Sudden gains in routine clinical care: application of a permutation test for trauma-focused cognitive behavioural therapy.

Background: Sudden gains, defined as large and stable improvements of psychopathological symptoms, are a ubiquitous phenomenon in psychotherapy. They have been shown to occur across several clinical contexts and to be associated with better short-term and long-term treatment outcome. However, the approach of sudden gains has been criticized for its tautological character: sudden gains are included in the computation of treatment outcomes, ultimately resulting in a circular conclusion. Furthermore, some authors criticize sudden gains as merely being random fluctuations.Objective: Use of efficient methods to evaluate whether the amount of sudden gains in a given sample lies above chance level.Method: We used permutation tests in a sample of 85 patients with posttraumatic stress disorder (PTSD) treated with trauma-focused cognitive behaviour therapy in routine clinical care. Scores of self-reported PTSD symptom severity were permuted 10.000 times within sessions and between participants to receive a random distribution.Results: Altogether, 18 participants showed a total of 24 sudden gains within the first 20 sessions. The permutation test yielded that the frequency of sudden gains was not beyond chance level. No significant predictors of sudden gains were identified and sudden gains in general were not predictive of treatment outcome. However, subjects with early sudden gains had a significantly lower symptom severity after treatment.Conclusions: Our data suggest that a significant proportion of sudden gains are due to chance. Further research is needed on the differential effects of early and late sudden gains.

Treatment-related sudden gains exhibit clinical significance when their manifestation is above chance level.We used permutation tests to examine their occurrence in trauma-focused cognitive behaviour therapy as applied in a naturalistic treatment setting.The occurrence of sudden gains in general was not significantly higher than chance, yet early sudden gains were associated with improved treatment outcome.

Selection of social comparison standards in cardiac patients with and without experienced defibrillator shock.

Patients with an implantable cardioverter-defibrillator (ICD) often report psychological distress. Literature suggests that patients with physical disease often compare their well-being and coping to fellow patients. However, we lack knowledge on social comparison among patients with ICD. In this study, we examined psychological distress and social comparison selection in patients with (ICD+) and without experienced ICD shocks (ICD-). We theorized that relative to ICD- patients, those with ICD+ display higher levels of psychological distress and thereby compare more frequently with fellow patients with more severe disease, but better disease coping and try to identify more strongly with these standards to improve their own coping. We recruited 92 patients with (ICD+, n = 38) and without an experienced ICD shock (ICD-, n = 54), who selected one of four comparison standards varying in disease severity and coping capacity. Relative to ICD-, ICD+ patients reported higher levels of device-related distress, but there were no significant differences in anxiety, depression, or quality of life. ICD+ patients selected more often comparison standards with poor coping and, irrespective of standard choice, displayed more negative mood following comparison. Our results show that ICD+ patients tend to perform unfavorable comparisons to fellow patients, which might explain higher psychological distress and worse coping. These findings warrant further research into social comparison as a relevant coping mechanism in ICD patients.

Associations among posttraumatic stress disorder symptoms, life satisfaction, and well-being comparisons: A longitudinal investigation.

Many individuals who encounter potentially traumatic events go on to develop symptoms of posttraumatic stress disorder (PTSD). Research suggests that survivors of traumatic events frequently compare their current well-being to different standards; yet, knowledge regarding the role of comparative thinking in well-being is limited to a few cross-sectional studies. We therefore examined the temporal associations among aversive well-being comparisons (i.e., comparisons threatening self-motives), PTSD symptoms, and life satisfaction in individuals exposed to traumatic events. Participants (N = 518) with a trauma history completed measures of PTSD symptoms and life satisfaction, as well as the Comparison Standards Scale for Well-being (CSS-W), at assessment points 3 months apart. The CSS-W assesses the frequency, perceived discrepancy, and affective impact of aversive social, temporal, counterfactual, and criteria-based comparisons related to well-being. All participants reported having engaged in aversive well-being comparisons during the last 3 weeks. Comparison frequency emerged as a significant predictor of PTSD symptoms, ß = .24, beyond baseline PTSD symptom severity. Life satisfaction contributed unique variance to the comparison process by predicting comparison frequency, ß = -.18; discrepancy, ß = -.24; and affective impact, ß = .20. The findings suggest that frequent aversive comparisons may lead to a persistent focus on negative aspects of well-being, thereby exacerbating PTSD symptoms, and further indicate that comparison frequency, discrepancy, and affective impact are significantly influenced by life satisfaction. Taken together, the findings support the need for a thorough examination of the role of comparative thinking in clinical populations, which may ultimately help improve clinical care.

