Authors:Alina Thompson; Ottmar V. Lipp Pages: 1 - 10 Abstract: Publication date: May 2017 Source:Behaviour Research and Therapy, Volume 92 Author(s): Alina Thompson, Ottmar V. Lipp Extant literature suggests that extinction training delivered during the memory reconsolidation period is superior to traditional extinction training in the reduction of fear recovery, as it targets the original fear memory trace. At present it is debated whether different types of fear memories are differentially sensitive to behavioral manipulations of reconsolidation. Here, we examined post-reconsolidation recovery of fear as a function of conditioned stimulus (CS) fear-relevance, using the unconditioned stimulus (US) to reactivate and destabilize conditioned fear memories. Participants (N = 56; 25 male; M = 24.39 years, SD = 7.71) in the US-reactivation and control group underwent differential fear conditioning to fear-relevant (spiders/snakes) and fear-irrelevant (geometric shapes) CSs on Day 1. On Day 2, participants received either reminded (US-reactivation) or non-reminded extinction training. Tests of fear recovery, conducted 24 h later, revealed recovery of differential electrodermal responding to both classes of CSs in the control group, but not in the US-reactivation group. These findings indicate that the US reactivation-extinction procedure eliminated recovery of extinguished responding not only to fear-irrelevant, but also to fear-relevant CSs. Contrasting previous reports, our findings show that post-reconsolidation recovery of conditioned responding is not a function of CS fear-relevance and that persistent reduction of fear, conditioned to fear-relevant CSs, can be achieved through behavioral manipulations of reconsolidation.
Authors:Rocco Mennella; Elisabetta Patron; Daniela Palomba Pages: 32 - 40 Abstract: Publication date: May 2017 Source:Behaviour Research and Therapy, Volume 92 Author(s): Rocco Mennella, Elisabetta Patron, Daniela Palomba Frontal alpha asymmetry has been proposed to underlie the balance between approach and withdrawal motivation associated to each individual's affective style. Neurofeedback of EEG frontal alpha asymmetry represents a promising tool to reduce negative affect, although its specific effects on left/right frontal activity and approach/withdrawal motivation are still unclear. The present study employed a neurofeedback training to increase frontal alpha asymmetry (right - left), in order to evaluate discrete changes in alpha power at left and right sites, as well as in positive and negative affect, anxiety and depression. Thirty-two right-handed females were randomly assigned to receive either the neurofeedback on frontal alpha asymmetry, or an active control training (N = 16 in each group). The asymmetry group showed an increase in alpha asymmetry driven by higher alpha at the right site (p < 0.001), as well as a coherent reduction in both negative affect and anxiety symptoms (ps < 0.05), from pre-to post-training. No training-specific modulation emerged for positive affect and depressive symptoms. These findings provide a strong rationale for the use of frontal alpha asymmetry neurofeedback for the reduction of negative affect and anxiety in clinical settings.
Authors:Emily L. Belleau; Eu Gene Chin; Sonya G. Wanklyn; Laura Zambrano-Vazquez; Julie A. Schumacher; Scott F. Coffey Pages: 43 - 50 Abstract: Publication date: Available online 25 January 2017 Source:Behaviour Research and Therapy Author(s): Emily L. Belleau, Eu Gene Chin, Sonya G. Wanklyn, Laura Zambrano-Vazquez, Julie A. Schumacher, Scott F. Coffey Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) are commonly co-occurring disorders associated with more adverse consequences than PTSD alone. Prolonged exposure therapy (PE) is one of the most efficacious treatments for PTSD. However, among individuals with PTSD-SUD, 35–62% of individuals drop out of trauma-focused exposure treatments. Thus, it is important to identify predictors of PTSD treatment dropout among substance abusers with PTSD in order to gain information about adapting treatment strategies to enhance retention and outcomes. The current study explored pre-treatment predictors of early termination from PE treatment in a sample of 85 individuals receiving concurrent treatment for PTSD and a SUD in a residential treatment facility as part of a randomized controlled trial. The results indicated that less education and more anxiety sensitivity uniquely predicted PE treatment dropout. Demographic variables, PTSD severity, SUD severity, mental health comorbidities, and emotion regulation difficulties did not predict treatment dropout. These results suggest that adding pre-treatment interventions that address anxiety sensitivity, and promote social adjustment and cognitive flexibility, could possibly improve PE retention rates in clients with high anxiety or low education.
Authors:Sabine Baker; Matthew R. Sanders; Karen M.T. Turner; Alina Morawska Pages: 78 - 90 Abstract: Publication date: April 2017 Source:Behaviour Research and Therapy, Volume 91 Author(s): Sabine Baker, Matthew R. Sanders, Karen M.T. Turner, Alina Morawska Objective This randomized controlled trial examined the efficacy of Triple P Online Brief, a low-intensity online positive parenting program for parents of children with early onset disruptive behavior problems. Method Two hundred parents with 2–9-year-old children displaying early onset disruptive behavior difficulties were randomly assigned to either the intervention condition (n = 100) or a Waitlist Control group (n = 100). Results At 8-week post-assessment, parents in the intervention group displayed significantly less use of ineffective parenting strategies and significantly more confidence in dealing with a range of behavior concerns. These effects were maintained at 9-month follow-up assessment. A delayed effect was found for child behavior problems, with parents in the intervention group reporting significantly fewer and less frequent child behavior problems at follow-up, but not at post-assessment. All effect sizes were in the small to medium range. There were no significant improvements in observed negative parent and child behavior. No change was seen for parents' adjustment, anger, or conflict over parenting. Consumer satisfaction ratings for the program were high. Conclusions A brief, low-intensity parenting program delivered via the Internet can bring about significant improvements in parenting and child behavior.
Abstract: Publication date: Available online 21 March 2017 Source:Behaviour Research and Therapy Author(s): Ee Pin Chang, Ullrich K.H. Ecker, Andrew C. Page We present evidence that dysphoric rumination involves a working memory (WM) updating deficit. Sixty-one undergraduates—pre-screened with rumination and depression scales—completed a novel task providing a specific measure of WM updating. This task involved the substitution of emotionally-valenced words, and provided an online measure of the time taken to remove outdated items from WM. Results showed that dysphoric ruminators spent less time removing outdated words from WM when the new to-be-remembered word was negative. This effect was (1) associated with impaired subsequent recall of negative words, arguably caused by interference from the insufficiently removed outdated words; and (2) correlated with participants’ rumination scores. This is the first study to use the novel removal task to investigate the nature of WM-updating impairments in rumination. The findings are consistent with a negative attentional bias in rumination, and provide preliminary evidence that rumination is associated with a valence-generic removal deficit during WM updating. Reducing the attentional bias could thus be an intervention target in the treatment of dysphoric rumination.
Abstract: Publication date: Available online 21 March 2017 Source:Behaviour Research and Therapy Author(s): Julie Ji, Ben Grafton, Colin MacLeod While there is consensus that depression is associated with a memory bias characterized by reduced retrieval of positive information that is restricted to information that had been self-referentially processed, there is less agreement concerning whether depression is characterized by an attention bias involving reduced attention to positive information. However, unlike memory research, previous attention research has not systematically examined the potential role of referential processing focus. The present study tested the hypothesis that evidence of depression-linked attentional avoidance of positive information would be more readily obtained following the self-referential processing of such information. We assessed attentional responding to positive information (and also to negative information) using a dot-probe procedure, after this information had been processed either in a self-referential or other-referential manner. The findings lend support to the hypothesis under scrutiny. Participants scoring high in depression score exhibited reduced attention to positive information compared to those scoring low in depression score, but only when this information had been processed in a self-referential manner. These findings may shed light on the mechanisms that underpin attentional selectivity in depression, while potentially also helping to account for inconsistencies in previous literature.
