Mood symptoms predict COVID-19 pandemic distress but not vice versa: An 18-month longitudinal study.

The COVID-19 pandemic has had medical, economic and behavioral implications on a global scale, with research emerging to indicate that it negatively impacted the population's mental health as well. The current study utilizes longitudinal data to assess whether the pandemic led to an increase in depression and anxiety across participants or whether a diathesis-stress model would be more appropriate. An international group of 218 participants completed measures of depression, anxiety, rumination and distress intolerance at two baselines six months apart as well as during the onset of the COVID-19 pandemic exactly 12 months later. Contrary to expectations, depression, rumination, and distress intolerance were at equivalent levels during the pandemic as they were at baseline. Anxiety was reduced by a trivial degree (d = .10). Furthermore, a comparison of quantitative explanatory models indicated that symptom severity and pandemic-related environmental stressors predicted pandemic-related distress. Pandemic-related distress did not predict symptom severity. These findings underscore the necessity of longitudinal designs and diathesis-stress models in the study of mental health during the COVID-19 pandemic. They also emphasize that individuals with higher rates of baseline psychopathology are as particularly at risk for higher levels of distress in response to disaster-related stressors.

Reinforcement sensitivity predicts affective psychopathology via emotion regulation: Cross-sectional, longitudinal and quasi-experimental evidence.

The current article presents a model wherein reinforcement sensitivity predicts depression and anxiety via trait preferences for concomitant emotion regulation strategies. In Study 1 (N = 593), BAS sensitivity positively predicted reappraisal and BIS sensitivity negatively predicted it. Reappraisal then negatively predicted depression. BIS sensitivity also predicted rumination, which predicted both depression and anxiety. Study 2a confirmed the model developed in Study 1 with an independent sample (N = 513) and examined the relationships longitudinally. While the cross-sectional relationships were generally maintained, reinforcement sensitivity did not predict reappraisal. In Study 2b, participants (N = 218) were assessed a third time one year later, at the onset of the COVID-19 pandemic. During this stressful time, BAS sensitivity did longitudinally predict reappraisal. These studies highlight the role of emotion regulation in mediating the relationship between reinforcement sensitivity and affective pathology, particularly during times of high stress.

Testing a new indirect measure of general self-worth: The Self-esteem Questionnaire-based Implicit Association Test.

The self-esteem Questionnaire-based Implicit Association Test (SE-qIAT) provides an indirect assessment of general self-worth that is based on the items of the well-validated Rosenberg Self-Esteem Scale (RSES), and the structure of this variant of the IAT enables a clearer interpretation, compared with the conventional self-esteem IAT. Study 1 (N = 224) provided support for the internal consistency, test-retest reliability, and implicit-explicit convergent validity of the SE-qIAT. In Study 2 (N = 305), the correlation of the SE-qIAT with the explicit RSES was replicated, and it was larger than the correlations of the SE-qIAT with other self-reports. As to criterion validity, the SE-qIAT moderated the effect of a mild social threat (being excluded in the Cyberball game) on participants' performance in a subsequent anagram task, and this effect was incremental to the explicit self-esteem assessment. In Study 3 (N = 334), the SE-qIAT correlated positively with the self-esteem IAT and negatively with a measure of depression. The two implicit tasks correlated uniquely with each other, above and beyond the variance they each shared with the explicit RSES. Taken together, these findings provide initial support for the reliability and validity of the SE-qIAT.

Increasing the Flexibility of Implicit Personality Assessment: An Examination of a Universal Assessment Procedure of the Self.

The current studies systematically examined a new version of the Questionnaire-Based Implicit Association Test (qIAT), which minimizes the differences between direct and indirect modes of assessment. Studies 1a (N = 276) and 1 b (N = 238) tested a method that enables an indirect assessment of questionnaires that include only non-reversed items. Studies 2a (N = 255) and 2 b (N = 284) tested a task that substitutes the problematic construct-related category labels with generic, universal categories. These studies, which focused on extraversion, supported the feasibility, reliability and validity of this procedure. Studies 3a-3c (N = 159, 154 and 151, respectively) supported the internal consistency, test-retest reliability and convergent validity of these methods, assessing three well-researched, semantically complex personality scales: Aggressive Humor Style, Need for Closure and Anxiety Sensitivity. Studies 4a (N = 195) and 4 b (N = 283) supported the implicitness of the qIAT, as most respondents were not aware of this task's purpose. In Study 4c (N = 598), participants who reported using antidepressants had lower self-esteem qIAT scores compared to a control group, thus supporting the criterion validity of this task. Taken together, findings suggest that the new qIAT substantially increases the scope of indirect personality assessment.

