Brief self-affirmation intervention for adults with psoriasis for reducing anxiety and depression and boosting well-being: Evidence from a randomized controlled trial.

BACKGROUND: There are relatively few studies to address mental health implications of self-affirming, especially across groups experiencing a chronic health condition. In this study, short- and longer-term effects of a brief self-affirmation intervention framed in terms of implementation intentions (if-then plans with self-affirming cognitions; S-AII) were evaluated against an active control group (non-affirming implementation intentions; N-AII), matched to the target condition, and mere goal intention condition (a non-active control) in adults with psoriasis. The three pre-registered primary outcomes captured depression, anxiety, and well-being. METHODS: Adults with psoriasis (N = 175; Mage = 36.53, s.d. = 11.52) were randomized into S-AII, N-AII, or control. Participants' mental health outcomes were assessed prior to randomization (at baseline), at week 2 (post-intervention), and at a 1-month follow-up. RESULTS: Linear mixed models were used and results were reported on the intention-to-treat principle. Analyses revealed that S-AII exerted significantly more improvement in the course of well-being (ds > 0.25), depressive symptoms (ds > -0.40), and anxiety (ds > -0.45) than the N-AII and control group at 2-week post-intervention. Though the differences between groups faded at 1-month follow-up, the within-group changes over time for S-AII in all mental health outcomes remained significant. CONCLUSIONS: Brief and low-intensity S-AII intervention exerted in the short-term a considerable impact on mental health outcomes. The S-AII shows promising results as a relevant public mental health strategy for enhancing well-being and reducing psychological distress. Future studies could consider whether these effects can be further enhanced with booster interventions.

Level of Personality Functioning Scale-Brief Form 2.0: Validity and reliability of the Polish adaptation. / Krótka Skala Poziomu Funkcjonowania Osobowosci ­ wersja 2.0 (LPFS-BF 2.0): Trafnosc i rzetelnosc polskiej adaptacji.

OBJECTIVES: This study examined psychometric properties of the Polish adaptation of the Level of Personality Functioning Scale-Brief Form 2.0 (LPFS-BF 2.0) measuring features corresponding to self - and interpersonal impairment of personality functioning as defined in the diagnostic guidelines for Personality Disorder in the DSM-5 Section III. METHODS: The study involved a non-clinical sample of N = 242 adults (52.9% female; Mage = 30.63 years, SDage = 11.81 years). To evaluate the criterion validity, the Personality Inventory for DSM-5 (PID-5), Personality Inventory for ICD-11 (PiCD), Agency-Communion-Inventory (AC-IN), and Mental Health Continuum-Short Form (MHC-SF) were administered. RESULTS: The LPFS-BF 2.0 yielded two reliable latent components that correspond to an interpretation of self - and interpersonal functioning and showed relevant associations with a personality disorder severity index, maladaptive personality traits, well-being, and personality constructs of agency and communion. The LPFS-BF 2.0 also demonstrated incremental validity over and above all the PID-5 pathological traits with respect to global well-being as an outcome. CONCLUSIONS: The Polish adaptation of the LPFS-BF 2.0 is a psychometrically and conceptually sound measure to assess features corresponding to self and interpersonal impairment of personality functioning as defined in the DSM-5 Section III. However, findings warrant replication in clinical populations.

Psychometric Evaluation of the Polish adaptation of a Self-Report Form of the DSM-5 Level of Personality Functioning Scale (LPFS-SR). / Wlasciwosci psychometryczne polskiej adaptacji Samoopisowej skali poziomu funkcjonowania osobowosci wedlug DSM-5 (LPFS-SR).

OBJECTIVES: This study examined psychometric properties of the Polish adaptation of a Self-Report Form of the DSM-5 Level of Personality Functioning Scale (LPFS-SR). It is a scale designed to measure general impairment, jointly with a detailed assessment of distinguished components of personality functioning characterized in terms of disturbances in self (identity and self-direction) and interpersonal (empathy and intimacy) functioning - Criterion A in the DSM-5 Alternative Model for Personality Disorders (AMPD). METHODS: The study involved a non-clinical sample of N = 242 adults (52.9% female; Mage = 30.63 years; SDage = 11.81 years). To provide an evaluation of the criterion validity, Personality Inventory for DSM-5 (PID-5), Personality Inventory for ICD-11 (PiCD), Level of Personality Functioning Scale - Brief Form 2.0 (LPFS-BF 2.0), and Big Five Inventory-2 (BFI-2) were administered. RESULTS: Our data supported that identity, self-direction, intimacy, and empathy components of the LPFS-SR can be characterized by a single, global dimension of personality dysfunction, consistent with the assumption that DSM-5 Criterion A is a relatively homogeneous construct. The LPFS-SR showed good reliability estimates and demonstrated conceptually sound associations with the PD severity index and related measures of personality functioning. Moreover, all the LPFS-SR components manifested at least partial distinction from maladaptive personality traits (i.e., Criterion B in the DSM-5 AMPD). CONCLUSIONS: These findings provide support for the validity of the Polish adaptation of the LPFS-SR as an operationalization of impairment in the core and common features of personality pathology described in the DSM-5 alternative model.