Comparison standards shape everyday judgments of low and high wellbeing in individuals with and without psychopathology: a diary-based investigation.

People can easily rate and express their current levels of wellbeing, but the cognitive foundations for such judgments are poorly understood. We examined whether comparisons to varying standards underlie fluctuating wellbeing judgments within-person (i.e., throughout daily episodes) and between-person (i.e., high vs. low levels of psychopathology). Clinical and non-clinical participants recorded subjective affect for each distinct episode for one week. Participants briefly described current, best, and worst daily episodes, which we coded for presence and type of comparison standard (social, past temporal, criteria-based, counterfactual, prospective temporal, and dimensional). Participants also rated their engagement with these standards and the respective affective impact. During best episodes, participants reported more downward (vs. upward) comparisons that resulted in positive affective impact. In worst episodes, upward (vs. downward) comparisons were more frequent. In best and worst episodes, we most frequently identified past-temporal and criteria-based comparisons, respectively. The clinical group engaged more often with all potential standard types during worst daily episodes and was more negatively affected by comparative thoughts, amid consistently more negative affect levels across all episode types. Our data suggest that judgments of affect and wellbeing may indeed rely on comparative thinking, whereby certain standards may characterize states of negative affect and poor mental health.

The efficacy of psychological interventions for adult post-traumatic stress disorder following exposure to single versus multiple traumatic events: a meta-analysis of randomised controlled trials.

BACKGROUND: Previous meta-analyses of psychological interventions for adult post-traumatic stress disorder (PTSD) did not investigate whether efficacy is diminished in individuals with PTSD related to multiple (vs single) traumatic events. We aimed to assess whether treatment efficacy would be lower in randomised controlled trials involving multiple-event-related PTSD versus single-event-related PTSD. METHODS: For this meta-analysis, we searched PsycINFO, MEDLINE, Web of Science, and PTSDpubs from database inception to April 18, 2023. Randomised controlled trials involving adult clinical samples (≥70% meeting full PTSD criteria) with adequate size (≥10 participants per arm) were included. We extracted data on trial characteristics, demographics, and outcome data. Random-effects meta-analyses were run to summarise standardised mean differences (Hedges' g). Trials involving 100% of participants with single-event-related PTSD versus at least 50% of participants with multiple-event-related PTSD (ie, associated with ≥two traumatic events) were categorised. Quality of evidence was assessed using the Cochrane criteria. The review protocol was registered in PROSPERO (CRD42023407754). FINDINGS: Overall, 137 (85%) of 161 randomised controlled trials were included in the quantitative synthesis, comprising 10 684 participants with baseline data and 9477 with post-treatment data. Of those randomly assigned, 5772 (54%) of 10 692 participants identified as female, 4917 (46%) as male, and three (<1%) as transgender or other. 34 (25%) of 137 trials exclusively involved women, 15 (11%) trials exclusively involved men, and the remainder were mixed samples. Mean age across the trials was 40·2 years (SD 9·0) ranging from 18·0 years to 65·4 years. 23 (17%) of 137 trials involved participants from low-income and middle-income countries (23 [17%] of 137). Data on ethnicity were not extracted. At treatment endpoint, psychological interventions were highly effective for PTSD when compared with passive control conditions in both samples with single-event-related PTSD (Hedges' g 1·04 [95% CI 0·77-1·31]; n=11; I2=43%) and multiple-event-related PTSD (Hedges' g 1·13 [0·90-1·35]; n=55, I2=87%), with no efficacy difference between these categories (p=0·48). Heterogeneity between studies was substantial but outlier-corrected analysis yielded similar results. Moderate-sized effects were found compared with active control conditions with no significant difference between single-trauma and multiple-trauma trials. Results were robust in various sensitivity analyses (eg, 90% cutoff for multiple-trauma trials) and analyses of follow-up data. The quality of evidence was moderate to high. INTERPRETATION: Contrary to our hypothesis, we found strong evidence that psychological interventions are highly effective treatments for PTSD in patients with a history of multiple traumatic events. Results are encouraging for clinical practice and could counteract common misconceptions regarding treatment and treatment barriers. FUNDING: None.