Abstract: Publication date: Available online 19 March 2017 Source:Behaviour Research and Therapy Author(s): Lindsey M. Collins, Meredith E. Coles Prior research in the treatment of depression and anxiety has demonstrated that a sudden reduction in symptoms between two consecutive sessions (sudden gain) is related to lower post-treatment symptom severity (e.g. Hofmann, Schulz, Meuret, Moscovitch, & Suvak, 2006; Tang & DeRubeis, 1999). However, only one study has examined sudden gains in the treatment of obsessive compulsive disorder (OCD). In that study, one-third of the patients with OCD experienced a sudden gain (I M Aderka et al., 2012). Further, patients who had a sudden gain had lower clinician-rated OCD symptom severity post-treatment (I M Aderka et al., 2012). In replication, the current study examined the frequency, characteristics, and clinical impact of sudden gains in 27 OCD patients during exposure and response prevention (ERP) therapy. Fifty two percent of patients experienced a sudden gain. The mean magnitude of a sudden gain represented, on average, 61.4% of total symptom reduction. Following treatment, individuals who had experienced a sudden gain were rated as less severe on the clinical global impression scale, but they did not experience a greater reduction in OCD symptoms (pre-to post-treatment) than those without a sudden gain. None of the pre-treatment characteristics tested were found to significantly predict whether a patient would have a sudden gain. Additional research examining predictors of, and patterns of, change in OCD symptoms is warranted.
Authors:Arne Leer; Iris M. Engelhard; Bert Lenaert; Dieter Struyf; Bram Vervliet; Dirk Hermans Abstract: Publication date: Available online 9 March 2017 Source:Behaviour Research and Therapy Author(s): Arne Leer, Iris M. Engelhard, Bert Lenaert, Dieter Struyf, Bram Vervliet, Dirk Hermans Eye Movement Desensitization and Reprocessing (EMDR) therapy for posttraumatic stress disorder involves making eye movements (EMs) during recall of a traumatic image. Experimental studies have shown that the dual task decreases self-reported memory vividness and emotionality. However valuable, these data are prone to demand effects and little can be inferred about the mechanism(s) underlying the observed effects. The current research aimed to fill this lacuna by providing two objective tests of memory performance. Experiment I involved a stimulus discrimination task. Findings were that EM during stimulus recall not only reduces self-reported memory vividness, but also slows down reaction time in a task that requires participants to discriminate the stimulus from perceptually similar stimuli. Experiment II involved a fear conditioning paradigm. It was shown that EM during recall of a threatening stimulus intensifies fearful responding to a perceptually similar yet non-threat-related stimulus, as evidenced by increases in danger expectancies and skin conductance responses. The latter result was not corroborated by startle EMG data. Together, the findings suggest that the EM manipulation renders stimulus attributes less accessible for future recall.
Authors:Noortje Vriends; Yasemin Meral; Javier A. Bargas-Avila; Christina Stadler; Susan M. Bögels Abstract: Publication date: Available online 3 March 2017 Source:Behaviour Research and Therapy Author(s): Noortje Vriends, Yasemin Meral, Javier A. Bargas-Avila, Christina Stadler, Susan M. Bögels We investigated the role of self-focused attention (SFA) in social anxiety (disorder) in an ecologically valid way. In Experiment 1 high (n = 26) versus low (n = 25) socially anxious single women between 18 and 30 years had a video (“Skype”) conversation with an attractive male confederate, while seeing themselves and the confederate on-screen. The conversation was divided in four phases: (I) warm-up, (II) positive (confederate was friendly to the participant), (III) critical (confederate was critical to the participant), and (IV) active (participant was instructed to ask questions to the confederate). Participant's SFA was measured by eye-tracked gaze duration at their own image relative to the confederates' video image and other places at the computer screen. Results show that high socially anxious participants were more self-focused in the critical phase, but less self-focused in the active phase than low socially anxious participants. In Experiment 2 women diagnosed with SAD (n = 32) and controls (n = 30) between 18 and 30 years conducted the same experiment. Compared to controls participants with SAD showed increased SFA across all four phases of the conversation, and SFA predicted increased self-rated anxiety during the conversation. In conclusion, in subclinical social anxiety SFA is high only when the interaction partner is critical, whereas instructions to ask questions to the confederate reduces subclinical socially anxious’ SFA, while clinical SAD is characterized by heightened self-focused attention throughout the interaction. Results support theories that social anxiety disorder is maintained by SFA, and imply that interventions that lower SFA may help prevent and treat social anxiety disorder, but that self-focused attention can also be adaptive in certain types of interaction, such as when receiving compliments.
Authors:Inna Arnaudova; Muriel A. Hagenaars Abstract: Publication date: Available online 28 February 2017 Source:Behaviour Research and Therapy Author(s): Inna Arnaudova, Muriel A. Hagenaars Affective films are often used in emotion research and negative films are frequently used as an analogue for trauma (trauma film paradigm). However, different films are used with possibly distinct consequences. We aimed to investigate specific effects of four negative films covering distinct themes (physical, sexual, traffic and food), and tested neutral and positive films with matching content. Self-reported emotional responses and heart rate during the films were examined (immediate responses) as well as intrusions of the films in the subsequent week (delayed responses). Within each theme, negative films were rated as more unpleasant than the positive and neutral counterparts. They also evoked more negative emotions and more intrusive memories. Across themes, the four negative films did not differ in terms of valence and arousal, but clearly differed on immediate (e.g., disgust, embarrassment, heart rate) and delayed (intrusions) effects. Thus, we urge researchers to carefully select negative films for their studies, as different films seem to evoke distinct emotional responses. In addition, using positive films within the same themes is recommended in order to control for effects of arousal. In general, the specific film material should be considered when comparing effects across studies.
Authors:Armita Golkar; Cathelijn Tjaden; Merel Kindt Abstract: Publication date: Available online 22 February 2017 Source:Behaviour Research and Therapy Author(s): Armita Golkar, Cathelijn Tjaden, Merel Kindt Background Previous studies have suggested that fear memories can be updated when recalled, a process referred to as reconsolidation. Given the beneficial effects of model-based safety learning (i.e. vicarious extinction) in preventing the recovery of short-term fear memory, we examined whether consolidated long-term fear memories could be updated with safety learning accomplished through vicarious extinction learning initiated within the reconsolidation time-window. We assessed this in a final sample of 19 participants that underwent a three-day within-subject fear-conditioning design, using fear-potentiated startle as our primary index of fear learning. Methods On day 1, two fear-relevant stimuli (reinforced CSs) were paired with shock (US) and a third stimulus served as a control (CS). On day 2, one of the two previously reinforced stimuli (the reminded CS) was presented once in order to reactivate the fear memory 10 min before vicarious extinction training was initiated for all CSs. The recovery of the fear memory was tested 24 h later. Results and conclusion Vicarious extinction training conducted within the reconsolidation time window specifically prevented the recovery of the reactivated fear memory (p = 0.03), while leaving fear-potentiated startle responses to the non-reactivated cue intact (p = 0.62). These findings are relevant to both basic and clinical research, suggesting that a safe, non-invasive model-based exposure technique has the potential to enhance the efficiency and durability of anxiolytic therapies.