A Factorial Randomized Controlled Trial of Implementation-Intention-Based Self-Affirmation Interventions: Findings on Depression, Anxiety, and Well-being in Adults With Psoriasis.

This study builds on growing evidence on implementation-intention-based self-affirmation intervention effects on mental health. Using a factorial design, this pre-registered study aimed to further investigate whether (1) strengthening the element of specificity within body-related self-affirming implementation intention (BS-AII) intervention compared to general self-affirming implementation intention (S-AII) would provide greater improvements in mental health outcomes for adults with psoriasis, and (2) whether the addition of a booster component would result in enhancing effectiveness at follow-up. A total of 306 adults with psoriasis were assessed for eligibility and 222 (aged 18-71 years) were randomized and received S-AII, BS-AII, or MGI (mere goal intention-control condition). Within each group, participants were again randomized to booster (B) or no-booster condition in a 3 × 2 factorial design, resulting in six groups: S-AII; S-AII + B; BS-AII; BS-AII + B; MGI; and MGI + B. Data were collected over three-time points, at baseline, 2 weeks post-intervention, and at 1-month later. Three primary outcomes were defined as a reduction of anxiety and depressive symptoms and enhancement of well-being. In terms of secondary outcomes, positive other- and self-directed feelings and also an emotional attitude toward the body were evaluated. To fully estimate intervention effects through intention-to-treat analysis, linear mixed models were used. A significant effect of time was observed, but no evidence of time-by-group interactions and no three-way interactions were detected. Exploratory analyses revealed two significant moderating effects of age and self-esteem, pointing to boundary conditions of the interventions. These findings offer to gain deeper insights on null (or negative) effects also reported in past works and highlight that self-affirmation interventions should be more thoroughly investigated and optimized before they can be broadly implemented in real-life contexts, especially to prevent backfiring and negative-enhancing effects.

Enhancing well-being and alleviating depressive symptoms in people with HIV/AIDS: An intervention based on if-then plans with self-affirming cognitions.

Effective antiretroviral treatment has increased the life expectancy of people living with HIV, and currently, the challenges of prominent importance appear to be mental health issues. This preregistered study among adults living with HIV/AIDS investigated the effectiveness of a brief self-affirmation intervention framed in terms of if-then plans (i.e. self-affirming implementation intentions [S-AII]) against both active and non-active control conditions, forming non-affirming implementation intentions and mere goal intentions, respectively. The primary outcomes were defined as a reduction of depressive symptoms and enhancement of well-being, along with secondary outcomes as positive other- and self-directed feelings. A total of 162 individuals were assessed for eligibility, and 130 (aged 18-74 years) were randomized to the study conditions. Intervention effects were estimated through intention-to-treat analysis, using linear mixed models. The S-AII intervention yielded improvements in overall well-being over 2 weeks (d = .23), primarily driven by positive changes in emotional (d = .24) and social (d = .30) dimensions of well-being. There were no significant differences in depression or secondary outcomes. Based on a minimal clinically important difference index, the S-AII intervention resulted in improvement in well-being in approximately 40 percent of participants. Nevertheless, further systematic research is needed to optimize self-affirmation-interventions, before their application in real-life contexts.

Assessment of personality disorder in the ICD-11 diagnostic system: Polish validation of the Personality Inventory for ICD-11. / Pomiar zaburzen osobowosci w systemie diagnostycznym ICD-11: Polska adaptacja Inwentarza osobowosci PiCD.

OBJECTIVES: This paper presents results of a study on the Polish adaptation of the Personality Inventory for ICD-11 (PiCD), which was developed to measure pathological traits under a new, dimensional model of personality disorders proposed in ICD-11. METHODS: The study involved a non-clinical sample of N = 597 adults (51.4% female; Mage = 30.24 years; SD = 12.07 years). For convergent and divergent validity, Personality Inventory for DSM-5 (PID-5) and Big Five Inventory-2 (BFI-2) were used. RESULTS: The results showed the Polish adaptation of the PiCD to be reliable and valid. Cronbach's alpha coefficient for PiCD scale scores ranged from 0.77 to 0.87 (Mα = 0.82). The four-factor structure of PiCD items with the three unipolar factors, "Negative Affectivity", "Detachment", and "Dissociality", and one bipolar "Anankastia" vs. "Disinhibition" factor was conformed. All PiCD traits are related to PID-5 pathological traits and BFI-2 normal traits in an expected way both in correlational and factor analyses. CONCLUSIONS: Obtained data demonstrate satisfactory internal consistency, factorial validity, and convergent-discriminant validity of the Polish adaptation of PiCD in a non-clinical sample.