Expanding the Scope of Implicit Personality Assessment: An Examination of the Questionnaire-Based Implicit Association Test (qIAT).

Self-report questionnaires can only yield information that people are able and willing to report, but implicit assessment methods are not commonly used in mainstream personality research. The Questionnaire-based Implicit Association Test (qIAT) was designed to address the limitations associated with the conventional self-concept IAT, and it enables an indirect assessment that is based on the items of standard self-reports. The present studies examined the psychometric properties of the qIAT across two personality constructs. Study 1 (N = 528) provided support for the internal consistency, test-retest reliability and convergent and discriminant validity of the qIAT that measured extraversion. Study 2 (N = 164) supported the reliability and validity of the qIAT assessment of conscientiousness, which predicted who returned to complete the second session of the study two weeks later, for which participants were paid in advance. This same prediction effect was marginally significant in Study 3 (N = 200), and across both Studies 2 and 3 the qIAT prediction of the criterion behavior was incremental to the parallel self-report questionnaire. Taken together, findings support the reliability and validity of the qIAT, which enables the indirect measurement of a wide variety of distinct personality constructs, currently measured only by self-report scales.

The dual-system theory of bipolar spectrum disorders: A meta-analysis.

Bipolar spectrum disorders are characterized by alternating intervals of extreme positive and negative affect. We performed a meta-analysis to test the hypothesis that such disorders would be related to dysregulated reinforcement sensitivity. First, we reviewed 23 studies that reported the correlation between self-report measures of (hypo)manic personality and measures of reinforcement sensitivity. A large relationship was found between (hypo)manic personality and BAS sensitivity (g = .74), but not with BIS sensitivity (g = -.08). This stands in contrast to self-reported depression which has a small, negative relationship with BAS sensitivity and a large positive one with BIS sensitivity (Katz et al., 2020). Next, we reviewed 33 studies that compared reinforcement sensitivity between euthymic, bipolar participants and healthy controls. There, bipolar disorder had a small, positive relationship with BAS sensitivity (g = .20) and a medium, positive relationship with BIS sensitivity (g = .64). These findings support a dualsystem theory of bipolar disorders, wherein BAS sensitivity is more closely related to mania and BIS sensitivity more closely to bipolar depression. Bipolar disorders show diatheses for both states with euthymic participants being BAS- and BIS- hypersensitive. Implications for further theory and research practice are expounded upon in the discussion.

Reinforcement sensitivity, depression and anxiety: A meta-analysis and meta-analytic structural equation model.

Reinforcement Sensitivity Theory (RST) posits that individual differences in reward and punishment processing predict differences in cognition, behavior, and psychopathology. We performed a quantitative review of the relationships between reinforcement sensitivity, depression and anxiety, in two separate sets of analyses. First, we reviewed 204 studies that reported either correlations between reinforcement sensitivity and self-reported symptom severity or differences in reinforcement sensitivity between diagnosed and healthy participants, yielding 483 effect sizes. Both depression (Hedges' g = .99) and anxiety (g = 1.21) were found to be high on punishment sensitivity. Reward sensitivity negatively predicted only depressive disorders (g = -.21). More severe clinical states (e.g., acute vs remission) predicted larger effect sizes for depression but not anxiety. Next, we reviewed an additional 39 studies that reported correlations between reinforcement sensitivity and both depression and anxiety, yielding 156 effect sizes. We then performed meta-analytic structural equation modeling to simultaneously estimate all covariances and control for comorbidity. Again we found punishment sensitivity to predict depression (ß = .37) and anxiety (ß = .35), with reward sensitivity only predicting depression (ß = -.07). The transdiagnostic role of punishment sensitivity and the discriminatory role of reward sensitivity support a hierarchical approach to RST and psychopathology.

Predictors and Moderators of Cognitive and Behavioral Therapy Outcomes for OCD: A Patient-Level Mega-Analysis of Eight Sites.