Authors:E.L. De Voogd; R.W. Wiers; E. Salemink Abstract: Publication date: Available online 22 February 2017 Source:Behaviour Research and Therapy Author(s): E.L. De Voogd, R.W. Wiers, E. Salemink Anxiety and depression, which are highly prevalent in adolescence, are both characterized by a negative attentional bias. As Attentional Bias Modification (ABM) can reduce such a bias, and might also affect emotional reactivity, it could be a promising early intervention. However, a growing number of studies also report comparable improvements in both active and placebo groups. The current study investigated the effects of eight online sessions of visual search (VS) ABM compared to both a VS placebo-training and a no-training control group in adolescents with heightened symptoms of anxiety and/or depression (n = 108). Attention bias, interpretation bias, and stress-reactivity were assessed pre- and post-training. Primary outcomes of anxiety and depressive symptoms, and secondary measures of emotional resilience were assessed pre- and post-training and at three and six months follow-up. Results revealed that VS training reduced attentional bias compared to both control groups, with stronger effects for participants who completed more training sessions. Irrespective of training condition, an overall reduction in symptoms of anxiety and depression and an increase in emotional resilience were observed up to six months later. The training was evaluated relatively negatively. Results suggest that online ABM as employed in the current study has no added value as an early intervention in adolescents with heightened symptoms.
Authors:Kristof Vansteelandt; Marlies Houben; Laurence Claes; Ann Berens; Ellen Sleuwaegen; Pascal Sienaert; Peter Kuppens Abstract: Publication date: Available online 21 February 2017 Source:Behaviour Research and Therapy Author(s): Kristof Vansteelandt, Marlies Houben, Laurence Claes, Ann Berens, Ellen Sleuwaegen, Pascal Sienaert, Peter Kuppens Nonsuicidal Self-Injury (NSSI) is prominent in individuals with Borderline Personality Disorder (BPD), and there is abundant evidence that affect regulation plays an important role in NSSI in the majority of patients. Affective variability is a core feature of BPD, and thus, we hypothesize that NSSI has an affect stabilization function in BPD. Affect stabilization is a process through which individuals attempt to make their affect more stable by reducing affective variability. We tested this hypothesis in 32 participants with BPD who reported on their NSSI and affect –using a displeasure-pleasure (valence) and activation-deactivation (activation) dimension– in an experience sampling study with 10 random signals scheduled per day for 8 days. Results indicated that individuals who engaged in NSSI show more Within Subject (WS) variance in valence and activation than individuals who did not engage in NSSI. However, within the NSSI patients, individuals who engaged more frequently in NSSI during the study showed less WS variance in valence and activation than patients who engaged less frequently in NSSI. This suggests that NSSI may be reinforced by its affect stabilization function. In the discussion, we explore alternative explanations for the relation between NSSI and affective variability, and consider the clinical implications.
Authors:Darius Gadeikis; Nikita Bos; Susanne Schweizer; Fionnuala Murphy; Barnaby Dunn Abstract: Publication date: Available online 21 February 2017 Source:Behaviour Research and Therapy Author(s): Darius Gadeikis, Nikita Bos, Susanne Schweizer, Fionnuala Murphy, Barnaby Dunn It is important to identify effective emotion regulation strategies to increase positive emotion experience in the general population and in clinical conditions characterized by anhedonia. There are indications that engaging in experiential processing (direct awareness of sensory and bodily experience) bolsters positive emotion experience but this has not been extensively tested during memory recall. To further test this notion, 99 community participants recalled two positive autobiographical memories. Prior to the second recall, participants either underwent an experiential, analytical, or distraction induction (n = 33 per condition). Subjective happiness and sadness ratings and heart rate variability (HRV) response were measured during each recall. Greater spontaneous use of experiential processing during the first memory was associated with greater happiness experience, but was unrelated to HRV and sadness experience. Inducing experiential processing increased happiness experience relative to both the analytical and distraction conditions (but had no impact on sadness experience). There was a significant difference in HRV between conditions. The experiential condition led to a trend-significant increase, and the other conditions a non-significant decrease, in HRV from the first to the second memory. These results suggest that engaging in experiential processing is an effective way to up-regulate positive emotion experience during positive memory recall.
Authors:Louise Beattie; Markus Bindemann; Simon D. Kyle; Stephany M. Biello Abstract: Publication date: Available online 10 February 2017 Source:Behaviour Research and Therapy Author(s): Louise Beattie, Markus Bindemann, Simon D. Kyle, Stephany M. Biello Attention biases to sleep-related stimuli are held to play a key role in the development and maintenance of insomnia, but such biases have only been shown with controlled visual displays. This study investigated whether observers with insomnia symptoms allocate attention to sleep-related items in natural scenes, by recording eye movements during free-viewing of bedrooms. Participants with insomnia symptoms and normal sleepers were matched in their visual exploration of these scenes, and there was no evidence that the attention of those with insomnia symptoms was captured more quickly by sleep-related stimuli than that of normal sleepers. However, the insomnia group fixated bed regions on more trials and, once fixated on a bed, also remained there for longer. These findings indicate that sleep stimuli are particularly effective in retaining visual attention in complex natural scenes.
Authors:Laurie Loop; Bénédicte Mouton; Marie Stievenart; Isabelle Roskam Abstract: Publication date: Available online 31 January 2017 Source:Behaviour Research and Therapy Author(s): Laurie Loop, Bénédicte Mouton, Marie Stievenart, Isabelle Roskam This research compared the efficacy of two parenting interventions that vary according to the number and the nature of variables in reducing preschoolers' externalizing behavior (EB). The goal was to identify which parenting intervention format (one-variable versus two-variable) caused higher behavioral adjustment in children. The first was a one-variable intervention manipulating parental self-efficacy beliefs. The second was a two-variable intervention manipulating both parents' self-efficacy beliefs and emotion coaching practices. The two interventions shared exactly the same design, consisting of eight parent group sessions. Effect on children's EB and observed behaviors were evaluated through a multi-method assessment at three points (pre-test, post-test and follow-up). The results highlighted that compared to the waitlist condition, the two intervention formats tended to cause a significant reduction in children's EB reported by their parent. However, the one-variable intervention was found to lead to a greater decrease in children's EB at follow-up. The opposite was reported for children's observed behavior, which was improved to a greater extent in the two-variable intervention at post-test and follow-up. The results illustrated that interventions' format cannot be considered as purely interchangeable since their impact on children's behavior modification is different. The results are discussed for their research and clinical implications.
Authors:Sergiu P. Vălenaș; Aurora Szentágotai-Tătar; Ben Grafton; Lies Notebaert; Andrei C. Miu; Colin MacLeod Abstract: Publication date: Available online 25 January 2017 Source:Behaviour Research and Therapy Author(s): Sergiu P. Vălenaș, Aurora Szentágotai-Tătar, Ben Grafton, Lies Notebaert, Andrei C. Miu, Colin MacLeod Rumination is a maladaptive form of repetitive thinking that enhances stress responses, and heightened disposition to engage in rumination may contribute to the onset and persistence of stress-related symptoms. However, the cognitive mechanisms through which ruminative disposition influences stress reactivity are not yet fully understood. This study investigated the hypothesis that the impact of ruminative disposition on stress reactivity is carried by an attentional bias reflecting impaired attentional disengagement from negative information. We examined the capacity of a measure of ruminative disposition to predict both attentional biases to negative exam-related information, and state anxiety, in students approaching a mid-term exam. As expected, ruminative disposition predicted state anxiety, over and above the level predicted by trait anxiety. Ruminative disposition also predicted biased attentional disengagement from, but not biased attentional engagement with, negative information. Importantly, biased attentional disengagement from negative information mediated the relation between ruminative disposition and state anxiety. These findings confirm that dispositional rumination is associated with difficulty disengaging attention from negative information, and suggest that this attentional bias may be one of the mechanisms through which ruminative disposition influences stress reactivity.
