A comparison of telehealth versus in-person group therapy: Results from a DBT-based dual diagnosis IOP.

OBJECTIVE: The effectiveness of remotely delivered group interventions and treatments for individuals with more complex psychiatric presentations is understudied. Nevertheless, the emergence of the COVID-19 pandemic shifted such treatments from in-person to remote service delivery without the establishment of comparable effectiveness between in-person and remote delivery. The current study presents the results of a private practice's transition from in-person treatment delivery to a videoconference-delivered Dialectical Behavior Therapy (DBT)-based intensive outpatient program (IOP) for individuals with comorbid mental health and substance use disorder diagnoses in response to the pandemic. METHODS: Change in symptoms of depression, anxiety, and stress following completion of the IOP was compared between the in-person and videoconference groups. RESULTS: Large reductions in symptoms were found following completion of the IOP for both the in-person and videoconference groups. Furthermore, no significant differences in symptom reduction were found between the groups. CONCLUSION: Although large-scale replication is needed, these results suggest that IOPs and other intensive group therapies delivered via videoconference may be as effective as in-person therapies, even among individuals with more complex psychiatric presentations. Providers who have transitioned group therapies to videoconference formats or are considering creating remote groups can be more confident that they are not sacrificing treatment efficacy.

What Drives Preventive Health Behavior During a Global Pandemic? Emotion and Worry.

BACKGROUND & PURPOSE: Primary prevention of COVID-19 has focused on encouraging compliance with specific behaviors that restrict contagion. This investigation sought to characterize engagement in these behaviors in U.S. adults early during the pandemic and to build explanatory models of the psychological processes that drive them. METHODS: US adults were recruited through Qualtrics Research Panels (N = 324; 55% female; Mage = 50.91, SD = 15.98) and completed 10 days of online reports of emotion, COVID-19 perceived susceptibility and worry, and recommended behaviors (social distancing, hand washing, etc.). Factor analysis revealed behaviors loaded on two factors suggesting distinct motivational orientations: approach and avoidance. RESULTS: Changes in approach and avoidance behaviors over the 10 days indicated large individual differences consistent with three types of participants. Discrete emotions, including fear, guilt/shame, and happiness were associated with more recommended behaviors. Fear and COVID-19 worry indirectly influenced each other to facilitate more behavioral engagement. While emotions and worry strongly predicted individual differences in behavior across the 10 days, they did not predict as well why behaviors occurred on one day versus another. CONCLUSIONS: These findings suggest how daily affective processes motivate behavior, improving the understanding of compliance and efforts to target behaviors as primary prevention of disease.

Drinking motives mediate emotion regulation difficulties and problem drinking in college students.

BACKGROUND: Problem drinking in college places students at an increased risk for a wealth of negative consequences including alcohol use disorders. Most research has shown that greater emotion regulation difficulties are related to increased problem drinking, and studies generally assume that drinking is motivated by efforts to cope with or enhance affective experiences. However, there is a lack of research specifically testing this assumption. OBJECTIVES: The current study sought to examine the mediating potential of drinking motives, specifically coping and enhancement, on the relationship between emotion regulation and problem drinking. METHOD: College participants (N = 200) completed an online survey, consisting of a battery of measures assessing alcohol use behaviors and related variables. RESULTS: Coping drinking motives fully mediated the emotion regulation/problem drinking relationship, and enhancement motives partially mediated this relationship. Exploratory analyses indicated that all four drinking motives (i.e. coping, enhancement, social, and conformity) simultaneously mediated the relationship between emotion regulation and quantity/frequency of alcohol use. However, only coping and enhancement significantly mediated the relationship between emotion regulation and alcohol-related consequences (e.g. alcohol dependence symptoms, alcohol-related injuries). CONCLUSION: The current results offer direction for potentially modifying brief alcohol interventions in efforts to reduce students' engagement in problem drinking behaviors. For example, interventions might incorporate information on the risks of using alcohol as a means of emotion regulation and offer alternative emotion regulation strategies.

Mental health treatment utilization among Gulf War era veterans with probable alcohol use disorder.

INTRODUCTION: Alcohol use disorder (AUD) is prevalent among veterans, and excessive alcohol use is associated with significant mental and physical health consequences. Currently, the largest cohort of veterans seeking services at the VA are those from the 1990s Gulf War Era. This cohort of veterans is unique due to the nature of their deployment resulting in a myriad of unexplained symptoms collectively known as "Gulf War Illness" and higher rates of mental health problems. The present study sought to examine the association between probable AUD and mental health treatment utilization in a sample of 1126 (882 male) Gulf War-era veterans. METHODS: Veterans completed a self-report survey including the AUDIT-C, questions about mental health treatment engagement, and demographic questions. RESULTS: Results demonstrated that approximately 20 % of the sample screened positive for probable AUD, determined by standard AUDIT-C cutoff scores. Among those screening positive for AUD, 25 % reported engaging in mental health treatment in the past year. Veterans with probable AUD who use VA care had 3.8 times the odds of receiving mental health services than veterans not using VA care. Use of mental health services was associated with mental health comorbidity and identifying as Black/African American. CONCLUSIONS: The results of the present study highlight a significant unmet need for mental health treatment among Gulf War-era veterans with AUD.

