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Sexual orientation and gender identity/expression change efforts (SOGIECEs) are discredited practices that are associated with serious negative effects and incompatible with modern standards for clinical practice. Despite evidence linking SOGIECEs with serious iatrogenic effects, and despite support for LGBTQ+-affirmative care alternatives, SOGIECE practices persist. In the 1970s and 1980s, Behavior Therapy published articles testing and/or endorsing SOGIECEs, thereby contributing to their overall development, acceptance, and use. The Behavior Therapy Task Force on SOGIECEs was assembled to conduct a rigorous review of the SOGIECE articles published in Behavior Therapy and to decide whether, and what, formal action(s) should be taken on these articles. This report provides a detailed review of the historic SOGIECE literature published in Behavior Therapy and outlines the Task Force's deliberative and democratic processes resulting in actions to: (1) add prominent advisory information to kâ¯=â¯24 SOGIECE papers in the form of digital "black box" disclaimers that caution readers that the SOGIECE practices tested or described in these papers are inconsistent with modern standards, (2) offset organizational financial benefits from the publication of these papers, and (3) promote LGBTQ+-affirmative practices. SOGIECEs are not the only concerning practices across the field's history, and the pages of today's scientific journals include practices that will be at odds with tomorrow's moral standards and ethical guidelines. This report calls for precautionary measures and editorial safeguards to minimize the future likelihood and impact of problematic published scholarship, including the need to fully include those with relevant lived experiences in all aspects of clinical science and peer review.
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Terapia Conductista , Identidad de Género , Conducta Sexual , Minorías Sexuales y de Género , Humanos , Terapia Conductista/métodos , Comités Consultivos , FemeninoRESUMEN
Individuals with Social Anxiety Disorder (SAD) are at risk for employment problems. This multi-site trial examined the efficacy of Work-Related Cognitive Behavioral Therapy provided alongside vocational services as usual (WCBT+VSAU), a group-based treatment designed to improve mental health and employment outcomes for individuals with SAD. Vocational service-seeking participants with SAD (N = 250) were randomized to either WCBT+VSAU or VSAU-alone. Hypotheses were that participants randomized to WCBT+VSAU would report less social anxiety, less depression, and more hours worked than participants randomized to VSAU-alone. WCBT+VSAU participants had significantly greater improvements on the Liebowitz Social Anxiety Scale (LSAS; d=-.25, CI=-0.49 to -0.02, p = .03) at post-assessment compared to VSAU-alone. The conditions did not differ on any variable at later time points or on secondary outcomes. Unexpectedly, participants randomized to VSAU-alone experienced LSAS improvements, similar to WCBT+VASU at later timepoints. Baseline psychological flexibility (beta=-.098 [-0.19-0.008]) and depression (beta=-0.18 [-0.34-0.009]) moderated change in social anxiety. Participants with lower psychological flexibility and higher depression responded more strongly to WCBT+VSAU than VSAU-alone over the duration of the study, suggesting that WCBT+VSAU may particularly benefit those with greater psychopathology. Results indicate that vocational centers are promising settings for treating SAD and employment-focused refinements are likely needed to improve work outcomes.
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Terapia Cognitivo-Conductual , Fobia Social , Desempleo , Humanos , Terapia Cognitivo-Conductual/métodos , Masculino , Femenino , Adulto , Fobia Social/terapia , Fobia Social/psicología , Desempleo/psicología , Desempleo/estadística & datos numéricos , Persona de Mediana Edad , Resultado del Tratamiento , Depresión/terapia , Rehabilitación Vocacional/métodosRESUMEN
This study explored relationships among perceived interpersonal competence and demographic and work history variables in a randomized control trial for social anxiety disorder (SAD) that compared work-related group cognitive behavioral therapy plus vocational services (WCBT+VSAU) to vocational services only (VSAU-alone). Intervention effects of perceived interpersonal competence on treatment outcomes over 12 weeks were also examined. Data from 250 job seekers with SAD (59.2% Female; 40.8% Black/African American; 82.4% Non-Hispanic/non-Latino/a) were analyzed. We predicted negative relationships between perceived interpersonal competence and symptoms/impairment and that individuals with lower perceived interpersonal competence would benefit more quickly in WCBT+VSAU relative to VSAU-alone. Results indicated that perceived interpersonal competence did not vary by gender, race, ethnicity, homeless status, or employment history. There were no intervention effects of perceived interpersonal competence regarding social anxiety or overall functional impairment, but results supported negative relationships between perceived interpersonal competence and lower social anxiety and overall functional impairment in both conditions. Separately, perceived interpersonal competence moderated effects in the depression model such that there were faster declines in depression at lower perceived interpersonal competence levels in WCBT+VSAU, but not in VSAU-alone. Results indicate the value of attending to perceived interpersonal competence in interventions, which may result in mood benefits.