Authors:Andrew T. Gloster; Jens Klotsche; Joseph Ciarrochi; Georg Eifert; Rainer Sonntag; Hans-Ulrich Wittchen; Jürgen Hoyer Abstract: Publication date: Available online 24 January 2017 Source:Behaviour Research and Therapy Author(s): Andrew T. Gloster, Jens Klotsche, Joseph Ciarrochi, Georg Eifert, Rainer Sonntag, Hans-Ulrich Wittchen, Jürgen Hoyer Background Psychological flexibility theory (PFT) suggests three key processes of change: increases in value-directed behaviors, reduction in struggle with symptoms, and reduction in suffering. We hypothesized that Acceptance and Commitment Therapy (ACT) would change these processes and that increases in valued action and decreases in struggle would precede change in suffering. Method Data were derived from a randomized clinical trial testing ACT (vs. waitlist) for treatment-resistant patients with primary panic disorder with/without agoraphobia (n = 41). Valued behavior, struggle, and suffering were assessed at each of eight sessions. Results Valued actions, struggle, and suffering all changed over the course of therapy. Overall changes in struggle and suffering were interdependent whereas changes in valued behavior were largely independent. Levels of valued behaviors influenced subsequent suffering, but the other two variables did not influence subsequent levels of valued action. Discussion This finding supports a central tenet of PFT that increased (re-)engagement in valued behaviors precedes reductions in suffering. Possible implications for a better understanding of response and non-response to psychotherapy are discussed.
Authors:Leigh-Anne Burr; Mahmood Javiad; Grace Jell; Aliza Werner Seidler; Barnaby D. Dunn Abstract: Publication date: Available online 24 January 2017 Source:Behaviour Research and Therapy Author(s): Leigh-Anne Burr, Mahmood Javiad, Grace Jell, Aliza Werner Seidler, Barnaby D. Dunn The way individuals appraise positive emotions may modulate affective experience during positive activity scheduling. Individuals may either engage in dampening appraisals (e.g., think “this is too good to last”) or amplifying appraisals (e.g., think “I deserve this”). A cross-over randomized design was used to examine the consequences of these appraisal styles. Participants (N = 43) rated positive affect (PA) and negative affect (NA) during four daily walks in pleasant locations, whilst following dampening, emotion-focus amplifying (focusing on how good one feels), self-focus amplifying (focusing on positive self qualities), or control instructions. There was no difference between the two amplifying and control conditions, which all increased PA and reduced NA during the walks. However, the dampening condition significantly differed from all other conditions, reducing PA and increasing NA during the walk. Individual differences in anhedonia symptoms did not significantly moderate the pattern of findings. This evidence supports the view that dampening appraisals may be one mechanism driving anhedonia and may account for why positive activity scheduling can sometimes backfire when utilized in the clinic.
Authors:B. Ainsworth; H. Bolderston; M. Garner Abstract: Publication date: Available online 24 January 2017 Source:Behaviour Research and Therapy Author(s): B. Ainsworth, H. Bolderston, M. Garner Background Worry is a key component of anxiety and may be an effective target for therapeutic intervention. We compared two psychological processes (attention and acceptance) on the frequency of intrusive worrying thoughts in an experimental worry task. Method 77 participants were randomised across three groups and completed either a 10 min attention or acceptance-based psychological exercise, or progressive muscle relaxation control. We subsequently measured anxiety, and the content and frequency of intrusive thoughts before and after a ‘worry induction task’. Results Groups did not differ in baseline worry, anxiety or thought intrusions. Both attention and acceptance-based groups experienced fewer negative thought intrusions (post-worry) compared to the relaxation control group. The acceptance exercise had the largest effect, preventing ‘worry induction’. Increases in negative intrusive thoughts predicted subjective anxiety. Discussion We provide evidence that acceptance and attention psychological exercises may reduce anxiety by reducing the negative thought intrusions that characterise worry. Graphical abstract
Authors:H.R. Trompetter; S.M.A. Lamers; G.J. Westerhof; M. Fledderus; E.T. Bohlmeijer Abstract: Publication date: Available online 19 January 2017 Source:Behaviour Research and Therapy Author(s): H.R. Trompetter, S.M.A. Lamers, G.J. Westerhof, M. Fledderus, E.T. Bohlmeijer The dual-factor model of mental health suggests that enhancing positive mental health and alleviating psychopathology do not automatically go hand-in-hand. This study investigates the relationship between the effectiveness on depression/anxiety symptoms and positive mental health of Acceptance and Commitment Therapy (ACT). It draws on RCT data (n = 250) of a self-help ACT. Patients’ depression/anxiety symptoms and positive mental health were completed at baseline, at post-intervention after nine weeks, and at follow-up after five months. Percentage of unique variance of depression/anxiety symptoms explained by positive mental health (and vice versa), and the degree of classificatory agreement between improvements in positive mental health and depression/anxiety, were examined using regression analysis and Reliable Change Index (RCI). Positive mental health, i.e. baseline and change, explained 15% and 12% of the variance in follow-up depression and anxiety symptoms, beyond the 7% and 9% that was explained by baseline levels of depression and anxiety. Depression and anxiety symptoms, i.e., baseline and change, explained 10% and 9% of the variance in follow-up positive mental health, on top of the 35% that was explained by baseline levels of positive mental health. Cross-classification of the Reliable Changes showed that 64% of the participants that improved during the ACT-intervention, improved on either depression symptoms or positive mental health, and 72% of the participants improved on either anxiety symptoms or positive mental health. The findings support the dual-factor model and suggest that it is important to systematically implement measures of both psychopathology and positive mental health in mental health care and therapy evaluations.
Authors:Trine Eilenberg; Ditte Hoffmann; Jens S. Jensen; Lisbeth Frostholm Abstract: Publication date: Available online 19 January 2017 Source:Behaviour Research and Therapy Author(s): Trine Eilenberg, Ditte Hoffmann, Jens S. Jensen, Lisbeth Frostholm Objective The present study is based on a previously reported successful randomized controlled trial (RCT) on Acceptance and Commitment Group therapy (ACT-G) for severe health anxiety (HA) and investigates intervening variables of ACT for HA. The process primarily targeted by ACT is psychological flexibility (PF). No randomized study has yet examined the possible intervening variables of ACT for HA. Methods 126 patients diagnosed with severe HA were enrolled in the RCT of which 107 were included in the analyses. The outcome measure was illness worry (Whiteley Index) and included process variables were PF and facets of mindfulness. Results Statistically significant indirect effects (IE) of ACT-G on the outcome of illness worry 6 months after treatment were found for PF (IE = 5.5, BCa 99% CI -12.3;-1.2) and one mindfulness subscale, namely ‘non-react’ (IE = 6.5 BCa 99% CI -15.3: 1.0). Conclusion In line with the ACT model of change, PF may have a small to moderate IE on decrease in illness worry. Of the mindfulness scales, only ‘non-react’ showed a significant IE. Although tentative, due to no active comparison control condition, these results support that PF is a intervening variable in ACT treatment aimed at reducing illness worry in patients with severe HA.
Authors:Shian-Ling Keng; Elysia Li Yan Tan; Tory A. Eisenlohr-Moul; Moria J. Smoski Abstract: Publication date: Available online 18 January 2017 Source:Behaviour Research and Therapy Author(s): Shian-Ling Keng, Elysia Li Yan Tan, Tory A. Eisenlohr-Moul, Moria J. Smoski The present study investigated the relative effects of mindfulness, reappraisal and suppression in reducing sadness, and the extent to which implementation of these strategies affects cognitive resources in a laboratory context. A total of 171 Singaporean undergraduate participants were randomly assigned to receive brief training in mindfulness, reappraisal, or suppression prior to undergoing a sad mood induction. Individual adherence to Asian cultural values was assessed as a potential moderator of strategy effectiveness. Participants rated their mood and completed a Color-Word Stroop task before and after mood regulation instructions. Analyses using multi-level modelling showed that the suppression condition caused less robust declines in sadness over time compared to mindfulness. There was also a nonsignificant trend in which mindfulness was associated with greater sadness recovery compared to reappraisal. Suppression resulted in lower average sadness compared to mindfulness among those high on Asian cultural values, but not those low on Asian cultural values. Both mindfulness and reappraisal buffered against increases in Stroop interference from pre-to post-regulation compared to suppression. The findings highlight the advantage of mindfulness as a strategy effective not only in the regulation of sad mood, but also in the preservation of cognitive resources in the context of mood regulation.
