Personality Pathology in Winter Depression: Prevalence and Treatment Trajectories in Cognitive-Behavioral Therapy and Light Therapy.

Personality disorders are highly comorbid with major depression; however, findings are mixed regarding their impact on depression treatment outcomes and trajectories. Limited research has studied personality pathology in winter depression, specifically. This study (1) explored the prevalence of personality pathology in winter depression and (2) examined its effects on winter depression treatment trajectories. Participants were 174 adults with Major Depression, Recurrent with Seasonal Pattern from a randomized clinical trial comparing group cognitive-behavioral therapy for seasonal affective disorder (CBT-SAD) and light therapy. Participants completed the Millon Clinical Multiaxial Inventory-III (MCMI-III; Millon et al., 1994) at baseline. The prevalence of MCMI-III-defined pathological personality traits and personality disorders in this sample was 98/174 (56.3%) with any trait and 65/174 (37.4%) with any disorder. Dependent was the most common elevation (65/174, 37.4%), trait (43/174, 24.7%), and disorder (22/174, 12.6%). Most participants with pathological personality elevations had only one personality disorder (58/174, 33.3%) and one pathological personality trait (82/174, 47.1%). Growth curve analysis revealed personality pathology predicted higher baseline depression scores, but the number of MCMI-III pathological personality elevations (i.e., traits and disorders) and personality disorders did not predict change in depression over the timeframe of pretreatment, weekly during treatment, posttreatment, and follow-ups one and two winters later in CBT-SAD or light therapy. Results suggest that personality pathology is not a negative prognostic indicator or prescriptive factor for winter depression treatment with CBT-SAD or light therapy, which may inform treatment algorithms and decision-making in practice.

Reflexive Gaze Shifts and Fear Recognition Deficits in Children with Callous-Unemotional Traits and Impulsivity/Conduct Problems.

The ability to efficiently recognize the emotions on others' faces is something that most of us take for granted. Children with callous-unemotional (CU) traits and impulsivity/conduct problems (ICP), such as attention-deficit hyperactivity disorder, have been previously described as being "fear blind". This is also associated with looking less at the eye regions of fearful faces, which are highly diagnostic. Previous attempts to intervene into emotion recognition strategies have not had lasting effects on participants' fear recognition abilities. Here we present both (a) additional evidence that there is a two-part causal chain, from personality traits to face recognition strategies using the eyes, then from strategies to rates of recognizing fear in others; and (b) a pilot intervention that had persistent effects for weeks after the end of instruction. Further, the intervention led to more change in those with the highest CU traits. This both clarifies the specific mechanisms linking personality to emotion recognition and shows that the process is fundamentally malleable. It is possible that such training could promote empathy and reduce the rates of antisocial behavior in specific populations in the future.

Children's affective and arousal responses to live interparental conflict: Links with appraisals.

While previous research has consistently found that negative forms of interparental conflict predict poorer outcomes in children, less is known about children's immediate responses to conflict. In a sample of 101 children (9-11 years of age) and their parents, we used a novel methodological approach to examine children's affect and perceived arousal responses to a live conflict between their parents in the lab. In addition, we examined children's self-reported cognitions regarding interparental conflict as predictors of these affect and perceived arousal responses. Children reported their affect and perceived arousal responses at 3 time points: before the live interparental conflict, immediately following the conflict, and again immediately following a positive family conversation task. Mixed effects models indicated that children's positive affect decreased following the interparental conflict, and increased following the positive family conversation. Negative affect and perceived arousal decreased linearly across all 3 time points such that they were the lowest following the positive family conversation. Children's perceptions of interparental conflict predicted children's negative affect and perceived arousal scores, but not their degree of change from 1 time point to the next. Findings are discussed in terms of clinical intervention for families and directions for future research in this area. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Isolating Trait and Method Variance in the Measurement of Callous and Unemotional Traits.