Evaluation of the Scales for Social Comparison of Appearance and Social Comparison of Well-Being.

People constantly compare their appearance and well-being to that of other individuals. However, a measure of social comparison of well-being is lacking and existing appearance-related social comparison assessment is limited to comparison tendency using predefined social situations. This limits our understanding of the role of social comparison in appearance and well-being. Therefore, we developed the Scale for Social Comparison of Appearance (SSC-A) and the Scale for Social Comparison of Well-Being (SSC-W) to assess upward and downward social comparisons with regard to (a) frequency, (b) perceived discrepancy to the standard, and (c) engendered affective impact during the last 3 weeks. In one longitudinal and three cross-sectional studies (Ns = 500-1,121), we administered the SSC-A or SSC-W alongside measures of appearance social comparison, body satisfaction, self-concept, social rank, well-being, envy, rumination, depression, and anxiety. Confirmatory factor analyses supported the expected two-factor model representing upward and downward social comparison for both scales. Overall, upward comparison displayed the anticipated associations with the measured constructs, whereas downward comparison showed mostly small or nonsignificant correlations with the validators. The SSC-A and SSC-W are efficient measures of social comparison for appearance and well-being with good evidence for their reliability and validity in our samples.

The longitudinal relationship between well-being comparisons and anxiety symptoms in the context of uncontrollability of worries and external locus of control: a two-wave study.

BACKGROUND: Anxiety is a prevalent mental health condition. Comparisons of one's own well-being to different aversive standards may contribute to the development and maintenance of anxiety symptoms. OBJECTIVES: Our primary goal was to investigate whether aversive well-being comparisons predict anxiety symptoms and vice versa. Additionally, we aimed at examining exploratorily whether well-being comparisons are reciprocally related to metacognitive beliefs about worrying and external control beliefs. METHODS: In this two-wave longitudinal survey design, 922 participants completed measures of anxiety, metacognitions about the uncontrollability of worries, external locus of control, and the Comparison Standards Scale for Well-being (CSS-W) at two timepoints, three-months apart. The CSS-W assesses the frequency, perceived discrepancy, and affective impact of social, temporal, counterfactual, and criteria-based comparisons. RESULTS: When autoregressive effects were adjusted for, aversive comparison frequency, comparison affective impact, and uncontrollability of worries at the first timepoint predicted subsequent anxiety symptoms. Furthermore, well-being comparison frequency and discrepancy at the second timepoint were predicted by baseline anxiety symptoms. External locus of control predicted comparison frequency and discrepancy. CONCLUSIONS: Well-being comparisons contribute distinct variance to anxiety symptoms and vice versa, pointing to a vicious cirlcle of symptom escalation. These findings have significant implications for future research.

The associations among well-being comparisons and affective styles in depression, anxiety, and mental health quality of life.

