Moving Beyond the Negative: Contributions of Positive and Negative Affect on Quality of Life in Patients With Generalized Anxiety Disorder.

Individuals with generalized anxiety disorder (GAD) report poorer quality of life (QOL) than do nonanxious controls. Further, although positive affect (PA) and negative affect (NA) have been shown to predict QOL, no previous literature has tested this relationship in the context of individuals with GAD. In the present study, we evaluated the unique and interactive contributions of PA and NA on QOL within a sample of individuals diagnosed with GAD (N = 50). Specifically, a hierarchical regression was conducted to evaluate the unique contributions of PA, NA, and their interaction on QOL, over and above symptoms of depression. PA and depression symptoms were both significant predictors of QOL, whereas neither the main effect for NA nor the PA × NA interaction was statistically significant. Results suggest that, for those with GAD, PA uniquely contributes to QOL. Strategies to upregulate PA may be a useful treatment target for increasing QOL in individuals with GAD.

Implicit Cognition and Psychopathology: Looking Back and Looking Forward.

Implicit cognitive processing is theorized to have a central role in many forms of psychopathology. In the current review, we focus on implicit associations, by which we mean evaluative representations in memory that are difficult to control and do not require conscious reflection to influence affect, cognition, or behavior. We consider definitional and measurement challenges before examining recent empirical evidence for these associations in anxiety, obsessive-compulsive, posttraumatic stress, depressive, and alcohol use disorders. This examination is framed by a brief review of the ways that prominent models of psychopathology represent biased implicit processing of disorder-relevant information. We consider to what extent models reflect more traditional automatic/implicit versus strategic/explicit dual-process perspectives or reflect more recent dynamical systems perspectives in which mental representations are iteratively reprocessed, evolving continuously. Finally, we consider the future research needed to better understand the interactive and temporal dynamics of implicit cognition in psychopathology.

Evaluating the Indirect Effects of Trait Mindfulness Facets on State Tripartite Components Through State Rumination and State Experiential Avoidance.

The present study investigated whether specific trait mindfulness facets indirectly influenced state negative affect (NA), positive affect (PA), and physiological hyperarousal (PH) through state rumination and state experiential avoidance. Participants (n = 360, 68% female) rated trait mindfulness facets, then completed an interview task about life experiences intended to elicit state NA, PA, and PH. After the interview task, participants completed measures of state NA, PA, and PH, and state measures of rumination and experiential avoidance. Indirect effect results indicated that the relationships between Nonjudge, Nonreact, and Describe, and each of the state tripartite components indirectly flowed through state rumination. Further, there was a significant indirect effect of Nonjudge and Actaware on each of the three state tripartite components through experiential avoidance. Overall, strengthening the mindfulness skills of Nonjudge, Nonreact, Describe, and Actaware may have positive downstream effects via reducing reliance on maladaptive emotion regulation strategies, such as rumination or experiential avoidance.

The mediating role of state maladaptive emotion regulation in the relation between social anxiety symptoms and self-evaluation bias.

Although social anxiety symptoms are robustly linked to biased self-evaluations across time, the mechanisms of this relation remain unclear. The present study tested three maladaptive emotion regulation strategies - state post-event processing, state experiential avoidance, and state expressive suppression - as potential mediators of this relation. Undergraduate participants (N = 88; 61.4% Female) rated their social skill in an impromptu conversation task and then returned to the laboratory approximately two days later to evaluate their social skill in the conversation again. Consistent with expectations, state post-event processing and state experiential avoidance mediated the relation between social anxiety symptoms and worsening self-evaluations of social skill (controlling for research assistant evaluations), particularly for positive qualities (e.g. appeared confident, demonstrated social skill). State expressive suppression did not mediate the relation between social anxiety symptoms and changes in self-evaluation bias across time. These findings highlight the role that spontaneous, state experiential avoidance and state post-event processing may play in the relation between social anxiety symptoms and worsening self-evaluation biases of social skill across time.

Attentional Bias Modification for Social Anxiety Disorder: What do Patients Think and Why does it Matter?

