yaël Saada, Odile Duguey-Cachey, Bruno Quintard We translated and adapted the French version of the Basic Documentation for Psycho-Oncology (Po-Bado standard version) and we report its psychometric properties. The Po-Bado is a 12-item documentation instrument that measures psychosocial burden in cancer patients (all types and stages). The intensity of a patient’s psychological suffering is evaluated by a health-care professional (e.g. doctor, psychologist, nurse) in a semi-guided interview. Overall, 252 cancer patients (M age = 57 years, SD = 12.8 years) participated, completing the Po-Bado during a supportive care consultation following initial diagnosis. Our results show good reliability of the Po-Bado scores, with high internal consistency and inter-rater coefficients. Low temporal stability indicated that the Po-Bado measures a state-like phenomenon (vs. trait-like). Validity analysis showed significant correlations between cancer-specific psychosocial burden and negative mood (i.e., depression, anxiety) and psychological disturbance as assessed by the GHQ-12. Confirmatory factor analysis validated the Po-Bado’s two-factor structure, i.e., somatic and psychological burdens. A ROC curve determined the optimal cut-off score of 7.5. These results suggest that the Po-Bado is an easily applicable tool for clinicians and researchers to screen effectively for psychosocial burden in oncology.
Authors:Eliora Porter; Dianne L. Chambless Abstract: Publication date: Available online 13 December 2016 Source:Behavior Therapy Author(s): Eliora Porter, Dianne L. Chambless Little is known about the quality of socially anxious individuals’ romantic relationships. In the present study, we examine associations between social anxiety and social support in such relationships. In Study 1, we collected self-report data on social anxiety symptoms and received, provided, and perceived social support from 343 undergraduates and their romantic partners. One year later couples were contacted to determine whether they were still in this relationship. Results indicated that men’s social anxiety at Time 1 predicted higher rates of break-up at Time 2. Men’s and women’s perceived support, as well as men’s provided support, were also significantly predictive of break-up. Social anxiety did not interact with any of the support variables to predict break-up. In Study 2, a subset of undergraduate couples with a partner high (n = 27) or low (n = 27) in social anxiety completed two 10-minute, lab-based, videorecorded social support tasks. Both partners rated their received or provided social support following the interaction, and trained observers also coded for support behaviors. Results showed that socially anxious individuals received less support from their partners during the interaction according to participant- but not observer-report. High and lower social anxiety couples did not differ in terms of the target’s provision of support. Taken together, results suggest that social anxiety is associated with difficulties even in the context of established romantic relationships. Clinical implications are discussed.
Authors:Ann Meulders; Kristof Vandael; Johan W.S. Vlaeyen Abstract: Publication date: Available online 5 December 2016 Source:Behavior Therapy Author(s): Ann Meulders, Kristof Vandael, Johan W.S. Vlaeyen Increasing evidence suggests that pain-related fear is key to the transition from acute to chronic pain. Previous research has shown that perceptual similarity with a pain-associated movement fosters the generalization of fear to novel movements. Perceptual generalization of pain-related fear is adaptive as it enables individuals to extrapolate the threat value of one movement to another without the necessity to learn anew. However, excessive spreading of fear to safe movements may become maladaptive and may lead to sustained anxiety, dysfunctional avoidance behaviors, and severe disability. A hallmark of human cognition is the ability to extract conceptual knowledge from a learning episode as well. Although this conceptual pathway may be important to understand fear generalization in chronic pain, research on this topic is lacking. We investigated acquisition and generalization of concept-based pain-related fear. During acquisition, unique exemplars of one action category (CS+, e.g., opening boxes) were followed by pain, whereas exemplars of another action category (CS-, e.g., closing boxes) were not. Subsequently, spreading of pain-related fear to novel exemplars of both action categories was tested. Participants learned to expect the pain to occur and reported more pain-related fear to the exemplars of the CS+ category compared to those of the CS- category. During generalization, fear and expectancy generalized to novel exemplars of the CS+ category, but not to the CS- category. This pattern was not corroborated in the eyeblink startle measures. This is the first study that demonstrates that pain-related fear can be acquired and generalized based on conceptual knowledge.