Cognitive (CT) and behavioral treatments (BT) for OCD are efficacious separately and in combination. Tailoring treatment to patient-level predictors and moderators of outcome has the potential to improve outcomes. The present study combined data from eight treatment clinics to examine the benefits of BT (n = 125), CT (n = 108), and CBT (n = 126), and study predictors across all treatments and moderators of outcome by treatment type. All three methods led to large benefits for OCD and depression symptoms. Residual gain scores for OCD symptoms were marginally smaller for BT compared to treatments containing CT. For depression, significantly more gains were evident for CBT than BT, and CT did not differ from either. Significantly fewer BT participants (36%) achieved clinically significant improvement compared to CT (56%), and this was marginally evident for CBT (48%). For all treatments combined, no predictors were identified in residual gain analyses, but clinically improved patients had lower baseline depression and stronger beliefs about responsibility/threat and importance/control of thoughts. Moderator analyses indicated that higher baseline scores on depression adversely affected outcomes for BT but not CT or CBT, and lower OCD severity and more education were associated with positive outcomes for CT only. A trend was evident for higher responsibility/threat beliefs to moderate clinical improvement outcomes for those receiving cognitive (CT and CBT), but not behavioral (BT) treatment. Medication status and comorbidity did not predict or moderate outcomes. Findings are discussed in light of models underlying behavioral and cognitive treatments for OCD.

Gain through pain: Augmenting in vivo exposure with enhanced attention to internal experience leads to increased resilience to distress.

Recent variants of exposure therapy ask clients to directly engage with the distress associated with avoided experiences in order to become more resilient to future anxiety-provoking situations. In this study, we consider how this engagement impacts behavioral willingness. Forty-eight participants with high fear of cockroaches completed in vivo exposures while either mindfully attending externally to the feared object (Ext), or to both the object and their internal distress (Int/Ext). While both groups showed improvement, behavioral, subjective and physiological measures revealed different patterns of change. Immediate testing showed that participants in the Ext condition improved more in subjective distress, with no other differences between groups. A second testing a week later in an ecologically valid environment showed that participants the Int/Ext intervention continued to improve behaviorally, regardless of their reported subjective discomfort. These findings highlight the importance of explicit engagement with distress during exposures, that forego immediate subjective relief for long-term behavioral improvement.

Measuring regulation in the here and now: The development and validation of the State Emotion Regulation Inventory (SERI).

The relationship between context and emotion regulation is currently at the center of a burgeoning area of research. Commonly used emotion regulation questionnaires, however, are predominantly trait-based, and insensitive to situational choice of regulatory strategy. The current work describes the development and validation of the State Emotion Regulation Inventory (SERI), a brief measure of situational use of distraction, reappraisal, brooding and acceptance. In Study 1, an initial item pool was constructed, based on commonly used trait-based emotion regulation surveys. Then, the psychometric properties of the items were examined with a group of 181 participants who recalled a saddening autobiographical event, identified a distressing thought it triggered, and then waited for 3 minutes without instruction, as an opportunity to allow for spontaneous emotion regulation. Participants then completed the initial item pool, and other relevant trait-based scales. Exploratory factor analysis suggested a 4-factor solution, corresponding to the 4 regulatory strategies measured in the SERI. The 4 items to exclusively load highest on each factor were selected for the final measure. Assembled subscales correlated with relevant trait-based subscales in the expected directions. In Study 2, another sample of 155 participants completed the same procedure and the new SERI, and confirmatory factor analysis supported the 4-factor structure of this instrument. As a brief, validated instrument, the SERI may be a useful measure for studies of state emotion regulation, in protocols that use repeated measures in a single session, over the course of multiple sessions, or via ecological momentary assessments. (PsycINFO Database Record

Now you have my attention: Empathic accuracy pathways in couples and the role of conflict.

Recent research on empathy finds evidence for 2 different pathways that enable individuals to accurately infer other persons' inner mental states: an automatic, indirect pathway that operates by having a mental state similar to the target's and (correctly) assuming that this state is similar to the target's, and a more controlled direct pathway that involves assessing the target's mental state with no regard for one's own. We present 3 daily diary studies (N = 53, 38 and 80 couples) examining the contribution of these pathways to empathic accuracy in daily assessments of romantic partners' negative moods, and examine the effects of gender and relational conflict on these pathways. Our studies revealed that both pathways consistently contributed to accuracy. Additionally, partners demonstrated greater indirect accuracy on conflict (vs. nonconflict) days, and indirect accuracy was somewhat higher for women than for men on conflict days (with the opposite pattern on nonconflict days). More importantly, we found evidence for a novel third pathway, in which the perception of conflict itself led to (correct) higher estimation of negative affect and thus, to higher accuracy. This pathway figured more consistently for men than for women. In our discussion, we link the pathways obtained in these studies to the extant social neuroscientific literature on empathy systems, arguing that the indirect pathway involves the effects of experience sharing, while the direct and conflict-based pathways involve the mental state attributions (Zaki & Ochsner, 2011). These findings demonstrate the importance of examining various empathic pathways for the understanding of empathic processes. (PsycINFO Database Record

Pushed by Symptoms, Pulled by Values: Promotion Goals Increase Motivation in Therapeutic Tasks.