To examine hypothesized influence of method variance from negatively keyed items in measurement of callous-unemotional (CU) traits, nine a priori confirmatory factor analysis model comparisons of the Inventory of Callous-Unemotional Traits were evaluated on multiple fit indices and theoretical coherence. Tested models included a unidimensional model, a three-factor model, a three-bifactor model, an item response theory-shortened model, two item-parceled models, and three correlated trait-correlated method minus one models (unidimensional, correlated three-factor, and bifactor). Data were self-reports of 234 adolescents (191 juvenile offenders, 43 high school students; 63% male; ages 11-17 years). Consistent with hypotheses, models accounting for method variance substantially improved fit to the data. Additionally, bifactor models with a general CU factor better fit the data compared with correlated factor models, suggesting a general CU factor is important to understanding the construct of CU traits. Future Inventory of Callous-Unemotional Traits analyses should account for method variance from item keying and response bias to isolate trait variance.

Affective Differences Between Psychopathy Variants and Genders in Adjudicated Youth.

The present study used Model-Based Cluster analysis to identify primary and secondary psychopathy variants in a mixed-gender sample of 150 adjudicated adolescents (60 % male; M = 15.2 years old). Distinct primary and secondary psychopathy groups emerged and were entered into a structural equation path model for the purpose of predicting group differences in emotional experiences reported between youth assigned to each variant. Youth characterized by secondary psychopathy reported experiencing significantly more frequent and more intense negative affect than their primary psychopathy counterparts. Frequency and intensity of affect also mediated the association between psychopathy variants and symptoms of depression, in which the secondary psychopathy group endorsed significantly more symptoms of major depression than the primary psychopathy group. Overall, these results suggest that different causal processes and affective experiences may underlie distinct trajectories to primary and secondary psychopathy variants in adjudicated adolescents. As such, youths comprising the secondary subtype of psychopathy may be more aptly considered "callous and emotional," compared with the primary subtype who present as prototypically callous and unemotional.

Going "Fourth" From Medical School: Fourth-Year Medical Students' Perspectives on the Fourth Year of Medical School.

PURPOSE: To learn what graduating medical students considered the primary purposes of the fourth year of medical school, their approach to residency selection, and the challenges they faced in meeting their fourth-year goals. METHOD: A 52-question Web-based survey was administered to fourth-year students from 20 U.S. MD-granting medical schools in spring 2014. Quantitative data were analyzed with one-way analysis of variance, chi-square analysis, or paired t tests. Responses to an open-ended question were coded into themes and confirmed. RESULTS: A total of 1,367/2,884 (47.4%) students responded. Students applied to a mean of 36.4 (SD = 22.6) residency programs and interviewed at a mean of 12.3 (SD = 5.6) programs. Surgery applicants applied to more programs (mean = 58.2, SD = 22.3; P < .001); radiology applicants interviewed at more programs (mean = 16.9, SD = 8.5; P < .001). Students took a mean of 1.8 (SD = 0.8) monthlong away electives in their career specialty of choice; surgery and emergency medicine applicants were more likely to complete away electives (P < .001). Students agreed the fourth year has multiple valuable purposes, including maximizing the likelihood of matching into their residency of choice, gaining a broad educational experience, and preparing for residency. The main purpose varied by specialty, but overall students ranked preparing for residency highest. Completing away electives and interviewing were expensive; approximately 35% of students could not complete away electives because of financial constraints. CONCLUSIONS: Medical students view the fourth year as a time for residency selection and preparation.

Poor sleep quality as a risk factor for lapse following a cannabis quit attempt.

Treatments for cannabis dependence are associated with high rates of lapse/relapse, underscoring the importance of identifying malleable risk factors that are associated with quit failure. Whereas research has demonstrated that poor sleep quality following cannabis discontinuation is related to subsequent use, there has yet to be an examination of whether poor sleep quality prior to a quit attempt results in a similar pattern of lapse. The present study addressed this gap by examining the role of pre-quit sleep quality on early lapse to cannabis use following a self-guided quit attempt, among 55 cannabis dependent military veterans. Results indicated that participants who experienced poor pre-quit sleep quality had greater risk for lapse within the first 2 days (out of 7) following their quit attempt. Findings are discussed in terms of improving treatments for individuals who report poor sleep quality prior to a cannabis quit attempt.

Factor mixture model of anxiety sensitivity and anxiety psychopathology vulnerability.

