Reducing safety behaviors to prevent anxious symptoms: a pre-registered prevention intervention study.

The purpose of this pre-registered study was to test the efficacy of a simple, low-impact safety behavior prevention intervention for anxiety. The intervention was delivered online using a 4-week workbook format. Participants (n = 130) were a non-clinical sample of American college students; they were randomly assigned to one of two intervention conditions: safety-behavior reduction or active control condition (academic skills). Results showed that participants in the safety behavior workbook condition did not report fewer safety behaviors or lower levels of anxiety compared to the active control condition post-intervention. Exploratory analyses found that fidelity mattered; participants who completed all the workbook activities reported a significant decrease in the safety-behaviors relative to the control condition. However, those who reduced their use of safety behaviors reported greater levels of anxiety compared to participants in the control condition who reduced their safety behaviors. These results suggest that encouraging safety behavior reduction in non-clinical samples may have the unintended consequence of maintaining anxiety.

The Hierarchical Taxonomy of Psychopathology (HiTOP) Is Not an Improvement Over the DSM.

In their response to our article (both in this issue), DeYoung and colleagues did not sufficiently address three fundamental flaws with the Hierarchical Taxonomy of Psychopathology (HiTOP). First, HiTOP was created using a simple-structure factor-analytic approach, which does not adequately represent the dimensional space of the symptoms of psychopathology. Consequently, HiTOP is not the empirical structure of psychopathology. Second, factor analysis and dimensional ratings do not fix the problems inherent to descriptive (folk) classification; self-reported symptoms are still the basis on which clinical judgments about people are made. Finally, HiTOP is not ready to use in real-world clinical settings. There is currently no empirical evidence demonstrating that clinicians who use HiTOP have better clinical outcomes than those who use the Diagnostic and Statistical Manual of Mental Disorders (DSM). In sum, HiTOP is a factor-analytic variation of the DSM that does not get the field closer to a more valid and useful taxonomy.

Folk Classification and Factor Rotations: Whales, Sharks, and the Problems With the Hierarchical Taxonomy of Psychopathology (HiTOP).

The Hierarchical Taxonomy of Psychopathology (HiTOP) uses factor analysis to group people with similar self-reported symptoms (i.e., like-goes-with-like). It is hailed as a significant improvement over other diagnostic taxonomies. However, the purported advantages and fundamental assumptions of HiTOP have received little, if any scientific scrutiny. We critically evaluated five fundamental claims about HiTOP. We conclude that HiTOP does not demonstrate a high degree of verisimilitude and has the potential to hinder progress on understanding the etiology of psychopathology. It does not lend itself to theory-building or taxonomic evolution, and it cannot account for multifinality, equifinality, or developmental and etiological processes. In its current form, HiTOP is not ready to use in clinical settings and may result in algorithmic bias against underrepresented groups. We recommend a bifurcation strategy moving forward in which the DSM is used in clinical settings while researchers focus on developing a falsifiable theory-based classification system.

Preventative and restorative safety behaviors: Effects on exposure treatment outcomes and risk for future anxious symptoms.

OBJECTIVES: Two studies investigated the differential effect of preventative and restorative safety behaviors on the treatment and development of anxiety and depression. METHOD: Study 1 investigated the impact of preventative and restorative safety behaviors in prolonged exposure therapy among US veterans with PTSD (N = 95). Study 2 was a 3-month prospective study investigating preventative and restorative safety behaviors as risk factors for anxious and depressive symptoms in a non-clinical sample (N = 84). RESULTS: The results of Study 1 showed that both preventative and restorative safety behaviors were associated with worse treatment outcomes (both PTSD symptoms and depressive symptoms). The results of Study 2 found that preventative, but not restorative, safety behaviors predicted increases in future anxious symptoms. Neither preventative nor restorative safety behaviors conferred risk for increases in future depression symptoms (anhedonia). CONCLUSIONS: Preventative and restorative safety behaviors impact PTSD treatment outcomes, while only preventative safety behaviors predict future anxiety.

The impact of service-connected disability and therapist experience on outcomes from prolonged exposure therapy with veterans.

OBJECTIVE: Although prolonged exposure therapy (PE) has been shown to be effective in treating posttraumatic stress disorder (PTSD), a sizable minority do not benefit. Examining patient and therapist characteristics that impact treatment outcome may improve treatment delivery and identify individuals who are less likely to respond to treatment or are at risk to prematurely discontinue treatment. The current study uses a sample from a large urban Veterans' Affairs (VA) hospital to build on a previous report that identified correlates of treatment outcome for Veterans who received PE. METHOD: Two hundred eighty-seven veterans completed measures of PTSD, depression, and quality of life at the beginning and end of treatment. Veterans' service-connected disability rating, therapist experience, benzodiazepine prescription, and traumatic brain injury diagnosis were investigated as predictors of treatment outcome in linear regression analyses. RESULTS: Results showed that Veterans with a service-connected disability for a mental health condition had smaller treatment gains than those without service connection (p < .01). Additionally, results showed that patients treated by certified PE therapists had larger treatment gains than those treated by noncertified PE therapists (p < .01). Finally, younger age and therapist certification were associated with dropout from treatment (p < .05). CONCLUSION: Veterans treated by PE-certified therapists and Veterans who were not service-connected for a mental health condition fared better in treatment. Results suggest that additional study of both the national effort to train VA clinicians in PE and the impact of service connection on PTSD treatment outcome may be helpful for future research. (PsycINFO Database Record

The Safety Behavior Assessment Form: Development and Validation.

