A Pragmatic, Person-Centered View of Cannabis in the United States: Pursuing Care That Transcends Beliefs.

BACKGROUND: Rates of cannabis use are increasing in the United States, likely as a result of changes in societal attitudes and expanding legalization. Although many patients report wanting to discuss the risks and benefits of cannabis use with their clinical providers, many providers hold conflicting beliefs regarding cannabis use and often do not engage patients in discussion about cannabis. This dilemma is underscored by the limitations imposed on cannabis related research, and lack of empirically based best-practice guidelines for clinicians when addressing cannabis use with patients. OBJECTIVES: We aimed to briefly summarize clinician and patient attitudes toward cannabis use and review current clinical guidelines and provide suggestions to assist health care providers and clinicians in increasing their comfort and skill in discussing cannabis use with patients. METHODS: A narrative review on attitudes toward cannabis use and clinical guidelines was performed to summarize the literature and provide evidence-based recommendations. RESULTS: Attitudes toward cannabis use have been shaped by personal and political factors and contribute to clinician hesitance in speaking with patients about the topic. Administrative barriers have hindered the development of clearer public health guidelines that might enable the dissemination of evidence-based information on the health effects of cannabis use and might ultimately lead to better health outcomes. CONCLUSION: Not discussing cannabis use with patients may be a crucial missed opportunity for harm reduction. In the absence of empirically supported best-practice guidelines, a person-centered approach can facilitate conversations on the harms and benefits of cannabis use.

COVID-19 News and Its Association With the Mental Health of Sexual and Gender Minority Adults: Cross-sectional Study.

BACKGROUND: Sexual and gender minority (SGM; people whose sexual orientation is not heterosexual or whose gender identity varies from what is traditionally associated with the sex assigned to them at birth) people experience high rates of trauma and substantial disparities in anxiety and posttraumatic stress disorder (PTSD). Exposure to traumatic stressors such as news related to COVID-19 may be associated with symptoms of anxiety and PTSD. OBJECTIVE: This study aims to evaluate the relationship of COVID-19 news exposure with anxiety and PTSD symptoms in a sample of SGM adults in the United States. METHODS: Data were collected between March 23 and August 2, 2020, from The PRIDE Study, a national longitudinal cohort study of SGM people. Regression analyses were used to analyze the relationship between self-reported news exposure and symptoms of anxiety using the Generalized Anxiety Disorder-7 and symptoms of COVID-19-related PTSD using the Impact of Events Scale-Revised. RESULTS: Our sample included a total of 3079 SGM participants. Each unit increase in COVID-19-related news exposure was associated with greater anxiety symptoms (odds ratio 1.77, 95% CI 1.63-1.93; P<.001) and 1.93 greater odds of PTSD (95% CI 1.74-2.14; P<.001). CONCLUSIONS: Our study found that COVID-19 news exposure was positively associated with greater symptoms of anxiety and PTSD among SGM people. This supports previous literature in other populations where greater news exposure was associated with poorer mental health. Further research is needed to determine the direction of this relationship and to evaluate for differences among SGM subgroups with multiple marginalized identities.

Identifying the presence and timing of discrete mood states prior to therapy.

The present study tested a novel, person-specific method for identifying discrete mood profiles from time-series data, and examined the degree to which these profiles could be predicted by lagged mood and anxiety variables and time-based variables, including trends (linear, quadratic, cubic), cycles (12-hr, 24-hr, and 7-day), day of the week, and time of day. We analyzed ambulatory data from 45 individuals with mood and anxiety disorders prior to therapy. Data were collected four-times-daily for at least 30 days. Latent profile analysis was applied person-by-person to discretize each individual's continuous multivariate time series of rumination, worry, fear, anger, irritability, anhedonia, hopelessness, depressed mood, and avoidance. That is, each time point was classified according to its unique blend of emotional states, and latent classes representing discrete mood profiles were identified for each participant. We found that the modal number of latent classes per person was three (mean = 3.04, median = 3), with a range of two to four classes. After splitting each individual's time series into random halves for training and testing, we used elastic net regularization to identify the temporal and lagged predictors of each mood profile's presence or absence in the training set. Prediction accuracy was evaluated in the testing set. Across 127 models, the average area under the curve was 0.77, with sensitivity of 0.81 and specificity of 0.75. Brier scores indicated an average prediction accuracy of 83%.

An idiographic statistical approach to clinical hypothesis testing for routine psychotherapy: A case study.