Authors:Thomas H. Ollendick; Lars-Göran Öst; Sarah M. Ryan; Nicole N. Capriola; Lena Reuterskiöld Abstract: Publication date: Available online 18 January 2017 Source:Behaviour Research and Therapy Author(s): Thomas H. Ollendick, Lars-Göran Öst, Sarah M. Ryan, Nicole N. Capriola, Lena Reuterskiöld Catastrophic beliefs and lowered coping expectancies are often present in individuals with specific phobias (SPs). The current study examined these beliefs and expectancies in 251 youth who received One Session Treatment for one of the three most common types of SP in youth (animals, natural environment, and situational). We compared the children's subjective beliefs to objective ratings of the likelihood of occurrence and the dangerousness of the feared events. Results revealed pre-treatment differences in the youths' beliefs across phobia types and age. Specifically, children with animal phobias rated their beliefs as more likely to occur than did children with environmental and situational phobias. In addition, older children rated their beliefs as more dangerous than younger children. However, regardless of phobia type or child age, the beliefs improved following treatment. Changes in catastrophic beliefs and coping expectancies were related to changes in clinical severity following treatment but not 6-months following treatment. Moreover, at pre-treatment, children viewed their beliefs as significantly more catastrophic and likely to occur than did independent coders of these beliefs; however, these differences were no longer evident following treatment. Clinical implications are discussed, highlighting how changes in beliefs and expectancies might be associated with treatment outcomes.
Authors:J. Cobb Scott; Gerlinde Harb; Janeese A. Brownlow; Jennifer Greene; Ruben C. Gur; Richard J. Ross Abstract: Publication date: Available online 13 January 2017 Source:Behaviour Research and Therapy Author(s): J. Cobb Scott, Gerlinde Harb, Janeese A. Brownlow, Jennifer Greene, Ruben C. Gur, Richard J. Ross Posttraumatic stress disorder (PTSD) is associated with cognitive deficits in attention, executive control, and memory, although few studies have investigated the relevance of cognitive difficulties for treatment outcomes. We examined whether cognitive functioning and history of traumatic brain injury (TBI) were associated with response to cognitive-behavioral therapy (CBT) for PTSD-related sleep problems. In a randomized controlled trial of Imagery Rehearsal (IR) added to components of CBT for Insomnia (IR + cCBT-I) compared to cCBT-I alone for PTSD-related recurrent nightmares, 94 U.S. veterans completed a battery of cognitive tests. TBI was assessed via structured clinical interview. Mixed-effects models examined main effects of cognitive functioning and interactions with time on primary sleep and nightmare outcomes. Significant verbal immediate memory by time interactions were found for nightmare distress, nightmare frequency, and sleep quality, even after controlling for overall cognitive performance and depression. TBI exhibited main effects on outcomes but no interactions with time. Findings indicated that individuals with lower verbal memory performance were less likely to respond to treatment across two sleep interventions. Veterans with TBI displayed greater symptoms but no altered trajectories of treatment response. Together with prior literature, findings suggest that verbal memory functioning may be important to consider in PTSD treatment implementation.
Authors:Dubravka Gavric; David A. Moscovitch; Karen Rowa; Randi E. McCabe Abstract: Publication date: Available online 4 January 2017 Source:Behaviour Research and Therapy Author(s): Dubravka Gavric, David A. Moscovitch, Karen Rowa, Randi E. McCabe Background Post-event processing (PEP) is defined as repetitive negative thinking following anxiety provoking social events. PEP is thought to maintain anxiety symptoms in Social Anxiety Disorder (SAD) but little is known about the specific factors that contribute to the maintenance of PEP. Aims The current study investigated how perceptions of performance and positive metacognitive beliefs might contribute to the persistence of PEP. Method Participants with SAD (n = 24) as well as anxious (n = 24) and healthy (n = 25) control participants completed a standardized social performance task in the lab. Their engagement in PEP and perceptions of performance were assessed in the week that followed. Results Immediately following the social task, individuals with SAD rated their performance more negatively and endorsed a greater number of positive metacognitive beliefs about PEP than did participants in both control groups. Importantly, both metacognitive beliefs and initial negative self-ratings of performance mediated the relationship between group status and PEP in the days following the event. Conclusions These results are consistent with cognitive and metacognitive models of SAD and enhance our understanding of the cognitive processes which may function to initiate and maintain negative thinking patterns in SAD.
Authors:Andrea N. Niles; Kate B. Wolitzky-Taylor; Joanna J. Arch; Michelle G. Craske Abstract: Publication date: Available online 4 January 2017 Source:Behaviour Research and Therapy Author(s): Andrea N. Niles, Kate B. Wolitzky-Taylor, Joanna J. Arch, Michelle G. Craske Background No prior studies have examined moderators of dropout between distinct treatments for anxiety disorders. This study applied a novel statistical approach for examining moderators of dropout from traditional cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT). Method We combined data from two randomized controlled trials (N = 208) comparing CBT and ACT for patients with DSM-IV anxiety disorders. Adapting Kraemer's method for constructing and evaluating composite moderators (2013), 26 variables were examined for individual effect sizes. Forward-stepwise regression combined with k-fold cross validation was used to identify a model to predict treatment dropout. Results Four baseline variables comprised the final composite moderator: self-reported degree of control over internal anxiety, current psychiatric medication use, religiosity, and endurance in a voluntary hyperventilation stressor. This composite moderator predicted differential dropout from ACT vs. CBT with a medium effect size (r = 0.28), and had a significantly larger effect size than any individual moderator. Conclusions Findings reveal that specific patient profiles predict differential dropout from ACT vs. CBT for anxiety disorders. In the first investigation of a composite moderator with a dichotomous outcome, findings also support the superiority of composite over individual moderators.
Authors:Kim Haesen; Tom Beckers; Frank Baeyens; Bram Vervliet Pages: 16 - 24 Abstract: Publication date: March 2017 Source:Behaviour Research and Therapy, Volume 90 Author(s): Kim Haesen, Tom Beckers, Frank Baeyens, Bram Vervliet Adaptive defensive actions necessitate a fear learning system that is both fast and specific. Fast learning serves to minimize the number of threat confrontations, while specific learning ensures that the acquired fears are tied to threat-relevant cues only. In Pavlovian fear conditioning, fear acquisition is typically studied via repetitive pairings of a single cue with an aversive experience, which is not optimal for the examination of fast specific fear learning. In this study, we adopted the one-trial overshadowing procedure from basic learning research, in which a combination of two visual cues is presented once and paired with an aversive electrical stimulation. Using on-line shock expectancy ratings, skin conductance reactivity and startle reflex modulation as indices of fear learning, we found evidence of strong fear after a single conditioning trial (fast learning) as well as attenuated fear responding when only half of the trained stimulus combination was presented (specific learning). Moreover, specificity of fear responding tended to correlate with levels of state and trait anxiety. These results suggest that one-trial overshadowing can be used as a model to study fast specific fear learning in humans and individual differences therein.