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Empleo , Fobia Social , Humanos , Femenino , Masculino , Fobia Social/terapia , Afecto , Resultado del Tratamiento , Ansiedad/terapia , Ansiedad/psicologíaRESUMEN
To evaluate the usefulness of the DSM-5 maladaptive personality domains in explaining the similarities and differences among four disorders included in the obsessive-compulsive spectrum, 428 Italian community-dwelling women (mean age = 31.96 years, SD = 12.30 years) were administered the Obsessive-Compulsive Spectrum Disorder Scales and the Personality Inventory for DSM-5-Short Form as part of an ongoing online survey on women's health. Multiple Indicators Multiple Causes (MIMIC) confirmatory bifactor analysis results showed that the OCSD general factor (i.e., obsessive-compulsive spectrum factor) was positively associated with Negative Affectivity, whereas Body Dysmorphic Disorder (BDD), Hoarding Disorder (HD), and Skin-Picking Disorder (SPD) specific factors showed significant and substantial differential relationships with dysfunctional personality domains. Specifically, BDD was positively associated with Negative Affectivity, Detachment and Psychoticism domains; HD was associated with high Negative Affectivity and Psychoticism; and SPD was associated with Detachment. © 2020 John Wiley & Sons, Ltd.
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Trastorno Obsesivo Compulsivo , Adulto , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Italia , Trastorno Obsesivo Compulsivo/diagnóstico , Trastorno Obsesivo Compulsivo/epidemiología , Personalidad , Trastornos de la Personalidad/diagnóstico , Trastornos de la Personalidad/epidemiologíaRESUMEN
Addressing the 'replication crisis' and questionable research practices are at the forefront of international research agendas in clinical psychological science. The aim of this paper is to consider how the quality of research practices can be improved by a specific focus on publication practices. Currently, the responsibility for documenting quality research practices is primarily placed on authors. However, barriers to improved quality publication practices cut across all levels of the research community and require a broader approach that shares the burden for ensuring the production of high quality publications. We describe a framework that is intended to be ambitious and aspirational and encourage discussion and adoption of strategies to improve quality publication practices (QPPs). The framework cuts across multiple stakeholders and is designed to enhance (a) the quality of reporting; (b) adherence to protocols and guidelines; (c) timely accessibility of study materials and data. We discuss how QPPs might be improved by (a) funding bodies considering formally supporting QPPs; (b) research institutions encouraging a research culture that espouses quality research practices, and internally supporting QPP review processes and professional development in QPPs; (c) journals expanding editorial teams to include reviewers with design and statistical expertise, considering strategies to enhance QPP adherence during the peer review process, and committing to ongoing assessment and development of QPP training for peer reviewers; and (d) authors and peer reviewers integrating QPPs during the manuscript preparation/peer review process, engaging in ongoing QPP training, and committing to openness and transparency initiatives. We discuss the current state and potential next steps within each stage of the framework and provide information and resources to enhance QPPs. We hope that the suggestions offered here inspire research institutions, leaders and faculty to discuss, reflect on, and take action towards, integrating these, or other, QPPs into their research practice and workplace.
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Difusión de la Información , Publicaciones Periódicas como Asunto , Psicología , Investigación , Humanos , Reproducibilidad de los ResultadosRESUMEN
Objective: To examine the effects of universal and targeted suicide prevention programs on relevant outcomes in college campuses. Methods: College suicide prevention programs published from 2009 to 2018 were assessed on outcomes including knowledge, skills, self-efficacy, suicidal ideation, and suicidal behaviors. Effects of the interventions on outcome variables with sufficient studies to warrant meta-analysis (ie, knowledge, skills, and self-efficacy) were meta-analyzed. Studies reporting on the remaining outcomes (ie, suicidal ideation and behaviors) were systematically reviewed. Results: Significant increases in suicide prevention knowledge, skills, and self-efficacy were observed in universal prevention interventions that typically employed gatekeeper prevention strategies. Evidence of reductions in suicidal ideation and behaviors was observed across targeted suicide prevention programs for at-risk students. Conclusion: Prevention programs are beneficial for training those likely to come in contact with people endorsing suicidality, but further research is needed to show that suicide interventions can consistently have significant effects on suicidal students as well.