Anankastia or Psychoticism? Which One Is Better Suited for the Fifth Trait in the Pathological Big Five: Insight From the Circumplex of Personality Metatraits Perspective.

Both the ICD-11 and the DSM-5 (Section III) classification systems introduced dimensional models of personality disorders, with five broad domains called the Pathological Big Five. Nevertheless, despite large congruence between the two models, there are also substantial differences between them, with the most evident being the conceptualization of the fifth dimension: Anankastia in the ICD-11 vs. Psychoticism in the DSM-5. The current paper seeks an answer to the question of which domain is structurally better justified as the fifth trait in the dimensional model of personality disorders. For this purpose, we provided both a conceptual and empirical comparison of the ICD-11 and the DSM-5 models, adopting the Circumplex of Personality Metatraits-a comprehensive model of personality structure built on the basis of the higher-order factors of the Big Five-as a reference framework. Two studies were conducted: the first on a sample of 242 adults (52.9% female; M age = 30.63, SD age = 11.82 years), and the second on a sample of 355 adults (50.1% female; M age = 29.97, SD age = 12.26 years) from the non-clinical population. The Personality Inventory for ICD-11 (PiCD), the Personality Inventory for DSM-5 (PID-5), and the Circumplex of Personality Metatraits Questionnaire-Short Form (CPM-Q-SF) were administered in both studies, together with the PID-5BF+M algorithm for measuring a common (ICD-11 + DSM-5) six-domain model. Obtained empirical findings generally support our conceptual considerations that the ICD-11 model more comprehensively covered the area of personality pathology than the DSM-5 model, with Anankastia revealed as a more specific domain of personality disorders as well as more cohesively located within the overall personality structure, in comparison to Psychoticism. Moreover, the results corroborated the bipolar relations of Anankastia vs. Disinhibition domains. These results also correspond with the pattern of relationships found in reference to the Big Five domains of normal personality, which were also included in the current research. All our findings were discussed in the context of suggestions for the content and conceptualization of pathological personality traits that flow from the CPM as a comprehensive model of personality structure including both pathological and normal poles of personality dimensions.

Using the theory of self-affirmation and self-regulation strategies of mental contrasting and forming implementation intentions to reduce social anxiety symptoms.

Background and Objectives: Based on the results of past research on emotion regulation and positive behavioral change via self-affirmation, it was hypothesized that self-affirmation should help socially anxious individuals to reduce social anxiety symptoms. The effectiveness of a brief self-affirmation intervention framed in terms of implementation intentions (if-then plans with self-affirming cognitions) was compared against forming non-affirming implementation intentions (with distraction as a way of coping) and inactive control condition. Additionally, it was tested whether mental contrasting can augment the impact of the self-affirmation intervention. Design/Methods: Participants (N = 198, aged 18-45) were randomly assigned to one of three intervention conditions (self-affirming implementation intention, mental contrasting with self-affirming implementation intention, or non-affirming implementation intention) or an inactive control-group. Social anxiety symptoms were assessed at baseline and at one-week post-intervention. Results: The difference between the interventions and the control group was substantial. However, there were no differences in the reduction of overall social anxiety levels between the interventions. Each of the interventions produced a statistically significant reduction in social anxiety (Cohen's ds from -.40 to -.50). Conclusions: The results indicate no advantage for self-affirming over non-affirming implementation intentions in reducing social anxiety symptoms. Moreover, no superiority of mental contrasting was found.

Personality Trait Interactions in Risk for and Protection against Social Anxiety Symptoms.

Previous attempts to identify personality traits that enhance inclination to social anxiety (SA) have been limited by a tendency to focus on selected traits in isolation, rather than examining their interactions. Additional research is needed to better understand whether and how these dimensions are linked to SA. In a prospective study, it was examined how interactions between the Big Five personality factors predict SA symptoms. A total of 135 individuals, aged 18-50 years, were recruited. Personality traits were measured at baseline, and SA symptoms were assessed one month later. Results showed that low emotional stability was an independent predictor of higher levels of SA. Additionally, two significant interactions emerged: the interactions between extraversion and openness, and between openness and agreeableness predicted SA symptoms. At high openness, higher extraversion was associated with significantly lower levels of SA, suggesting that the interaction provides incrementally greater protection against SA. Thus, extraverts are likely to be protected against social anxiety symptoms, but more so the more open they are. Moreover, at high levels of agreeableness, low openness has been shown to be uniquely predictive for higher levels of SA symptoms, indicating that the combined effect of openness with agreeableness may be more important to SA than either trait in isolation. These findings highlight the importance of testing interaction effects of personality traits on psychopathology.