OBJECTIVE: To develop and validate an easy to administer measure of safety behaviors called the Safety Behavior Assessment Form (SBAF). METHOD: We provide reliability and validity evidence from four studies. The first study used a cross-sectional design with a sample consisting of both clinical (U.S. military Veterans; n = 42) and nonclinical participants (undergraduates; n = 198). Study 2 used a cross-sectional design with a sample of U.S. military Veterans (n = 215). Study 3 used a pre-post treatment design with a sample of U.S. military Veterans (n = 42). Study 4 used a 2-time-point longitudinal design with a sample of undergraduates (n = 77). RESULTS: The SBAF demonstrated strong levels of internal consistency and test-retest reliability in all four studies. The SBAF also demonstrated predictive and discriminant validity. In Study 3, the SBAF predicted anxious, but not depressive, treatment outcomes in a sample of Veterans. In Study 4, the SBAF predicted prospective changes in anxiety over a 2-week interval in a sample of undergraduates even after controlling for a competing measure of safety behaviors. CONCLUSION: Results of these four studies indicate that the SBAF is a reliable and valid measure of safety behaviors that can be used in both clinical and nonclinical settings.

Occupational and biopsychosocial risk factors for carpal tunnel syndrome.

OBJECTIVE: To investigate a biopsychosocial model of risk for carpal tunnel syndrome (CTS). In addition, a host of exploratory psychosocial variables was investigated as potential risk factors for CTS. METHODS: A case-control design was used comparing 87 CTS and 74 sex-matched general orthopedic patients from an outpatient orthopedic clinic. All participants underwent the same diagnostic protocol (ie, physical evaluation and electrodiagnostic testing) and completed a self-report questionnaire assessing a wide range of potential occupational, personological, and psychosocial risk factors. RESULTS: Multiple logistic regression analyses revealed that occupational repetition, not engaging in vigorous exercise, physical activities with wrist strain, poorer physical health, and lower job satisfaction were significantly related to the presence of CTS. Obesity was borderline significantly related to the presence of CTS. CONCLUSIONS: The biopsychosocial model provides a useful heuristic for conceptualizing CTS risk among injured workers.

Outcomes of Prolonged Exposure therapy for veterans with posttraumatic stress disorder.

Prolonged Exposure (PE) is an evidenced-based psychotherapy for posttraumatic stress disorder (PTSD) that is being disseminated nationally within the U.S. Department of Veterans Affairs (VA) with promising initial results. Empirical evidence, however, regarding the effectiveness of PE for treatment of PTSD in military veterans is limited. Building on previous treatment outcome research, the current study investigated the effectiveness of PE in a diverse veteran sample. One-hundred fifteen veterans were enrolled in PE at an urban VA medical center and its surrounding outpatient clinics. PTSD and depression symptoms as well as quality of life were measured before and after treatment. Several baseline patient characteristics were examined as predictors of treatment response. Eighty-four participants completed treatment. Participants experienced a 42% reduction in PTSD symptoms, a 31% reduction in depression symptoms, and an increase in quality of life following PE. Veterans not prescribed psychotropic medication reported greater PTSD symptom reduction than veterans prescribed such medication. The implications of these results for treatment programs targeting PTSD in veterans are discussed.

Are there demonstrable effects of distant intercessory prayer? A meta-analytic review.

BACKGROUND: The use of alternative treatments for illness is common in the United States. Practitioners of these interventions find them compatible with personal philosophies. Consequently, distant intercessory prayer (IP) for healing is one of the most commonly practiced alternative interventions and has recently become the topic of scientific scrutiny. PURPOSE: This study was designed to provide a current meta-analytic review of the effects of IP and to assess the impact of potential moderator variables. METHODS: A random effects model was adopted. Outcomes across dependent measures within each study were pooled to arrive at one omnibus effect size. These were combined to generate the overall effect size. A test of homogeneity and examination of several potential moderator variables was conducted. RESULTS: Fourteen studies were included in the meta-analysis yielding an overall effect size of g = .100 that did not differ from zero. When one controversial study was removed, the effect size reduced to g = .012. No moderator variables significantly influenced results. CONCLUSIONS: There is no scientifically discernable effect for IP as assessed in controlled studies. Given that the IP literature lacks a theoretical or theological base and has failed to produce significant findings in controlled trials, we recommend that further resources not be allocated to this line of research.