Authors:Kate J. Zelic; Jeffrey A. Ciesla; Kelsey S. Dickson; Laura C. Hruska; Shannon N. Ciesla Abstract: Publication date: Available online 1 December 2016 Source:Behavior Therapy Author(s): Kate J. Zelic, Jeffrey A. Ciesla, Kelsey S. Dickson, Laura C. Hruska, Shannon N. Ciesla Co-rumination involves excessive dwelling on negative aspects of problems within a dyadic relationship (Rose, 2002). While research has focused on the tendency to co-ruminate within particular relationships, we were interested in examining the behavior of co-rumination outside the context of a pre-existing relationship. Using an experimental manipulation of co-rumination, the primary goal of this study was to experimentally test the effects of co-rumination and examine its associations with negative and positive affectivity. Participants were randomly assigned to one of three interviewing style conditions: a co-ruminative style, a problem solving style, or a distracting style. Results revealed that the co-rumination condition significantly differed from both the distraction and problem solving conditions on overall negative affect, sadness, and anxiety, but not on hostility. There were no significant differences amongst groups on positive affect. In conclusion, this investigation revealed detrimental effects of co-ruminative behavior even between strangers.
Authors:Teresa M. Au; Shannon Sauer-Zavala; Matthew W. King; Nicola Petrocchi; David H. Barlow; Brett T. Litz Abstract: Publication date: Available online 29 November 2016 Source:Behavior Therapy Author(s): Teresa M. Au, Shannon Sauer-Zavala, Matthew W. King, Nicola Petrocchi, David H. Barlow, Brett T. Litz Accumulating research suggests that shame can strongly contribute to the development and maintenance of posttraumatic stress disorder (PTSD). Interventions that promote self-compassion have shown promise for reducing shame related to various clinical problems, but this approach has not been systematically evaluated for traumatized individuals. The aim of this study was to develop a brief compassion-based therapy and assess its efficacy for reducing trauma-related shame and PTSD symptoms. Using a multiple baseline experimental design, the intervention was evaluated in a community sample of trauma-exposed adults (N = 10) with elevated trauma-related shame and PTSD symptoms. Participants completed weekly assessments during a 2-, 4-, or 6-week baseline phase and a 6-week treatment phase, and at 2- and 4-weeks after the intervention. By the end of treatment, 9 of 10 participants demonstrated reliable decreases in PTSD symptom severity, while 8 of 10 participants showed reliable reductions in shame. These improvements were maintained at 2- and 4-week follow-up. The intervention was also associated with improvements in self-compassion and self-blame. Participants reported high levels of satisfaction with the intervention. Results suggest that the intervention may be useful as either a stand-alone treatment or as a supplement to other treatments.
Authors:Lorenzo Lorenzo-Luaces; Ellen Driessen; Robert J. DeRubeis; Henricus L. Van; John R. Keefe; Mariëlle Hendriksen; Jack Dekker Abstract: Publication date: Available online 23 November 2016 Source:Behavior Therapy Author(s): Lorenzo Lorenzo-Luaces, Ellen Driessen, Robert J. DeRubeis, Henricus L. Van, John R. Keefe, Mariëlle Hendriksen, Jack Dekker Prior studies have suggested that the association between the alliance and depression improvement varies as a function of prior history of depression. We sought to replicate these findings and extend them to short-term psychodynamic supportive psychotherapy (SPSP) in a sample of patients who were randomized to one of these treatments and were administered the Helping Alliance Questionnaire (N = 282) at week 5 of treatment. Overall, the alliance was a predictor of symptom change (d = 0.33). In SPSP, the alliance was a modest but robust predictor of change irrespective of prior episodes (d = 0.25-0.33). By contrast, in CBT, the effects of the alliance on symptom change were large for patients with 0 prior episodes (d = 0.86), moderate for those with 1 prior episode (d = 0.49) and small for those with 2+ prior episodes (d = 0.12). These findings suggest a complex interaction between patient features and common vs. specific therapy processes. In CBT, the alliance relates to change for patients with less recurrent depression whereas other CBT-specific processes may account for change for patients with more recurrent depression.