Self-esteem is related to anxiety in psoriasis patients: A case control study.

OBJECTIVE: In psoriasis, taking steps to improve emotional health is important to bring lasting benefits to patients' physical health and overall well-being. We aimed to identify factors that relate to anxiety in psoriasis and are potentially modifiable and that thus qualify as targets for future planned interventions for improving mental health. In this study, the importance of coping strategies and self-esteem as potential targets were tested. METHODS: A total of 102 patients diagnosed with psoriasis, aged 26-65 years (M = 43.39 years, SD = 10.56) and 98 healthy controls (with an overall age, gender, educational attainment distribution similar to that of the cases) completed the Rosenberg's Self-Esteem Scale, the Coping Inventory for Stressful Situations, and the State-Trait Anxiety Inventory. RESULTS: Patients with psoriasis compared to healthy controls reported significantly higher rates of anxiety and emotion- and avoidance-oriented coping strategies, presented lower rates of task-oriented coping strategies, and significantly lower levels of self-esteem. Importantly, our results revealed that self-esteem in psoriasis patients was strongly related to anxiety. Moreover, the increased rates of anxiety in psoriasis were not significantly associated with the coping strategies, suggesting that in patients with psoriasis coping strategies are secondary to other factors such as self-image and self-esteem. CONCLUSIONS: The results identify self-esteem as a target to adopt in further interventions for psoriasis patients. Recommendations for future research and intervention development are discussed.

Social anxiety questionnaire (SAQ): Development and preliminary validation.

BACKGROUND: The Social Anxiety Questionnaire (SAQ) was designed to assess five dimensions of social anxiety as posited by the Clark and Wells' (1995; Clark, 2001) cognitive model. METHODS: The development of the SAQ involved generation of an item pool, followed by a verification of content validity and the theorized factor structure (Study 1). The final version of the SAQ was then assessed for reliability, temporal stability (test re-test reliability), and construct, criterion-related, and contrasted-group validity (Study 2, 3, and 4). RESULTS: Following a systematic process, the results provide support for the SAQ as reliable, and both theoretically and empirically valid measure. A five-factor structure of the SAQ verified and replicated through confirmatory factor analyses reflect five dimensions of social anxiety: negative self-processing; self-focused attention and self-monitoring; safety behaviours; somatic and cognitive symptoms; and anticipatory and post-event rumination. LIMITATIONS: Results suggest that the SAQ possesses good psychometric properties, while recognizing that additional validation is a required future research direction. It is important to replicate these findings in diverse populations, including a large clinical sample. CONCLUSIONS: The SAQ is a promising measure that supports social anxiety as a multidimensional construct, and the foundational role of self-focused cognitive processes in generation and maintenance of social anxiety symptoms. The findings make a significant contribution to the literature, moreover, the SAQ is a first instrument that offers to assess all, proposed by the Clark-Wells model, specific cognitive-affective, physiological, attitudinal, and attention processes related to social anxiety.

Associations between site of skin lesions and depression, social anxiety, body-related emotions and feelings of stigmatization in psoriasis patients.

INTRODUCTION: Research has demonstrated a link between psoriasis and a multitude of psychological impairments; however, relatively few studies have examined the importance of site of skin lesions for negative psychological outcomes in psoriasis patients. AIM: To investigate relationships between anatomical location of psoriatic lesions and experiences of stigmatization, negative emotional attitude towards the body, depression and social anxiety. MATERIAL AND METHODS: Adult psoriasis patients (N = 193) completed the Stigmatization Scale, the Body Emotions Scale, the Beck Depression Inventory and the Social Anxiety Questionnaire. The body surface area index was used to assess the location and extent of psoriasis. RESULTS: Feelings of stigmatization were found to be most closely related to the presence of psoriatic lesions on the chest, and the arms and hands. Higher levels of social anxiety were found to be most closely related to the location of psoriatic lesions on the head and neck. Negative emotional attitude towards the body was found to be most closely related to the location of psoriatic lesions on the arms and hands, and on the head and neck. Higher levels of depressive symptoms were most closely related to the presence of psoriatic lesions on the head and neck, the arms and hands, and the genital area. CONCLUSIONS: The presence of psoriatic lesions on the head, neck, and chest, and also on the arms and hands and the genital area, should alert clinicians to a higher risk of psychological impairments. This may help to better recognize and prevent cumulative life course impairment.

