Judging others makes me forget: Assessing the cognitive, behavioural, and emotional consequences of other-evaluations on self-evaluations for social anxiety.

BACKGROUND AND OBJECTIVES: People with Social Anxiety Disorder (SAD) evaluate themselves negatively before, during, and after anxiety-provoking social situations, which leads to negative consequences (e.g., performance deficits, memory impairments, and post-event processing). Despite decades of research, little is known regarding whether these evaluations generalize to how they view others. Social projection theory-the belief that others are similar to oneself-might further extend the basic Cognitive Behavioural Therapy (CBT) model. Our aim was to understand whether the degree to which people negatively evaluate a visibly anxious person causes them to negatively evaluate themselves. METHODS: 172 unselected participants completed several baseline questionnaires. We then randomly assigned participants to provide high-, medium-, or no-evaluation of a videotaped anxious person (i.e., other-evaluations) while we assessed their state anxiety. After, they evaluated the anxious person on multiple criteria. Participants then participated in an impromptu conversation task and subsequently evaluated their own performance. RESULTS: Although our manipulation was effective, we found no emotional or behavioural differences between conditions. However, people in the high-evaluation condition recalled significantly fewer facts about their conversation partner than did people in the medium- and no-evaluation conditions. LIMITATIONS: After data cleaning, the sample size was slightly smaller than planned; most analyses were nonetheless appropriately powered. Our findings may not generalize beyond unselected undergraduate students; replication in a clinical sample is warranted. CONCLUSIONS: These findings highlight the cognitive consequences (i.e., memory impairments) of other-evaluations, which cognitive behavioural therapists should consider when treating individuals with SAD.

Measuring social isolation in older adults: A rapid review informing evidence-based research and practice.

OBJECTIVES: Older adults account for 18.5% of the Canadian population and are at risk of experiencing social isolation, compared to other age groups. Researchers define social isolation as a lack of social contact and relationships, but many social isolation measures do not reflect this definition. The aim of our study is to review the existing measures of social isolation with older adults to recommend evidence-based measures to researchers and practitioners. METHODS: We conducted a rapid review on PsycInfo and PsycTests. We included articles that were written in English or French, were peer-reviewed, used an older adult sample, included a self-report social isolation measure, and reported psychometric information. RESULTS: Following exclusion of ineligible articles, 12 measures were available for analysis. We further categorized the measures into: five most recommended measures, five measures that require further research, and two measures not recommended for use with older adults. CONCLUSIONS: We observed a range of measures with varying suitability to be used with older adults; some were empirically driven but did not have strong psychometric properties, or vice-versa. CLINICAL IMPLICATIONS: It is imperative that interventions aimed to address social isolation in older adults use evidence-based measures to assess progress and report treatment effectiveness.

A Systematic Review of Black People Coping With Racism: Approaches, Analysis, and Empowerment.

This article reviews the current research literature concerning Black people in Western societies to better understand how they regulate their emotions when coping with racism, which coping strategies they use, and which strategies are functional for well-being. A systematic review of the literature was conducted, and 26 studies were identified on the basis of a comprehensive search of multiple databases and reference sections of relevant articles. Studies were quantitative and qualitative, and all articles located were from the United States or Canada. Findings demonstrate that Black people tend to cope with racism through social support (friends, family, support groups), religion (prayer, church, spirituality), avoidance (attempting to avoid stressors), and problem-focused coping (confronting the situation directly). Findings suggest gender differences in coping strategies. We also explore the relationship between coping with physical versus emotional pain and contrast functional versus dysfunctional coping approaches, underscoring the importance of encouraging personal empowerment to promote psychological well-being. Findings may help inform mental-health interventions. Limitations include the high number of American-based samples and exclusion of other Black ethnic and national groups, which is an important area for further exploration.

Technology-Mediated Sexual Interactions, Social Anxiety, and Sexual Wellbeing: A Scoping Review.