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Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud/estadística & datos numéricos , Servicios de Salud para Estudiantes/estadística & datos numéricos , Prevención del Suicidio , Humanos , Autoeficacia , Estudiantes , Ideación Suicida , UniversidadesRESUMEN
PURPOSE: To explore the feasibility and utility of using a workshop, and supervision-consultation plus external facilitation to disseminate and implement cognitive-behavioral therapy in Veterans Affairs (VA) community-based outpatient clinics (CBOCs). METHODS: This study occurred in the context of a randomized controlled trial aimed at comparing 2 methods for implementing Coordinated Anxiety Learning Management (CALM) in VA CBOCs. A 3-phase (workshop, supervision-consultation, external facilitation) model was used to support 32 VA CBOC mental health providers in learning and adopting CALM in their clinical practice. Qualitative data describe training activities and the feasibility and utility of each training phase in addressing challenges to adopting CALM. FINDINGS: All 3 phases of the model were feasible to use with our sample of CBOC mental health providers. Providers reported challenges learning CALM during the workshop and concerns about not having enough training post-workshop to use CALM in practice. Providers primarily utilized supervision-consultation to tailor CALM to their practice, including learning how to prioritize a target disorder, "switch" the focus of treatment to a different disorder when comorbidities were present, and modify CALM sessions to fit shorter treatment visits. Providers primarily utilized external facilitation to further tailor CALM to their practice through implementation (eg, concrete help) and support-oriented help. Key lessons for implementing CALM in CBOCs are presented and discussed. CONCLUSIONS: Findings provide initial evidence for the feasibility and utility of using each component of a facilitation-enhanced training model to promote CBOC VA providers' implementation of a computer and manual version of CALM in their practice.
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Ansiedad , Servicios Comunitarios de Salud Mental , Veteranos , Instituciones de Atención Ambulatoria , Ansiedad/diagnóstico , Ansiedad/terapia , Humanos , Estados Unidos , United States Department of Veterans AffairsRESUMEN
This paper provides a methodological description of a multi-site, randomized controlled trial (RCT) of a cognitive-behavioral intervention for enhancing employment success among unemployed persons whose employment efforts have been undermined by social anxiety disorder (SAD). SAD is a common and impairing condition, with negative impacts on occupational functioning. In response to these documented employment-related impairments, in a previous project, we produced and tested an eight-session work-related group cognitive-behavioral therapy provided alongside vocational services as usual (WCBT + VSAU). WCBT is delivered by vocational service professionals and is designed in a context and style that overcomes accessibility and stigma-related obstacles with special focus on employment-related targets. Our previous project found that WCBT + VSAU significantly improved social anxiety, depression, and a range of employment-related outcomes compared to a control group of socially anxious job-seekers who received vocational services as usual without WCBT (VSAU-alone). Participants in this study were all homeless, primarily African American job-seekers with high levels of psychiatric comorbidity and limited education and employment histories. The present, two-region study addresses whether WCBT + VSAU enhances job placement, job retention and mental health outcomes in a larger sample assessed over an extended follow-up period. In addition, this trial evaluates whether the effects of WCBT + VSAU generalize to a new population of urban-based, racially diverse job-seekers with vocational and educational histories that differ from our original sample. This study also investigates the system-effects of WCBT + VSAU in a new site that will be informative for broad implementation of WCBT + VSAU. Finally, this project involves a refined, technology-assisted form of WCBT + VSAU designed to be delivered more easily by vocational services professionals.
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Pets have numerous, effective methods to communicate with their human hosts. Perhaps most conspicuous of these are distress vocalizations: in cats, the 'miaow' and in dogs, the 'whine' or 'whimper'. We compared a sample of young adults who owned cats and or dogs ('pet-owners' n = 264) and who did not (n = 297) on their ratings of the valence of animal distress vocalizations, taken from a standardized database of sounds. We also examined these participants' self-reported symptoms of anxiety and depression, and their scores on a measure of interpersonal relationship functioning. Pet-owners rated the animal distress vocalizations as sadder than adults who did not own a pet. Cat-owners specifically gave the most negative ratings of cat miaows compared with other participants, but were no different in their ratings of other sounds. Dog sounds were rated more negatively overall, in fact as negatively as human baby cries. Pet-owning adults (cat only, dog only, both) were not significantly different from adults with no pets on symptoms of depression, anxiety or on self-reported interpersonal relationship functioning. We suggest that pet ownership is associated with greater sensitivity to negative emotion in cat and dog distress vocalizations.