Authors:Jack Cotter; Alison R. Yung; Rebekah Carney; Richard J. Drake Pages: 25 - 31 Abstract: Publication date: March 2017 Source:Behaviour Research and Therapy, Volume 90 Author(s): Jack Cotter, Alison R. Yung, Rebekah Carney, Richard J. Drake Dysfunctional metacognitive beliefs are common among people with psychosis. In this meta-analysis we examined whether these are also present in people meeting at-risk mental state (ARMS) criteria. We also explored the relationship between metacognitive beliefs and symptoms in the ARMS group. An electronic database search of Ovid MEDLINE, PsycINFO and Embase from inception until August 2016 was conducted using keyword search terms synonymous with ARMS and metacognition. Eligible studies were original research articles that examined metacognitive beliefs using the Metacognitions Questionnaire (MCQ) among people meeting ARMS criteria. Studies included in the meta-analyses also reported comparison MCQ data acquired from healthy controls, help-seeking individuals, or people with psychotic disorders. Eleven eligible studies were identified, reporting data from six unique ARMS samples. People with ARMS did not differ from those with established psychotic disorders on any MCQ subscale, but they reported significantly more dysfunctional metacognitive beliefs than healthy or help-seeking controls. Maladaptive metacognitive beliefs were associated with a range of symptoms in ARMS individuals, but evidence for associations with specific subthreshold psychotic phenomena was inconsistent. This evidence indicates how valuable assessment and treatment of dysfunctional metacognitive beliefs may be but suggests that specific aspects of methodology should be addressed.
Authors:David F. Tolin; Amber L. Billingsley; Lauren S. Hallion; Gretchen J. Diefenbach Pages: 32 - 40 Abstract: Publication date: March 2017 Source:Behaviour Research and Therapy, Volume 90 Author(s): David F. Tolin, Amber L. Billingsley, Lauren S. Hallion, Gretchen J. Diefenbach Recent clinical trial research suggests that baseline low end-tidal CO2 (ETCO2, the biological marker of hyperventilation) may predict poorer response to cognitive-behavioral therapy (CBT) for anxiety-related disorders. The present study examined the predictive value of baseline ETCO2 among patients treated for such disorders in a naturalistic clinical setting. Sixty-nine adults with a primary diagnosis of a DSM-5 anxiety disorder, obsessive-compulsive disorder, or posttraumatic stress disorder completed a 4-min assessment of resting ETCO2, and respiration rate (the first minute was analyzed). Lower ETCO2 was not associated with a diagnosis of panic disorder, and was associated with lower subjective distress ratings on certain measures. Baseline ETCO2 significantly predicted treatment dropout: those meeting cutoff criteria for hypocapnia were more than twice as likely to drop out of treatment, and ETCO2 significantly predicted dropout beyond other pre-treatment variables. Weekly measurement suggested that the lower-ETCO2 patients who dropped out were not responding well to treatment prior to dropout. The present results, along with previous clinical trial data, suggest that lower pre-treatment ETCO2 is a negative prognostic indicator for CBT for anxiety-related disorders. It is suggested that patients with lower ETCO2 might benefit from additional intervention that targets respiratory abnormality.
Authors:Julian A. Rubel; David Rosenbaum; Wolfgang Lutz Pages: 58 - 66 Abstract: Publication date: March 2017 Source:Behaviour Research and Therapy, Volume 90 Author(s): Julian A. Rubel, David Rosenbaum, Wolfgang Lutz Objective Knowledge of patients' in-session experiences that lead to symptom change in psychotherapy is limited. This study aims to investigate the within- and between-patient relationships between three in-session processes in psychotherapy (coping skills, therapeutic relationship quality, and emotional involvement) and symptom change on a session-by-session level. Method Participants (n = 1550) with various disorders, including primarily depression and anxiety, were treated with CBT in a German outpatient clinic. Symptom distress was assessed before each session and patients' in-session experiences were assessed at the end of each session using session reports. Person-mean centering was applied to disaggregate within- and between-patients. Within- and between-patient process scores were tested in multilevel models as predictors of next session symptom change. Results On a within-patient level, better session-specific coping skills, better therapeutic alliance, and deeper emotional involvement were followed by next session symptom improvements. In a combined model, only coping skills specifically predicted next session symptom change. Additionally, these coping skills were especially helpful when combined with a better therapeutic relationship quality. On a between-patient level, better therapeutic alliance and more coping skills were associated with lower symptom scores during treatment, while deeper emotional involvement was associated with higher symptom scores. Testing these between-patient effects in a combined model left only coping skills (the more, the greater symptom improvement) and emotional involvement (the deeper, the less symptom improvement) as significant predictors. These two also exhibited a combined effect on symptom change on the between-patient level. Discussion The results highlight the importance of a thorough disaggregation of within- and between-patient variability in psychotherapy process-outcome research as well as the consideration of several potentially important time-varying covariates. While coping skills showed to be the most central for subsequent symptom change, therapeutic relationship quality only seemed to be a facilitative factor in enhancing these effects, but was not sufficiently helpful on its own.
Authors:Jenna Course-Choi; Harry Saville; Nazanin Derakshan Pages: 1 - 13 Abstract: Publication date: February 2017 Source:Behaviour Research and Therapy, Volume 89 Author(s): Jenna Course-Choi, Harry Saville, Nazanin Derakshan Worry is the principle characteristic of generalised anxiety disorder, and has been linked to deficient attentional control, a main function of working memory (WM). Adaptive WM training and mindfulness meditation practice (MMP) have both shown potential to increase attentional control. The present study hence investigates the individual and combined effects of MMP and a dual adaptive n-back task on a non-clinical, randomised sample of high worriers. 60 participants were tested before and after seven days of training. Assessment included self-report questionnaires, as well as performance tasks measuring attentional control and working memory capacity. Combined training resulted in continued reduction in worry in the week after training, highlighting the potential of utilising n-back training as an adjunct to established clinical treatment. Engagement with WM training correlated with immediate improvements in attentional control and resilience, with worry decreasing over time. Implications of these findings and suggestions for future research are discussed.
Authors:Jennifer P. Read; Rachel L. Bachrach; Jeffrey D. Wardell; Scott F. Coffey Abstract: Publication date: Available online 24 December 2016 Source:Behaviour Research and Therapy Author(s): Jennifer P. Read, Rachel L. Bachrach, Jeffrey D. Wardell, Scott F. Coffey Despite their centrality to learning theories, strikingly little attention has been paid to the role of cognitions in efforts to understand associations between posttraumatic stress disorder (PTSD) and alcohol drinking. In the present study, we sought to examine information processing pathways for trauma and alcohol information, and the effects of posttraumatic stress and trauma cue exposure on these pathways. Participants were college students (N = 232; 49% female; M age = 19.56,SD = 1.44) categorized into three diagnostic groups based on current PTSD status determined by structured clinical interview. These students then were exposed to a personalized trauma or neutral cue script, followed by a Stroop task modified to include trauma, alcohol, and contrast words. Indices of mood and urge to drink alcohol were administered throughout the task. Findings revealed that those with PTSD who were exposed to the personalized trauma cue showed a general response slowing across all stimuli types on the Stroop task. Intriguingly, this slowing effect was significantly associated with urge to drink alcohol for only those PTSD participants who were exposed to the trauma cues. In contrast, we did not find support for the hypothesis that trauma cues would lead to attention bias to trauma and alcohol specific Stroop stimuli among participants with PTSD, nor did slower RT for specific word types predict unique variance in urge to drink alcohol. Findings suggest that individual (PTSD) and environmental (cue) circumstances may work conjointly to precipitate changes in cognitive processing – changes that may have implications for drinking motivation. Given the importance of cognition in the etiology of both PTSD and drinking, this is a mechanism that warrants further investigation.
Authors:Leslie R. Rith-Najarian; Alayna L. Park; Tina Wang; Ana I. Etchison; Denise A. Chavira; Bruce F. Chorpita Abstract: Publication date: Available online 23 December 2016 Source:Behaviour Research and Therapy Author(s): Leslie R. Rith-Najarian, Alayna L. Park, Tina Wang, Ana I. Etchison, Denise A. Chavira, Bruce F. Chorpita This review included 136 published randomized controlled trials (RCTs) of youth cognitive behavioral therapy (CBT) treatments. We aimed to test the premise that evidence-based youth treatments can be better differentiated from each other by applying more nuanced standards of evidence. Accordingly, we applied three standards to this article sample to determine how many treatments produced significant results: (a) on multiple target symptom measures, (b) at follow-up, and/or (c) against an active comparison group. We identified how many trials met standards individually and in combination. Although 87 of the 136 articles produced at least one significant treatment result at post-assessment, the subsets of “passing” articles were smaller and varied for any one of our three standards, with only 11 articles (8%) meeting all three standards simultaneously. Implications are discussed regarding the definition of “evidence-based,” the need for multi-parameter filtering in treatment selection and clinical decision making, and future directions for research. We ultimately argue the value in assessing youth treatments for different types of evidence, which is better achieved through dynamic sets of standards, rather than a single approach to assessing general strength of evidence.