BACKGROUND: In the past decade, a great deal of research has examined the efficacy and mechanisms of attentional bias modification (ABM), a computerized cognitive training intervention for anxiety and other disorders. However, little research has examined how anxious patients perceive ABM, and it is unclear to what extent perceptions of ABM influence outcome. AIMS: To examine patient perceptions of ABM across two studies, using a mixed methods approach. METHOD: In the first study, participants completed a traditional ABM program and received a hand-out with minimal information about the purpose of the task. In the second study, participants completed an adaptive ABM program and were provided with more extensive rationale and instructions for changing attentional biases. RESULTS: A number of themes emerged from qualitative data related to perceived symptom changes and mechanisms of action, acceptability, early perceptions of the program, barriers/facilitators to engagement, and responses to adaptive features. Moreover, quantitative data suggested that patients' perceptions of the program predicted symptom reduction as well as change in attentional bias. CONCLUSIONS: Our quantitative data suggest that it may be possible to quickly and inexpensively identify some patients who may benefit from current ABM programs, although our qualitative data suggest that ABM needs major modifications before it will be an acceptable and credible treatment more broadly. Although the current study was limited by sample size and design features of the parent trials from which these data originated, our findings may be useful for guiding hypotheses in future studies examining patient perceptions towards ABM.

Body Dysmorphic, Obsessive-Compulsive, and Social Anxiety Disorder Beliefs as Predictors of In Vivo Stressor Responding.

This study tested the potential transdiagnostic nature of body dysmorphic disorder (BDD), obsessive-compulsive disorder (OCD), and social anxiety disorder (SAD) beliefs, in addition to testing the specificity of those beliefs, in predicting how individuals responded to symptom-specific stressors. Participants included 127 adults (75% women) with a broad range of symptom severity. Path analysis was used to evaluate whether specific maladaptive beliefs predicted distress in response to symptom-relevant stressors over and above other beliefs and baseline distress. SAD beliefs emerged as a significant predictor of distress in response to a mirror gazing (BDD-relevant), a thought (OCD-relevant), and a public speaking (SAD-relevant) task, controlling for other disorder beliefs and baseline distress. BDD beliefs were also a robust predictor of BDD stressor responding. Results suggest that social anxiety-relevant beliefs may function as a transdiagnostic risk factor that predicts in vivo symptoms across a range of problem areas.

Using implicit attitudes of exercise importance to predict explicit exercise dependence symptoms and exercise behaviors.

OBJECTIVES: "Fast" (i.e., implicit) processing is relatively automatic; "slow" (i.e., explicit) processing is relatively controlled and can override automatic processing. These different processing types often produce different responses that uniquely predict behaviors. In the present study, we tested if explicit, self-reported symptoms of exercise dependence and an implicit association of exercise as important predicted exercise behaviors and change in problematic exercise attitudes. DESIGN: We assessed implicit attitudes of exercise importance and self-reported symptoms of exercise dependence at Time 1. Participants reported daily exercise behaviors for approximately one month, and then completed a Time 2 assessment of self-reported exercise dependence symptoms. METHOD: Undergraduate males and females (Time 1, N = 93; Time 2, N = 74) tracked daily exercise behaviors for one month and completed an Implicit Association Test assessing implicit exercise importance and subscales of the Exercise Dependence Questionnaire (EDQ) assessing exercise dependence symptoms. RESULTS: Implicit attitudes of exercise importance and Time 1 EDQ scores predicted Time 2 EDQ scores. Further, implicit exercise importance and Time 1 EDQ scores predicted daily exercise intensity while Time 1 EDQ scores predicted the amount of days exercised. CONCLUSION: Implicit and explicit processing appear to uniquely predict exercise behaviors and attitudes. Given that different implicit and explicit processes may drive certain exercise factors (e.g., intensity and frequency, respectively), these behaviors may contribute to different aspects of exercise dependence.

Transitioning to college: Testing cognitive bias modification for interpretations as an inoculation tool for social anxiety in college first-years.