Authors:Daniel A. Santisteban; Sara J. Czaja; Sankaran N. Nair; Maite P. Mena; Alina R. Tulloch Abstract: Publication date: Available online 12 November 2016 Source:Behavior Therapy Author(s): Daniel A. Santisteban, Sara J. Czaja, Sankaran N. Nair, Maite P. Mena, Alina R. Tulloch
Authors:Eliora Porter; Dianne L. Chambless; John R. Keefe Abstract: Publication date: Available online 11 November 2016 Source:Behavior Therapy Author(s): Eliora Porter, Dianne L. Chambless, John R. Keefe Social anxiety is associated with difficulties in intimate relationships. Because fear of negative evaluation is a cardinal feature of social anxiety disorder, perceived criticism and upset due to criticism from partners may play a significant role in socially anxious individuals’ intimate relationships. In the present study, we examine associations between social anxiety and perceived, observed, and expressed criticism in interactions with romantic partners. In Study 1, we collected self-report data from 343 undergraduates and their romantic partners on social anxiety symptoms, perceived and expressed criticism, and upset due to criticism. One year later couples reported whether they were still in this relationship. Results showed that social anxiety was associated with being more critical of one’s partner, and among women, being more upset by criticism from a partner. Social anxiety was not related to perceived criticism, nor did criticism variables predict relationship status at Time 2. In Study 2, undergraduate couples with a partner high (n = 26) or low (n = 26) in social anxiety completed a 10-minute, videorecorded problem-solving task. Both partners rated their perceived and expressed criticism and upset due to criticism following the interaction, and observers coded interactions for criticism. Results indicated that social anxiety was not significantly related to any of the criticism variables, but post hoc analyses cast doubts upon the external validity of the problem-solving task. Results are discussed in light of known difficulties with intimacy among individuals with social anxiety.
Authors:Aaron T. Beck Abstract: Publication date: Available online 10 November 2016 Source:Behavior Therapy Author(s): Aaron T. Beck Recent innovations in behavior modification have, for the most part, detoured around the role of cognitive processes in the production and alleviation of symptomatology. Although self-reports of private experiences are not verifiable by other observers, these introspective data provide a wealth of testable hypotheses. Repeated correlations of measures of inferred constructs with observable behaviors have yielded consistent findings in the predicted direction. Systematic study of self-reports suggests that an individual's belief systems, expectancies, and assumptions exert a strong influence on his state of well-being, as well as on his directly observable behavior. Applying a cognitive model, the clinician may usefully construe neurotic behavior in terms of the patient's idiosyncratic concepts of himself and of his animate and inanimate environment. The individual's belief systems may be grossly contradictory; i.e., he may simultaneously attach credence to both realistic and unrealistic conceptualizations of the same event or object. This inconsistency in beliefs may explain, for example, why an individual may react with fear to an innocuous situation even though he may concomitantly acknowledge that this fear is unrealistic. Cognitive therapy, based on cognitive theory, is designed to modify the individual's idiosyncratic, maladaptive ideation. The basic cognitive technique consists of delineating the individual's specific misconceptions, distortions, and maladaptive assumptions, and of testing their validity and reasonableness. By loosening the grip of his perseverative, distorted ideation, the patient is enabled to formulate his experiences more realistically. Clinical experience, as well as some experimental studies, indicate that such cognitive restructuring leads to symptom relief.
Authors:Joaquim Soler; Alba Franquesa; Albert Feliu-Soler; Ausias Cebolla; Javier García-Campayo; Rosa Tejedor; Marcelo Demarzo; Rosa Baños; Juan Carlos Pascual; Maria J. Portella Abstract: Publication date: Available online 9 November 2016 Source:Behavior Therapy Author(s): Joaquim Soler, Alba Franquesa, Albert Feliu-Soler, Ausias Cebolla, Javier García-Campayo, Rosa Tejedor, Marcelo Demarzo, Rosa Baños, Juan Carlos Pascual, Maria J. Portella
Authors:E. Van Roekel; C. Vrijen; V.E. Heininga; M. Masselink; E.H. Bos; A.J. Oldehinkel Abstract: Publication date: Available online 8 October 2016 Source:Behavior Therapy Author(s): E. Van Roekel, C. Vrijen, V.E. Heininga, M. Masselink, E.H. Bos, A.J. Oldehinkel Objective Anhedonia is a major public health concern and has proven particularly difficult to counteract. It has been hypothesized that anhedonia can be deterred by engagement in rewarding social and physical events. The aims of the present study were to examine (1) the effects of personalized lifestyle advice based on observed individual patterns of lifestyle factors and experienced pleasure in anhedonic young adults; and (2) whether a tandem skydive can enhance the motivation to carry out the recommended lifestyle changes. Method Participants (N=69; Mage =21.5, SD=2.0; 79.7% female) were selected through an online screening survey among young adults. Inclusion criteria were persistent anhedonia and willingness to perform a tandem skydive. Participants filled out questionnaires on their smartphones for two consecutive months (3x per day). After the first month, they were randomly assigned to one of three groups: (1) no intervention, (2) lifestyle advice, and (3) lifestyle advice and tandem skydive. The momentary questionnaire data were analyzed using interrupted time series analyses (ITSA) in a multilevel model and monthly pleasure and depression questionnaires by repeated measures ANOVA. Results No group differences were found in monthly depression and pleasure scores, but the momentary data showed higher positive affect (PA) and pleasure ratings in the month following the intervention in the two intervention groups than in the control group. The tandem skydive did not have any effects above the effects of the lifestyle advice. Conclusion Our results indicate that providing personalized lifestyle advice to anhedonic young adults can be an effective way to increase PA and pleasure.