Technology-mediated sexual interactions (TMSI) are interpersonal exchanges via technology of self-created sexual material, including photos, videos, and auditory or text messages. There is little research on the factors that predict both TMSI experiences and their sexual wellbeing outcomes. Social anxiety is anxiety experienced in response to social or performance situations. From a cognitive-behavioural perspective, people higher in social anxiety may avoid TMSI, preventing positive or negative consequences. They also may use TMSI to avoid the anxiety caused by in-person sexual interactions, benefiting from access to sexual interactions while perpetuating anxiety about them. The purpose of this scoping review was to explore the role of social anxiety in TMSI and its sexual wellbeing outcomes. We executed a comprehensive search strategy across eight academic databases and searched reference lists of included articles. We included 19 articles written in English or French that had a human sample and were published between 1991 and 2021 and evaluated connections between social anxiety constructs (e.g., shyness, anxiety) and TMSI-related experiences (e.g., sexting, internet sex addiction). The pattern of results suggested that social anxiety constructs may predict some but not all forms of TMSI. Future research from a cognitive-behavioural perspective will expand knowledge on social anxiety, TMSI, and its sexual wellbeing outcomes.

Smiling won't make you feel better, but it might make people like you more: Interpersonal and intrapersonal consequences of response-focused emotion regulation strategies.

Emotion regulation (ER) is integral to well-being and relationship quality. Experimental studies tend to explore the intrapersonal effects of ER (i.e. impacts of ER on oneself) and leave out the interpersonal impacts (i.e. the bidirectional impact of ER on the regulator and partner). The ER strategy expressive suppression shows maladaptive interpersonal and intrapersonal consequences during distressing conversations. We aimed to explore whether other ER strategies that modify facial expressions (i.e. expressive dissonance) have similar consequences to suppressing emotional expressions. We randomly assigned 164 women participants to use expressive dissonance and expressive suppression or to naturally express emotions, while engaging in a conversation task with a confederate. We observed intrapersonal outcomes, including electrodermal activity and self-reported affect throughout the experiment, and memory performance after. Video coders unaware of the study goals assessed the conversation on interpersonal qualities (e.g. friendliness and likeability). There were no differences between conditions on intrapersonal outcomes. Participants engaging in expressive dissonance, however, were rated more positively, and participants in the expressive suppression condition were rated more negatively on interpersonal qualities, relative to the control condition. Although neither strategy appeared to impact the participant, intrapersonally, both notably influenced the observer's impression of the participant.

Smiling won't necessarily make you feel better: Response-focused emotion regulation strategies have little impact on cognitive, behavioural, physiological, and subjective outcomes.

BACKGROUND AND OBJECTIVES: Response-focused emotion regulation (RF-ER) strategies may alter people's evoked emotions, influencing intrapersonal outcomes. Researchers have found that participants engaging in expressive suppression (ES; a RF-ER strategy) experience increased sympathetic nervous system arousal, affect, and lowered memory accuracy. It is unclear, however, whether all RF-ER strategies exert maladaptive effects. Expressive dissonance (ED; displaying an expression opposite from how one feels) is a RF-ER strategy, and likely considered "maladaptive". As outlined by the facial feedback hypothesis, however, smiling may increase positive emotion, suggesting it may be an adaptive strategy. We compared the effects of ED and ES to a control condition on psychophysiology, memory, and affect, to assess whether ED is an adaptive RF-ER strategy, relative to ES, in response to negative stimuli. We recruited women only to account for known gender-based differences in emotion regulation. METHODS: We randomly assigned 144 women-identifying participants to engage in ED, ES, or to naturally observe, while viewing negative and arousing images. We recorded electrodermal activity and self-reported affect throughout and participants completed memory tasks after the picture task. RESULTS: We ran a series of repeated measures and one-way ANOVAs and found no differences between groups across outcomes. LIMITATIONS: The generalizability of our findings may be limited to young, undergraduate women. CONCLUSION: Engaging in ES or ED may not differentially impact outcomes among young, undergraduate women, shedding doubt on a conclusion in past literature that specific strategies are categorically adaptive or maladaptive. Future research exploring RF-ER strategies among diverse populations is warranted.

Do anxiety and depression symptoms moderate the effect of motivational enhancement therapy as a pretreatment to dialectical behaviour therapy skills training? A follow-up analysis of a pilot randomised controlled trial for youth.

