Vulnerabilities in social anxiety: Integrating intra- and interpersonal perspectives.

What are the major vulnerabilities in people with social anxiety? What are the most promising directions for translational research pertaining to this condition? The present paper provides an integrative summary of basic and applied translational research on social anxiety, emphasizing vulnerability factors. It is divided into two subsections: intrapersonal and interpersonal. The intrapersonal section synthesizes research relating to (a) self-representations and self-referential processes; (b) emotions and their regulation; and (c) cognitive biases: attention, interpretation and judgment, and memory. The interpersonal section summarizes findings regarding the systems of (a) approach and avoidance, (b) affiliation and social rank, and their implications for interpersonal impairments. Our review suggests that the science of social anxiety and, more generally, psychopathology may be advanced by examining processes and their underlying content within broad psychological systems. Increased interaction between basic and applied researchers to diversify and elaborate different perspectives on social anxiety is necessary for progress.

The Relationship Between Adult Attachment and Complicated Grief: A Systematic Review.

Attachment insecurity, including attachment anxiety and attachment avoidance, is proposed as a key factor disrupting adaptive recovery following bereavement, resulting in complicated grief. However, findings are inconsistent across studies. This review aimed to synthesise existing research on attachment patterns in adults experiencing complicated grief to better understand this relationship. 22 cross-sectional and longitudinal studies (5149 participants), published between 2003 and 2020, met inclusion criteria. Higher levels of attachment anxiety were consistently associated with symptoms of complicated grief. Higher levels of attachment avoidance were associated with symptoms of complicated grief, although this relationship was less consistent. The review has implications for clinical practice as bereaved adults with insecure attachment histories may be particularly vulnerable to experiencing complicated grief. The research is limited by the reliance on mainly cross-sectional studies. Future research should focus on longitudinal studies, and studies that explore men's experiences, and of individuals living in non-Western countries.

A taxonomy of intrusive mental images in clinical disorders: what can "non-veridical" images tell us about the nature of human memory?

Intrusive mental images associated with autobiographical memories or depicting imagined scenes are common in psychological disorders. Although there is a growing body of literature on their contribution to psychopathology and their role in therapy, to date there have been limited attempts to categorise the different types of images that patients experience. In this article, we present a taxonomy which ranges from veridical to non-veridical intrusive images. We highlight the fact that many types of images consist of a blend of veridical and imagined details. After presenting some of the main explanations for the existence of blended and non-veridical images, we reflect on what the evidence on the content and origin of intrusive images tells us about the nature of human memory. We argue that it supports the idea of memory being constructive and briefly discuss what this means for clinical and non-clinical settings in which intrusive images have to be evaluated and used.

Views and experiences of compassion in Sri Lankan students: An exploratory qualitative study.

Practicing compassion has shown to reduce distress and increase emotional well-being in clinical and non-clinical populations. The existing research is primarily focused on Western populations although the concepts of compassion are heavily influenced by Asian Buddhist views. There is a dearth of compassion research conducted particularly in the Asian context. Therefore, this study aimed to explore the views and lived experiences of compassion in Sri Lankan students, to understand whether compassion is a socially embraced construct in Sri Lanka, considering that Sri Lanka is a Buddhist influenced society. Participants' views and lived experiences of compassion towards themselves and to/from others were also investigated, with a specific focus on their perceived inhibitors and facilitators of compassion. Aims were set to identify whether Western compassion-based practices could be successfully applied to Asian societies such as Sri Lanka. An Interpretative Phenomenological Analysis approach was used to obtain and analyse qualitative data from a convenience sample of 10 Sri Lankan students, recruited from a Psychology course. The phenomenological analysis of the semi-structured face-to-face interviews elicited three predominant themes: What compassion means to me, what I make of it, and compassion through facilitators and inhibitors. The findings suggested that participants shared a similar understanding of the concept of compassion as reflected in the Western definitions. Experiences and views of compassion were shaped by several factors including religion, culture, society, and upbringing. In general, this study revealed that participants were well aware of the concept of compassion as well as its impact on their psychological well-being. Despite this, inhibitors existed in experiencing compassion. The religious and collectivistic-cultural influences need to be further explored and taken into account when implementing Western compassion-based practices to non-Western contexts such as Sri Lanka.

The effect of attachment security priming and oxytocin on physiological responses to trauma films and subsequent intrusions.

