A Pilot Study of Transdiagnostic Group Cognitive-behavior Therapy for Anxiety: An Intensive Weekend Intervention.

Anxiety disorders are highly prevalent and can cause serious functional impairment. Cognitive-behavioral treatments are effective but they are not always readily available. One factor contributing to this problem is the large number of disorder-specific treatments that require a high level of clinician training and resources, despite the similarity in the mechanisms underlying the various anxiety disorders and their treatments. Group-based, transdiagnostic cognitive-behavioral therapy (TCBT) has been shown to reduce the burden on clinicians while maintaining strong positive treatment outcomes. Furthermore, long courses of treatment may limit some individuals' ability to participate because of issues related to transportation, work, or childcare. Research has supported the efficacy of brief, intensive treatment for anxiety. The goal of the study presented here was to combine these 2 innovative treatment modalities by examining the feasibility and acceptability of TCBT provided in an intensive weekend format. The results of this pilot study indicated that this format was acceptable to a sample of Veterans (N=13) based on their feedback. This pilot study also demonstrated that the format was feasible, as all Veterans who initiated treatment completed the entire program (N=8). Preliminary outcome data suggested that TCBT delivered in an intensive weekend format may have positive effects for individuals with anxiety, including reduction in symptoms of anxiety and depression as well as improved overall functioning. Clinical implications and directions for future research are discussed.

Using acceptance and commitment therapy techniques to enhance treatment engagement in veterans with posttraumatic stress disorder.

Evidence-based treatments for posttraumatic stress disorder (PTSD) are available for veterans, but many do not benefit due to low treatment engagement. This may be partially due to avoidance behaviors characteristic of individuals with PTSD. Acceptance and Commitment Therapy (ACT) is a transdiagnostic treatment approach that aims to reduce avoidance. The authors propose the use of adjunctive ACT techniques to enhance engagement with treatment for PTSD. ACT techniques such as cognitive defusion and values clarification have been shown to promote engagement with other cognitive-behavioral treatments, but no studies to date have examined these techniques as adjuncts to treatment for PTSD. Because of its focus on reducing avoidance, ACT is uniquely suited for promoting treatment engagement with the "gold standard" treatments for PTSD. The authors review the existing research on ACT as an adjunctive intervention, discuss specific concepts and techniques from ACT that are relevant to PTSD, and provide recommendations for future research.

Sexual Trauma, Cognitive Appraisals, and Sexual Intrusive Thoughts and Their Subtypes: A Moderated Mediation Analysis.

The relationships between sexual trauma, cognitive appraisals, and subtypes of sexual intrusive thoughts have not been adequately examined in the context of obsessive-compulsive concerns. We employed variations of a moderated mediation model to test these relationships, situating sexual trauma as the predictor, sexual intrusive thoughts as the outcome, cognitive appraisals of these thoughts as the mediator, and subtypes of sexual intrusive thoughts as the moderator of the predictor-mediator link. Based on the continuum perspective, 180 individuals (159 females, 21 males) with or without a history of sexual trauma were recruited to complete measures assessing their most distressing sexual intrusion, cognitive appraisals, and severity of sexual intrusive thoughts. The results indicated that individuals with a history of sexual trauma reported more intrusions with sexual harm content, greater distress with sexual intrusions, more dysfunctional appraisals, and more severe sexual intrusions. The trauma-sexual intrusions link was also separately mediated by responsibility and importance/control appraisals (and when combined), with medium-to-large effect sizes, although this model was not moderated by whether intrusions contained sexual harm content or not. These findings shed light on the posttraumatic effects of sexual violence on sexual intrusions, their appraisals, and level of distress and functional impairment associated with sexual intrusive thoughts, with key clinical and research implications.

The Mediating Role of Emotion Regulation Difficulties in the Relationship Between Self-Compassion and OCD Severity in a Non-Referred Sample.

Self-compassion involves extending kindness and understanding to one's self. Research has demonstrated inverse relationships between self-compassion and maladaptive constructs associated with obsessive-compulsive disorder (OCD), including emotion regulation (ER) difficulties. The current study sought to explore associations between self-compassion, ER difficulties, and OCD severity. Data were collected at the International Obsessive-Compulsive Disorder Foundation convention from 62 attendees who reported having a diagnosis of OCD (51% male, mean age 35.9 years). Findings demonstrated that self-compassion and ER difficulties were associated with overall OCD severity. Results also indicated that ER difficulties mediated relationships between self-compassion and overall OCD severity, as well as the severity of two OCD symptom dimensions, responsibility for harm and unacceptable thoughts. These findings suggest that self-compassion and ER difficulties may be involved in the maintenance and severity of OCD.