BACKGROUND AND OBJECTIVES: Reducing social anxiety development among incoming college students may improve college adjustment and mental health outcomes. This study tested whether cognitive bias modification for interpretations (CBM-I) reduces social anxiety and increases adjustment during the transition to college, and whether changes in outcomes would be mediated by changes in interpretation biases. METHODS: Participants (N = 73) were randomly assigned to a 3-session weekly CBM-I condition or symptom tracking (ST) control condition. Multilevel models were used to estimate within-person trajectories from baseline to one week post-intervention and to test whether trajectories differed by condition. RESULTS: Those in the CBM-I condition (vs. ST) reported higher increases in social adjustment across time. There were not significant differences between conditions for changes in social anxiety, academic adjustment, and personal adjustment. CBM-I was indirectly linked to improvements in outcome variables via more adaptive interpretation biases. LIMITATIONS: CBM-I was administered in a laboratory setting, requiring more resources than some computerized interventions. CONCLUSIONS: Data tentatively support CBM-I for first-year students to increase social adjustment. Further, mediation findings provide support for targeting interpretation biases to improve social anxiety and adjustment outcomes. Yet, CBM-I did not outperform ST in improving social anxiety symptoms or other areas of college adjustment, and effect sizes were small, suggesting that more work is needed to amplify the potential of CBM-I as a therapeutic tool.

Anxiety sensitivity and panic symptoms: the moderating influence of distress tolerance.

BACKGROUND AND OBJECTIVES: Anxiety sensitivity (AS) is the fear of consequences of anxiety-related sensations, and has been linked to the development of panic symptoms. Distress tolerance (DT) encompasses one's behavioral or self-perceived ability to handle aversive states. We examined whether higher DT buffers the relationship between AS and changes in panic symptoms across two timepoints, spaced ∼three weeks apart. DESIGN AND METHODS: At Time 1, 208 participants completed questionnaires and a physical DT task (breath-holding duration), a cognitive DT task (anagram persistence), and a self-report measure of DT (perceived DT). Panic symptoms were assessed at both timepoints. Structural equation modeling was used to evaluate two models in which AS and DT predicted changes in panic. RESULTS: Contrary to hypotheses, for those with longer breath-holding duration (higher physical DT), higher fears of physical anxiety-related sensations (higher physical AS) were associated with worse panic outcomes over time. CONCLUSIONS: Findings suggest that those with lower physical DT may have been less willing to engage with difficult tasks in the short-term. Although disengagement in the short-term may provide temporary relief, it is possible that averse psychopathological consequences stemming from rigid or habitual avoidance of distressing states may develop over longer periods of time.

Distressed Drinking: The Moderating Impact of Distress Tolerance on the Relation Between Anxiety Sensitivity, Panic Symptoms, and Alcohol Use and Problems.

OBJECTIVE: Undergraduate students are at particular risk for greater alcohol use, which is linked to anxiety disorders among a variety of other negative consequences. Understanding transdiagnostic factors underlying alcohol use problems and other disorders, such as anxiety and mood disorders, can help identify potential targets for intervention. METHOD: The present study (N = 208 undergraduates; 76.9% female) tested relations between self-reported anxiety sensitivity, panic symptoms, alcohol use and problems, and two different measures of distress tolerance. Specifically, the distress tolerance measures assessed (a) perceived ability to handle negative emotion states (emotional distress tolerance), measured via self-report, and (b) behavioral ability to tolerate discomforting physical sensations (physical distress tolerance), measured via a breath-holding duration task. RESULTS: Consistent with expectations, anxiety sensitivity was associated with greater panic symptoms, which in turn was associated with greater alcohol use problems, for individuals with low but not high levels of physical distress tolerance. Contrary to expectations, there was no evidence that panic symptoms explained the relation between anxiety sensitivity and alcohol use and problems at either low or high levels of emotional distress tolerance. CONCLUSIONS: Taken together, these results suggest that a possible target to decrease alcohol use problems is to increase capacity to withstand or engage with discomforting physiological and panic sensations (i.e., to cultivate greater physical distress tolerance).

A Randomized Test of Interpretation Bias Modification for Perfectionism Versus Guided Visualization Relaxation Among High Perfectionistic Undergraduate Students.

