The Suicide Dot Probe Task: Psychometric properties and validity in relation to suicide-related outcomes.

BACKGROUND: Attentional biases to suicide-related stimuli have been linked to suicide-related outcomes. However, behavioral tasks that have been previously modified to capture suicide-specific attentional biases have demonstrated inconsistent reliability and validity. Adaptation of the Dot Probe Task, a computerized assessment that has been adapted to study a wide variety of biases, may be a promising candidate for assessing suicide-specific biases. METHODS: In 280 recently discharged inpatients (51% male; Mage = 40.22 years), we evaluated the psychometric properties of a modified Suicide Dot Probe Task. Participants completed this task and assessments of suicidal thoughts and behaviors at baseline and 6-month follow-up. RESULTS: The Suicide Dot Probe Task demonstrated poor-to-moderate internal consistency and poor test-retest reliability, and participant response times were slower to suicide-specific and dysphoric stimuli than positive stimuli. However, there were no differences based on the presence or characteristics of recent or lifetime suicidal ideation or attempts. Participants' suicide-specific biases were not predictive of suicidal ideation or attempts at follow-up. CONCLUSIONS: The Suicide Dot Probe Task exhibited questionable reliability, and differences in attentional biases were not associated with suicidal ideation or attempts. This study contributes to a body of research demonstrating the questionable utility of several behavioral tasks to study suicide-specific attentional biases.

The Skidmore Anxiety Stigma Scale (SASS): A covert and brief self-report measure.

Shame and concerns about stigma are salient barriers to treatment for people with anxiety disorders, and yet very little stigma research has focused on this class of disorders. One explanation for this research gap is the absence of a brief, psychometrically sound measure for assessing public stigma for the anxiety disorders as a class. This (three-study) paper presents the psychometric properties of a 7-item scale that covertly assesses anxiety stigma by presenting as a test of knowledge. Items for the measure were derived from a mixed-methods project (Study 1) which assessed patient (N = 47) experiences with stigma. Subsequently, exploratory factor analysis (N = 270) demonstrated that the scale fit a one-factor solution (Study 2). Study 3 comprehensively evaluated the measure's psychometric properties, including confirming the one-factor solution. Results further demonstrated test-retest reliability, convergent and discriminant validity, and internal consistency. This brief measure fills an important gap by providing means for covertly assessing public stigma encountered by individuals with anxiety disorders and thus subverts social desirability concerns that plague self-report measures of stigma. Thus, the SASS increases the feasibility of work capturing the nature and impact of anxiety stigma - a highly relevant barrier to treatment.

Evaluating approaches to marketing cognitive behavioral therapy: does evidence matter to consumers?

Direct-to-consumer marketing initiatives may improve utilization of evidence-based therapy.  An important decision in such marketing efforts is how to effectively present scientific evidence supporting these treatments to potential consumers (if at all). This OSF preregistered study experimentally tested whether the language used to describe research evidence supporting cognitive behavioral therapy (CBT) for anxiety disorders affected consumer treatment attitudes and intentions. Adult participants (N = 303) recruited via mTurk were first assessed for their understanding of the term "evidence-based." They were then randomized to read a description of CBT employing either: formal research language (e.g., "large-scale clinical trials have demonstrated…"), informal language about research support derived from prior qualitative work (e.g., "people have better results…"), or no information about research. Perceptions of CBT (including credibility and expectancy) and likelihood of pursuing CBT (pull demand) were assessed. Results indicated that only half the sample understood the meaning of the term "evidence-based." The conditions that discussed research support outperformed the control condition on CBT perceptions, credibility, general expectancies, and perceived effectiveness. Post-hoc comparisons provided some evidence that qualitatively-derived language was more effective than formal research language for promoting positive perceptions of CBT. Implications for marketing content are discussed.

Impact of causal explanations for social anxiety disorder on stigma and treatment perceptions.

Background and aims: There is evidence to suggest that biogenetic explanations for symptoms of mental disorders have become increasingly popular. Research suggests that such explanations provokes mixed blessings: biological explanations may reduce blame but also encourage prognostic pessimism and promote perceptions of pharmacological treatment over psychotherapy. The goal of this study was to evaluate the impact of different causal explanations on social anxiety disorder.Method: About 205 adults completed an experiment where they read a vignette describing an individual with social anxiety disorder and were randomly assigned to a symptom explanation that was: (1) biological, (2) biopsychosocial, (3) psychosocial, or (4) no explanation.Results: The psychosocial condition yielded the highest perceived credibility and lowest attributions of blame. The biological condition promoted positive expectations for medication effectiveness compared to other conditions. Conditions did not differ on prognostic expectations.Conclusions: Calls attention to the risk of generalizing from previous research to mental disorders as a whole.

