Examining attentional biases underlying trait anxiety in younger and older adults.

Previous research has not adequately assessed the independent contributions of component attentional processes to anxiety-linked biases. MacLeod and Sadler developed a novel, lexical decision task using negative and neutral word stimuli, to enable the independent measurement of attentional engagement and disengagement. Their results suggest that anxiety-linked attentional biases are associated with facilitated attentional engagement with negative information. The present study aimed to determine the replicability of these findings, with two important extensions. First, this study included positive word stimuli in the lexical decision task, to determine whether anxiety-linked attentional biases exist only towards negative information, or toward emotionally arousing information in general. Second, this study explored age-related differences in anxiety-linked attentional biases. Younger (N=32) and older adults (N=32) with both high and low trait anxiety completed the lexical decision task. The results suggest that heightened anxiety may be associated with a deficit in engaging with positive words. No age-related differences in anxiety-linked attentional biases were apparent.

Interpersonal problems across anxiety, depression, and eating disorders: a transdiagnostic examination.

OBJECTIVES: Integrative models of psychopathology suggest that quality of interpersonal relationships is a key determinant of psychological well-being. However, there is a relative paucity of research evaluating the association between interpersonal problems and psychopathology within cognitive behavioural therapy. Partly, this may be due to lack of brief, well-validated, and easily interpretable measures of interpersonal problems that can be used within clinical settings. The aim of the present study was to evaluate the psychometric properties, factor invariance, and external validity of the Inventory of Interpersonal Problems 32 (IIP-32) across anxiety, depression, and eating disorders. METHODS: Two treatment-seeking samples with principal anxiety and depressive disorders (AD sample, n = 504) and eating disorders (ED sample, n = 339) completed the IIP-32 along with measures of anxiety, depression, and eating disorder symptoms, as well as quality of life (QoL). RESULTS: The previously established eight-factor structure of the IIP-32 provided the best fit for both the AD and ED groups, and was robustly invariant across the two samples. The IIP-32 also demonstrated excellent external validity against well-validated measures of anxiety, depression, and eating disorder symptoms, as well as QoL. CONCLUSION: The IIP-32 provides a clinically useful measure of interpersonal problems across emotional and ED.

The relationship between interpersonal problems, therapeutic alliance, and outcomes following group and individual cognitive behaviour therapy.

BACKGROUND: Cognitive behavioural therapy (CBT) is efficacious, but there remains individual variability in outcomes. Patient's interpersonal problems may affect treatment outcomes, either directly or through a relationship mediated by helping alliance. Interpersonal problems may affect alliance and outcomes differentially in individual and group (CBGT) treatments. The main aim of this study was to investigate the relationship between interpersonal problems, alliance, dropout and outcomes for a clinical sample receiving either individual or group CBT for anxiety or depression in a community clinic. METHODS: Patients receiving individual CBT (N=84) or CBGT (N=115) completed measures of interpersonal problems, alliance, and disorder specific symptoms at the commencement and completion of CBT. RESULTS: In CBGT higher pre-treatment interpersonal problems were associated with increased risk of dropout and poorer outcomes. This relationship was not mediated by alliance. In individual CBT those who reported higher alliance were more likely to complete treatment, although alliance was not associated with symptom change, and interpersonal problems were not related to attrition or outcome. LIMITATIONS: Allocation to group and individual therapy was non-random, so selection bias may have influenced these results. Some analyses were only powered to detect large effects. Helping alliance ratings were high, so range restriction may have obscured the relationship between helping alliance, attrition and outcomes. CONCLUSIONS: Pre-treatment interpersonal problems increase risk of dropout and predict poorer outcomes in CBGT, but not in individual CBT, and this relationship is not mediated by helping alliance. Stronger alliance is associated with treatment completion in individual, but not group CBT.

Expectancy bias in anxious samples.

Although it is well documented that anxious individuals have negative expectations about the future, it is unclear what cognitive processes give rise to this expectancy bias. Two studies are reported that use the Expectancy Task, which is designed to assess expectancy bias and illuminate its basis. This task presents individuals with valenced scenarios (Positive Valence, Negative Valence, or Conflicting Valence), and then evaluates their tendency to expect subsequent future positive relative to negative events. The Expectancy Task was used with low and high trait anxious (Study 1: n = 32) and anxiety sensitive (Study 2: n = 138) individuals. Results suggest that in the context of physical concerns, both high anxious samples display a less positive expectancy bias. In the context of social concerns, high trait anxious individuals display a negative expectancy bias only when negatively valenced information was previously presented. Overall, this suggests that anxious individuals display a less positive expectancy bias, and that the processes that give rise to this bias may vary by type of situation (e.g., social or physical) or anxiety difficulty.

The relationship between interpersonal problems, negative cognitions, and outcomes from cognitive behavioral group therapy for depression.

BACKGROUND: Interpersonal functioning is a key determinant of psychological well-being, and interpersonal problems (IPs) are common among individuals with psychiatric disorders. However, IPs are rarely formally assessed in clinical practice or within cognitive behavior therapy research trials as predictors of treatment attrition and outcome. The main aim of this study was to investigate the relationship between IPs, depressogenic cognitions, and treatment outcome in a large clinical sample receiving cognitive behavioral group therapy (CBGT) for depression in a community clinic. METHODS: Patients (N=144) referred for treatment completed measures of IPs, negative cognitions, depression symptoms, and quality of life (QoL) before and at the completion of a 12-week manualized CBGT protocol. RESULTS: Two IPs at pre-treatment, 'finding it hard to be supportive of others' and 'not being open about problems,' were associated with higher attrition. Pre-treatment IPs also predicted higher post-treatment depression symptoms (but not QoL) after controlling for pre-treatment symptoms, negative cognitions, demographics, and comorbidity. In particular, 'difficulty being assertive' and a 'tendency to subjugate one's needs' were associated with higher post-treatment depression symptoms. Changes in IPs did not predict post-treatment depression symptoms or QoL when controlling for changes in negative cognitions, pre-treatment symptoms, demographics, and comorbidity. In contrast, changes in negative cognitions predicted both post-treatment depression and QoL, even after controlling for changes in IPs and the other covariates. LIMITATIONS: Correlational design, potential attrition bias, generalizability to other disorders and treatments needs to be evaluated. CONCLUSIONS: Pre-treatment IPs may increase risk of dropout and predict poorer outcomes, but changes in negative cognitions during treatment were most strongly associated with improvement in symptoms and QoL during CBGT.