In order to develop more targeted, efficient, and effective psychotherapeutic interventions, calls have been made in the literature for greater use of idiographic hypothesis testing. Idiographic analyses can provide useful information regarding mechanisms of change within individuals over time during treatment. However, it remains unclear how clinicians might utilize idiographic statistical analyses during routine treatment to test clinical hypotheses, and in turn, guide treatment. We present an idiographic statistical framework for clinical hypothesis testing with routine treatment data that enables clinicians to examine a) whether the client's symptoms and hypothesized mechanisms change over time, b) whether trajectories of change reflect the timing of interventions, c) whether mechanisms predict subsequent symptoms, and d) whether relationships exist between multiple mechanisms, symptoms, or other treatment-related constructs over time. We demonstrate the utility of the approach for clinical hypothesis testing by applying it to routine treatment data collected from a 56 year-old male who presented with a combination of anger problems, anxiety, and depressive symptoms. We discuss how results from analyses can inform the case-formulation and guide clinical decision-making. We aim to make these methods more accessible by providing an online platform where clinicians can enter client data, test their clinical hypotheses using idiographic analyses, and utilize the results to disseminate their findings.

Open trial of a personalized modular treatment for mood and anxiety.

Psychosocial treatments for mood and anxiety disorders are generally effective, however, a number of treated individuals fail to demonstrate clinically-significant change. Consistent with the decades-old aim to identify 'what works for whom,' personalized and precision treatments have become a recent area of interest in medicine and psychology. The present study followed the recommendations of Fisher (2015) to employ a personalized modular model of cognitive-behavioral therapy. Employing the algorithms provided by Fernandez, Fisher, and Chi (2017), the present study collected intensive repeated measures data prior to therapy in order to perform person-specific factor analysis and dynamic factor modeling. The results of these analyses were then used to generated personalized modular treatment plans on a person-by-person basis. Thirty-two participants completed therapy. The average number of sessions was 10.38. Hedges g's for the Hamilton Rating Scale for Depression (HRSD) and Hamilton Anxiety Rating Scale (HARS) were 2.33 and 1.62, respectively. The change per unit time was g = .24/session for the HRSD and g = 0.17/session for the HARS. The current open trial provides promising data in support of personalization, modularization, and idiographic research paradigms.

Evidence for the Feasibility of Person-Specific Ecological Momentary Assessment Across Diverse Populations and Study Designs.

Clinical psychological science has seen an exciting shift toward the use of person-specific (idiographic) approaches to studying psychopathology and change in treatment at the level of the individual. One commonly used method in idiographic research is ecological momentary assessment (EMA). EMA offers a way to sample individuals intensively - often multiple times per day - as they go about their lives. While these methods offer benefits such as greater ecological validity and streamlined data collection, many share concerns about their feasibility across diverse clinical populations. To investigate the feasibility of using EMA to study psychological processes idiographically both in- and out of the context of therapy, the present study aggregated participants across seven studies spanning diverse clinical and community populations (N = 496), all of which utilized an idiographic EMA approach to study symptoms of psychopathology (e.g., PTSD, mood and anxiety, substance abuse). In a series of linear regression models, participant and study design characteristics were used to predict compliance with EMA surveys. Across study designs, we found that (1) participants were willing to report on symptoms and mechanisms relating to a wide range of psychopathological domains; (2) on average, participants completed 82.21% (SD = 16.34%) of all EMA surveys; and (3) compliance with EMA surveys was not significantly related to participant demographics, psychological diagnosis, personality characteristics, or most study characteristics (e.g., number of surveys per day). These findings suggest feasibility of idiographic EMA for collecting the data needed to understand psychopathology and change in treatment at the level of the individual.

Affect Dynamics as Predictors of Symptom Severity and Treatment Response in Mood and Anxiety Disorders: Evidence for Specificity.