Authors:Maurice Topper; Paul M.G. Emmelkamp; Ed Watkins; Thomas Ehring Abstract: Publication date: Available online 23 December 2016 Source:Behaviour Research and Therapy Author(s): Maurice Topper, Paul M.G. Emmelkamp, Ed Watkins, Thomas Ehring Background This randomized controlled trial evaluated the efficacy of a preventive intervention for anxiety disorders and depression by targeting excessive levels of repetitive negative thinking (RNT; worry and rumination) in adolescents and young adults. Methods Participants (N = 251, 83.7% female) showing elevated levels of RNT were randomly allocated to a 6-week cognitive-behavioral training delivered in a group, via the internet, or to a waitlist control condition. Self-report measures were collected at pre-intervention, post-intervention, 3 m and 12 m follow-up. Results Both versions of the preventive intervention significantly reduced RNT (d = 0.53 to .89), and symptom levels of anxiety and depression (d = 0.36 to .72). Effects were maintained until 12 m follow-up. The interventions resulted in a significantly lower 12 m prevalence rate of depression (group intervention: 15.3%, internet intervention: 14.7%) and generalized anxiety disorder (group intervention: 18.0%, internet intervention: 16.0%), compared to the waitlist (32.4% and 42.2%, respectively). Mediation analyses demonstrated that reductions in RNT mediated the effect of the interventions on the prevalence of depression and generalized anxiety disorder. Conclusions Results provide evidence for the efficacy of this preventive intervention targeting RNT and support a selective prevention approach that specifically targets a known risk factor to prevent multiple disorders.
Authors:Richard J. Macatee; Brian J. Albanese; Norman B. Schmidt; Jesse R. Cougle Abstract: Publication date: Available online 18 December 2016 Source:Behaviour Research and Therapy Author(s): Richard J. Macatee, Brian J. Albanese, Norman B. Schmidt, Jesse R. Cougle Cognitive theories of anxiety psychopathology cite biased attention towards threat as a central vulnerability and maintaining factor. However, many studies have found threat bias indices to have poor reliability and have failed to observe the theorized relationship between threat bias and anxiety symptoms; this may be due to the non-unitary nature of threat bias and the influence of state-level variables on its expression. Accumulating data suggests that state anxious mood is important for the robust expression of threat bias and for relations to emerge between threat bias and symptoms, though this possibility has not been experimentally tested. Eye-tracking was used to assess multiple forms of threat bias (i.e., early vigilance, sustained attention, facilitated engagement, delayed disengagement) thought to be related to anxiety. A non-clinical sample (N = 165) was recruited to test the hypothesis that biased attention towards threat, but not dysphoric or positive emotional stimuli, during an anxious mood induction, but not at a pre-stress baseline, would prospectively predict greater worry symptoms on days in which more naturalistic stressors occurred. Results revealed the hypothesized moderation effect for sustained attention towards threat after the mood induction but not at baseline, though sustained attention towards dysphoric stimuli also moderated the effect of stressors on worry. Worry-relevant sustained attention towards negative emotional stimuli may be a partially mood-context dependent phenomenon.
Authors:Meredith L. Wallace; Dana L. McMakin; Patricia Z. Tan; Dana Rosen; Erika E. Forbes; Cecile D. Ladouceur; Neal D. Ryan; Greg J. Siegle; Ronald E. Dahl; Philip C. Kendall; Anthony Mannarino; Jennifer S. Silk Abstract: Publication date: Available online 18 December 2016 Source:Behaviour Research and Therapy Author(s): Meredith L. Wallace, Dana L. McMakin, Patricia Z. Tan, Dana Rosen, Erika E. Forbes, Cecile D. Ladouceur, Neal D. Ryan, Greg J. Siegle, Ronald E. Dahl, Philip C. Kendall, Anthony Mannarino, Jennifer S. Silk Do day-to-day emotions, social interactions, and sleep play a role in determining which anxious youth respond to supportive child-centered therapy (CCT) versus cognitive behavioral therapy (CBT)? We explored whether measures of day-to-day functioning (captured through ecological momentary assessment, sleep diary, and actigraphy), along with clinical and demographic measures, were predictors or moderators of treatment outcome in 114 anxious youth randomized to CCT or CBT. We statistically combined individual moderators into a single, optimal composite moderator to characterize subgroups for which CCT or CBT may be preferable. The strongest predictors of better outcome included: (a) experiencing higher positive affect when with one's mother and (b) fewer self-reported problems with sleep duration. The composite moderator indicated that youth for whom CBT was indicated had: (a) more day-to-day sleep problems related to sleep quality, efficiency, and waking, (b) day-to-day negative events related to interpersonal concerns, (c) more DSM-IV anxiety diagnoses, and (d) college-educated parents. These findings illustrate the value of both day-to-day functioning characteristics and more traditional sociodemographic and clinical characteristics in identifying optimal anxiety treatment assignment. Future studies will need to enhance the practicality of real-time measures for use in clinical decision making and evaluate additional anxiety treatments.
Authors:André Wannemueller; Dirk Adolph; Hans-Peter Joehren; Simon E. Blackwell; Jürgen Margraf Abstract: Publication date: Available online 14 December 2016 Source:Behaviour Research and Therapy Author(s): André Wannemueller, Dirk Adolph, Hans-Peter Joehren, Simon E. Blackwell, Jürgen Margraf Psychophysiological responses indicating the preparation of defensive behaviour, such as heart rate (HR)-increase and startle-response (SR) potentiation, have often been reported amongst individuals suffering from phobic disorders when exposed to phobia-related information. Although exposure is widely considered the ‘gold standard’ for treatment of Specific Phobia, it is unclear to what extent psychophysiological defensive response patterns change following treatment, and whether any changes are maintained. We assessed the acoustic SR- and HR-response to neutral, positive, negative and phobia-related pictures and sounds in 41 individuals currently suffering from dental phobia, 22 formerly dental phobic individuals who had remitted following an exposure-based treatment eight months prior to assessment, and 29 control individuals with no history of dental phobia. We observed SR-potentiation to dental-related stimuli in controls combined with HR–deceleration. In contrast, amongst phobic individuals SR-potentiation was accompanied by HR-acceleration to dental pictures. Successfully treated individuals showed inhibited startle reactivity in combination with HR-deceleration to dental related materials of both modalities. Our findings suggest inappropriate fight-flight preparation amongst individuals with dental phobia, reflecting overactivation of the defensive system. However, successful treatment results in inhibited physiological defence preparation, with remitted individuals displaying a response pattern that differed from that of phobic individuals and controls.