AIM: We conducted a follow-up analysis of a pilot randomised controlled trial to examine whether baseline depression and anxiety symptoms moderated the impact of a motivational enhancement therapy (MET) pretreatment to dialectical behaviour therapy skill training (DBT-ST) for EA experiencing emotion dysregulation. METHODS: All participants completed a 12-week DBT-ST group intervention and participants in the MET/DBT-ST condition also completed a 4-week group MET pretreatment. Nineteen MET/DBT-ST participants and 26 DBT-ST only participants completed the treatment as per protocol. RESULTS: Baseline anxiety and depression symptoms moderated the impact of the MET pretreatment for participants' reductions in emotion dysregulation and psychological distress, respectively, at a 3-month follow-up: participants with more severe baseline symptoms benefited more from the pretreatment. However, baseline symptoms did not moderate the effect of MET immediately after treatment. CONCLUSIONS: These results identified for whom MET is most effective as a pretreatment for DBT-ST amongst a heterogenous sample of EA in a real-world setting.

Motivational Enhancement as a Pretreatment to a Transdiagnostic Intervention for Emerging Adults with Emotion Dysregulation: A Pilot Randomized Controlled Trial.

OBJECTIVE: New approaches are needed to help the large number of emerging adults (EA) presenting with early-stage mental health problems. The goal of this pilot study was to carry out a randomized controlled trial to investigate whether motivational enhancement therapy (MET) improved the treatment effects of a 12-week psychological intervention, Dialectical Behaviour Therapy Skills Training (DBT-ST), for EA presenting in the early stages of mental health difficulties. Participants were recruited from the Youth Wellness Centre at St. Joseph's Healthcare Hamilton and McMaster University's Student Wellness Centre in Hamilton, Canada. METHODS: Seventy-five participants were randomized to receive MET followed by DBT-ST or to DBT-ST alone. We assessed psychological distress, emotion dysregulation, and depression and anxiety symptoms as outcomes. RESULTS: We found that both treatment groups had significant reductions in emotional dysregulation, psychological distress, depression, and anxiety at post-treatment and at the three-month follow-up. Participants assigned to MET pre-treatment experienced greater improvement in psychological distress at the end of treatment. CONCLUSION: This pilot study provides preliminary evidence of the potential augmentation of DBT-ST using MET in a real-world setting. Future studies should examine whether MET uniquely augments DBT-ST through the use of a comparable pre-treatment control group.

OBJECTIF: De nouvelles approches sont nécessaires pour aider le grand nombre d'adultes émergeants (AE) qui présentent des problèmes de santé mentale au stade précoce. La présente étude pilote avait pour but d'exécuter un essai randomisé contrôlé afin de rechercher si la thérapie d'amélioration motivationnelle (TAM) améliorait les effets du traitement d'une intervention psychologique de 12 semaines, soit la formation technique à la thérapie comportementale dialectique (FT-TCD), pour les AE qui présentent les premiers stades de difficultés de santé mentale. Les participants ont été recrutés au centre Youth Wellness de St. Joseph's Healthcare Hamilton et au centre Student Wellness de l'Université McMaster, à Hamilton, Canada. MÉTHODES: Soixante-quinze participants ont reçu au hasard la TAM suivie de la FT-TCD ou uniquement la FT-TCD. Nous avons évalué la détresse psychologique, la dérégulation émotionnelle, et les symptômes dépressifs et anxieux comme résultats. RÉSULTATS: Nous avons constaté que les deux groupes du traitement avaient des réductions significatives de la dérégulation émotionnelle, de la détresse psychologique, de la dépression et de l'anxiété au post-traitement et au suivi de 3 mois. Les participants affectés à la TAM de prétraitement ont eu une plus grande amélioration de la détresse psychologique en fin de traitement. CONCLUSION: Cette étude pilote offre des données probantes préliminaires de l'augmentation potentielle de la FT-TCD utilisant la TAM dans une situation réelle. Les futures études devraient examiner si la TAM n'augmente seulement la FT-TCD que par le recours à un groupe témoin prétraitement comparable.

Exploring the impact of safety behaviour use on cognitive, psychophysiological, emotional and behavioural responses during a speech task.