Authors:Adam Rogers; Matthew Fuller-Tyszkiewicz; Vivienne Lewis; Isabel Krug; Ben Richardson Abstract: Publication date: Available online 8 October 2016 Source:Behavior Therapy Author(s): Adam Rogers, Matthew Fuller-Tyszkiewicz, Vivienne Lewis, Isabel Krug, Ben Richardson Although the influence of stable, trait-like factors (such as trait body dissatisfaction and appearance internalization) on instances of appearance comparison has been well documented, the additive and interactive influence of contextual factors (such as one’s current body satisfaction) on comparison behaviors is unknown. Therefore, the present study tested a Person x Situation model in which both state and trait body image variables interacted to predict engagement in various forms of comparison (upward, downward, and lateral). Participants included 161 women who completed a baseline measure of trait body dissatisfaction and internalization, and then completed, via an iPhone app, an ecological momentary assessment phase in which they reported momentary experiences of mood and comparison behaviors at up to 6 random times per day for 7 days. Multilevel analyses revealed that upward comparisons (comparisons against more attractive people) were more likely for individuals with heightened trait and/or state negative body image, but these predictive effects of state and trait on appearance comparisons appear largely independent of each other. Furthermore, neither state nor trait body image variables were related to the other forms of comparison, and time lag at the state-level between predictor and outcome did not seem to influence the strength of these associations. Present findings are consistent with the notion that how an individual feels in the moment about their appearance may influence engagement in deleterious appearance behaviors. However, further testing is needed to confirm these causal hypotheses.
Authors:Enrique Echeburúa; Montserrat Gómez; Montserrat Freixa Abstract: Publication date: Available online 8 October 2016 Source:Behavior Therapy Author(s): Enrique Echeburúa, Montserrat Gómez, Montserrat Freixa Gambling disorder (GD) in individuals with chronic schizophrenia is relevant because there are higher rates of GD in schizophrenic populations (10%) than in the non-schizophrenic population (1-5%). In addition, these patients have more severe alcohol use disorder (i.e., meeting at least 6 of the DSM-5 11 criteria for diagnosis of this disorder), higher depression scores, a poor adherence to treatment, and more frequent use of outpatient mental health care. One of the main problems in GD is therapeutic failure (defined as three or more lapse episodes during treatment) or relapse (three or more lapse episodes in the follow-up period). Predicting a relapse of GD in individuals with chronic schizophrenia can be useful in targeting the patients for aftercare services. The main aim of this study was to estimate the time to a GD relapse (survival rate) and to evaluate some of the qualitative and quantitative variables related to a GD relapse by a survival analysis. The sample consisted of 35 patients with chronic schizophrenia and GD who were treated with pharmacological and cognitive-behavioral therapy. The therapeutic failure rate in the treatment period was 43%, and it was associated with the number of episodes of schizophrenia, the age of gambling onset, and the age of the patients. The relapse rate in the follow-up period was 32%, and it was associated with the patients’ age, educational level, and weekly allowance. The implications of this study for future research are discussed.
Authors:Shannon Sauer-Zavala; Cassidy A. Gutner; Todd J. Farchione; Hannah T. Boettcher; Jacqueline R. Bullis; David H. Barlow Abstract: Publication date: Available online 25 September 2016 Source:Behavior Therapy Author(s): Shannon Sauer-Zavala, Cassidy A. Gutner, Todd J. Farchione, Hannah T. Boettcher, Jacqueline R. Bullis, David H. Barlow Research in psychopathology has identified psychological processes that are relevant across a range of Diagnostic and Statistical Manual (DSM) mental disorders, and these efforts have begun to produce treatment principles and protocols that can be applied transdiagnostically. However, review of recent work suggests that there has been great variability in conceptions of the term “transdiagnostic” in the treatment development literature. We believe that there is value in arriving at a common understanding of the term “transdiagnostic.” The purpose of the current manuscript is to outline three principal ways in which the term “transdiagnostic” is currently used, to delineate treatment approaches that fall into these three categories, and to consider potential advantages and disadvantages of each approach.