Does Motivation Impact OCD Symptom Severity? An Exploration of Longitudinal Effects.

Understanding the role of patient motivation in OCD treatment is of clinical importance given the requisite autonomous role of patients in Exposure and Response Prevention. The present study investigated state- and trait-like relations between three variables: two previously established motivational constructs, readiness to change (RTC) and committed action (CA), derived from the University of Rhode Island Change Assessment, and OCD symptom severity as measured by the self-report Yale-Brown Obsessive Compulsive Scale (Y-BOCS-SR). Utilizing a random-intercept cross-lagged panel model (RI-CLPM) design, we assessed autoregressive, within-time correlations, and cross-lagged effects of RTC, CA, and Y-BOCS-SR scores at admission, month 1 of treatment, and discharge from an intensive/residential treatment program for OCD. Results revealed significant autoregressive (i.e., state-like) effects for CA and Y-BOCS-SR, negative within-time correlations between state CA and Y-BOCS-SR across all time points, a positive within-time correlation between state CA and RTC at admission, and a cross-lagged effect between state Y-BOCS-SR at month 1 of treatment and state RTC at discharge. Results also demonstrated that the stability of the RTC variable was attributable to trait-like factors in the present sample. This study is novel in its use of RI-CLPM in an OCD sample and represents an important addition to the literature on the longitudinal impacts of dynamic constructs of motivation. Our findings may provide future researchers with strategies to supplement ERP with CA-driven motivational interviewing.

Attentional Bias Modification for Social Anxiety Disorder: What do Patients Think and Why does it Matter?

BACKGROUND: In the past decade, a great deal of research has examined the efficacy and mechanisms of attentional bias modification (ABM), a computerized cognitive training intervention for anxiety and other disorders. However, little research has examined how anxious patients perceive ABM, and it is unclear to what extent perceptions of ABM influence outcome. AIMS: To examine patient perceptions of ABM across two studies, using a mixed methods approach. METHOD: In the first study, participants completed a traditional ABM program and received a hand-out with minimal information about the purpose of the task. In the second study, participants completed an adaptive ABM program and were provided with more extensive rationale and instructions for changing attentional biases. RESULTS: A number of themes emerged from qualitative data related to perceived symptom changes and mechanisms of action, acceptability, early perceptions of the program, barriers/facilitators to engagement, and responses to adaptive features. Moreover, quantitative data suggested that patients' perceptions of the program predicted symptom reduction as well as change in attentional bias. CONCLUSIONS: Our quantitative data suggest that it may be possible to quickly and inexpensively identify some patients who may benefit from current ABM programs, although our qualitative data suggest that ABM needs major modifications before it will be an acceptable and credible treatment more broadly. Although the current study was limited by sample size and design features of the parent trials from which these data originated, our findings may be useful for guiding hypotheses in future studies examining patient perceptions towards ABM.

Improving perceptions of cognitive-behavioral therapy with brief website exposure: Does neuroscientific allure impact attitudes?

BACKGROUND AND OBJECTIVES: The current study aimed to determine whether brief exposure to a webpage about cognitive-behavioral therapy (CBT) for the anxiety disorders improved knowledge and perceptions of this treatment. Further, this study tested whether participants were uniquely compelled by CBT if the mechanism of change cited neurological processes. METHOD: Participants (N = 389) recruited online viewed a webpage screenshot that described CBT for anxiety. Participants were randomized to view a version of the webpage which either described the mechanism of change as: 1) psychological, 2) neurological, 3) combination of neurological and psychological, or 4) no mechanism described. Participants completed measures of knowledge and perception of CBT before and after viewing the webpage. Credibility ratings and symptoms were assessed after viewing the webpage. RESULTS: Knowledge of CBT was limited and perceptions were largely neutral to somewhat positive at baseline. Both knowledge and perceptions of CBT meaningfully improved after viewing the webpage. Mechanism of change did not impact perceptions of CBT or its credibility, though in the neurological and combination conditions there was less improvement in knowledge than in the psychological or control conditions. Greater symptoms of anxiety were associated with slightly less improvement in knowledge and perceptions. LIMITATIONS: The study did not include long-term follow up, so the durability of the effects is unknown. Further, sample homogeneity undermines broad generalizability. CONCLUSIONS: There is significant room and capacity to improve lay-people's knowledge and perceptions of CBT. Neurological explanations did not appear to uniquely promote the perception of CBT or its credibility.