BACKGROUND: There is a debate among researchers and clinicians regarding whether the judicious use of safety behaviours (SBs) during exposure therapy is helpful or detrimental. Central to this debate is the premise that SBs may interfere with one's ability to gather disconfirmatory evidence. AIMS: No study to date has assessed how SB use may impact cognitive mechanisms implicated during an exposure-like task. We investigated multiple cognitive, emotional, psychophysiological and behavioural underpinnings of exposure with and without SBs. METHOD: Speech anxious participants (n = 111) were randomly assigned to deliver an evaluated speech with or without SBs. Self-reported anxiety ratings and psychophysiological arousal measures were recorded at baseline, in anticipation of the speech, and following the speech. Measures of working memory, ability to gather disconfirmatory evidence, speech duration, objective and subjective speech performance, and speech task acceptability were administered. RESULTS: There were no differences between conditions on working memory, self-reported anxiety, psychophysiological arousal, ability to gather disconfirmatory evidence, speech duration, or objective and subjective speech performance. All participants were able to gather disconfirmatory evidence. However, condition did influence willingness to deliver future speeches. Our sample was largely female undergraduate students, and we offered only a small number of specific safety behaviours. CONCLUSIONS: Judicious SB use may not necessarily be detrimental, but clients may believe them to be more helpful than they actually are.

Hoping for more: How cognitive science has and hasn't been helpful to the OCD clinician.

Cognitive-behavioural models of obsessive-compulsive disorder (OCD) stemmed from knowledge acquired from cognitive science. Researchers continue to apply basic cognitive-affective science methods to understanding OCD, with the overarching goal of improving and refining evidence-based treatments. However, the degree to which such research has contributed to this goal is unclear. We reviewed OCD research in the general areas that comprise basic cognitive science, and evaluated the degree to which it has contributed to our understanding of the development, maintenance, and treatment of OCD. We focused on studies that either compared people with and without OCD and/or used experimental psychopathology methods with human participants, and attempted to resolve some of the conflicting theories related to the importance of cognitive deficits vs. cognitive biases. Overall, we observed equivocal findings for deficits in perception, attention, memory, and executive functioning. Moreover, many so-called deficits were moderated and/or explained by OCD-relevant beliefs, highlighting the role of confidence in cognitive processes as integral to our understanding of OCD. We discussed these findings in terms of cognitive measurement, cognitive-behavioural models, and clinical applicability, and made recommendations for future research that may offer innovation and insight helpful to clinicians working to improve the symptoms and lives of people with OCD.

Looking at the bigger picture: Young men's sexual health from a psychological perspective.

Researchers have seldom compared how various psychological factors relate to men's sexual health. We sought to identify whether and how psychological risk factors (i.e. anxiety sensitivity, emotion regulation, psychological distress) predict men's sexual health (i.e. functioning, sexual quality of life, frequency of sexual activity). Men ( N = 306) completed an online survey measuring emotional, psychological, and sexual outcomes. Comparisons of four path analysis models suggested that psychological risk factors are related to some but not all sexual health markers. We will highlight the factors that may place young men at risk for developing mental and sexual health difficulties.

How Do Psychological Risk Factors Predict Sexual Outcomes? A Comparison of Four Models of Young Women's Sexual Outcomes.

BACKGROUND: Recent research findings suggest that women who report high anxiety sensitivity (AS; the fear of physiologic sensations associated with anxiety) also report increased sexual dysfunction and decreased sexual satisfaction. Moreover, findings suggest that maladaptive emotion regulation (ER) can contribute to the relation between AS and psychological distress, thereby indirectly influencing sexual outcomes. Identifying relations among these variables and how they specifically relate to sexual outcomes could be vital for diagnostic and therapeutic purposes. As such, a comparison of different models of sexual outcomes that encompass psychological and sexual risk factors is needed. AIM: To compare four psychological models of women's sexual outcomes in a cross-sectional sample and specifically to investigate whether psychological factors (ie, AS, ER, psychological distress) uniquely or jointly predict related, but distinct, sexual outcomes in women: sexual functioning, sexual quality of life, and frequency of sexual activity. METHODS: Women (N = 316) completed an online survey that included the Anxiety Sensitivity Index-3, Difficulties with Emotion Regulation Scale, Depression Anxiety Stress Scales, Sexual Quality of Life Scale-Female, Female Sexual Function Index, and Sexual Experiences Questionnaire-Female. OUTCOMES: Outcome variables included women's self-reported sexual functioning, sexual quality of life, and frequency of sexual activity. RESULTS: Path analysis models demonstrated that psychological factors predicted orgasm, sexual pain, sexual quality of life, and frequency of partnered sexual activity in women but predicted sexual desire, arousal, lubrication, and frequency of solitary sexual activity to a lesser degree. We found that ER significantly accounted for the relation between AS and psychological distress through mediation and moderation pathways. CLINICAL TRANSLATION: Clinicians would benefit from incorporating psychological risk factors in their assessment and interventions of women's sexual concerns. STRENGTHS AND LIMITATIONS: This is the first study to compare models of women's sexual lives using indicators of mental and sexual health. However, our study was limited to a cross-sectional sample of young women in one university setting. CONCLUSIONS: AS, ER, and psychological distress are related to sexual functioning, sexual quality of life, and frequency of partnered sexual activity in young women. Psychological risk factors should be taken into consideration to better understand women's sexual lives. Tutino JS, Ouimet AJ, Shaughnessy K. How Do Psychological Risk Factors Predict Sexual Outcomes? A Comparison of Four Models of Young Women's Sexual Outcomes. J Sex Med 2017;14:1232-1240.