To further understand protective mechanisms to prevent post-traumatic stress disorder or assist recovery from psychological trauma, this study investigated whether pharmacological and psychological activation of a secure attachment representation elicits higher felt-security and a related response pattern of reduced physiological arousal and increased parasympathetic activation; and whether it protects individuals from developing intrusions and experiencing distress in the week following exposure to a trauma film. Using a double-blind, experimental mixed factorial design, 101 volunteers received either oxytocin or placebo and either secure attachment or neutral priming before watching a trauma film. We measured felt security as an indicator of the strength of activation of a secure attachment representation, skin conductance and heart rate as indicators of physiological arousal, and high frequency heart rate variability as an indicator of parasympathetic activation during the priming and the film. Participants then completed a seven-day intrusion diary. Secure attachment priming, but not oxytocin administration or the combination of both, was associated with reduced physiological arousal and increased parasympathetic activity during priming. Although secure attachment priming was not related to the absolute number of intrusions or to less perceived distress or physiological arousal during the trauma film, it was associated with lower intrusion-related distress in the 7-days post-testing. Our findings extend previous research that suggests the importance of interventions that address intrusion-related distress for recovery from trauma, and suggest a promising role for secure attachment priming in trauma-focused psychological therapies. We contribute to the growing literature that finds that higher subjective distress during a trauma is associated with higher intrusion-related distress. We discuss theoretical implications and possible mechanisms through which secure attachment priming may exert potential beneficial effects.

Imagery rescripting in non-clinical paranoia: a pilot study of the impact on key cognitive and affective processes.

BACKGROUND: Paranoia is often accompanied by distressing intrusions associated with traumatic memories, yet one of the best-evidenced interventions, imagery rescripting (IR), is not routinely offered. This is likely to be due to poor understanding of the effects of IR on postulated mechanisms of change as well as the absence of a robust evidence base. AIMS: This study aimed to establish proof of principle that IR impacts key cognitive-affective processes associated with distressing intrusions - memory characteristics and self-representations - and level of paranoia. METHOD: We used a within-subject repeated measures design to examine the effect of single-session IR on memory characteristics (level of intrusions, vividness, distress, encapsulated belief strength, emotion intensity and frequency), self-representation variables, affect and paranoia. Fifteen participants were seen once before and once after the IR session, to gather baseline and follow-up data. RESULTS: As predicted, participants reported reductions in memory characteristics, improved self-esteem and positive affect, and reduced negative affect and paranoia, with large effect sizes. These effects were maintained at follow-up. CONCLUSIONS: While a within-subject design is useful for initial exploration of novel interventions, controlled studies are needed to determine causality. This is the first study to examine mechanisms of IR in paranoia. A controlled trial is now warranted.

Expert viewpoints of peer support for people experiencing homelessness: A Q sort study.

Peers have shared experiences of phenomena such as mental illness, addiction, and homelessness. Homelessness services are increasingly utilizing peers in their models to support people experiencing homelessness. While there is extensive literature on peer support in general, few studies focus on the potential change mechanisms that might underpin this intervention, particularly regarding homelessness. This study aims to utilize expert opinions to identify common viewpoints on components involved in effective peer support. Forty-three statements were developed from previous literature that broadly describes elements involved in peer support. Forty experts (20 peers and 20 professionals) ranked the statements into a hierarchy. Q methodology is a rigorous method to objectively research participants' subjective viewpoints, using a by-person rather than by-variable approach to factor analysis. The study was done in three stages: first-order analysis to identify shared viewpoints within (a) the peer participant group, (b) the professional participant group, and (c) a second-order analysis of Stage 1 and 2 results to identify common viewpoints held across participant groups. Stage 3 analysis resulted in three differing viewpoints; the dominant viewpoint asserts that effective peer support is rooted in experiential knowledge, where peers build unique, trusting relationships to provide clients with a different level of support. The results highlighted different types of peer support and defined a new one: a unidirectional, mentorship type of intentional peer support. Strengths and limitations are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The impact of self-imagery on aspects of the self-concept in individuals with high levels of eating disorder cognitions.

