Case conceptualization from a process-based and modular perspective: Rationale and application to mood and anxiety disorders.

This article presents the theoretical, clinical, and practical arguments supporting a process-based transdiagnostic approach to psychotherapy. A working definition of "psychological process" is provided, as well as a tri-dimensional categorization of psychological processes potentially involved in psychopathology. Guidelines are proposed to select psychological interventions based on the active psychopathological processes evidenced in a given case. We also provide a rationale to organize treatment as a set of modules, each addressing a specific psychopathological process. Next, we review the main processes that may be active in mood and anxiety disorders, and that are accessible to clinicians in regular practice. For each process, we propose a validated assessment questionnaire. Finally, we offer a free-access web-based instrument that allows clients to fill in these questionnaires via an internet survey, and that provides therapists with a tool to easily decode and interpret the questionnaire results and to present them to the clients.

Attentional focus during exposure in spider phobia: The effect of valence and schematicity of a partial distractor.

This study examines the impact of partial distractor valence and schematicity (i.e., their relation to fear representation) on exposure efficacy. One hundred forty-one spider phobics were exposed to spider pictures and asked, in a between-subjects experimental design, to form mental images of words that were fear related (to spiders) and negative (schematic negative), fear unrelated and negative (non-schematic negative) or fear unrelated and positive (non-schematic positive). Multilevel measures of anxiety were performed at pre-exposure, post-exposure and 6 days' follow-up. Results show that both of the negative condition groups displayed similar results on all outcome variables and systematically differed from the positive condition group. While the latter group displayed a stronger decline in distress during exposure itself, the other groups showed greater exposure benefits: a stronger decline in emotional and avoidance responses and skin conductance responses from pre- to post-exposure and more approach behaviours when confronted with a real spider. The critical feature of distraction thus seems not to be the fact of being distracted from the phobic stimulus, but rather the fact of performing emotional avoidance by distracting oneself from negative affect. The results highlight that the acceptance of aversive emotional states is a critical active process in successful exposure.

Attentional focus during exposure in spider phobia: the role of schematic versus non-schematic imagery.

Research has provided controversial results regarding the role of distraction (vs. attentional focus) during exposure therapy. In the present study, we manipulated the nature of the concepts activated during exposure. Sixty-six spider phobics were exposed to pictures of spiders and asked, or not, to form mental images of concepts that were either related or unrelated to spiders. At pre-exposure, mid-exposure, post-exposure, and follow-up, subjective distress, heart rate variability, and skin conductance responses were measured and the Fear of Spiders Questionnaire and a Behavioural Avoidance Test were performed. Results showed that the activation of concepts unrelated to spiders led to return of distress at follow-up. Moreover, the activation of concepts related to spiders decreased emotional and avoidance responses between sessions. This pattern of results suggests that the nature of the activated concepts does not influence subjective distress during exposure, but plays an important role in the maintenance of distress reduction between sessions.

Probing smoking craving with a multidimensional approach: validation of the 12-item French-language version of the Questionnaire on Smoking Urges.

BACKGROUND: The current study examined the psychometric properties of the 12-item French-language version of the Questionnaire on Smoking Urges (QSU-12), a widely used multidimensional measure of cigarette craving. METHODS: Daily smokers (n=230) completed the QSU-12, the Fägerstrom Test for Nicotine Dependence, and items about addiction-related symptoms. Additional participants (n=40) completed the QSU-12 and the Fägerstrom Test for Nicotine Dependence and were assessed for expired carbon monoxide. RESULTS: Consistent with studies validating the English version of the scale, confirmatory factor analyses supported a two-factor solution in the French version of the scale. Good scale and subscales reliabilities were observed, and convergent validity was evidenced through relationships with dependence and addiction-related symptoms. CONCLUSION: The French-language version of the QSU-12 is an adequate instrument to assess the multidimensional construct of craving in both research and clinical practice.

Optimal attentional focus during exposure in specific phobia: a meta-analysis.

Over the last 30 years, researchers have disagreed over the consequences of diverting attention from threat for exposure efficacy, which is an important theoretical and clinical debate. Therefore, the present meta-analysis assessed the efficacy of attentionally focused exposure against distracted and attentionally uninstructed exposure regarding distress, behavioral, and physiological outcomes. We included 15 randomized studies with specific phobia, totaling 444 participants and targeting outcomes at post-exposure and follow-up. Results indicated no difference between the efficacy of distracted exposure as opposed to focused or uninstructed exposure for distress and physiology. For behavior, at post-exposure, results were marginally significant in favor of distracted as opposed to focused exposure, while at follow-up results significantly favored distraction. However, concerning behavior, uninstructed exposure was superior to distraction. Moderation analyses revealed that, regarding distress reduction and approach behavior, distracted exposure significantly outperformed focused exposure when the distracter was interactive (g=1.010/g=1.128) and exposure was spread over the course of multiple sessions (g=1.527/g=1.606). No moderation analysis was significant for physiological measures. These findings suggest that distraction during exposure could be less counterproductive than previously considered and even beneficial under certain circumstances. Theoretical implications and future directions for research are discussed.

Assessing public speaking fear with the short form of the Personal Report of Confidence as a Speaker scale: confirmatory factor analyses among a French-speaking community sample.

BACKGROUND: The main aim of this study was to assess the reliability and structural validity of the French version of the 12-item version of the Personal Report of Confidence as Speaker (PRCS), one of the most promising measurements of public speaking fear. METHODS: A total of 611 French-speaking volunteers were administered the French versions of the short PRCS, the Liebowitz Social Anxiety Scale, the Fear of Negative Evaluation scale, as well as the Trait version of the Spielberger State-Trait Anxiety Inventory and the Beck Depression Inventory-II, which assess the level of anxious and depressive symptoms, respectively. RESULTS: Regarding its structural validity, confirmatory factor analyses indicated a single-factor solution, as implied by the original version. Good scale reliability (Cronbach's alpha = 0.86) was observed. The item discrimination analysis suggested that all the items contribute to the overall scale score reliability. The French version of the short PRCS showed significant correlations with the Liebowitz Social Anxiety Scale (r = 0.522), the Fear of Negative Evaluation scale (r = 0.414), the Spielberger State-Trait Anxiety Inventory (r = 0.516), and the Beck Depression Inventory-II (r = 0.361). CONCLUSION: The French version of the short PRCS is a reliable and valid measure for the evaluation of the fear of public speaking among a French-speaking sample. These findings have critical consequences for the measurement of psychological and pharmacological treatment effectiveness in public speaking fear among a French-speaking sample.