Emotion Regulation Difficulties in Relation to Anxiety, Depression, and Functional Impairment Among Treatment-Seeking Smokers.

Psychological distress is elevated among smokers and plays a key role in the maintenance of smoking behavior. Although research has implicated emotion regulation (ER) difficulties as a transdiagnostic construct for psychological distress, empirical work has not yet investigated ER difficulties among treatment-seeking smokers. The purpose of the current study was to increase understanding of ER difficulties in relation to depression, anxious arousal, and functional impairment among treatment-seeking smokers. Participants included adult daily treatment-seeking smokers (N = 568; Mage = 37, SD = 13.46; 51.9% male). Results indicated that global ER difficulties were significantly related to depression, anxious arousal, and functional impairment. Analyses focused on the lower-order facets of ER and indicated that limited access to ER strategies, difficulty engaging in goal-directed behavior, and lack of emotional clarity were significantly related to depression; limited access to ER strategies, nonacceptance of emotions, and impulsivity were significantly associated with anxious arousal; and limited access to ER strategies and difficulty engaging in goal-directed behavior were significantly related to functional impairment. The significant ER effects were evident above and beyond the variance accounted for by neuroticism and tobacco dependence. These findings highlight the importance of considering ER difficulties to better understand psychological distress among smokers.

Clinicians' Beliefs, Observations, and Treatment Effectiveness Regarding Clients' Sexual Addiction and Internet Pornography Use.

This study addressed how sex addiction and problematic IP use present to mental health professionals (MHPs), and how MHPs conceptualize and treat these issues. MHPs (N = 183) reported on beliefs about, experiences with, and treatment of problematic sexual behaviors (PBS). Most MHPs saw clients with PBS, but most do not feel competent to treat PBS. Specialized MHPs endorsed seeing more clients with PBS and feeling more effective than nonspecialists. Sexual addiction and problematic IP use share similarities, but differ in etiology and co-occurring problems. Diagnostic ambiguity, insufficient knowledge, and limited dissemination may hinder MHPs ability to assess and treat PBSs.

Investigating Treatment Outcomes Across OCD Symptom Dimensions in a Clinical Sample of OCD Patients.

Despite the heterogeneous nature of obsessive-compulsive disorder (OCD), many self-report assessments do not adequately capture the clinical picture presenting within each symptom dimension, particularly unacceptable thoughts (UTs). In addition, obsessions and ordering/arranging compulsions are often underrepresented in samples of treatment outcome studies for OCD. Such methodological discrepancies may obscure research findings comparing treatment outcomes across OCD symptom dimensions. This study aimed to improve upon previous research by investigating treatment outcomes across OCD symptom dimensions using the Dimensional Obsessive-Compulsive Scale, which offers a more comprehensive assessment of UTs. The study included a primarily residential sample of 134 OCD patients. Results indicated that there were no significant differences in treatment outcomes across symptom dimensions. However, the severity of UTs remained significantly greater than other symptom dimensions at both admission and discharge. Thus, it is possible that UTs may exhibit uniquely impairing features, compared with other symptom dimensions. It is also possible that these findings may reflect the characteristics of the residential OCD samples. These speculations as well as implications for OCD treatment and future research are discussed.

Is a gin and tonic more like gin or tonic? A comparison of comorbid and non-comorbid anxiety disorder diagnostic pairs.

Despite findings indicating that anxiety disorders are more likely to co-occur with each other than occur in isolation, little research has explored precise areas of overlap and differentiation among comorbid pairs of anxiety disorders. Furthermore, many studies comparing phenomena across anxiety disorders define comparison groups based on principal diagnoses, with lesser regard for comorbid diagnoses, raising the question as to whether this is a valid approach to analyzing comparisons. To better understand the extent to which comparisons by principal diagnoses are valid, the current study investigated whether comorbid hierarchically opposing diagnostic pairs showed similarities and differences from their non-comorbid, or "pure", counterparts on measures of clinician-rated functioning, specific symptoms, vulnerability factors, and demographic characteristics. The study included a total of 353 participants with diagnoses of either Panic Disorder (PD) only, Social Phobia (SP) only, Generalized Anxiety Disorder (GAD) only, or some comorbid pair of the three. Consistent with hypotheses, results demonstrated that hierarchically opposing diagnostic pairs showed more overlap than differentiation with each other and with non-comorbid counterparts on measures of a given specific non-comorbid diagnosis, indicating that defining comparisons by principal diagnoses may be invalid and misleading. The implications regarding the nosological structure of the DSM and research practice will be discussed.