BACKGROUND AND OBJECTIVES: Low self-esteem has been identified as a maintaining factor in Cognitive Behavioural models of eating disorders and links have been identified between early memories, negative core beliefs and mental imagery. This study explored the impact of positive and negative self-imagery on aspects of the working self (implicit and explicit self-esteem, self-concept clarity and self-discrepancy) and affect. METHODS: Participants with high levels of eating disorder cognitions completed measures of explicit self-esteem, self-concept clarity, self-discrepancy and affect prior to completing a positive or negative self-imagery retrieval task. Baseline measures were then repeated and a measure of implicit self-esteem completed. RESULTS: Positive self-imagery retrieval led to a significant increase in positive explicit self-esteem and a significant reduction in negative explicit self-esteem and actual-ideal self-discrepancies. Negative self-imagery retrieval led to a significant increase in negative explicit self-esteem and actual-ideal self-discrepancies and a significant reduction in positive explicit self-esteem. Levels of implicit self-esteem did not differ between the two groups post imagery manipulation. Retrieving a positive self-image also led to an improvement in state self-concept clarity; however, no effect was found for the negative self-imagery intervention. Holding a positive self-image in mind led to an increase in state positive affect and a reduction in state negative affect. The opposite was found for negative self-image retrieval. LIMITATIONS: The study did not measure implicit self-esteem at baseline. CONCLUSIONS: Imagery techniques that involve the retrieval of a positive self-image may help to improve aspects of the working-self and affect in those with eating difficulties.

Impact of imagery rescripting on adverse self-defining memories and post-recall working selves in a non-clinical sample: a pilot study.

Imagery rescripting (ImRS) effectively targets intrusive images and symptoms in a number of disorders, but the mechanisms of change behind it are not yet clear. This study investigated the impact of ImRS on the characteristics of adverse self-defining memories and post-recall working selves in a non-clinical sample. In the first session, participants recalled an adverse memory and completed state self and affect measures. Then they attended an ImRS session and a follow-up session one week later. Participants rated their memory as less negative, less distressing and less important for their sense of self at follow-up compared to the first session. They also reported higher state self-esteem and positive affect, as well as reduced negative affect and anxiety after recalling the memory. Results suggest that, by modifying the meaning of adverse memories, ImRS may facilitate their integration with individuals' sense of self and reduce the negative impact that they have on individuals' online representation of the self when retrieved. An implication of these findings is that cognitive-behavioural therapy may need to conceptualise the self in broader terms, moving beyond core beliefs. To complement this, research could focus on changes in patients' sense of self in order to understand the mechanisms through which interventions like ImRS work.

Investigating the phenomenology of imagery following traumatic burn injuries.

Intrusive images related to adverse experiences are an important feature of a number of psychological disorders and a hallmark symptom of posttraumatic stress disorder (PTSD). Depression, anxiety, and PTSD are all common reactions following a burn injury. However, the nature of burn-related trauma memories and associated intrusions and their contribution to psychological disorders is not well understood. The aim of the study was to take a broad look at the nature of imagery experienced by people who have sustained a burn injury. Nineteen participants completed self-report questionnaires assessing depression, anxiety, and PTSD symptoms and were administered a semi-structured interview which explored the characteristics (vividness, sensory modalities, intrusions, emotion intensity) of imagery formed in relation to their burn injuries. Ongoing intrusive imagery was reported by over half the participants and there were significant correlations between frequency of intrusive images and posttraumatic symptoms, and between intensity of emotions associated with intrusive images and depression and posttraumatic symptoms. A thematic analysis of the memory narratives revealed four main themes: threat to self, view of the world, view of others, and positive psychological change. These results are discussed in relation to existing trauma theory and burn injury literature. Implications for clinical practice and recommendations for further research are proposed.

CBT for eating disorders: The impact of early changes in eating pathology on later changes in personality pathology, anxiety and depression.

Whilst studies have consistently identified early symptom reduction as an important predictor of treatment outcome, the impact of early change on common comorbid features has not been investigated. This study of CBT for eating disorders explored patterns of early change in eating pathology and longer-term change in personality pathology, anxiety and depression. It also explored the impact of early change in eating pathology on overall change in personality pathology, anxiety and depression. Participants were 179 adults diagnosed with eating disorders who were offered a course of CBT in an out-patient community eating disorders service in the UK. Patients completed a measure of eating disorder psychopathology at the start of treatment and following the 6th session. They also completed measures of personality disorder cognitions, anxiety and depression at the start and end of treatment. There were significant changes in eating pathology over the first six sessions of treatment. Significant improvements were also seen in personality disorder pathology, anxiety and depression by the end of therapy. Effect sizes were medium to large for both completer and intention to treat analyses. Early changes in eating pathology were associated with later changes in common comorbid features, with early reduction in restraint being a key predictor. These findings demonstrate that early symptom change can be achieved in CBT for eating disorders when delivered in routine clinical practice. Such change has long-term benefits that go beyond the domain of eating pathology, enhancing change in personality pathology, anxiety and depression.

