The Effects of Childhood and Adolescent Adversity on Substance Use Disorders and Poor Health in Early Adulthood.

Childhood and adolescent adversity have been shown to predict later mental and physical health outcomes. Understanding which aspects and developmental timings of adversity are important, and the mechanisms by which they have their impact may help guide intervention approaches. A large subset of adolescents (N = 457; Female 68.9 %) from the 10-year longitudinal Youth Emotion Project was examined to better understand the associations among childhood/adolescent adversity, substance use disorder, and later health quality. Adolescent (but not childhood) adversities were associated with poorer health in late adolescence/early adulthood, adolescent adversities were associated with subsequent onset of substance use disorder, and adolescent adversities continued to be associated with poorer health in late adolescence/early adulthood after accounting for the variance explained by substance use disorder onset. These associations were observed after statistically accounting for emotional disorders and socioeconomic status. Specific domains of adversity uniquely predicted substance use disorder and poorer health outcomes. In contrast with current recent research, our findings suggest the association between childhood/adolescent adversity and poorer health outcomes in late adolescence and emerging adulthood are not entirely accounted for by substance use disorder, suggesting efforts to curtail family-based adolescent adversity may have downstream health benefits.

DEFICITS IN DISENGAGING ATTENTION FROM THREAT PREDICT IMPROVED RESPONSE TO COGNITIVE BEHAVIORAL THERAPY FOR ANXIETY.

BACKGROUND: Pretreatment biases in attending toward threat have been shown to predict greater symptom reduction following cognitive behavioral therapy (CBT) for anxiety. Findings to date do not extend to clinical severity of diagnoses and they assess treatment response immediately posttreatment and not at follow-up. Research in this area has also not examined components of vigilance (e.g., engagement, disengagement) or whether these effects are confined to external attention and not attention to internal symptoms of anxiety. METHODS: In the present investigation, 96 adults with a range of anxiety disorders completed a dot probe task to assess threat-related attention biases before and after 12 sessions of CBT. RESULTS: Pretreatment deficits in disengaging attention from external and internal threats, and not the speed of engagement with threat, predicted reductions in clinical severity of diagnoses that were maintained 2 years later. The presence of posttreatment attention biases was not associated with increased clinical severity after treatment. CONCLUSIONS: Pretreatment deficits in disengaging attention from threat may promote better and more durable response to CBT for a range anxiety disorders.

A Preliminary Test of the Efficacy of Brief Self-Administered Behavioral Interventions for Rumination.

Rumination is theorized to be a cognitive avoidance process that is implicated in several manifestations of psychopathology. Few interventions directly target rumination as a core process maintaining emotional disorder symptoms. This pilot study compared the feasibility and preliminary efficacy of self-directed behavioral approaches for reducing rumination. Participants (N = 60) with elevations in rumination were randomized to 3 weeks of self-directed interventions: (a) scheduled rumination time; (b) a strategy combining mindfulness, shaping, and disengagement strategies; or (c) self-monitoring control. Both active treatment conditions outperformed self-monitoring control on post-treatment depression scores. Scheduled rumination time significantly outperformed the other two conditions on measures of rumination and worry. No between-group differences emerged on the secondary outcome (i.e., anxiety symptoms). Brief, self-directed, behavioral interventions targeting rumination are feasible and demonstrate preliminary efficacy. Scheduled rumination time shows moderate to large effects. The use of a small, non-treatment seeking sample was the primary limitation.

Development and Initial Pilot Testing of a fully integrated treatment for comorbid social anxiety disorder and alcohol use disorder in a community-based SUD clinic setting.

OBJECTIVES: Social anxiety disorder (SAD) and alcohol use disorder (AUD) are highly comorbid and this comorbidity is associated with poorer clinical outcomes. Integrating exposure-based treatment for SAD into the context of typical AUD treatment programs should improve engagement and treatment outcomes for this population. METHODS: After initial development of a fully integrated, intensive outpatient program (IOP) for individuals with comorbid SAD and AUD, patients with SAD and AUD were recruited from a community-based SUD specialty clinic (N = 56) and randomized to either (a) usual care (UC), consisting of the evidence-based Matrix Model of Addiction IOP; or (b) the Fully Integrated Treatment (FIT) for comorbid SAD and AUD IOP. Participants were assessed on indices of social anxiety and alcohol use. RESULTS: By the 6-month follow-up, those in FIT showed superior improvement to UC on number of drinking days in the past 30 days and social anxiety severity at follow-up, but there were no differences between groups on quantity of alcohol consumed on drinking days. Alcohol-related problems improved in both groups, with no statistically significant differences. Within-group improvement was observed in FIT (but not in UC) on drinking to cope with social anxiety and avoidance of social situations without alcohol, but between-group effects were non-significant. In sum, the integrated treatment of SAD and AUD led to greater reductions in both the frequency of drinking and in social anxiety symptoms than usual care. CONCLUSIONS: Targeting social anxiety in the context of AUD treatment is a promising approach to improving the treatment of this common comorbidity.