Adaptation of a paradigm for examining the development of fear beliefs through the verbal information pathway in preschool-age children.

Verbal threat information has been shown to induce fear beliefs in school-age children (i.e. 6-12 years; for a review see Muris & Field, 2010). The current study adapted an existing paradigm (Field & Lawson, 2003) to examine the impact of verbal threat information on self-report and behavioral measures of fear in preschool-age children. Thirty children (aged 3-5) were provided with threat, positive, or no information about three novel Australian marsupials. There was a significant increase in fear belief for the animal associated with threat information compared to the animal associated with positive or no information. Verbal threat information did not impact behavioral avoidance in the complete sample; however, findings from an exploratory subgroup analysis excluding three-year-olds indicated that children demonstrated significant behavioral avoidance for the threat condition compared to the positive condition. These findings provide additional support for Rachman's theory of fear acquisition (1977, 1991) and suggest this paradigm may be used to examine the age at which verbal threat information becomes a relevant mode of fear acquisition for young children.

A Randomized Survey of the Public's Expectancies and Willingness to Participate in Clinical Trials of Antidepressants Versus Psychotherapy for Depression.

BACKGROUND: Expectancies and treatment preferences are known to affect the outcomes of patients enrolled in clinical trials for depression, but there is little research on their influence when the public is considering participation in these trials. METHOD: We conducted an online survey (May 2013) in which participants (N = 615) were randomly assigned to read hypothetical descriptions of clinical trials for depression based on 1 of the following study designs: medication versus placebo, medication versus medication, psychotherapy versus placebo, or psychotherapy versus psychotherapy. Afterward, individuals rated willingness to participate in the trial, logic and credibility of the treatments, and expected success and improvement in symptoms. RESULTS: There were no differences in expectancies for ratings of credibility and logic or success and improvement among clinical trial designs. However, self-reported willingness to participate in the study was rated significantly higher in the 2 psychotherapy trial designs (active-comparator and placebo-controlled) compared with the active-comparator medication design (P < .05). Psychiatric treatment history, general treatment preferences, and depression severity were positively correlated with willingness to participate primarily in the active-comparator medication design. CONCLUSIONS: Consistent with the broader treatment preference literature, individuals reported a greater willingness to participate in psychotherapy compared with antidepressant studies. Thus, people's perceptions of different treatments are likely to influence not only the outcomes of clinical trials for depression but also decisions to participate in these trials in the first place.

The Extinction and Return of Fear of Public Speaking.

Prior studies indicate extinguished fear often partially returns when participants are later tested outside the extinction context. Cues carried from the extinction context to the test context sometimes reduce return of fear, but it is unclear whether such extinction cues (ECs) reduce return of fear of public speaking. Here we assessed return of fear of public speaking, and whether either of two types of ECs can attenuate it. Participants gave speeches of increasing difficulty during an exposure practice session and were tested 2 days later in a different context. Testing occurred in the presence of physical ECs, after mentally rehearsing the exposure session, or without either reminder. Practice reduced fear of public speaking, but fear partially returned at test. Neither physical nor mental ECs reduced partial return of fear of public speaking. The return of extinguished fear of public speaking, although small, was reliable, but not appreciably sensitive to presence of ECs.

Understanding Perceptions of Anxiety Disorders and Their Treatment.

Characterizing areas of limited knowledge about anxiety disorders and their treatment may help inform treatment dissemination efforts and public health programming. In a sample of 626 adults recruited via Amazon's Mechanical Turk, this study evaluated 1) perceptions of symptoms of anxiety disorders and depression, 2) perceived usefulness of coping approaches (i.e., professional and non-professional help), and 3) awareness of available resources. Results indicated that participants generally recognized that symptoms warranted professional help, and recognition was associated with self-efficacy for seeking mental health care, but not with participants' own symptoms. Furthermore, participants perceived psychotherapy to be the most useful coping approach. Of concern is the perception that symptoms are the result of personal weakness (particularly among male participants and for social anxiety disorder), as well as limited knowledge about publicly available resources. In all, results suggest that there are areas for growth regarding mental health literacy for anxiety disorders.