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BACKGROUND: Although psychological treatments for social anxiety disorder (SAD) can be highly effective, many individuals do not respond to treatment. Identifying factors associated with improved outcomes can facilitate individualized treatment choices. We investigated whether patterns of neural connectivity predicted treatment responses and whether treatment type, cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT), moderated this effect. METHODS: Participants with SAD (nâ¯=â¯34) underwent fMRI prior to treatment and completed implicit and explicit emotion regulation tasks. Neural connectivity measures were estimates of amygdala-prefrontal cortex connectivity. Treatment responder status was defined using the 'clinically significant change index' (Loerinc et al., 2015). RESULTS: Right amygdala-right ventrolateral prefrontal cortex connectivity during implicit emotion regulation was a significant predictor of treatment response (ORâ¯=â¯9.01, 95% CIâ¯=â¯1.77, 46.0, pâ¯=â¯.008). Stronger inverse connectivity was associated with greater likelihood of treatment response. There were no significant neural moderators of treatment response to CBT versus ACT. LIMITATIONS: The primary limitation of this work was the small sample size which restricted the power to detect significant moderation effects, and results should be interpreted as preliminary. CONCLUSIONS: Amygdala-vlPFC connectivity during affect labeling predicted treatment responder status following CBT or ACT for social anxiety disorder. This suggests that the functioning of neural circuitry supporting emotion regulation capacities may be a 'gateway' to receiving benefit from psychological treatments. Future work should aim to replicate this effect in a larger sample and consider methods for enhancing functional connectivity within this circuitry as a potential treatment adjunct.
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Amígdala del Cerebelo/fisiopatología , Terapia Cognitivo-Conductual , Vías Nerviosas/fisiopatología , Fobia Social/terapia , Corteza Prefrontal/fisiopatología , Adulto , Amígdala del Cerebelo/diagnóstico por imagen , Emociones/fisiología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Fobia Social/fisiopatología , Corteza Prefrontal/diagnóstico por imagen , Adulto JovenRESUMEN
Anxiety disorders are the most common mental disorders and are often chronic and disabling. Although exposure-based treatments are effective, a substantial number of individuals fail to fully remit or experience a return of symptoms after treatment. Understanding the critical processes underlying the development and treatment of anxiety disorders will help identify individuals at risk and optimize treatments. Aversive associative learning offers explanatory pathways through which fear and anxiety emerge, spread, persist, and resurge. This narrative review examines the advances made in our understanding of associative fear and avoidance learning in anxiety disorders. Overall, the extant literature supports a key role of aversive associative learning in the development and treatment of anxiety disorders. However, research targeting specific mechanisms such as extinction generalization and avoidance, the fragility of extinction, and moderating influences of individual differences pertinent to anxiety disorders (e.g., age, sex, depression) is needed. We discuss the need for more ecological valid and complex paradigms to model ambiguity and conflict as well as for clinical translation studies to optimize treatment.
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Trastornos de Ansiedad/psicología , Reacción de Prevención/fisiología , Extinción Psicológica/fisiología , Miedo/psicología , Trastornos de Ansiedad/terapia , Condicionamiento Clásico/fisiología , Humanos , InvestigaciónRESUMEN
Violation of unconditioned stimulus (US) expectancy during extinction training may enhance associative learning and result in improved long-term extinction retention compared to within-session habituation. This experiment examines variation in US expectancy (i.e., expectancy violation) as a predictor of long-term extinction retention. It also examines within-session habituation of fear-potentiated startle (electromyography, EMG) and fear of conditioned stimuli (CS) throughout extinction training as predictors of extinction retention. Participants (n = 63) underwent fear conditioning, extinction and retention and provided continuous ratings of US expectancy and EMG, as well as CS fear ratings before and after each phase. Variation in US expectancy throughout extinction and habituation of EMG and fear was entered into a regression as predictors of retention and reinstatement of levels of expectancy and fear. Greater variation in US expectancy throughout extinction training was significantly predictive of enhanced extinction performance measured at retention test, although not after reinstatement test. Slope of EMG and CS fear during extinction did not predict retention of extinction. Within-session habituation of EMG and self-reported fear is not sufficient for long-term retention of extinction learning, and models emphasizing expectation violation may result in enhanced outcomes.