Thinking high but feeling low: An exploratory cluster analysis investigating how implicit and explicit spider fear co-vary.

Research has demonstrated large differences in the degree to which direct and indirect measures predict each other and variables including behavioural approach and attentional bias. We investigated whether individual differences in the co-variance of "implicit" and "explicit" spider fear exist, and whether this covariation exerts an effect on spider fear-related outcomes. One hundred and thirty-two undergraduate students completed direct and indirect measures of spider fear/avoidance, self-report questionnaires of psychopathology, an attentional bias task, and a proxy Behavioural Approach Task. TwoStep cluster analysis using implicit and explicit spider fear as criterion variables resulted in three clusters: (1) low explicit/low implicit; (2) average explicit/high implicit; and (3) high explicit/low implicit. Clusters with higher explicit fear demonstrated greater disgust propensity and sensitivity and less willingness to approach a spider. No differences between clusters emerged on anticipatory approach anxiety or attentional bias. We discuss results in terms of dual-systems and cognitive-behavioural models of fear.

Affective correlates of trichotillomania across the pulling cycle: Findings from an Italian sample of self-identified hair pullers.

Etiological models of trichotillomania (TTM) conceptualize hair pulling as a dysfunctional emotion regulation strategy; accordingly, some research has found that affective states change differentially across the hair pulling cycle. We explored emotional changes in a sample of Italian individuals reporting TTM. Eighty-nine participants reporting TTM completed a 12-item section of the Italian Hair Pulling Questionnaire online and rated the extent to which they had experienced 12 affective states before, during, and after hair pulling. Overall, participants reported increased levels of shame, sadness, and frustration from pre- to post-pulling, and decreased levels of calmness after hair pulling episodes. Moreover, participants reported increased pleasure and relief across the pulling cycle, and variations in the direction of change for anger and anxiety depending on the hair pulling phase. Lastly, reported boredom decreased across the hair pulling cycle. These findings highlight the importance of considering emotional changes experienced across the pulling cycle in Italian hair pullers.

Compulsivity and Impulsivity in Pathological Gambling: Does a Dimensional-Transdiagnostic Approach Add Clinical Utility to DSM-5 Classification?

Although the phenomenology of Pathological Gambling (PG) is clearly characterized by impulsive features, some of the Diagnostic and Statistical Manual of Mental Disorder (DSM-5) criteria for PG are similar to those of Obsessive Compulsive Disorder (OCD). Therefore, the compulsive-impulsive spectrum model may be a better (or complementary) fit with PG phenomenology. The present exploratory research was designed to further investigate the compulsive and impulsive features characterizing PG, by comparing PG individuals, alcohol dependents (ADs), OCD patients, and healthy controls (HCs) on both self-report and cognitive measures of compulsivity and impulsivity. A better understanding of the shared psychological and cognitive mechanisms underlying differently categorized compulsive and impulsive disorders may significantly impact on both clinical assessment and treatment strategies for PG patients. With respect to self-report measures, PG individuals reported more compulsive and impulsive features than did HCs. As regards motor inhibition ability indices, PG individuals and HCs performed similarly on the Go/No-go task and better than AD individuals and OCD patients. Results from the Iowa Gambling Task highlighted that PG, AD, and OCD participants performed worse than did HCs. An in-depth analysis of each group's learning profile revealed similar patterns of impairment between PG and AD individuals in decision-making processes. Current findings support the utility of adopting a dimensional-transdiagnostic approach to complement the DSM-5 classification when working with PG individuals in clinical practice. Indeed, clinicians are encouraged to assess both compulsivity and impulsivity to provide individualized case conceptualizations and treatment plans focusing on the specific phenomenological features characterizing each PG patient.