OBJECTIVE: Frame-of-reference theories suggest that individuals use different comparison types to evaluate their well-being. Research indicates that the frequency of aversive well-being comparisons is related to depression, with engendered comparison affective impact partly accounting for this relationship. We aimed to replicate this finding, examine whether this extends to anxiety and mental health quality of life, and whether these pathways are moderated by affective styles of concealing, adjusting, and tolerating. We expected concealing as a response-focused style to be associated with higher effects of comparison affective impact on depression, anxiety, and mental health quality of life. Adjusting as an antecedent-focused strategy was expected to mitigate the effects of aversive comparison frequency on comparison affective impact, and the effects of comparison affective impact on the outcomes. Finally, tolerating was expected to be associated with lower effects on both pathways. METHODS AND MEASURES: Participants (N = 596) responded to measures of well-being comparisons, affective styles, depression, anxiety, and mental health quality of life. RESULTS: Frequency of aversive well-being comparisons was associated with all outcomes. These relationships were partially mediated by comparison affective impact. Adjustment moderated the pathway between aversive comparison frequency and comparison affective impact. No other moderation effect emerged. CONCLUSION: The comparison process appears important in well-being evaluations.

Comparison Is the Thief of Joy? Introducing the Attitudes Towards Social Comparison Inventory.

Social comparison has a significant impact on individuals' motivation, affect, and behavior. However, we lack a scale that captures individual differences in attitudes toward social comparison. To address this gap, we developed the Attitudes Toward Social Comparison Inventory (ASCI) drawing on existing scales that tap into metacognitive beliefs about worrying, self-motives, beliefs about emotions, and the general comparative-processing model. We examined the psychometric properties of the ASCI in a longitudinal study (N = 1,084), and a second (N = 550) and third cross-sectional study (N = 306). Through exploratory and confirmatory factor analyses, we identified a 12-item two-factor solution capturing positive and negative attitudes toward social comparison. The ASCI demonstrated measurement invariance across gender and time. The two factors were differentially and longitudinally associated with relevant constructs, including social comparison, metacognitive beliefs about worrying, depression, self-concept clarity, envy, and self-esteem. The ASCI facilitates comprehensive investigations of social comparison processes.

Cognitive factors underlying the impact of postmigration stressors on subjective well-being: Well-being comparisons and self-efficacy.

BACKGROUND: Migration and the resulting challenges in the host country can have a profound impact on the mental health of refugees and intensify preoccupation with one's own well-being. Yet, cognitive factors underlying the adverse impact of postmigration stressors are poorly understood. OBJECTIVE: We aimed at exploring the frequency and nature of well-being comparisons in the context of flight and migration using the Comparison Standards Scale for Well-being (CSS-W), which assesses well-being related social, temporal, counterfactual, criteria-based and dimensional aversive and appetitive comparisons. We further aimed at examining the mediating role of well-being comparisons and general self-efficacy in the relationship between postmigration stressors and psychological well-being. METHODS: We conducted a survey with 1070 Arabic speaking forcibly displaced people in Germany assessing well-being comparisons, general self-efficacy, postmigration stressors, subjective well-being and social media engagement. RESULTS: Factor analysis of the CSS-W yielded a theoretically grounded two-factor structure proposing an aversive (mostly upward) and an appetitive (mostly downward) comparison factor. Aversive and appetitive comparisons were reported by more than 99% of participants, with temporal comparisons being reported by 98.7% of participants. Postmigration stressors were significantly related to subjective well-being and aversive well-being comparisons and general self-efficacy partially mediated this relationship. Appetitive well-being comparisons, however, were not significantly related to neither postmigration stressors nor general self-efficacy. CONCLUSION: Aversive well-being comparisons and general self-efficacy seem to play a significant role in the adverse effects of postmigration stressors on subjective well-being. Longitudinal research is needed to examine the directional dynamics between general self-efficacy, well-being comparisons and postmigration stressors.

Associations between sleep problems and posttraumatic stress symptoms, social functioning, and quality of life in refugees with posttraumatic stress disorder.