BACKGROUND: The purpose of the present study was to shed light on the latent structure and nature of individual differences in anxiety sensitivity (AS) and related risk for psychopathology. METHODS: The present study evaluated the latent structure of AS using factor mixture modeling (FMM; Lubke and Muthén, 2005) and tested the relations between the observed FMM-based model of AS and psychopathology in a large, diverse adult clinical research sample (N=481; 57.6% women; M(SD)(age)=36.6(15.0) years). RESULTS: Findings showed that a two-class three-factor partially invariant model of AS demonstrated significantly better fit than a one-class dimensional model and more complex multi-class models. As predicted, risk conferred by AS taxonicity was specific to anxiety psychopathology, and not to other forms of psychopathology. LIMITATIONS: The sample was not epidemiologic, self-report and psychiatric interview data were used to index AS and psychopathology, and a cross-sectional design limited inference regarding the directionality of observed relations between AS and anxiety psychopathology. CONCLUSIONS: Findings are discussed with respect to the nature of AS and related anxiety psychopathology vulnerability specifically, as well as the implications of factor mixture modeling for advancing taxonomy of vulnerability and psychopathology more broadly.

School children's consumption of lower-calorie flavored milk: a plate waste study.

During January 2011, the US Department of Agriculture issued proposed regulations with substantial changes to nutrition standards for school foods and beverages to improve the healthfulness of school meals. Milk availability is limited to fat-free or 1% white milk and fat-free flavored milk. Most elementary school students choose flavored milk. Milk processors are lowering the calories provided by flavored milks by reducing the fat and/or added sugars content. Milk is an important source of shortfall nutrients; thus, it is important to know how children accept these new milks. Four schools in the northeast and south serving lower-calorie flavored milk (≤150 kcal/8 oz) were selected for a quasi-experimental plate waste study. Five control schools serving standard flavored milk (>150 kcal/8 oz) were enrolled from the same regions. During May and June 2010, flavored milk cartons were collected from 793 third- to fifth-grade students after lunch and individually weighed to determine consumption. Overall, students consumed an average of 5.52±0.10 oz flavored milk. Students consumed an average of 5.88±0.12 oz standard flavored milk (n=497) compared with an average of 4.92±0.17 oz lower-calorie flavored milk (n=296). Using linear mixed models, we found that children drinking standard milk were more likely to consume >7 oz, although the difference was not significant (P=0.09). After adjusting for group differences in socioeconomic status, region, and sex, no differences in consumption were detected (P=0.29). Because none of these milks were in full compliance with proposed regulations, milk consumption should be further monitored.

Gender differences in psychopathic traits, types, and correlates of aggression among adjudicated youth.

The current study investigated gender differences in types and correlates of aggression among 150 adjudicated youth (M age = 15.2, SD = 1.4). In cluster analysis, consistent with past studies, one aggressive group characterized by moderate levels of reactive aggression and one characterized by high levels of proactive and reactive aggression emerged and these patterns were consistent across gender. For both boys and girls, the combined proactive/reactive aggression cluster showed the greatest levels of aggression, impulsivity, and callous-unemotional traits, supporting a severity over a typology model of proactive and reactive aggression. Girls displayed significantly higher rates of physical and relational aggression than boys. Girls were highly aggressive toward both girls and boys, whereas boys were highly aggressive only toward other boys. Girls also showed multiple indications of severity and emotionality, indexed by higher rates of negative affect, anxiety, distress about social provocations, and empathy.

Dimensional, categorical, or dimensional-categories: testing the latent structure of anxiety sensitivity among adults using factor-mixture modeling.

The present study tested multiple, competing latent structural models of anxiety sensitivity (AS), as measured by the Anxiety Sensitivity Index-3 (ASI-3; Taylor et al., 2007). Data were collected from 3 sites in North America (N=634). Participants were predominantly university students (M=21.3 years, SD=5.4). ASI-3 data were evaluated using an integration of mixture modeling and confirmatory factor analysis-factor mixture modeling (FMM; Muthén, 2008). Results supported a 2-class 3-factor partially invariant model of AS. Specifically, the FMM analyses indicated that AS is a taxonic (two-class) variable, and that each categorical class has a unique multidimensional factor structure. Consistent with the specific point-prediction regarding the hypothesized parameters of the putative latent class variable, FMM indicated that the putatively "high-risk" subgroup of cases or latent form of AS composed approximately 12% of the studied sample whereas the putatively "normative" subgroup of cases or latent form of AS composed 88% of the sample. In addition, the AS Physical and Psychological Concerns subscales, but not the Social Concerns subscale, most strongly discriminated between the two latent classes. Finally, comparison of continuous levels of AS Physical and Psychological Concerns between FMM-derived AS latent classes and independent clinical samples of patients with anxiety disorders provided empirical support for the theorized taxonic-dimensional model of AS and anxiety psychopathology vulnerability. Findings are discussed in regard to the implications of this and related research into the nature of AS and anxiety psychopathology vulnerability.