Authors:Lance L. Hawley; Christine A. Padesky; Steven D. Hollon; Enza Mancuso; Judith M. Laposa; Karen Brozina; Zindel V. Segal Abstract: Publication date: Available online 23 September 2016 Source:Behavior Therapy Author(s): Lance L. Hawley, Christine A. Padesky, Steven D. Hollon, Enza Mancuso, Judith M. Laposa, Karen Brozina, Zindel V. Segal Cognitive behavioral therapy (CBT) for depression is highly effective. An essential element of this therapy involves acquiring and utilizing CBT skills; however, it is unclear whether the type of CBT skill used is associated with differential symptom alleviation. Outpatients (N = 356) diagnosed with a primary mood disorder received 14 two-hour group sessions of CBT for depression, using the Mind Over Mood protocol. In each session, patients completed the Beck Depression Inventory and reported on their use of CBT skills: behavioral activation (BA), cognitive restructuring (CR), and core belief (CB) strategies. Bivariate latent difference score (LDS) longitudinal analyses were used to examine patterns of differential skill use and subsequent symptom change, and multi-group LDS analyses were used to determine whether longitudinal associations differed as a function of initial depression severity. Higher levels of BA use were associated with a greater subsequent decrease in depressive symptoms for patients with mild to moderate initial depression symptoms relative to those with severe symptoms. Higher levels of CR use were associated with a greater subsequent decrease in depressive symptoms, whereas higher levels of CB use were followed by a subsequent increase in depressive symptoms, regardless of initial severity. Results indicated that the type of CBT skill used is associated with differential patterns of subsequent symptom change. BA use was associated with differential subsequent change as a function of initial severity (patients with less severe depression symptoms demonstrated greater symptom improvement), whereas CR use was associated with symptom alleviation and CB use with an increase in subsequent symptoms regardless of initial severity.
Authors:Neville M Blampied Abstract: Publication date: Available online 20 September 2016 Source:Behavior Therapy Author(s): Neville M Blampied The paper reviews the history, construction and interpretation of modified Brinley plots, a scatter-plot used in therapy outcome research to compare each individual participant’s scores on the same dependent variable at time one (normally pre-treatment baseline; X-axis) with scores at selected times during or after treatment (Y-axis). Since 1965 eponymously named Brinley plots have occasionally been used in experimental psychology to display group mean data. Between 1979 and 1995 a number of clinical researchers modified Brinley plots to show individuals’ data but these plots have received little subsequent use. When constructed with orthogonal axes having the same origin and scale values, little or no change over time is shown by individuals’ data points lying on or closely about the diagonal (450 o) while the magnitude and direction of any improvement (or deterioration), outliers, and the extent of replication across cases shows via dispersion of points away from 450 o. Interpretation is aided by displaying reliable change boundaries, clinical cut-offs, means, variances, confidence intervals, and effect sizes directly on the graph. Modified Brinley plots are directly informative about individual change during therapy in the context of concurrent change in others in the same (or a different) condition, clearly show if outcomes are replicated and if they are clinically significant, and make nomothetic group information, notably effect sizes, directly available. They usefully compliment other forms of analysis in therapy outcome research.
Authors:Michelle G. Newman Abstract: Publication date: Available online 23 August 2016 Source:Behavior Therapy Author(s): Michelle G. Newman This is the introduction to the second of two special issues in honor of the 50th anniversary of the Association for Behavioral and Cognitive Therapy. The goal of this issue is to pay tribute to prior seminal Behavior Therapy publications on current therapies and future directions, to provide an updated review of important topics covered by these papers, and to make recommendations for the future. Each invited paper in this issue highlights a particular Behavior Therapy publication’s contribution to our understanding and also provides an updated review or meta-analysis on the topic of the original paper. The topics covered here include review papers on current therapies such as cognitive and behavioral therapies, youth and family psychotherapy, unified protocols, and third-wave therapies. In addition, we include a review paper on implementation science, and meta-analyses on individualized psychotherapy, and culturally adapted interventions. With the two 50th anniversary issues of Behavior Therapy, we hope to inspire additional research and discussion.