A new Italian questionnaire to assess caregivers of cancer patients' satisfaction with palliative care: multicenter validation of the post mortem questionnaire-short form.

CONTEXT: Caregiver satisfaction with palliative care is a crucial indicator of its effectiveness. In light of the lack of validated or reliable Italian instruments, the Post Mortem Questionnaire-Short Form (QPM-SF), a self-report questionnaire, has been developed to assess home and inpatient hospice care. OBJECTIVES: The present study was designed to evaluate the psychometric properties of QPM-SF and assess for differences in quality of palliative care between hospice and home care settings. METHODS: A total of 584 caregivers of terminal cancer patients completed QPM-SF one month after the death of the care recipient. To assess test-retest reliability, a subgroup of 50 caregivers completed the questionnaire a second time, one month later. RESULTS: QPM-SF showed good internal consistency and temporal stability and a four-factor structure: "Integrated home care," "Hospice," "Physical care-Information-Global evaluation," and "Needs." CONCLUSION: QPM-SF may be considered a valid, reliable, and well-accepted self-report instrument for examining and implementing palliative care interventions.

Interrelationships between spider fear associations, attentional disengagement and self-reported fear: a preliminary test of a dual-systems model.

Recent conceptualisations of anxiety posit that equivocal findings related to the time-course of disengaging from threat-relevant stimuli may be attributable to individual differences in associative and rule-based processing. The current study was designed to test the hypothesis that strength of spider-fear associations would indirectly predict reported spider fear via impaired disengagement. One hundred and thirty-one undergraduate volunteer participants completed the Go/No-go Association Task, a visual search task, and self-report spider fear questionnaires. Stronger spider-fear associations were associated with reduced disengagement accuracy, whereas higher levels of reported spider fear were related to faster engagement with and disengagement from spiders. Bootstrapping multiple mediation analyses demonstrated that stronger-spider fear associations evidenced an indirect relationship with reported spider fear via reduced disengagement accuracy, highlighting the importance of fine-grained analyses of different aspects of cognitive bias. Results are discussed in terms of cognitive models of anxiety.

Cognitive vulnerability to anxiety: A review and an integrative model.

Consistent research evidence supports the existence of threat-relevant cognitive bias in anxiety, but there remains controversy about which stages of information processing are most important in the conferral of cognitive vulnerability to anxiety. To account for both theoretical and empirical discrepancies in the literature, an integrative multi-process model is proposed wherein core assumptions of dual-systems theories from social and cognitive psychology are adapted to explain attentional and interpretive biases in the anxiety disorders. According to the model, individual differences in associative and rule-based processing jointly influence orientation, engagement, disengagement, and avoidance of threat-relevant stimuli, as well as negatively-biased interpretation of ambiguous stimuli in anxious populations. By linking anxiety-related symptoms to basic principles of information processing, the model parsimoniously integrates different kinds of cognitive biases in anxiety, providing a useful framework for future research and clinical intervention.

A meta-analysis of CBT for pathological worry among clients with GAD.

Previous meta-analyses assessing the effectiveness of Cognitive Behavioural Therapy (CBT) for Generalized Anxiety Disorder (GAD) used general measures of anxiety to assess symptom severity and improvement (e.g., Hamilton Anxiety Ratings Scale or a composite measure of anxiety). While informative, these studies do not provide sufficient evidence as to whether CBT significantly reduces the cardinal symptom of GAD: pathological worry. The current meta-analysis employed stringent inclusion criteria to evaluate relevant outcome studies, including the use of the Penn State Worry Questionnaire as the main outcome variable. Results showed a large overall effect size (ES) that was moderated by age and modality of treatment. Specifically, the largest gains were found for younger adults and for individual treatment. Analyses also revealed overall maintenance of gains at 6- and 12-month follow-up. Clinical implications of different treatment packages are discussed, as well as potential explanations for the differential effectiveness of CBT.