Evidence for deficits in reward responsivity in antisocial youth with callous-unemotional traits.

This study investigated reward responsivity in youth with high levels of callous-unemotional (CU) traits using a cross-sectional design. Whereas deficits in responding to punishment cues are well established in youth with CU traits, it is unclear whether responsivity to rewarding stimuli is impaired as well. Participants were 148 predominantly Caucasian, adjudicated adolescents between the ages of 11 and 17 (M = 15.1, SD = 1.4) who completed the Balloon Analogue Risk Task as part of a larger battery investigating aggression and social information processing. A Reward Responsivity variable was created to capture changes in participants' responding after receiving a reward. A hierarchical regression analysis indicated that higher levels of CU traits significantly predicted less reward responsivity, above and beyond gender, sensation seeking, and impulsivity. Results support Blair's (2004) Integrated Emotion Systems model that proposes individuals with CU traits are impaired in their responsivity to both appetitive and aversive stimuli.

Callous-unemotional traits and social information processing: multiple risk-factor models for understanding aggressive behavior in antisocial youth.

This study examined multiple risk factor models of links among callous-unemotional traits, aggression beliefs, social information processing, impulsivity, and aggressive behavior in a sample of 150 antisocial adolescents. Consistent with past research, results indicated that beliefs legitimizing aggression predicted social information processing biases and that social information processing biases mediated the effect of beliefs on aggressive behavior. Callous-unemotional traits accounted for unique variance in aggression above and beyond effects of more established risk factors of early onset of antisocial behavior, social information processing, and impulsivity. These findings add to recent research showing that callous-unemotional traits are a unique risk factor associated with aggression and criminal offending and suggest that targeting both affective and cognitive vulnerabilities may enhance clinical intervention with antisocial youth.

Body vigilance: bi-national examination of the construct.

Two inter-related studies evaluated the measurement model and construct validity of body vigilance, as indexed by the body vigilance scale [BVS; Schmidt et al., 1997: J Consulting Clin Psychol 65:214-220]. Confirmatory factor analyses (CFA) and convergent, discriminant, and incremental tests of validity of body vigilance were conducted among separate nonclinical samples from the United States (US) (study 1) and Spain (study 2). In both the US and Spanish samples, poor fit for the four-item unidimensional measurement model of body vigilance was observed; good fit, however, was found for a unidimensional, three-item measurement model. Subsequent analyses demonstrated both theoretically predicted as well as a number of unexpected associations between body vigilance and a variety of theoretically relevant external criterion variables. Results are discussed in terms of their clinical implications for advancing assessment of body vigilance and theoretical implications for better understanding the nomological nature of the construct.

Marijuana coping motives interact with marijuana use frequency to predict anxious arousal, panic related catastrophic thinking, and worry among current marijuana users.

The present investigation evaluated whether coping motives for marijuana use interacted with past 30-day frequency of marijuana use in relation to anxiety-relevant variables among community-recruited young adult marijuana users (n=149). As expected, after covarying cigarettes per day, alcohol use, and total years of marijuana use, the interaction between frequency of past 30-day marijuana use and coping motives predicted anxious arousal symptoms, agoraphobic cognitions, and worry. Marijuana users who demonstrated high use frequency and high coping motives demonstrated the highest levels of anxiety across these anxiety-relevant criterion variables. No such effects were evident, as expected, for depressive symptoms, offering explanatory specificity for anxiety relative to depressive factors. These results are discussed in relation to better understanding the role of marijuana use and coping motives in regard to anxiety vulnerability.

Effects of a community toxic release on the psychological status of children.