While many therapies focus on the reduction of disturbing symptoms, others pursue behavior consistent with personally held values. Based on regulatory focus theory (Higgins, 1997), reducing symptoms is a type of prevention goal while pursuing values is a promotion goal. In the current study, 123 undergraduate students elicited a negative, self-focused emotion-laden cognition. They were then randomly assigned to construe their negative thought as either (a) an impediment to valued behaviors, (b) a cause of unpleasant symptoms, or to one of two control conditions: (c) distraction or (d) no intervention. Then, participants in all groups completed a series of repetitive therapeutic tasks that targeted their elicited negative cognitions. Results showed that participants who construed treatment in terms of valued behavior promotion spent more time on a therapeutic task than all other groups. The group in the unpleasant symptom promotion condition did not differ from either control group. The motivational advantage of value promotion was not accounted for by differences in mood. The present findings suggest that clients may be better motivated through value promotion goals, as opposed to symptom prevention goals.

Examination of the core cognitive components of cognitive behavioral therapy and acceptance and commitment therapy: an analogue investigation.

We aimed to examine the core elements of cognitive behavioral therapy and acceptance and commitment therapy that target distressing negative cognitions, cognitive restructuring (CR) and cognitive defusion (CD), respectively. Participants (N=142) recalled a saddening autobiographical event, identified a distressing thought it triggered, and completed a task that induced rumination on these cognitions. They then completed one of four brief interventions that targeted these emotionally charged cognitions: analogue versions of CR and CD, and two control interventions. The personal negative cognitions were then reactivated to examine the protective effects of these interventions. CR and CD were similarly efficacious in alleviating distress, compared to a control intervention that focused on participants' negative thoughts. Mood improvement was associated with state levels of reappraisal and not with acceptance in CR, whereas the reverse was observed in CD. Improvement was associated with perceived efficacy of the intervention in CR but not in CD. The present findings suggest that although CR and CD effectively promote different types of cognitive strategies, they may share important features that set them both apart from maladaptive forms of coping.

Attentional biases in PTSD: More evidence for interference.

Attentional biases to trauma-related stimuli have been widely demonstrated in individuals with posttraumatic stress disorder (PTSD). However, the majority of these studies used methods not suited to differentiating difficulty disengaging attention from threatening stimuli (interference) from facilitated detection of threat. In the current study, a visual search task (VST) with a lexical decision component was used to differentiate between attentional interference and facilitation. Forty-six sexual assault survivors with High PTSD or Low PTSD symptoms completed the VST with three types of stimuli (trauma-related, general threat-related, and semantically-related neutral words), to examine the specificity of attentional biases associated with PTSD symptoms. High PTSD participants showed increased interference to trauma-related words relative to Low PTSD participants. Furthermore, the increased attentional interference in High PTSD participants was specific to trauma-related stimuli. No evidence was found for facilitated detection of threatening stimuli in PTSD. These results provide additional support for attentional biases in PTSD relating to attentional interference with trauma-related cues rather than facilitated detection of threat. The implications for this pattern of results are discussed in relation to anxiety disorders that are characterized by rumination and/or intrusions (e.g., PTSD, GAD) rather than those more circumscribed to fight or flight response (e.g., phobias).

Acceptance and commitment therapy and the new generation of cognitive behavioral treatments.

Acceptance and Commitment Therapy (ACT) is one of several recently-developed acceptance-based cognitive behavioral treatments which broaden the scope of CBT. The theory underlying ACT suggests that verbal representations generated by the human mind inevitably increase the psychological presence of pain and often lead to psychological inflexibility or the dominance of language products over other sources of information. Furthermore, the adequacy of problem-solving strategies that are used to achieve desired goals and decrease suffering is substantially decreased when applied to private experience. Therefore, humans have a greatly expanded capacity to experience aversive stimulation, but simultaneously are not well-equipped to deal effectively with such unwanted experiences. Acknowledging the inevitability of psychological pain, ACT aims at replacing experiential avoidance and similar harmful processes with more adaptive strategies, with the general goal of pursuing broad life objectives. This is achieved by encouraging mindful acceptance of unwanted experiences and by fostering committed action which is consistent with one's chosen values.

Medication adherence in psychopharmacologically treated adults with ADHD.