Clinical perfectionism contributes to the onset and maintenance of multiple psychological concerns. We conducted a randomized, longitudinal test of the efficacy of a web-based intervention for perfectionism (specifically, cognitive bias modification, interpretation retraining; CBM-I), compared to an active treatment comparison condition (specifically, guided visualization relaxation training) for reducing perfectionism and related psychopathology. College students (N = 167) with elevated perfectionism were randomized to one of the two study conditions and were asked to complete their assigned intervention twice weekly for 4 weeks. Participants completed measures of perfectionism and psychological symptoms at baseline, 2 weeks (midway through the intervention period), 4 weeks (at the conclusion of the intervention period), and 8 weeks (1 month follow-up). CBM-I was rated as acceptable overall, though relaxation training was rated slightly more favorably. CBM-I outperformed relaxation training on improving perfectionism-relevant interpretation biases (i.e., increasing nonperfectionistic interpretations and decreasing perfectionistic interpretations), though with small effect sizes and inconsistency across study timepoints. Self-reported perfectionism showed small decreases across time in both intervention conditions. Support was found for a key hypothesized mechanism of CBM-I, such that randomization to CBM-I had a longitudinal, indirect effect on decreasing psychopathology symptom scores through improving perfectionism-relevant interpretation biases. However, in light of small effect sizes, the present study failed to provide compelling evidence that CBM-I for perfectionism contributes meaningfully to the treatment of perfectionism.

Sensation seeking moderates the effects of alcohol and drug use prior to sex on sexual risk in young men who have sex with men.

Men who have sex with men (MSM) account for more than half of all new HIV/AIDS diagnoses in the United States each year, and young MSM (ages 13-24) have the highest increases in new infections. Identifying which young MSM engage in sexual risk-taking in which contexts is critical in developing effective behavioral intervention strategies for this population. While studies have consistently found positive associations between the use of certain drugs and sexual risk, research on alcohol use as a predictor of risk has been less consistent. Participants included 114 young MSM from a longitudinal study of LGBT youth (ages 16-20 at baseline). Participants reported number of unprotected sex acts with up to nine partners across three waves of data collection spanning a reporting window of 18 months, for a total of 406 sexual partners. Sensation seeking was evaluated as a moderator of the effects of both alcohol and drug use prior to sex on sexual risk. Higher levels of sensation seeking were found to significantly increase the positive associations between frequency of unprotected sex and frequency of both alcohol use and drug use with partners. Follow-up analysis found that average rates of alcohol use moderated the association between alcohol use prior to sex and sexual risk, such that decreases in average alcohol use increased the positive association between these variables. Results suggest that while drug use with partners increased sexual risk for all young MSM, the effects of alcohol use prior to sex were limited in low sensation-seeking young MSM as well as those who are high alcohol consumers on average. Implications for future research and behavioral interventions are discussed.

Unpacking the racial disparity in HIV rates: the effect of race on risky sexual behavior among Black young men who have sex with men (YMSM).

The purpose of this study is to evaluate the large disparity in HIV prevalence rates between young Black and White Americans, including young men who have sex with men (YMSM). Research focusing on individual behaviors has proven insufficient to explain the disproportionately high rate of HIV among Black YMSM. The purpose of the present study was to gain a greater understanding of the pronounced racial disparity in HIV by evaluating whether YMSM are more likely to engage in risky sexual behaviors as a function of their partner's race. Participants included 117 YMSM from a longitudinal study evaluating lesbian, gay, bisexual, and transgender youth (ages 16-20 at baseline), who reported characteristics and risk behaviors of up to 9 sexual partners over an 18-month period. Results indicated that participants were less likely to have unprotected sex with Black partners, and this finding was not driven by a response bias (i.e., Black YMSM did not appear to be minimizing their reports of unprotected sex). Furthermore, there was support for the hypothesis that participants' sexual networks were partially determined by their race insofar as sexual partnerships were much more likely to be intra-racial (as opposed to interracial). It is possible that dyad- and sexual network-level factors may be needed to understand racial disparities in HIV among YMSM.

The Impact of Peer and Family Functioning on Transgender and Gender-Diverse Children's Mental Health.