Skidmore Clips of Neutral and Expressive Scenarios (SCENES): Novel dynamic stimuli for social cognition research.

Social cognition research has relied primarily on photographic emotional stimuli. Such stimuli likely have limited ecological validity in terms of representing real world social interactions. The current study presents evidence for the validity of a new stimuli set of dynamic social SCENES (Skidmore Clips of Emotional and Neutral Expressive Scenarios). To develop these stimuli, ten undergraduate theater students were recruited to portray members of an audience. This audience was configured to display (seven) varying configurations of social feedback, ranging from unequivocally approving to unequivocally disapproving (including three different versions of balanced/neutral scenes). Validity data were obtained from 383 adult participants recruited from Amazon's Mechanical Turk. Each participant viewed three randomly assigned scenes and provided a rating of the perceived criticalness of each scene. Results indicate that the SCENES reflect the intended range of emotionality, and pairwise comparisons suggest that the SCENES capture distinct levels of critical feedback. Overall, the SCENES stimuli set represents a publicly available (www.scenesstimuli.com) resource for researchers interested in measuring social cognition in the presence of dynamic and naturalistic social stimuli.

An attempt to target anxiety sensitivity via cognitive bias modification.

Our goals in the present study were to test an adaptation of a Cognitive Bias Modification program to reduce anxiety sensitivity, and to evaluate the causal relationships between interpretation bias of physiological cues, anxiety sensitivity, and anxiety and avoidance associated with interoceptive exposures. Participants with elevated anxiety sensitivity who endorsed having a panic attack or limited symptom attack were randomly assigned to either an Interpretation Modification Program (IMP; n = 33) or a Control (n = 32) condition. During interpretation modification training (via the Word Sentence Association Paradigm), participants read short sentences describing ambiguous panic-relevant physiological and cognitive symptoms and were trained to endorse benign interpretations and reject threatening interpretations associated with these cues. Compared to the Control condition, IMP training successfully increased endorsements of benign interpretations and decreased endorsements of threatening interpretations at visit 2. Although self-reported anxiety sensitivity decreased from pre-selection to visit 1 and from visit 1 to visit 2, the reduction was not larger for the experimental versus control condition. Further, participants in IMP (vs. Control) training did not experience less anxiety and avoidance associated with interoceptive exposures. In fact, there was some evidence that those in the Control condition experienced less avoidance following training. Potential explanations for the null findings, including problems with the benign panic-relevant stimuli and limitations with the control condition, are discussed.

Initial data on recollections of pathways to inflated responsibility beliefs in patients with obsessive-compulsive disorder.

BACKGROUND: Despite literature establishing a relationship between maladaptive beliefs and symptoms of obsessive-compulsive disorder (OCD), there are few studies addressing how these beliefs develop. Salkovskis and colleagues (1999) proposed specific domains of childhood experiences leading to heightened beliefs regarding responsibility. Prior studies in students and individuals who just completed treatment for OCD have found support for this theory. However, we are not aware of published data from individuals with current OCD. AIMS: This paper presents initial data from adults currently meeting criteria for OCD as well as both anxious and non-anxious controls. METHOD: Recollections of childhood experiences, current OCD-related beliefs, and OCD symptoms were assessed using self-report measures in 39 individuals seeking treatment for OCD, 36 anxious controls and 39 healthy controls. RESULTS: Initial data suggested that in individuals with OCD, increased reports of childhood exposure to overprotection and experiences where one's actions caused or influenced misfortune were associated with stronger OCD-related beliefs. Further, compared to community controls, individuals with OCD reported more childhood experiences where one's actions caused or influenced misfortune, though they did not differ from anxious controls in childhood responsibility experiences. CONCLUSIONS: These initial findings provide minimal support for the proposed model of the development of inflated responsibility beliefs, and highlight the need for research examining the etiology of OCD related beliefs with updated models, larger samples, and ultimately using prospective methods.

Symptoms of the anxiety disorders in a perinatal psychiatric sample: a chart review.