OBJECTIVE: One of the potential causes of residual symptoms of ADHD in adults can be difficulties with consistent adherence to medications. METHOD: This formative study examined self-reported medication adherence in adults with ADHD with clinically significant symptoms despite medication treatment. RESULTS: Mean adherence for the two-week period prior to the assessment point was 86%, with 18% of the sample reporting less than 80% adherence, and 43% less than 90% adherence. Adherence correlated with ADHD symptoms but not anxiety or depression. Those with less than 80% adherence had higher ADHD severity compared to those whose adherence was at least 80%. CONCLUSION: These data suggest that self-report of adherence to ADHD medications may be a useful and expedient way of assessing adherence, and that assessment and counseling about adherence may be an important part of treatment. Future research using an objective indicator of adherence is needed to follow up on these findings.

The role of attentional biases in PTSD: is it interference or facilitation?

Although attentional biases have been demonstrated in individuals with posttraumatic stress disorder (PTSD), the cognitive methodologies used have not allowed for disambiguation of two types of attentional biases. It remains unclear if PTSD involves difficulty disengaging attention from threatening stimuli (interference) or facilitated detection. To differentiate between attentional interference and facilitation, 57 male Vietnam-era veterans (30 High PTSD and 27 Low PTSD) completed a visual search task with a lexical decision component. High PTSD veterans who engaged in the interference task first showed increased interference to threat-relevant words relative to Low PTSD veterans. However, no evidence was found for facilitated detection of threatening stimuli in PTSD.

Inositol augmentation of lithium or valproate for bipolar depression.

OBJECTIVE: Despite promising new therapies, bipolar depression remains difficult to treat. Up to half of patients do not respond adequately to currently approved treatments. This study evaluated the efficacy of adjunctive inositol for bipolar depression. METHODS: Seventeen participants with DSM-IV criteria for bipolar depression and a 17-item Hamilton Rating Scale for Depression (HRSD) > or =15 on proven therapeutic levels of lithium or valproate for >2 weeks were randomized to receive double-blind inositol or placebo for 6 weeks. At the end of double-blind treatment, subjects were eligible for an 8-week open-label trial of inositol. RESULTS: Response was defined a priori as >50% reduction in the HRSD and a Clinical Global Impression of 1-2. Four of nine subjects (44%) on inositol and zero of eight subjects on placebo met response criteria (p = 0.053). There was no difference between groups in the average change score for the HRSD or Young Mania Rating Scale (YMRS). Response to inositol was highly variable. Of nine subjects randomized to inositol, two had >50% worsening in HRSD scores at the end of treatment, three had no change and four had >50% improvement. Those who had worsening in depressive symptoms on inositol had significantly higher scores at baseline on the YMRS total score and irritability, disruptive/aggressive behavior and unkempt appearance items. CONCLUSIONS: There was a trend for more subjects on inositol to show improvement in bipolar depression symptoms, but, on average, inositol was not more effective than placebo as an adjunct for bipolar depression. Baseline levels of anger or hostility may be predictive of clinical response to inositol.

Who sees trees before forest? The obsessive-compulsive style of visual attention.

It has been suggested that individuals with obsessive-compulsive personalities tend to focus on small local details in their surroundings, whereas histrionic individuals are characterized by more global information processing. Using the global-local hierarchical-letters paradigm, we were able to provide support for the first but not the second hypothesis. Measures related to obsessive-compulsive personality disorder were associated with excessive visual attention to small details of the hierarchical letters. Specifically, the obsessive-compulsive cognitive style was associated with local interference, which reflects the effects of distraction by to-be-ignored small details on identification of global information.

A pilot study of functional Cognitive Behavioral Therapy (fCBT) for schizophrenia.

BACKGROUND: The feasibility and preliminary efficacy of a novel cognitive behavioral treatment for decreasing psychotic symptoms and improving social functioning was evaluated in a pilot study. This represents the first treatment outcome study of CBT for psychosis with a manualized, active comparison condition. METHODS: Thirty outpatients with schizophrenia or schizoaffective disorder, depressed type with residual psychotic symptoms were randomly assigned to either 16 weekly sessions of functional cognitive behavioral therapy (fCBT) or psychoeducation (PE) with assessments conducted at baseline and post-treatment by blind evaluators. RESULTS: Attrition was only 7% and did not differ between fCBT and PE, indicating good tolerability of both treatments. For this sample with persistent symptoms, between groups effects were not significantly different, but within group effect sizes indicated greater treatment benefit for fCBT on positive symptoms, particularly for the PSYRATS voices subscale. CONCLUSION: The results suggest that fCBT is well tolerated and holds promise for reducing persistent positive symptoms.