Many patients with posttraumatic stress disorder (PTSD) suffer from sleep problems, leading to impairments in social functioning and quality of life. Refugees are at high risk for sleep problems due to stressful life circumstances and a high PTSD prevalence. However, limited data on the frequency of sleep problems in refugees with diagnosed PTSD exist. This study examined the frequency of sleep problems in refugees with PTSD and their associations with symptoms of PTSD. Additionally, we investigated the contribution of sleep problems to social functioning and quality of life. Participants (N = 70) were refugees from different countries of origin currently living in Germany. All participants met the criteria for PTSD and completed measures of PTSD symptom severity, subjective sleep problems, social impairment, and quality of life. There was a very high frequency of sleep problems in the sample (100%), and sleep problems were significantly associated with both clinician-rated, r = .47, and self-rated, r = .30, PTSD symptom severity after controlling for overlapping items. Contrary to expectations, sleep problems did not predict social impairment, d = 0.16, nor quality of life, d = 0.13, beyond the effect of other PTSD symptoms. The findings highlight the widespread frequency of sleep problems among refugees. Future studies should assess the causal nature of the association between sleep problems and measures of psychosocial functioning in more detail and examine its dynamic change over time.

Efficacy of imagery rescripting in treating mental disorders associated with aversive memories - An updated meta-analysis.

Imagery rescripting (ImRs) is frequently applied to treat different psychological complaints. We conducted an updated meta-analysis based on randomised controlled trials on the efficacy of ImRs for mental disorders associated with aversive memories. Medline, PsycInfo, and Web of Science were searched up to May 2023. Seventeen trials were included with a total of 908 participants (417 in the ImRs condition), suffering from posttraumatic stress disorder, anxiety disorders, depression, or eating disorders. Random effect models yielded an overall effect of g = 0.68 (95 % CI 0.18 to 1.18; k = 7) compared to passive controls (mostly waitlist). The effect compared to (prolonged) exposure, cognitive restructuring, and EMDR was non-significant (g = -0.01; 95 % CI -0.18 to 0.15; k = 11). Follow-up assessments indicated a long-term treatment effect. Results suggest that ImRs can effectively treat a variety of psychological disorders and produce similar treatment effects as evidence-based interventions. Limitations include the bounded number of included trials for each mental disorder. The meta-analysis was registered on PROSPERO (CRD42020220696) and received no funding.

Crying over spilled milk? A network analysis of aversive well-being comparison, brooding rumination and depressive symptoms.

BACKGROUND: Comparative thinking about one's well-being is ubiquitous. Comparisons that threaten an individual's self-motives are aversive and interact with rumination and depression. Aversive well-being comparisons include upward social, past temporal, counterfactual, and criteria-based comparisons, as well as downward prospective temporal comparisons. Although the frequency, discrepancy, and affective impact of aversive comparison total scores have been associated with brooding rumination and depression, no study has investigated the interaction of specific comparison standards (e.g., social or counterfactual) with symptom cascades of brooding and depressive symptoms. METHODS: To examine this interaction, we conducted network analyses on the interplay between aversive well-being comparisons, brooding rumination, and depression. Specifically, we conducted a cross-sectional study in N = 500 dysphoric individuals and a longitudinal study in N = 921 participants at two timepoints, three months apart. Participants completed measures of depression, brooding, and the Comparison Standards Scale for Well-being, which assessed the frequency, perceived discrepancy, and affective impact of aversive well-being comparisons. RESULTS: Feelings of worthlessness emerged as the most central attribute in the networks of the dysphoric sample. Longitudinally, brooding and depressive symptoms predicted aversive comparisons, but not the other way around, which accounted for social and other-referent counterfactual comparisons to a greater degree than for other comparison types. LIMITATIONS: We used nonclinical samples. CONCLUSIONS: The findings highlight the critical role of comparison standards in depression. Further research is warranted to detect potential intervention targets for mitigating negative effects of negative self-evaluation.

The efficacy and acceptability of psychological interventions for adult PTSD: A network and pairwise meta-analysis of randomized controlled trials.