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Aprendizaje por Asociación , Extinción Psicológica , Miedo , Habituación Psicofisiológica , Condicionamiento Clásico , Femenino , Humanos , Masculino , Reflejo de Sobresalto , Incertidumbre , Adulto JovenRESUMEN
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
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Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/psicología , Bases de Datos como Asunto , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/psicología , Emociones , Relaciones Interpersonales , Caracteres Sexuales , Percepción del Habla , Calidad de la Voz , Adolescente , Femenino , Humanos , Individualidad , Lactante , Masculino , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND AND OBJECTIVES: Cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) have both garnered empirical support for the effective treatment of social anxiety disorder. However, not every patient benefits equally from either treatment. Identifying moderators of treatment outcome can help to better understand which treatment is best suited for a particular patient. METHODS: Forty-nine individuals who met criteria for social anxiety disorder were assessed as part of a randomized controlled trial comparing 12 weeks of CBT and ACT. Pre-treatment avoidance of social situations (measured via a public speaking task and clinician rating) was investigated as a moderator of post-treatment, 6-month follow-up, and 12-month follow-up social anxiety symptoms, stress reactivity, and quality of life. RESULTS: Public speaking avoidance was found to be a robust moderator of outcome measures, with more avoidant individuals generally benefitting more from CBT than ACT by 12-month follow-up. In contrast, clinician-rated social avoidance was not found to be a significant moderator of any outcome measure. LIMITATIONS: Results were found only at 12-month follow-up. More comprehensive measures of avoidance would be useful for the field moving forward. CONCLUSIONS: Findings inform personalized medicine, suggesting that social avoidance measured behaviorally via a public speaking task may be a more robust factor in treatment prescription compared to clinician-rated social avoidance.
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Terapia de Aceptación y Compromiso/métodos , Terapia Cognitivo-Conductual/métodos , Fobia Social/rehabilitación , Habla , Adolescente , Adulto , Reacción de Prevención/fisiología , Miedo/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Fobia Social/psicología , Escalas de Valoración Psiquiátrica , Calidad de Vida , Resultado del Tratamiento , Adulto JovenRESUMEN
With DSM-5, the APA began providing guidelines for anxiety disorder severity assessment that incorporates newly developed self-report scales. The scales share a common template, are brief, and are free of copyright restrictions. Initial validation studies have been promising, but the English-language versions of the scales have not been formally validated in clinical samples. Forty-seven individuals with a principal diagnosis of Social Anxiety Disorder (SAD) completed a diagnostic assessment, as well as the DSM-5 SAD severity scale and several previously validated measures. The scale demonstrated internal consistency, convergent validity, and discriminant validity. The next steps in the validation process are outlined.
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Manual Diagnóstico y Estadístico de los Trastornos Mentales , Fobia Social/diagnóstico , Fobia Social/terapia , Autoinforme/normas , Índice de Severidad de la Enfermedad , Adolescente , Adulto , Terapia Cognitivo-Conductual/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicometría , Reproducibilidad de los Resultados , Listas de Espera , Adulto JovenRESUMEN
OBJECTIVE: This article reports on the test-retest reliability and sensitivity to change of a set of brief dimensional self-rating questionnaires for social anxiety disorder (SAD-D), specific phobia (SP-D), agoraphobia (AG-D), panic disorder (PD-D), and generalized anxiety disorder (GAD-D), as well as a general cross-cutting anxiety scale (Cross-D), which were developed to supplement categorical diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). METHODS: The German versions of the dimensional anxiety scales were administered to 218 students followed up approximately 2 weeks later (Study 1) and 55 outpatients (23 with anxiety diagnoses) followed-up 1 year later (Study 2). Probable diagnostic status in students was determined by the DIA-X/M-CIDI stem screening-questionnaire (SSQ). In the clinical sample, Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnoses were assessed at Time 1 using the DIA-X/M-CIDI. At Time 2, the patient-version of the Clinical Global Impression-Improvement scale (CGI-I) was applied to assess change. RESULTS: Good psychometric properties, including high test-retest reliability, were found for the dimensional scales except for SP-D. In outpatients, improvement at Time 2 was associated with significant decrease in PD-D, GAD-D, and Cross-D scores. Discussion Major advantages of the scales include that they are brief, concise, and based on a consistent template to measure the cognitive, physiological, and behavioral symptoms of fear and anxiety. Further replication in larger samples is needed. Given its modest psychometric properties, SP-D needs refinement. CONCLUSION: Increasing evidence from diverse samples suggests clinical utility of the dimensional anxiety scales.