Symptoms of anxiety are a central feature of perinatal mental health, yet the anxiety disorders have received considerably less attention than depression in both perinatal research and practice. The present investigation involved a retrospective review of the clinical records of 334 patients seen at a psychiatric day hospital program serving pregnant and postpartum women. We examined the frequency with which the patients in this setting reported symptoms of anxiety, clinical correlates of elevated anxiety, and patterns of diagnosis in the clinical record. The results suggest that anxiety symptoms are very common in this population and that the presence of anxiety is associated with a more severe clinical profile, including higher rates of suicidality and increased use of psychotropic medications during pregnancy and postpartum. Although anxiety symptom levels were markedly elevated in this sample, anxiety disorders were diagnosed at relatively low rates. Implications for clinical practice, including discharge and treatment planning, are discussed.

Perinatal antidepressant use: understanding women's preferences and concerns.

Perinatal depression is prevalent and linked with a host of adverse consequences for women and newborns. Rates of engagement in depression treatment are, however, strikingly low among pregnant and postpartum women, with the majority of affected women receiving no mental health treatment. Research indicates that perinatal women are extremely reluctant to take antidepressant medications, yet the nature of women's concerns and treatment decision- making patterns have not been well documented. Developing a clearer understanding of women's treatment preferences and behaviors may help identify solutions to the under-treatment of perinatal depression. In this mixed methods study, we conducted in-depth interviews with 61 pregnant women, approximately half of whom were experiencing clinical levels of depression. In addition to assessing psychiatric diagnoses, symptoms, and functional impairment, we conducted qualitative interviews addressing women's preferences for depression treatment, concerns, and decision-making patterns. Consistent with prior reports, women were significantly more likely to voice a preference for non-pharmacologic depression treatments, as opposed to antidepressant medications. Many depressed women reported a great degree of uncertainty regarding how to treat their depression, and those with more severe depression symptoms were more likely to endorse decisional conflict. Analysis of qualitative comments yielded detailed information about the nature of women's concerns and preferences related to use of antidepressant medications and other aspects of treatment engagement. We discuss findings in the context of improving patient-centered care for perinatal depression.

Time-course of attention biases in social phobia.

Theoretical models of social phobia implicate preferential attention to social threat in the maintenance of anxiety symptoms, though there has been limited work characterizing the nature of these biases over time. The current study utilized eye-movement data to examine the time-course of visual attention over 1500ms trials of a probe detection task. Nineteen participants with a primary diagnosis of social phobia based on DSM-IV criteria and 20 non-clinical controls completed this task with angry, fearful, and happy face trials. Overt visual attention to the emotional and neutral faces was measured in 50ms segments across the trial. Over time, participants with social phobia attend less to emotional faces and specifically less to happy faces compared to controls. Further, attention to emotional relative to neutral expressions did not vary notably by emotion for participants with social phobia, but control participants showed a pattern after 1000ms in which over time they preferentially attended to happy expressions and avoided negative expressions. Findings highlight the importance of considering attention biases to positive stimuli as well as the pattern of attention between groups. These results suggest that attention "bias" in social phobia may be driven by a relative lack of the biases seen in non-anxious participants.

Social anxiety and difficulty disengaging threat: evidence from eye-tracking.

Theoretical models of social phobia propose that biased attention contributes to the maintenance of symptoms; however these theoretical models make opposing predictions. Specifically, whereas Rapee and Heimberg (1997) suggested the biases are characterised by hypervigilance to threat cues and difficulty disengaging attention from threat, Clark and Wells (1995) suggested that threat cues are largely avoided. Previous research has been limited by the almost exclusive reliance on behavioural response times to experimental tasks to provide an index of attentional biases. The current study evaluated the relationship between the time-course of attention and symptoms of social anxiety and depression. Forty-two young adults completed a dot-probe task with emotional faces while eye-movement data were collected. The results revealed that increased social anxiety was associated with attention to emotional (rather than neutral) faces over time as well as difficulty disengaging attention from angry expressions; some evidence was found for a relationship between heightened depressive symptoms and increased attention to fear faces.

Retrospective reports of behavioral inhibition and young adults' current symptoms of social anxiety, depression, and anxious arousal.

The primary goal of this study was to investigate the specificity of the social versus nonsocial components of self-reported behavioral inhibition during childhood with young adults' current symptoms of anhedonic depression, social anxiety, and anxious arousal. As hypothesized, the social component of BI demonstrated some specificity for symptoms of social anxiety versus other internalizing disorders. Furthermore, results support the hypothesis that the relationship between BI and depressive symptoms is mediated by levels of social anxiety and anxious arousal.