Although high levels of internalizing and externalizing psychopathology have been documented among transgender and gender-diverse (TGD) youth, contextual factors influencing the development of psychopathology among TGD children are relatively understudied. The current study tested the interaction between two relational factors, children's caregiver-reported peer relations and family functioning, on TGD children's internalizing and externalizing symptoms. The sample consisted of 49 primary caregivers of TGD children, who were age 6-12 at baseline. A cross-sectional path analysis was run to test the relations between peer relations, family functioning, and their interaction on internalizing and externalizing symptoms. A longitudinal path analysis was run to test the relations between variables over time. In the cross-sectional model, among families with adequate family functioning, peer problems were associated with greater internalizing symptoms. Among families that were functioning poorly, there was not a significant relationship between peer problems and internalizing symptoms. Further, among children who did not experience peer problems, poorer family functioning was associated with greater internalizing symptoms. Peer problems, but not family functioning or the interaction term, was associated with externalizing symptoms. Longitudinal analyses did not support the hypothesis of an interaction between peer relations and family functioning. The current research indicated that poor peer relations and poor family functioning each confer risk for internalizing symptoms among TGD children, and poor peer relations carries risk for externalizing symptoms among TGD youth.

Automatic and strategic measures as predictors of mirror gazing among individuals with body dysmorphic disorder symptoms.

The current study tests cognitive-behavioral models of body dysmorphic disorder (BDD) by examining the relationship between cognitive biases and correlates of mirror gazing. To provide a more comprehensive picture, we investigated both relatively strategic (i.e., available for conscious introspection) and automatic (i.e., outside conscious control) measures of cognitive biases in a sample with either high (n = 32) or low (n = 31) BDD symptoms. Specifically, we examined the extent that (1) explicit interpretations tied to appearance, as well as (2) automatic associations and (3) strategic evaluations of the importance of attractiveness predict anxiety and avoidance associated with mirror gazing. Results indicated that interpretations tied to appearance uniquely predicted self-reported desire to avoid, whereas strategic evaluations of appearance uniquely predicted peak anxiety associated with mirror gazing, and automatic appearance associations uniquely predicted behavioral avoidance. These results offer considerable support for cognitive models of BDD, and suggest a dissociation between automatic and strategic measures.

Do thoughts about dieting matter? Testing the relationship between thoughts about dieting, body shape concerns, and state self-esteem.

BACKGROUND AND OBJECTIVES: Dieters are likely primed to think about their diet throughout the day (e.g., as they feel hungry). However, prior research has not tested whether and how thinking about dieting might have negative effects, like poor self-esteem and body shape concerns. METHODS: We experimentally primed dieters' thoughts about their diets and tested whether: 1) dieting thoughts are related to poor state self-esteem through body shape concerns; and 2) dieting thoughts are related to body shape concerns through poor state self-esteem. Dieting participants (N = 225) were randomly assigned to complete a dieting or neutral prime. RESULTS: Unexpectedly, there was a different pattern of results across male (n = 72) and female (n = 144) dieters. When accounting for body shape concerns, males primed to think about dieting (vs. neutral condition) reported greater state self-esteem. Further, the dieting prime indirectly led to lower body shape concerns through greater state global self-esteem. However, for females, the dieting prime indirectly led to poorer state self-esteem through its effects on body shape concerns. LIMITATIONS: The sample was collected online and was predominantly female and Caucasian. Other limitations include self-report of dieting status and body mass index. CONCLUSIONS: The findings suggest that for males, thoughts about dieting may actually be associated with greater state self-esteem, which may indirectly predict lower body shape concerns. In contrast, for females, when thoughts about dieting activate body shape concerns, poorer state self-esteem may follow. These results highlight important, potentially gender-specific relationships between thoughts about dieting, body shape concerns, and state self-esteem.

Don't Tell Me What to Think: Comparing Self- and Other-Generated Distraction Methods for Controlling Intrusive Thinking.