OBJECTIVE: A comprehensive quantitative summary of the efficacy and acceptability of psychological interventions (PIs) for adult posttraumatic stress disorder (PTSD) is lacking. METHOD: We conducted a systematic literature search to identify randomized controlled trials (RCTs) examining the efficacy and acceptability (all-cause dropout) of psychological interventions (i.e., trauma-focused cognitive behavior therapy [TF-CBT], eye movement desensitization and reprocessing [EMDR], other trauma-focused interventions and non-trauma-focused interventions). RESULTS: One hundred fifty-seven RCTs were included comprising 11,565 patients. Most research (64% of RCTs) accumulated for TF-CBT. In network meta-analyses, all therapies were effective when compared to control conditions. Interventions did not differ significantly in their efficacy. Yet, TF-CBT yielded higher short- (g = 0.17, 95% CI [0.03-0.31], number of comparisons kes = 190), mid- (i.e., ≤5 months posttreatment, g = 0.23, 95% CI [0.06-0.40], kes = 73) and long-term efficacy (i.e., >5 months posttreatment, g = 0.20, 95% CI [0.04-0.35], kes = 41) than non-trauma-focused interventions. There was some evidence of network inconsistencies, and heterogeneity in outcomes was large. In pairwise meta-analysis, slightly more patients dropped out from TF-CBT than non-trauma-focused interventions (RR = 1.36; 95% CI [1.08-1.70], kes = 22). Other than that, interventions did not differ in their acceptability. CONCLUSIONS: Interventions with and without trauma focus are effective and acceptable in the treatment of PTSD. While TF-CBT yields the highest efficacy, slightly more patients discontinued TF-CBT than non-trauma-focused interventions. Altogether, the present results align with results of most previous quantitative reviews. Yet, results need to be interpreted with caution in light of some network inconsistencies and high heterogeneity in outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Reinstatement of thought conditioning following extinction and counterconditioning.

Pairing a cue (e.g., an image of a geometrical figure) with an outcome (e.g., an image with aversive content) can result in the cue eliciting thoughts of that outcome (i.e., thought conditioning). Previous research suggests an advantage of counterconditioning over extinction in reducing thoughts of (aversive) outcomes. However, it is unclear how robust this effect is. This study aimed to (1) replicate the previously observed advantage of counterconditioning over extinction and (2) test whether counterconditioning leads to less reinstatement of thoughts of an aversive outcome relative to extinction. Participants (N = 118) underwent a differential conditioning procedure and were then assigned to one of three conditions: extinction (i.e., the aversive outcome was no longer presented), no extinction (i.e., the aversive outcome continued to be presented) and counterconditioning (i.e., the aversive outcome was replaced with positive images). After three unsignaled outcome presentations, participants indicated in a return of fear test the extent to which they thought of the aversive outcome. As predicted, counterconditioning was more successful in reducing thinking of the aversive outcome than extinction. Yet, there were no differences in return of thoughts of the aversive outcome between the two conditions. Future research should consider other return of fear procedures.

Baseline Severity as a Moderator of the Waiting List-Controlled Association of Cognitive Behavioral Therapy With Symptom Change in Social Anxiety Disorder: A Systematic Review and Individual Patient Data Meta-analysis.