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Ansiedad/diagnóstico , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Adolescente , Adulto , Factores de Edad , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y Especificidad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Prior research has demonstrated that there is some association between treatment engagement and treatment outcome in behavioral therapy for anxiety disorders. However, many of these investigations have been limited by weak measurement of treatment engagement variables, failure to control for potentially important baseline variables, and failure to consider various treatment engagement variables simultaneously. The purpose of the present study is to examine the relationship between two treatment engagement variables (treatment expectancy and homework compliance) and the extent to which they predict improvement from cognitive-behavioral therapy (CBT) for anxiety disorders. METHODS: 84 adults with a DSM-IV-defined principal anxiety disorder took part in up to 12 sessions of CBT or acceptance and commitment therapy. Pre- and post-treatment disorder severity was assessed using clinical severity ratings from a semi-structured diagnostic interview. Participants made ratings of treatment expectancy after the first session. Homework compliance was assessed each session by the treating clinician. RESULTS: Contrary to hypotheses, treatment expectancy and homework compliance were poorly correlated. Regression analyses revealed that homework compliance, but not treatment expectancy, predicted a significant portion of the variance in treatment outcome (10%). CONCLUSIONS: The present research suggests that although treatment expectation and homework compliance likely represent unique constructs of treatment engagement, homework compliance may be the more important treatment engagement variable for outcomes. The present research suggests that improvement of homework compliance has the potential to be a highly practical and effective way to improve clinical outcomes in CBT targeting anxiety disorders.
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Terapia de Aceptación y Compromiso/métodos , Trastornos de Ansiedad/terapia , Terapia Cognitivo-Conductual/métodos , Cooperación del Paciente , Adolescente , Adulto , Trastornos de Ansiedad/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
In preparation for DSM-5's planned inclusion of dimensional assessments of psychopathology as a complement to traditional categorical diagnoses, we developed brief self-rated scales for anxiety disorders that are consistent in content and structure. In the present paper, we discuss the creation of the scales and examine their psychometric properties and clinical sensitivity. Phase One assessed psychometric properties of the initial versions of the scales in a large non-clinical sample (n = 702). Phase Two assessed the psychometric properties of revised versions of the scales, including test-retest reliability, in a non-clinical sample (n = 57). Phase Three examined the scales' psychometric properties and relationship with clinician ratings of disorder severity in a clinical sample (n = 48). The scales demonstrated internal consistency (α = 0.85-0.92), convergent validity (r(s) = 0.39-0.69), and test-retest reliability in the non-clinical samples (ICC = 0.51-0.81). In the clinical sample, the scales demonstrated significantly higher total scores than in the non-clinical sample (Cohen's d = 0.72-1.50) and moderate to high correlations with clinician ratings of disorder severity (r = 0.43-0.82) Although further evaluation and refinement of the scales (particularly the specific phobia and agoraphobia scales) is needed, the results provide preliminary support for the use of these scales in DSM-5 and thus take an important step toward the integration of standardized dimensional measurement into the diagnosis of anxiety disorders.
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Ansiedad/diagnóstico , Ansiedad/fisiopatología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Autoinforme , Sensibilidad y Especificidad , Estadísticas no Paramétricas , Adulto JovenRESUMEN
BACKGROUND: Dimensional assessments are planned to be included as supplements to categorical diagnoses in DSM-V. The aim of this study was to examine the unidimensionality, reliability, validity, and clinical sensitivity of brief self-rated scales for specific anxiety disorders in an unselected German sample of consecutive attendees to a psychological clinic. These scales use a common template to assess core constructs of fear and anxiety. METHODS: Dimensional scales for social anxiety disorder, specific phobia, agoraphobia, panic disorder, and generalized anxiety disorder were administered along with established scales to 102 adults seeking treatment for mental health problems at a German university outpatient clinic for psychotherapy. The computer-assisted clinical version of the Munich-Composite International Diagnostic Interview was used to assess mental disorders according to DSM-IV criteria. Dimensionality and scale reliability were examined using confirmatory factor analyses. Convergent and discriminant validity were examined by testing differences in the size of correlations between each dimensional anxiety scale and each of the previously validated scales. Each dimensional scale's ability to correctly differentiate between individuals with versus without an anxiety diagnosis was examined via the area under the curve. RESULTS: Analyses revealed unidimensionality for each scale, high reliability, and convergent and discriminant validity. Classification performance was good to excellent for all scales except for specific phobia. CONCLUSIONS: The application of the dimensional anxiety scales may be an effective way to screen for specific anxiety disorders and to supplement categorical diagnoses in DSM-V, although further evaluation and refinement of the scales (particularly the specific phobia scale) is needed.