Personality or pathology? Predictors of early substance use in first-year college students.

OBJECTIVE: The aim of the current study was to examine the dual role of personality and psychopathology in predicting substance use among first-year students. PARTICIPANTS: 103 first-semester undergraduate students were recruited via the university subject pool. METHODS: Participants completed personality questionnaires, structured clinical interviews, followed by the completion of diary entries each week reporting on substance use throughout their first semester. RESULTS: Results indicated that a past diagnosis of an affective (mood/anxiety/stress) disorder was the most significant predictor of substance use. Personality and current psychopathology had no association to substance use. CONCLUSION: This finding is consistent with developmental models of substance use relating to emotion-related disease and suggests that greater nuance is needed in understanding substance use risk in college students.

Examining the daily relationship between guilt, shame, and substance use among veterans with psychiatric disorders.

Background: Shame and guilt are key emotions known to amplify trauma-related symptoms in veterans. Maintenance of symptoms is facilitated by avoidance behaviors, such as substance use. However, limited research has examined the associations between shame, guilt, and substance use in daily life. Methods: The current study sought to examine the cross-lagged association between shame, guilt, and substance use. Forty veterans completed 28 days of experience sampling reporting on their current emotional experiences and use of substances. Results: Results suggest a reciprocal relationship among shame and guilt and substance use, such that shame and guilt separately predicted subsequent substance use, and substance use predicted subsequent shame and guilt. Conclusions: These results highlight the dynamic relationship among shame, guilt, and substance use and suggest the potential value of conceptualizing these clinical targets as mutually reinforcing to inform integrative intervention strategies that can interrupt the in-the-moment cascade of negative consequences.

Self-care behaviors and affect during the early stages of the COVID-19 pandemic.

OBJECTIVE: Self-care behaviors aimed at maintaining physical and mental health are often recommended during stressful contexts. We tested emotional predictors of self-care behaviors (healthy eating, exercise, engaging in a hobby, relaxation/meditation, time spent with a supportive person, talking online with friends/family) during the COVID-19 pandemic and their emotional consequences. We hypothesized a reciprocal within-person process whereby positive affect increases self-care behaviors (Hypothesis 1) and self-care behaviors increase positive affect while decreasing negative affect (Hypothesis 2). METHOD: A 10-day daily diary was completed by 289 adult participants in the United States during spring 2020 when counties in 40 out of 50 states had some form of stay-at-home orders. RESULTS: Lagged analyses for Hypothesis 1 suggested that positive affect did not significantly predict residualized change in self-care behaviors; however, more intense negative affect predicted increased self-care behaviors from one day to the next. Concurrent analyses for Hypothesis 2 indicated most self-care behaviors were associated with more positive affect and some with less negative affect on the same day. Lagged analyses for Hypothesis 2 indicated that self-care behaviors largely did not predict residualized change in positive or negative affect from one day to the next. At the between-person level, people who experienced more positive affect engaged in more self-care behaviors across the sampling period. CONCLUSION: Self-care behaviors continue to have mental health benefits during stressful environments such as the COVID-19 pandemic and stay-at-home orders. Negative affect can play an adaptive role during times of stress by facilitating self-care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Predicting negative affect variability and spontaneous emotion regulation: Can working memory span tasks estimate emotion regulatory capacity?

[Correction Notice: An Erratum for this article was reported online in Emotion on Jan 7 2021 (see record 2021-06077-001). In the article, in the Results and Discussion sections for Study 2 and in Table 6, it was stated that RSPAN scores predicted spontaneous down-regulation of negative affect from one diary signal to the next. However, because RSPAN scores are a person-level variable, it is an error to describe the results in that way. RSPAN scores cannot predict variability within person (i.e., signal to signal) but rather predict variability between person (i.e., person to person). Hence, a corrected interpretation would be to state that the RSPAN predicted levels of negative affect across the experience sampling diary, even when considering trait and state levels of affect and variability in daily stress. The analysis remains correct and the findings remain meaningful.] We tested the association of 2 versions of the Reading Span Task of working memory capacity, a conventional neutral version (RSPAN-N) and an adapted task with incidental negative content (RSPAN-E), for predicting objective indicators (behavioral displays; autonomic activation) of negative emotion regulation during a laboratory provocation, as well as reported negative emotion in daily life experience sampling. Across 2 samples, both tasks demonstrated utility as estimates of spontaneous negative emotion regulation capacity, predicting down-regulation of negative emotion in daily life and during a lab challenge. In addition, scores from both tasks appear to be independent of self-reported distress, a confound often present in studies of emotion regulation. There was some incremental evidence that the RSPAN-E may have advantages over the RSPAN-N for predicting some indices of emotion processing. Together these findings provide further evidence for the role of working memory (among other executive-control abilities) in emotion regulatory processing and suggest that RSPAN tasks may have considerable potential as tools in research on emotion processing and emotion regulation in psychological health and adjustment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Micro Versus Macro Processes: How specific stress exposure impacts sleep, affect, and risk-related behavior on the path to disease in high-risk adults.