Importance: Social anxiety disorder (SAD) can be adequately treated with cognitive behavioral therapy (CBT). However, there is a large gap in knowledge on factors associated with prognosis, and it is unclear whether symptom severity predicts response to CBT for SAD. Objective: To examine baseline SAD symptom severity as a moderator of the association between CBT and symptom change in patients with SAD. Data Sources: For this systematic review and individual patient data meta-analysis (IPDMA), PubMed, PsycInfo, Embase, and the Cochrane Library were searched from January 1, 1990, to January 13, 2023. Primary search topics were social anxiety disorder, cognitive behavior therapy, and randomized controlled trial. Study Selection: Inclusion criteria were randomized clinical trials comparing CBT with being on a waiting list and using the Liebowitz Social Anxiety Scale (LSAS) in adults with a primary clinical diagnosis of SAD. Data Extraction and Synthesis: Authors of included studies were approached to provide individual-level data. Data were extracted by pairs of authors following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline, and risk of bias was assessed using the Cochrane tool. An IPDMA was conducted using a 2-stage approach for the association of CBT with change in LSAS scores from baseline to posttreatment and for the interaction effect of baseline LSAS score by condition using random-effects models. Main Outcomes and Measures: The main outcome was the baseline to posttreatment change in symptom severity measured by the LSAS. Results: A total of 12 studies including 1246 patients with SAD (mean [SD] age, 35.3 [10.9] years; 738 [59.2%] female) were included in the meta-analysis. A waiting list-controlled association between CBT and pretreatment to posttreatment LSAS change was found (b = -20.3; 95% CI, -24.9 to -15.6; P < .001; Cohen d = -0.95; 95% CI, -1.16 to -0.73). Baseline LSAS scores moderated the differences between CBT and waiting list with respect to pretreatment to posttreatment symptom reductions (b = -0.22; 95% CI, -0.39 to -0.06; P = .009), indicating that individuals with severe symptoms had larger waiting list-controlled symptom reductions after CBT (Cohen d = -1.13 [95% CI, -1.39 to -0.88] for patients with very severe SAD; Cohen d = -0.54 [95% CI, -0.80 to -0.29] for patients with mild SAD). Conclusions and Relevance: In this systematic review and IPDMA, higher baseline SAD symptom severity was associated with greater (absolute but not relative) symptom reductions after CBT in patients with SAD. The findings contribute to personalized care by suggesting that clinicians can confidently offer CBT to individuals with severe SAD symptoms.

Intraindividual variability and emotional change as predictors of sudden gains in imagery rescripting and EMDR for PTSD in adult survivors of childhood abuse.

Sudden gains, defined as large and stable improvements in symptom severity during psychological treatment, have consistently been found to be associated with better outcomes across treatments and diagnoses. Yet, insights on coherent predictors of sudden gains and on emotional changes around sudden gains in post-traumatic stress disorder (PTSD) are lacking. We aimed at replicating a measure of intraindividual variability as a predictor for sudden gains and testing its independence from change during treatment. Furthermore, we expected changes in emotions of guilt, shame and disgust prior to sudden gains to predict sudden gains. Data from a pre-registered randomized controlled trial (RCT) of eye-movement desensitization and reprocessing (emdr) and Imagery Rescripting (ImRs) for PTSD in 155 adult survivors of childhood abuse were used. Intraindividual variability of PTSD symptoms in both treatments did not predict sudden gains status and was not independent of change during treatment. In the EMDR condition, levels of shame during treatment predicted sudden gains and shame decreased shortly before a sudden gain in both treatments. Reductions in all emotions during sudden gains were significantly higher for participants with sudden gains than for comparable intervals in non-sudden gainers. Our findings do not support the predictive validity of intraindividual variability for sudden gains. The decrease of guilt, shame and disgust during sudden gains warrants further research on their role as a mechanism of treatment change for PTSD.

Self-efficacy and locus of control as transdiagnostic factors in Middle Eastern refugees.

Background: Many refugees report high levels of psychopathology. As a countermeasure, some psychological interventions aim at targeting mental health difficulties in refugees transdiagnostically. However, there is a lack of knowledge about relevant transdiagnostic factors in refugee populations.Objective: To inform intervention efforts empirically, we investigated whether self-efficacy and locus of control are transdiagnostically associated with symptoms of depression, anxiety, somatisation, psychological distress, and a higher-order psychopathology factor ('p') in Middle Eastern refugees residing in Germany.Method: In total, 200 Middle Eastern refugees took part in this cross-sectional study, comprising 160 male and 40 female refugees. Participants were, on average, 25.56 years old (SD = 9.19), and 182 (91%) originally came from Syria, while remaining refugees were from Iraq or Afghanistan. They completed measures of depression, anxiety, somatisation, self-efficacy, and locus of control.Results: In multiple regression models adjusting for demographic factors (gender and age), self-efficacy and external locus of control were transdiagnostically related to depression, anxiety, somatic symptoms, psychological distress, and a higher-order psychopathology factor. Internal locus of control had no detectable effect in these models.Conclusions: Self-efficacy and external locus of control appear critical in the mental health of refugees and may be important mechanisms in overcoming posttraumatic stress and resettlement stressors. Our findings support the need to target self-efficacy and external locus of control as transdiagnostic factors of general psychopathology in Middle Eastern refugees.