Cognitive control is central to the phenomenon of intrusive thinking in obsessive-compulsive and related disorders. The current study tested how attempts at cognitive control are impacted by self- vs. other-generated distractor thoughts. Participants (N=1913) were randomly assigned to suppress or monitor an intrusive thought and also randomly assigned to: a) self-generate a distractor, b) receive a distractor, or c) receive no distractor guidance. Participants reported subsequent thought recurrences, perceived success and effort keeping the thought out of mind, and positive and negative affect during a one-minute thinking period and a one-minute monitoring period. During the first thinking period only, self-generated distractors resulted in greater perceived control (p<.001; during monitoring instructions only) relative to no guidance, and less effort (ps<.001) relative to both other conditions. Interestingly, self-generated distractors led to longer duration of recurrences relative to both other conditions (ps≤.007). Finally, there were no distractor differences in trajectories of positive and negative affect (ps>.10). These findings suggest that the source of distractors may inform when attempts to control intrusive thinking will be helpful versus harmful.

Believing is seeing: Changes in visual perception following treatment for height fear.

BACKGROUND AND OBJECTIVES: People who are afraid of heights may have a perceptual bias, such that they see heights as higher than they truly are. The current study tested if there is a causal relationship between treatments for height fear and changes in perceptual bias. METHODS: Specifically, the effects on perceptual bias following three height fear interventions (exposure, cognitive bias modification for interpretations, and a combination of exposure and cognitive bias modification) and a control condition were examined in individuals with an extreme fear of heights (N = 107). RESULTS: Results provided preliminary evidence that some height fear interventions reduce perceptual bias. Specifically, participants that completed exposure had a significant decrease in perceptual bias, and participants in the cognitive bias modification and combination conditions had decreases in perceptual bias at the level of non-significant trends, while no reduction occurred for the control condition. LIMITATIONS: Limitations of this study include that the hypothesis was largely informed by data from a parent study and that the effect sizes were small; thus, replicating these results is warranted. CONCLUSIONS: These findings suggest that there may be a causal relationship between height fear treatments and altered perception of heights.

Perfectly imperfect: The use of cognitive bias modification to reduce perfectionism.

BACKGROUND AND OBJECTIVES: Perfectionism is a transdiagnostic risk and maintenance factor for psychopathology. The current study developed and evaluated a cognitive bias modification, interpretation retraining (CBM-I) intervention targeting maladaptive perfectionistic beliefs. METHODS: Participants were undergraduate students randomized to complete the perfectionism CBM-I (n = 33) or control condition task (n = 36) at two time points. Additionally, participants completed measures of perfectionistic interpretations and trait perfectionism, as well as an impossible anagram task designed to elicit perfectionistic concerns. RESULTS: Results indicated that after the intervention, participants who completed the perfectionism CBM-I endorsed fewer perfectionistic interpretations than participants in the control condition. Furthermore, although the study groups self-reported comparably low confidence in their anagram task performance, participants who completed the perfectionism CBM-I reported wanting to re-do significantly fewer anagrams than participants in the control condition, suggesting greater acceptance of imperfect performance following the intervention. Moreover, supporting a key hypothesized mechanism of effect in CBM-I, reductions in perfectionistic interpretations mediated the effect of condition on the desire to re-do anagram task items. LIMITATIONS: The study results should be viewed in light of limitations, including the short time-span of the study, and the use of a relatively small, non-clinical, and demographically homogenous convenience sample. CONCLUSIONS: Further research and development of the perfectionism CBM-I intervention are needed, but the present findings add to a nascent evidence base that suggests CBM-I holds promise as an accessible and transdiagnostic intervention for perfectionism.

A new mode of fear expression: perceptual bias in height fear.

Emotion and psychopathology researchers have described the fear response as consisting of four main components--subjective affect, physiology, cognition, and behavior. The current study provides evidence for an additional component in the domain of height fear (perception) and shows that it is distinct from measures of cognitive processing. Individuals High (N = 35) and Low (N = 36) in acrophobic symptoms looked over a two-story balcony ledge and estimated its vertical extent using a direct height estimation task (visual matching), and an indirect task (size estimation); the latter task seems to exhibit little influence from cognitive factors. In addition, implicit and explicit measures of cognitive processing were obtained. Results indicated that, as expected, the High Fear group showed greater relative, implicit height fear associations and explicit threat cognitions. Of primary interest, the High (compared to Low) Fear group estimated the vertical extent to be higher, and judged target sizes to be greater, even when controlling for the cognitive bias measures. These results suggest that emotional factors such as fear are related to perception.