Studies of affect dynamics in psychopathology often focus on the prediction of broad constructs like subjective well-being and psychological health. Less is known about how fluctuation in affect over time relates to specific symptom measures (e.g., anxiety or depression), or how these domains change in treatment. A clinical sample of 32 adults with mood and anxiety disorders (13 generalized anxiety, 5 major depression, 14 comorbid) completed four daily assessments of positive (PA) and negative affect (NA) for 30 days prior to receiving cognitive behavioral treatment. Anxiety and depression symptom severity were assessed pre- and post-treatment. We calculated three metrics of affect dynamics for each person's PA and NA time series: (1) variability (experiencing emotional extremes, the standard deviation of a person's PA or NA vector); (2) instability (magnitude of point-to-point change in emotion, the vector's mean squared successive difference); and (3) inertia (the extent to which emotions self-perpetuate over time, the lag-1 autocorrelation of the vector). Multiple regression models were run to test dynamics of positive and negative affect as between-subjects predictors of symptom severity and pre-to-posttreatment change in symptoms. Findings suggest NA dynamics are unrelated to depression symptom severity or treatment response, but we observed a specific effect of NA instability (MSSD) on both severity and response of anxiety symptoms. All PA dynamics were unrelated to anxiety or depression symptom severity. However, variability, instability, and inertia of PA were all found to relate to treatment response for both anxiety and depression symptoms. Taken together, our results suggest that affect dynamics have some specificity in their relationship to clinically relevant phenomena such as symptom severity and treatment outcomes at the between-subjects level of analysis.

Differential responses of positive affect, negative affect, and worry in CBT for generalized anxiety disorder: A person-specific analysis of symptom course during therapy.

INTRODUCTION: Research indicates that individuals with generalized anxiety disorder (GAD) may experience deficits in positive affect (PA), and tend to dampen or intentionally suppress PA. Despite the presence of PA-related pathology in GAD, little is known about change in PA during GAD treatment. OBJECTIVE: This study examines changes in PA, negative affect (NA) and worry in seven participants during cognitive behavioral therapy (CBT) for GAD. METHOD: Intensive repeated measures (i.e., time series) data were subjected to person-specific regression analysis to delineate individual change trajectories. RESULTS: Significant improvement in worry was observed in all but one participant. Fear and irritability - indices of NA - each improved in 5/7 participants while sadness improved in 4/7 participants (worsening in one). Of all symptom domains, PA had the poorest treatment response: PA improved in only 2/7 participants and actually significantly worsened in 5/7 individuals even as NA and worry improved during therapy. CONCLUSION: These findings indicate that treatment gains from traditional CBT for GAD may not generalize to improvements in PA regulation, or even emotional functioning more broadly. This evidence is a call to increase the focus on PA regulation in treatment for GAD; perhaps PA could be a missing piece in our understanding of ways to bolster GAD treatment outcomes.

PTSD and Romantic Relationship Satisfaction: Cluster- and Symptom-Level Analyses.

Previous studies have demonstrated bidirectional associations between posttraumatric stress disorder (PTSD) and romantic relationship dissatisfaction. Most of these studies were focused at the level of the disorder, examining the association between relationship dissatisfaction and having a diagnosis of PTSD or the total of PTSD symptoms endorsed. This disorder-level approach is problematic for trauma theorists who posit symptom-level mechanisms for these effects. In the present study, we examined the prospective, bidirectional associations between PTSD symptom clusters (e.g., reexperiencing) and relationship satisfaction using the data from 101 previously studied individuals who had had a recent motor vehicle accident. We also conducted exploratory analyses examining the prospective, bidirectional associations between individual PTSD symptoms and relationship satisfaction. Participants had completed the PTSD Checklist-Civilian Version and the Relationship Assessment Scale at 4, 10, and 16 weeks after the MVA. We performed time-lagged mixed-effects regressions to examine the effect of lagged relationship satisfaction on PTSD clusters and symptoms, and vice versa. No cluster effects were significant after controlling for a false discovery rate. Relationship satisfaction predicted prospective decreases in reliving the trauma (d = 0.42), emotional numbness (d = 0.46), and irritability (d = 0.49). These findings were consistent with the position that relationship satisfaction affects PTSD through symptom-level mechanisms.

Synesthesia in twins: incomplete concordance in monozygotes suggests extragenic factors.

Colored-sequence synesthesia (CSS) is a neurological condition in which sequential stimuli such as letters, numbers, or days of the week trigger simultaneous, involuntary color perception. Although the condition appears to run in families and several studies have sought a genetic link, the genetic contribution to synesthesia remains unclear. We conducted the first comparative twin study of CSS and found that CSS has a pairwise concordance of 73.9% in monozygotic twins, and a pairwise concordance of 36.4% in dizygotic twins. In line with previous studies, our results suggest a heritable element of synesthesia. However, consonant with the findings of previous single-pair case studies, our large sample size verifies that synesthesia is not completely conferred by genetics; if it were, monozygotic twins should have 100% concordance. These findings implicate a genetic mechanism of CSS that may work differently than previously thought: collectively, our data suggest that synesthesia is a heritable condition with incomplete penetrance that is substantially influenced by epigenetic and environmental factors.