Pre-treatment hippocampal functioning impacts context renewal for cholinergic modulated exposure therapy.

Our recent trial demonstrated individuals suffering from social anxiety with performance-related concerns who received virtual reality exposure augmented with scopolamine, a cholinergic antagonist, experienced significantly less post-treatment context renewal (CX) than placebo (Craske et al., 2019). The purpose of the present investigation was to determine who specifically benefits from scopolamine by examining hippocampal (HPC) functioning as a moderator of treatment response (Placebo n = 15, SCOP 0.5 mg n = 15, SCOP 0.6 mg n = 15). Skin conductance response to conditional stimulus (SCR-to-CS) termination suggested a dose-response relationship for enhanced HPC functioning individuals, wherein individuals receiving scopolamine demonstrated less fear at CX. In addition, SCR-to-CS onset indicated reduced fear at CX for impaired HPC individuals receiving SCOP 0.5 mg and SCOP 0.6 mg relative to Placebo. Our findings, however, lacked consistency across measures. Scopolamine remains a promising agent and additional research required to further understand its effects.

Rumination and worry as putative mediators explaining the association between emotional disorders and alcohol use disorder in a longitudinal study.

INTRODUCTION: The high rate of comorbidity between alcohol use and emotional disorders is well demonstrated, but the mechanisms underlying their relationship remain largely unidentified. One possibility is maladaptive responding to negative affect, such as worry and rumination. The present study sought to examine worry and rumination as putative mediators explaining the link between emotional disorders and alcohol use disorders. Methods Mediational analyses were conducted using a sample (n = 232) derived from a larger late adolescence/early adulthood longitudinal dataset (Youth Emotion Project; Zinbarg et al., 2010). Results A significant indirect effect was observed for emotional disorder severity on alcohol use disorder severity via rumination, but not via worry or the shared variance between worry and rumination. Conclusions These findings suggest that rumination may specifically confer risk for the development of alcohol use disorder for individuals with emotional disorders. Further, ruminative thinking may serve as a specific treatment target to reduce vulnerability to alcohol use disorder.

The longitudinal association between individual differences in recall of positive specific autobiographical memories and daily cortisol.

The present study examines the longitudinal association between cortisol (dys)regulation - mean cortisol awakening response (CAR) and area under the curve with respect to ground (AUCg) for total daily cortisol - and autobiographical memory. 135 participants (mean age at baseline = 16.1; Females = 78.5 %) provided cortisol samples (T1). Seven months later participants retrieved autobiographical memories cued by positive and negative words (T2). Four years subsequently, participants provided cortisol samples again (T3). The retrieval of more specific memories cued by positive words, but not negative words, was associated with higher AUCg four years later, independent of sex, recent life stressors and self-reported negative self-related cognitions. There were no associations between CAR and autobiographical memory. Neither AUC nor CAR at T1 predicted subsequent autobiographical memory abilities. People who retrieve more positive specific memories may be more likely to imagine and seek out positive experiences and this may be associated with higher cortisol levels.

Detecting depression using a framework combining deep multimodal neural networks with a purpose-built automated evaluation.

Machine learning (ML) has been introduced into the medical field as a means to provide diagnostic tools capable of enhancing accuracy and precision while minimizing laborious tasks that require human intervention. There is mounting evidence that the technology fueled by ML has the potential to detect and substantially improve treatment of complex mental disorders such as depression. We developed a framework capable of detecting depression with minimal human intervention: artificial intelligence mental evaluation (AiME). This framework consists of a short human-computer interactive evaluation that utilizes artificial intelligence, namely deep learning, and can predict whether the participant is depressed or not with satisfactory performance. Because of its ease of use, this technology can offer a viable tool for mental health professionals to identify symptoms of depression, thus enabling a faster preventative intervention. Furthermore, it may alleviate the challenge of observing and interpreting highly nuanced physiological and behavioral biomarkers of depression by providing a more objective evaluation. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Positive Affect as a Buffer between Chronic Stress and Symptom Severity of Emotional Disorders.