The associations between adult attachment, posttraumatic symptoms, and posttraumatic growth.

BACKGROUND AND OBJECTIVES: Individual differences after trauma vary considerably and can range from posttraumatic stress disorder (PTSD) to posttraumatic growth (PTG). Current theoretical models cannot fully explain this variability. Therefore, we integrated attachment theory with Ehlers and Clark's model of PTSD to understand whether attachment style is associated with negative appraisals of a traumatic event(s), posttraumatic stress symptoms (PTS), and PTG. Our aim was to test this integrated model PTSD in an analog sample who had experienced at least one traumatic event. DESIGN: We used structural equation modeling to test the association of adult attachment and posttraumatic cognitions (self and world/others) with PTS and PTG using a cross-sectional, correlational design. METHODS: The sample comprised 393 university staff and students (RangeAge= 18-49, 85% females) who completed online measures. RESULTS: Attachment anxiety and negative posttraumatic self-cognitions were positively associated. Negative posttraumatic self-cognitions were positively associated with PTS. Attachment anxiety had an indirect effect (via negative posttraumatic self-cognitions) on PTS, whereas attachment avoidance predicted more negative posttraumatic world cognitions and lower perceived PTG. CONCLUSIONS: The study highlights the importance of considering how attachment styles influence posttraumatic emotion regulation and cognitive processing of the trauma to determine posttraumatic mental health.

Cognitive-behavioural therapy for outpatients with eating disorders: effectiveness for a transdiagnostic group in a routine clinical setting.

Whilst there is a growing evidence to support the impact of cognitive-behavioural therapy (CBT) in the treatment of adults with eating disorders, much of this evidence comes from tightly controlled efficacy trials. This study aimed to add to the evidence regarding the effectiveness of CBT when delivered in a routine clinical setting. The participants were 203 adults presenting with a range of eating disorder diagnoses, who were offered CBT in an out-patient community eating disorders service in the UK. Patients completed measures of eating disorder pathology at the start of treatment, following the sixth session, and at the end of treatment. Symptoms of anxiety, depression, and psychosocial functioning were measured pre- and post-treatment. Approximately 55% of patients completed treatment, and there were no factors that predicted attrition. There were significant improvements in eating disorder psychopathology, anxiety, depression and general functioning, with particular changes in eating attitudes in the early part of therapy. Effect sizes were medium to large for both completer and intention to treat analyses. These findings confirm that evidence-based forms of CBT can be delivered with strong outcomes in routine clinical settings. Clinicians should be encouraged to deliver evidence-based treatments when working in these settings.

Self-imagery in individuals with high body dissatisfaction: the effect of positive and negative self-imagery on aspects of the self-concept.

BACKGROUND AND OBJECTIVES: Cognitive behavioural models of eating disorders highlight low self-esteem as a maintaining factor. This study explored the impact of positive and negative self-imagery on aspects of the working self (implicit and explicit self-esteem and self-concept clarity) in individuals with high body dissatisfaction (an important aspect of eating disorders). The impact of these images on state body satisfaction and affect was also explored. METHOD: A group of participants with high body dissatisfaction completed measures of explicit self-esteem, self-concept clarity, state body satisfaction and affect prior to completing a negative (n = 33) or positive (n = 33) self-imagery retrieval task. Following this they completed the baseline measures and a measure of implicit self-esteem. RESULTS: Holding a negative self-image in mind had a negative effect on explicit self-esteem, whilst holding a positive self-image had a beneficial effect. There were no effects of imagery on implicit self-esteem. Holding a negative image in mind led to a significant reduction in self-concept clarity; however, positive self-imagery did not affect self-concept clarity. Holding a negative self-image in mind led to a decrease in body satisfaction and state affect. The opposite was found for the positive self-imagery group. LIMITATIONS: Implicit self-esteem was not measured at baseline. CONCLUSIONS: Imagery techniques which promote positive self-images may help improve aspects of the working self, body satisfaction and affect in individuals with high levels of body dissatisfaction. As such, these imagery techniques warrant further investigation in a clinical population.

The retrieval of self-defining memories is associated with the activation of specific working selves.