This study sought to determine the emotional effects of a major community toxic release on children in the exposed community while controlling for the potential effects of response bias. Controlling for the response bias inherent in litigated contexts is an advance over previous studies of toxic exposure in children. A randomly selected representative sample of Exposed children (n = 31) was compared to a matched Control group (n = 28) from a nearby, unexposed community. Symptoms and complaints were assessed via interview with the children and their guardians, surveys and checklists, and well-established psychological instruments. Even when biased responding was controlled the Exposed children experienced more psychological distress, more physical symptoms, and greater general concern over their physical functioning than the Controls. The Exposed children also reported some concern about their future health and cancer risk but usually only if asked. Limitations and future research directions are discussed.

Anxiety sensitivity-physical concerns as a moderator of the emotional consequences of emotion suppression during biological challenge: an experimental test using individual growth curve analysis.

Anxiety-related responding to, and recovery from, a 5-min 10% carbon dioxide-enriched air presentation among 80 participants with no history of psychopathology was examined. Half of participants were instructed to suppress challenge-induced emotional responses, whereas their matched counterparts were instructed to observe such responses. Responding from immediately post-challenge through a 10-min recovery period was analyzed as a function of Anxiety Sensitivity-Physical Concerns and experimental condition using individual growth curve modeling. Anxiety Sensitivity-Physical Concerns moderated the effect of suppression only on emotion valence during recovery. In terms of main effects, suppression resulted in increased heart rate during recovery and Anxiety Sensitivity-Physical Concerns was positively associated with post-challenge self-reported anxiety. Results are discussed in terms of the potential role of inhibition-oriented affect regulation processes in the etiology of panic disorder.

Callous-unemotional traits in predicting the severity and stability of conduct problems and delinquency.

The current study tests whether the presence of callous-unemotional (CU) traits designates a group of children with conduct problems who show an especially severe and chronic pattern of conduct problems and delinquency. Ninety-eight children who were selected from a large community screening of school children in grades 3, 4, 6 and 7 were followed across four yearly assessments. Children with conduct problems who also showed CU traits exhibited the highest rates of conduct problems, self-reported delinquency, and police contacts across the four years of the study. In fact, this group accounted for at least half of all of the police contacts reported in the sample across the last three waves of data collection. In contrast, children with conduct problems who did not show CU traits continued to show higher rates of conduct problems across the follow-up assessments compared to non-conduct problem children. However, they did not show higher rates of self-reported delinquency than non-conduct problem children. In fact, the second highest rate of self-reported delinquency in the sample was found for the group of children who were high on CU traits but without conduct problems at the start of the study.

Anxiety disorders in childhood: casting a nomological net.

Empirical research highlights the need for improving the childhood anxiety disorder diagnostic classification system. In particular, inconsistencies in the stability estimates of childhood anxiety disorders and high rates of comorbidity call into the question the utility of the current DSM criteria. This paper makes a case for utilizing a nomological net model for advancing the understanding of childhood anxiety disorders. In this article, we discuss measurement and assessment issues related to improving the childhood anxiety disorder diagnostic system and show how these issues can be addressed by employing the nomological net of childhood anxiety. Because employing the nomological net involves drawing from etiological process theories to facilitate classification and assessment, an integrative model of childhood anxiety disorders is presented as a tentative heuristic. Then evidence for the existing symptom sets is discussed in the context of how process theory mechanisms may be utilized to improve classification and assessment. Testable hypotheses are presented. Measurement, disorder definition, treatment, and policy implications are also discussed.

A cross-sectional evaluation of the factorial invariance of anxiety sensitivity in adolescents and young adults.

This study examined the cross-sectional factorial invariance of anxiety sensitivity in an ethnically diverse sample of adolescents (n = 173; mean age 15.5 years) and young adults (n = 291; mean age 20.1 years). Research in adult and youth samples suggests that anxiety sensitivity is best understood as a hierarchical construct with several lower-order factors. Factor models based on previous research using both adult and youth samples were compared and a hierarchical model with three lower-order factors provided the best fit to the data. Results supported the hypothesis that the factor structure of the Anxiety Sensitivity Index was invariant across age and gender. The factor scores also demonstrated differential correlations with symptoms of anxiety and depression. Results are discussed with regard to construct validation and understanding the structure of anxiety sensitivity in youth.