Middle Eastern refugees report high levels of psychopathology.Transdiagnostic interventions are often applied, yet knowledge about relevant transdiagnostic factors is scarce.Self-efficacy and external locus of control emerged as relevant transdiagnostic factors.

Efficacy of psychological interventions for post-traumatic stress disorder in children and adolescents exposed to single versus multiple traumas: meta-analysis of randomised controlled trials.

BACKGROUND: Previous meta-analyses of psychotherapies for children and adolescents with post-traumatic stress disorder (PTSD) did not investigate whether treatment efficacy is diminished when patients report multiple (versus single) traumas. AIMS: To examine whether efficacy of psychological interventions for paediatric PTSD is diminished when patients report multiple (versus single) traumas. METHOD: We systematically searched PsycInfo, MEDLINE, Web of Science and PTSDpubs on 21 April 2022 and included randomised controlled trials (RCTs) meeting the following criteria: (a) random allocation; (b) all participants presented with partial or full PTSD; (c) PTSD is the primary treatment focus; (d) sample mean age <19 years; (e) sample size n ≥ 20. Trauma frequency was analysed as a dichotomous (single versus ≥2 traumas) and continuous (mean number of exposures) potential moderator of efficacy. RESULTS: Of the 57 eligible RCTs (n = 4295), 51 RCTs were included in quantitative analyses. Relative to passive control conditions, interventions were found effective for single-trauma-related PTSD (Hedges' g = 1.09; 95% CI 0.70-1.48; k = 8 trials) and multiple-trauma-related PTSD (g = 1.11; 95% CI 0.74-1.47; k = 12). Psychotherapies were also more effective than active control conditions in reducing multiple-trauma-related PTSD. Comparison with active control conditions regarding single-event PTSD was not possible owing to scarcity (k = 1) of available trials. Efficacy did not differ with trauma exposure frequency irrespective of its operationalisation and subgroup analyses (e.g. trauma-focused cognitive-behavioural therapy only). CONCLUSIONS: The current evidence base suggests that psychological interventions for paediatric PTSD can effectively treat PTSD in populations reporting single and multiple traumas. Future trials for PTSD following single-event trauma need to involve active control conditions.

Aversive well-being comparisons in dysphoria and the role of brooding rumination.

OBJECTIVES: Individuals frequently engage in comparisons on how they are doing relative to different standards. According to the general comparative-processing model, comparisons can be perceived as aversive (appraised as threatening the motives of the comparer) or appetitive (appraised as consonant with, or positively challenging the motives). Research indicates that aversive comparisons are associated with depression. We hypothesize that aversive comparisons play a significant role in the relationship between brooding rumination and depression. Drawing on central propositions of control theory that discrepancies instigate rumination, we investigated the mediating role of brooding rumination in this relationship. Reflecting the different directionality, we also examined whether well-being comparisons mediate the relationship between brooding rumination and depression. METHODS: Dysphoric participants (N = 500) were administered measures of depression and brooding rumination, and the Comparison Standards Scale for Well-being. The latter assesses aversive social, temporal, counterfactual, and criteria-based comparisons regarding their (a) frequency, (b) perceived discrepancy to the standard, and (c) engendered affective valence. RESULTS: The relationship between the frequency of aversive comparisons with depression was partially accounted for by comparison discrepancy and engendered affective valence and brooding rumination. The relationship between rumination and depression was partially mediated by sequential comparison processes. CONCLUSIONS: Longitudinal research needs to unravel the underlying directionality of the relationship between depression, brooding, and comparison. Relevant clinical implications of well-being comparison are discussed.