Research has demonstrated that stressors play a critical role in the development of generalized anxiety disorder (GAD), social anxiety disorder (SAD), and major depressive disorder (MDD). Separately, deficits in positive affect (PA) have been identified in GAD, SAD, and MDD. While previous research has linked the buffering effects of PA in chronic illness, such effects have yet to be investigated for chronic stressors and emotional disorder-related symptom severity. The purpose of the present study was to examine PA as a moderator of chronic interpersonal and non-interpersonal stress on GAD, SAD, and MDD symptom severity. Using a multilevel statistical approach with a sample of adolescents and young adults (N=463), PA was found to significantly moderate the relationship between chronic interpersonal stress and symptom severity for MDD and SAD. Findings suggest that in times of chronic interpersonal stress, higher PA may serve as a buffer from development of SAD and MDD symptoms.

Examining Positive and Negative Affect as Outcomes and Moderators of Cognitive-Behavioral Therapy and Acceptance and Commitment Therapy for Social Anxiety Disorder.

Traditional cognitive-behavioral therapy (CBT) for anxiety disorders has been designed to target reductions in negative affect (NA) associated with defense-related processes. However, a subset of anxiety disorders, including social anxiety disorder (SAD), are also characterized by low positive affect (PA) resulting from separate deficits in appetitive-related processes. In contrast to CBT, "third-wave" approaches, such as acceptance and commitment therapy (ACT), align more consistently with motivational processes and, as a result, PA. However, the differential effect of CBT and ACT on PA and NA has yet to be investigated. Using secondary data from a randomized controlled trial, the present study sought to compare CBT's (n = 45) and ACT's (n = 35) effect on PA and NA in SAD. Findings were compared to a wait-list (WL) control condition (n = 31), as well as normative data from a general adult sample. Baseline PA and NA were also examined as moderators and predictors of theory-relevant treatment outcomes. NA decreased significantly in both CBT and ACT from pre to posttreatment. Although ACT outperformed WL in reducing NA, this effect was not observed for CBT. PA increased significantly in both CBT and ACT from pre to posttreatment, with neither ACT nor CBT outperforming WL in increasing PA. Neither PA nor NA were found to moderate theoretically relevant treatment outcomes. Findings suggest that ACT and CBT share common treatment mechanisms, making them more similar than distinct. Further efforts should be focused on optimizing CBT's and ACT's influence on threat and reward learning, and elucidating common processes of change.

Sensing emotion in voices: Negativity bias and gender differences in a validation study of the Oxford Vocal ('OxVoc') sounds database.

Emotional expressions are an essential element of human interactions. Recent work has increasingly recognized that emotional vocalizations can color and shape interactions between individuals. Here we present data on the psychometric properties of a recently developed database of authentic nonlinguistic emotional vocalizations from human adults and infants (the Oxford Vocal 'OxVoc' Sounds Database; Parsons, Young, Craske, Stein, & Kringelbach, 2014). In a large sample (n = 562), we demonstrate that adults can reliably categorize these sounds (as 'positive,' 'negative,' or 'sounds with no emotion'), and rate valence in these sounds consistently over time. In an extended sample (n = 945, including the initial n = 562), we also investigated a number of individual difference factors in relation to valence ratings of these vocalizations. Results demonstrated small but significant effects of (a) symptoms of depression and anxiety with more negative ratings of adult neutral vocalizations (R2 = .011 and R2 = .008, respectively) and (b) gender differences in perceived valence such that female listeners rated adult neutral vocalizations more positively and infant cry vocalizations more negatively than male listeners (R2 = .021, R2 = .010, respectively). Of note, we did not find evidence of negativity bias among other affective vocalizations or gender differences in perceived valence of adult laughter, adult cries, infant laughter, or infant neutral vocalizations. Together, these findings largely converge with factors previously shown to impact processing of emotional facial expressions, suggesting a modality-independent impact of depression, anxiety, and listener gender, particularly among vocalizations with more ambiguous valence. (PsycINFO Database Record