Authors:Sarah Vigerland; Eva Serlachius; Ulrika Thulin; Gerhard Andersson; Jan-Olov Larsson; Brjánn Ljótsson Abstract: Publication date: Available online 14 December 2016 Source:Behaviour Research and Therapy Author(s): Sarah Vigerland, Eva Serlachius, Ulrika Thulin, Gerhard Andersson, Jan-Olov Larsson, Brjánn Ljótsson Objective This study investigated the long-term outcomes of internet-delivered cognitive behavior therapy (ICBT) for children with anxiety disorders, and potential pre-treatment predictors of treatment outcome. Method The sample included eighty-four children (8–12 years old) with anxiety disorders, from both a treatment group and a waitlist control (after participants had crossed over to treatment) of a previous randomized controlled study. Participants were assessed at post-treatment and three- and twelve-months after treatment using a semi-structured interview and parent ratings. Pre-treatment data were used to investigate predictors of treatment outcome at three-month follow-up. Results Intention-to-treat analysis showed that treatment gains were maintained at twelve-month follow-up, including clinician rated severity of the principal anxiety disorder, parent rated anxiety symptoms and global functioning, with mainly large effect sizes (Cohen's d = 0.63–2.35). Completer analyses showed that suspected autism spectrum disorder was associated with less change in symptom severity. No other pre-treatment measures significantly predicted treatment outcome. Conclusion This study suggests that internet-delivered CBT can have long-term beneficial effects for children with anxiety disorders. Predictors of treatment outcome need to be evaluated further. Trial registration Clinicaltrials.gov; NCT01533402.
Authors:Monika Trentowska; Jennifer Svaldi; Jens Blechert; Brunna Tuschen-Caffier Abstract: Publication date: Available online 13 December 2016 Source:Behaviour Research and Therapy Author(s): Monika Trentowska, Jennifer Svaldi, Jens Blechert, Brunna Tuschen-Caffier Background Body exposure is a common and effective treatment for body image disturbance in bulimia nervosa (BN). However, little is known about treatment mechanisms. Based on models of emotional processing and neurovisceral integration, we expected to observe a) initial activation and b) habituation of cognitive-affective and autonomic responding within one and between two standardized body exposure sessions. Methods A group of 13 women with BN and 13 healthy controls (HC) were repeatedly exposed to their bodies. Prior to and after treatment with three individualized mirror exposure sessions participants received a session of standardized exposure to videographic recordings of their body. Subjective ratings of body-related emotions and thoughts were assessed repeatedly throughout the standardized exposure sessions and autonomic responses were recorded continuously. Results Subjective and sympathetic responses were activated initially in both groups. Cognitive-affective responses habituated within the standardized sessions in both groups, whereas between the standardized sessions habituation was only found in women with BN. Increasing sympathetic responses were found within the sessions in both groups. Conclusions The results support cognitive-affective habituation during body exposure in BN and to a lesser extent in HC. Autonomic responses however did not show a corresponding pattern and did not distinguish between groups. Implications for body exposure research and practice are discussed.
Authors:Magali Van de Walle; Patricia Bijttebier; Rudi De Raedt; Guy Bosmans Abstract: Publication date: Available online 8 December 2016 Source:Behaviour Research and Therapy Author(s): Magali Van de Walle, Patricia Bijttebier, Rudi De Raedt, Guy Bosmans It has been suggested that an increased attentional focus on the mother should be maladaptive in middle childhood. However, the effect of a more narrow attentional field around the mother may depend on the mother-child relationship. The current study tested whether a more narrow attentional field around the mother is mainly maladaptive for children who tend to think repetitively about their mother (RTm) during distress. More specifically, it investigates whether RTm during distress provides the context in which an increased attentional focus on the mother is linked to depressive symptoms in middle childhood. RTm was measured using a self-report questionnaire. The breadth of children's attentional field around the mother was measured with the Attentional Breadth Task. This computer task assesses the extent to which children have a more narrow attentional field around the mother compared to unfamiliar women. Results of the current study (N = 157) support the hypothesis that 9–12 year old children who have a more narrow attentional field around the mother and who at the same time report more RTm during distress, have more depressive symptoms.
Authors:Susan H. Spence; Caroline L. Donovan; Sonja March; Justin Kenardy; Cate Hearn Abstract: Publication date: Available online 8 December 2016 Source:Behaviour Research and Therapy Author(s): Susan H. Spence, Caroline L. Donovan, Sonja March, Justin Kenardy, Cate Hearn The study examined whether the efficacy of cognitive behavioral treatment for Social Anxiety Disorder for children and adolescents is increased if intervention addresses specific cognitive and behavioral factors linked to the development and maintenance of SAD in young people, over and above the traditional generic CBT approach. Participants were 125 youth, aged 8–17 years, with a primary diagnosis of SAD, who were randomly assigned to generic CBT (CBT-GEN), social anxiety specific CBT (CBT-SAD) or a wait list control (WLC). Intervention was delivered using a therapist-supported online program. After 12-weeks, participants who received treatment (CBT-SAD or CBT-GEN) showed significantly greater reduction in social anxiety and post-event processing, and greater improvement in global functioning than the WLC but there was no significant difference between CBT-SAD and CBT-GEN on any outcome variable at 12-weeks or 6-month follow-up. Despite significant reductions in anxiety, the majority in both treatment conditions continued to meet diagnostic criteria for SAD at 6-month follow-up. Decreases in social anxiety were associated with decreases in post-event processing. Future research should continue to investigate disorder-specific interventions for SAD in young people, drawing on evidence regarding causal or maintaining factors, in order to enhance treatment outcomes for this debilitating condition.
Authors:Yinyin Zang; Jessica Yu; Daniel Chazin; Anu Asnaani; Laurie J. Zandberg; Edna B. Foa Abstract: Publication date: Available online 24 November 2016 Source:Behaviour Research and Therapy Author(s): Yinyin Zang, Jessica Yu, Daniel Chazin, Anu Asnaani, Laurie J. Zandberg, Edna B. Foa Objective The current study examines changes in coping among 165 adults meeting DSM-IV criteria for co-morbid posttraumatic stress disorder (PTSD) and alcohol dependence (AD). Method Participants were randomized to receive naltrexone or placebo, with or without prolonged exposure (PE). All participants received supportive counseling focused on alcohol use (BRENDA). Assessments of coping, PTSD, and AD were conducted at pre-treatment, mid-treatment, post-treatment, 3-month follow-up, and 6-month follow-up. Results Participants exhibited significant decreases in both avoidant coping and adaptive coping from pre-treatment to 6-month follow-up across all groups. Participants who received PE showed faster decreases in avoidant coping during this period than participants who did not receive PE. PTSD symptom reduction was associated with changes in both avoidant and adaptive coping across groups. Improvement in PTSD symptoms was related to a faster rate of reduction in avoidant coping in the PE groups compared to those receiving BRENDA alone. Conclusions The current results suggest that concurrent treatment for co-morbid PTSD-AD decreases avoidant and adaptive coping, and participants who show greater reductions in PTSD symptoms also show greater changes in coping style. Consistent with theorized mechanisms of change in PE, the addition of PE to supportive counseling for AD was associated with a greater reduction of avoidant coping than supportive counseling alone.
Authors:Regina Miranda; Mariann Weierich; Valerie Khait; Justyna Jurska; Susan M. Andersen Abstract: Publication date: Available online 22 November 2016 Source:Behaviour Research and Therapy Author(s): Regina Miranda, Mariann Weierich, Valerie Khait, Justyna Jurska, Susan M. Andersen The present study examined whether practice in making optimistic future-event predictions would result in change in the hopelessness-related cognitions that characterize depression. Individuals (N = 170) with low, mild, and moderate-to-severe depressive symptoms were randomly assigned to a condition in which they practiced making optimistic future-event predictions or to a control condition in which they viewed the same stimuli but practiced determining whether a given phrase contained an adjective. Overall, individuals in the induced optimism condition showed increases in optimistic predictions, relative to the control condition, as a result of practice, but only individuals with moderate-to-severe symptoms of depression who practiced making optimistic future-event predictions showed decreases in depressive predictive certainty, relative to the control condition. In addition, they showed gains in efficiency in making optimistic predictions over the practice blocks, as assessed by response time. There was no difference in depressed mood by practice condition. Mental rehearsal might be one way of changing the hopelessness-related cognitions that characterize depression.