How does stigma affect people with psoriasis?

INTRODUCTION: Psoriasis is associated with a major additional psychological burden. AIM: To investigate whether the extent of skin involvement, stigmatization, and perceived social support are related to depressive symptoms in psoriasis patients. MATERIAL AND METHODS: One hundred and forty-eight psoriasis patients completed in the BSA, the Beck Depression Inventory, Stigmatization Scale, and Multidimensional Scale of Perceived Social Support. RESULTS: Almost 13% of participants obtained a BDI total score indicating moderate depressive symptoms. The results of regression analysis revealed that greater depression severity in psoriasis patients is associated with higher levels of psoriasis-related stigma, lower perceived social support, female gender and a shorter duration of the disease, explaining 43% of the variance of depression. The stigmatization was the most powerful predictor of depressive symptoms for psoriasis patients and accounted for 33% of the variance. CONCLUSIONS: The extent of psoriasis does not directly lead to mood disturbance in these patients. Rather, social stigma accounted for this relationship. Strategies for reducing the stigma attached to patients with psoriasis are required.

Toward a better understanding of social anxiety and depression in psoriasis patients: The role of determinants, mediators, and moderators.

OBJECTIVE: To determine how and under which conditions psoriasis is related to the psychological impairments, in particular, to social anxiety and depression, the current study tested the interplay of selected factors such as gender, age of onset of psoriasis, cognitive and affective elements of body image, experiences of stigmatization, and patients' subjective perceptions of severity of the disease. METHODS: Adult psoriasis patients (N=193) completed the Appearance Schemas Inventory-Revised, the Stigmatization Scale, the Body Emotions Scale, the Beck Depression Inventory, and the Social Anxiety Questionnaire. The disease severity was defined based on the Body Surface Area (BSA) index. RESULTS: The effect of psoriasis on social anxiety was moderated by age of onset: higher severity of the disease was associated with higher levels of social anxiety, but only for patients with pre-adult onset psoriasis. Hierarchical multiple regressions revealed that in patients with adult-onset (≥18years of age) the importance of appearance to one's sense of self-worth was the main contributor to social anxiety, while in patients with pre-adult onset, social anxiety was most strongly related to experiences of stigmatization. Moreover, the results indicated that negative body-related emotions mediated the relationship between severity of the disease and depression. Additionally, the relationship between severity of psoriasis and body image emotions was moderated by gender. CONCLUSIONS: Findings significantly extend previous studies by confirming and highlighting the role of age of onset of psoriasis in psychological impairments, and provide more insight into factors that contribute to social anxiety in this group of patients.

Gender, Body Image and Social Support: Biopsychosocial Deter-minants of Depression Among Patients with Psoriasis.

The aim of this study was to examine the importance of psychosocial factors, such as emotional and instrumental social support, distress, and assumptions about appearance and its salience to one's self-worth, and to relate these factors to depressive symptoms in patients with psoriasis, according to gender. A group of 219 patients with psoriasis, aged 18-70 years completed the Beck Depression Inventory, the Appearance Schemas Inventory-Revised, the Berlin Social Support Scales, and the Distress Thermometer. Body Surface Area index was used to assess the severity of psoriasis. The main contributors to depression were: female gender, beliefs about appearance and its salience to one's self-worth, greater psychological distress, and lower levels of emotional social support. Therefore, improving the body image of patients with psoriasis, by reducing its salience in their personal lives, may play a role in the prevention of depression, especially in women.

The relationship between psoriasis and depression: A multiple mediation model.

This study examined the relationship between psoriasis and depression, proposing a multiple mediation model to analyse the relationship. A total of 193 patients with psoriasis aged 20-67 years completed the Beck Depression Inventory, the Stigmatization Scale, the Appearance Schemas Inventory-Revised, and the Body Emotions Scale. The Body Surface Area index was used to assess severity of psoriasis. Serial multiple mediation analysis revealed that experiences of stigmatization, maladaptive beliefs about appearance and its salience to one's self-evaluation, and negative emotional attitudes towards the body, jointly, sequentially mediated the relationship between the presence of skin lesions of psoriasis and depressive symptoms. These results highlight the importance of the associations between stigmatization and cognitive and affective aspects of body image in relation to depression in patients with psoriasis. We suggest that prevention and intervention programs for psoriasis patients that target body image enhancement would be worthy of further research.