BACKGROUND: The stress-to-disease association has been well-accepted for some time. However, the understanding of how stress exposure contributes to psychological disease progression remains unclear. OBJECTIVE: To test the real-time impact of variable stress exposure on risk-related clinical phenomena and affective disease progression in a high-risk sample of active-duty firefighters. METHODS: Participants completed weekly diaries reporting stressful event exposure, affect, sleep, and risk-related and healthy behaviors over six-months and were evaluated for lifetime and current psychiatric disease using clinical interviews before and after the sampling period. RESULTS: Stress exposure impacted clinical phenomena in differing ways. Major personal events and day-to-day hassles predicted health-impairing shifts in sleep and behavior that were associated with increases in symptoms and psychological distress over the 6-month period. In contrast, highly aversive incidents predicted greater adaptive behaviors that were uniquely predictive of symptom decreases over the six-month period. CONCLUSION: These findings shed new light on stress-to-disease processes, demonstrating how variable stress exposure influences critical shifts in behavior and sleep, contributing to psychological adjustment of firefighters over time. These data suggest practical ways to monitor risk in high-risk samples (e.g., monitoring sleep latency) and offer avenues for further explication of disease processes in real time.

Math matters: A novel, brief educational intervention decreases whole number bias when reasoning about COVID-19.

At the onset of the coronavirus disease (COVID-19) global pandemic, our interdisciplinary team hypothesized that a mathematical misconception-whole number bias (WNB)-contributed to beliefs that COVID-19 was less fatal than the flu. We created a brief online educational intervention for adults, leveraging evidence-based cognitive science research, to promote accurate understanding of rational numbers related to COVID-19. Participants from a Qualtrics panel (N = 1,297; 75% White) were randomly assigned to an intervention or control condition, solved health-related math problems, and subsequently completed 10 days of daily diaries in which health cognitions and affect were assessed. Participants who engaged with the intervention, relative to those in the control condition, were more accurate and less likely to explicitly mention WNB errors in their strategy reports as they solved COVID-19-related math problems. Math anxiety was positively associated with risk perceptions, worry, and negative affect immediately after the intervention and across the daily diaries. These results extend the benefits of worked examples in a practically relevant domain. Ameliorating WNB errors could not only help people think more accurately about COVID-19 statistics expressed as rational numbers, but also about novel future health crises, or any other context that involves information expressed as rational numbers. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Emotion Differentiation as a Protective Factor Against the Behavioral Consequences of Rumination: A Conceptual Replication and Extension in the Context of Social Anxiety.

Rumination is thought to play a central role in affective disorders such as social anxiety disorder (SAD). Past research indicates that rumination tends to exacerbate negative emotions and increase the risk of engaging in maladaptive coping behaviors (e.g., avoiding social activities). However, little is known on how to effectively protect against the negative outcomes of rumination. Previously, Zaki, Coifman, Rafaeli, Berenson, and Downey (2013) found that negative emotion differentiation (NED) protected against rumination and nonsuicidal self-injury in borderline personality disorder. Nevertheless, it is unclear whether this protective effect would extend to other populations and behaviors. Therefore, the present investigation sought to replicate and extend Zaki et al.'s (2013) findings in the context of SAD. In two studies, we examined if NED would moderate the positive association between rumination and frequency of social avoidance. Study 1 involved 29 individuals who met criteria for SAD with or without co-occurring major depressive episode, while Study 2 involved a nonclinical sample of 190 college students. All participants completed a measure of rumination and an experience-sampling diary which provided indices of NED and social avoidance. The results from both studies were unanimous: NED significantly moderated the relationship between rumination and social avoidance such that the positive association between rumination and social avoidance was significant for low but not moderate to high NED. Overall, the findings provide a conceptual replication of Zaki et al. (2013) and further evidence for the protective effects of NED against the maladaptive behavioral consequences of rumination across populations.