Off-task thinking among adults with and without social anxiety disorder: an ecological momentary assessment study.

Although task-unrelated thinking (often conceptualised as "mind-wandering") has been increasingly investigated in recent years, the content and correlates of everyday off-task thought in clinical disorders, particularly anxiety disorders, remain poorly understood. We aimed to address this gap by using ecological momentary assessment to assess off-task and on-task thoughts in adults with social anxiety disorder (SAD) and demographically matched controls. Findings showed that individuals with SAD more frequently engaged in internally oriented off-task thinking than healthy controls, but not externally oriented off-task thinking. Compared to thoughts focused on the task at hand, adults with SAD rated their internal off-task thoughts as less controllable, more self-focused, and as associated with worse mood than controls. However, when the SAD group was focused on the task at hand, group differences disappeared. Daily findings were paralleled by higher scores in SAD on a trait measure of unintentional, but not intentional, mind-wandering. In sum, the content and mood correlate of internally oriented off-task thoughts depended on the presence of clinical anxiety. In addition, focusing on the task at hand normalised thought content and mood in SAD, highlighting a window for intervention.

Enjoying food without caloric cost: The impact of brief mindfulness on laboratory eating outcomes.

OBJECTIVE: Mindfulness-based interventions have been increasingly applied to treat eating-related problems ranging from obesity to eating disorders. Yet few studies have empirically examined the mechanisms of a mindful approach to eating. The current studies examine the potential of brief mindfulness instructions to enhance the psychological and behavioral dimensions of eating. METHODS: In three experiments (total N = 319 undergraduates), we examined whether brief mindfulness instructions would enhance the positive sensory experience involved in tasting food as well as healthy eating behaviors. RESULTS: Relative to distraction control instructions, the first two studies demonstrated that brief mindfulness instructions increased the enjoyment of a commonly pleasurable food (chocolate; Study 1), and a food with generally more mixed associations (raisins; Study 2). The third study replicated and extended these findings to show that brief mindfulness instructions also led to lower calorie consumption of unhealthy food relative to distracted or no-instruction control conditions, an effect mediated by greater eating enjoyment. CONCLUSIONS: Findings demonstrated the power of brief mindfulness instructions to positively impact both health-relevant behavior and sensory experience associated with eating food. Implications for both theory and clinical applications of mindfulness are discussed.

The credibility of exposure therapy: Does the theoretical rationale matter?

OBJECTIVE: Little is understood about how the public perceives exposure-based therapy (ET) for treating anxiety and trauma-related disorders or how ET rationales affect treatment credibility. Distinct approaches to framing ET are practiced, including those emphasized in traditional cognitive behavioral therapy, acceptance and commitment therapy, and the more recent inhibitory learning model. However, their relative effect on ET's credibility remains unknown. METHOD: A final sample of 964 U.S. adults provided baseline views of ET. Participants rated ET treatment credibility following a simple ET definition (pre-rationale) and following randomization to rationale modules addressing ET goals, fear, and cognitive strategies from distinct theoretical perspectives (post-rationale). Baseline ET views, symptoms, and sociodemographic characteristics were examined as putative moderators and predictors. RESULTS: At baseline, the majority had never heard of ET. From pre- to post-rationale, ET treatment credibility significantly increased but the rationales' theoretical perspective had little impact. More negative baseline ET views, specific ethnic/racial minority group status, and lower education moderated or predicted greater increases in treatment credibility following the rationale. CONCLUSIONS: ET remains relatively unknown as a treatment for anxiety or trauma, supporting the need for direct-to-consumer marketing. Diverse theory-driven rationales similarly increased ET credibility, particularly among those less likely to use ET.

Has evidence-based psychosocial treatment for anxiety disorders permeated usual care in community mental health settings?

Cognitive behavioral therapy (CBT), particularly when it includes an exposure component, is an empirically supported psychosocial treatment for anxiety disorders that has been shown to be highly efficacious, desirable to patients, and cost-effective. However, access to and receipt of exposure-based treatment CBT anxiety remains lacking despite these benefits. The current study reviewed electronic medical records at a large public outpatient psychiatry clinic in order to clarify what usual care for anxiety disorders entails, and to determine the extent to which effective psychosocial treatment is accessible to, and implemented with anxiety disorder patients. Database queries generated from the billing and medical record system at the Los Angeles County Adult Outpatient Psychiatry Clinic identified 582 patients presenting with an anxiety disorder diagnosis in a 6-month time frame. These patients' electronic medical records were reviewed using a standardized data collection form. Findings indicated that the majority of patients received pharmacological treatment for their anxiety. The majority of the psychosocial treatment delivered was supportive therapy. Among the minority of patients who did initiate CBT, an even smaller minority received treatment that included an exposure component, and those who did receive exposure likely received a sub-optimal dose. Understanding usual care delivery patterns is an important preliminary step to identifying and addressing barriers to optimal anxiety disorder treatment in adult community mental health settings.