This article presents two studies that investigated the impact of the retrieval of self-defining memories on individuals' sense of self. Participants recalled positive and/or negative self-defining memories, rated memory characteristics and completed measures focusing on different self-aspects. Study 1 found that participants reported higher state self-esteem after recalling a positive memory than after recalling a negative one. They also reported lower negative self-consistency and higher state self-concept clarity and positive self-consistency, but this result became non-significant after controlling for state self-esteem. Study 2 found that participants reported higher state self-esteem, a marginally higher proportion of recreation/exploration, goals and a marginally lower proportion of achievement goals after recalling a positive memory than after recalling a negative one. They also reported a higher proportion of self-cognitions referring to emotional states after recalling memories from which they had not abstracted meaning than after recalling memories from which they had done this. These findings suggest that the retrieval of vivid, emotional and highly self-relevant memories may be accompanied by the activation of specific self-representations or working selves. They also suggest that the experience of memory-related intrusive images may temporarily influence individuals' sense of self. The implications of these findings for clinical practice are discussed.

Cognitive control processes in paranoia: the impact of threat induction on strategic cognition and self-focused attention.

BACKGROUND: Current clinical models emphasize certain cognitive processes in the maintenance of distressing paranoia. While a number of these processes have been examined in detail, the role of strategic cognition and self-focused attention remain under-researched. AIMS: This study examined the deployment of cognitive strategies and self-focused attention in people with non-clinical paranoia. METHOD: An experimental design was used to examine the impact of a threat activation task on these processes, in participants with high and low non-clinical paranoia. Twenty-eight people were recruited to each group, and completed measures of anxiety, paranoid cognition, strategic cognition and self-focused attention. RESULTS: The threat activation task was effective in increasing anxiety in people with high and low non-clinical paranoia. The high paranoia group experienced more paranoid cognitions following threat activation. This group also reported greater use of thought suppression, punishment and worry, and less use of social control strategies when under threat. No differences were found between the groups on measures of self-focused attention. CONCLUSIONS: This study shows that the threat activation task increased anxiety in people with high non-clinical paranoia, leading to increased paranoid thinking. The use of strategic cognition following threat activation varied dependent on level of non-clinical paranoia. If these differences are replicated in clinical groups, the strategies may be implicated in the maintenance of distressing psychosis, and may therefore be a valuable target for therapeutic intervention.

The emotion regulation questionnaire: validation of the ERQ-9 in two community samples.

The 10-item Emotion Regulation Questionnaire (ERQ) was developed by Gross and John (2003) to measure the habitual use of 2 emotion regulation strategies: reappraisal and suppression. Several studies using student samples have provided validation for the ERQ, although the only article (Wiltink et al., 2011) that evaluated the ERQ in a community sample was unable to replicate the original factor structure. Before using the ERQ in non-student samples, it is important to validate the scale in a sample broadly representative of the adult population and to determine the influence of demographic variables. The current study examined the psychometric properties of the ERQ in 2 community samples (Australia, N = 550; United Kingdom, N = 483; 17-95 years of age) using confirmatory analysis. The original ERQ factor structure was not supported by either the Australian or United Kingdom samples. However, with the removal of 1 item, a strong model fit was obtained for both samples (9-item ERQ [ERQ-9]). Using measurement invariance tests, the revised ERQ-9 was found to be equivalent across the samples and demographics (age, gender, and education). Gender, depression, anxiety, and stress were the only factors that were significantly associated with reappraisal and suppression use. Overall, the ERQ-9 provides better fit of the data than the 10-item ERQ. The utility of this measure is enhanced by the provision of normative data for males and females.

The influence of age on emotion regulation strategies and psychological distress.

BACKGROUND: To date there is promising, yet limited, evidence to suggest that differences exist between older and younger adults' emotion regulation styles. AIMS: The study aimed to explore emotion regulation style across the adult lifespan by assessing whether self-reported reappraisal, or suppression, differs across age groups, and how these emotion regulation strategies may impact upon psychological distress. METHOD: Three hundred and seventeen younger, 175 middle-aged and 85 older adults' emotion regulation styles and levels of psychological distress were measured using self-report questionnaires and examined using a cross-sectional design. RESULTS: The findings suggest that, compared to younger adults, older adults make greater use of suppression, the emotion regulation strategy. This greater use of suppression by older adults was not related to increased levels of psychological distress. By contrast, younger adults who reported high levels of suppression reported higher levels of psychological distress. In addition, older adults reported less anxiety and stress than younger adults, with no age differences in depression. CONCLUSIONS: Findings suggest a possible decoupling of the use of emotional suppression and psychological distress with age. Suppression may be a useful form of emotion regulation for the stressors experienced in later life and, arguably, therefore may not be associated with the negative outcomes observed in younger adults.