Inhibition Predicts the Course of Depression and Anxiety Symptoms Among Adolescents: The Moderating Role of Familial Risk.

ABSTRACT: Numerous theoretical models suggest that inhibition difficulties-the inability to moderate automatic responses-contribute to the onset and/or maintenance of internalizing symptoms. Inhibition deficits and internalizing disorders run in families and share overlapping genetic risk factors, suggesting that inhibition deficits may be particularly prognostic of internalizing symptoms in those with high familial risk. This study tested this hypothesis in a longitudinal sample during the transition from adolescence to early adulthood. As hypothesized, prospective associations between inhibition and anxiety and depressive symptoms 8 years later were moderated by familial risk for depression. Specifically, poorer inhibition prospectively predicted greater anxiety and depressive symptoms in those at high (but not low) familial risk for major depressive disorder. These findings provide preliminary support for impaired inhibition as an indicator of risk for later internalizing symptoms in those at high familial risk.

Associations Between Repetitive Negative Thinking and Habituation of Defensive Responding Within and Between Sessions.

Repetitive negative thinking (RNT) is a transdiagnostic risk factor for internalizing psychopathology, and theoretical models suggest that RNT may maintain symptoms by interfering with psychophysiological habituation. The present study therefore examined associations between RNT and habituation within and between study sessions. Community members (N=86) completed a habituation task involving exposure to acoustic probes at up to five sessions spaced 7 days apart on average. Eyeblink startle response was measured using the electromyography startle magnitude. Self-reported anxiety was assessed before and after the habituation task at each session. Multilevel growth curve modeling indicated that RNT was associated with a higher "floor" (i.e., asymptote) of startle responding as evidenced by reduced within-session startle habituation at later sessions. Results suggest that RNT may disrupt startle habituation and are consistent with theoretical models proposing that RNT sustains physiological activation to support avoidance of negative emotional contrasts or perceived future threats. Supplementary Information: The online version contains supplementary material available at 10.1007/s42761-022-00121-w.

The Reliability and Validity of Response-Based Measures of Attention Bias.

Background: Attention bias to threat is a fundamental transdiagnostic component and potential vulnerability factor for internalizing psychopathologies. However, the measurement of attentional bias, such as traditional scores from the dot-probe paradigm, evidence poor reliability and do not measure intra-individual variation in attentional bias. Methods: The present study examined, in three independent samples, the psychometric properties of a novel attentional bias (AB) scoring method of the dot-probe task based on responses to individual trials. For six AB scores derived using the response-based approach, we assessed the internal consistency, test-retest reliability, familial associations, and external validity (using Social Anxiety Disorder, a disorder strongly associated with attentional bias to threatening faces). Results: Compared to traditional AB scores, response-based scores had generally better internal consistency (range of Cronbach's alphas: 0.68-0.92 vs. 0.41-0.71), higher test-retest reliabilities (range of Pearson's correlations: 0.26-0.77 vs. -0.05-0.35), and were more strongly related in family members (range of ICCs: 0.11-0.27 vs. 0-0.05). Furthermore, three response-based scores added incremental validity beyond traditional scores and gender in the external validators of current and lifetime Social Anxiety Disorder. Conclusions: Findings indicate that response-based AB scores from the dot-probe task have better psychometric properties than traditional scores.

Mobile applications may be the future of veteran mental health support but do veterans know yet? A survey of app knowledge and use.

Given the substantial investment in the development of mental health mobile applications (apps), information about penetration in the patient populations of interest is critical. This study describes the proportion of veterans who are knowledgeable of and utilize the Department of Veteran Affairs (VA) and Department of Defense (DoD) mental health apps. A cross-sectional survey of 140 veterans was conducted in primary care and outpatient mental health clinics at a large VA facility. Ninety-one percent of veterans (n = 127) reported smartphone ownership. Of these, 42.5% and 20.4% had heard of and used at least one of the 22 VA/DoD mental health apps, respectively. When veterans were asked to pick the individual VA/DoD apps they had previously used from a list, the proportion of participants who reported prior use ranged from 0% (Moving Forward) to 6.5% (Mindfulness Coach). Treatment for psychiatric problems relevant to the apps did not predict veteran knowledge/use of the VA/DoD apps. Rates of app use remained low among veterans reporting symptoms/diagnoses apps were designed to address (e.g., 7.5% of veterans who reported posttraumatic stress disorder (PTSD) had used PTSD Coach). The most common barrier to app use (endorsed by 65.7% of participants) was awareness of the apps. Expansion of existing VA/DoD efforts to educate patients and providers treating relevant conditions is indicated. Evaluation of evidence-based mobile health support specialists in clinical settings may also be indicated. This study provides critical information to guide future dissemination efforts and to help evaluate the impact of investments to date. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The roles of disgust sensitivity and anxiety sensitivity in attentional bias in dental anxiety.

Individuals with dental anxiety show biased attentional processing of threat- and dental-related information. Disgust sensitivity and anxiety sensitivity are both associated with dental fears and attentional biases. Whereas disgust sensitivity is generally associated with attentional avoidance (Armstrong et al., 2014), anxiety sensitivity may be associated with attentional engagement (Keogh et al., 2001a). Elucidating the role of these constructs in dental anxiety-relevant attentional biases could inform theoretical models and/or intervention recommendations. Participants (N = 51) with high dental anxiety completed a Posner paradigm to assess attentional biases to dental versus neutral stimuli. We examined whether disgust sensitivity and anxiety sensitivity moderated degree of attentional bias. Results indicated that both disgust sensitivity (mutilation subscale) and anxiety sensitivity (physical concerns subscale) statistically moderated degree of attentional bias at trend level, and in opposite directions. Simple effects analyses further indicated that disgust sensitivity regarding mutilation was associated with less attentional bias toward dental relative to neutral stimuli, potentially indicating attentional avoidance, and remained so when adjusting for anxiety sensitivity. In contrast, simple effects analysis indicated that anxiety sensitivity regarding physical concerns was not associated with magnitude of attentional bias. If replicated, findings highlight the potential role of disgust in dental anxiety.

The emotion-elicited late positive potential is stable across five testing sessions.

Many studies have examined associations between neural and behavioral markers of attention to emotion and individual differences in affective functioning. However, the majority of these studies are cross-sectional, and examine associations between brain, behavior, and individual differences at one or two time-points, limiting our understanding of the extent to which these neural responses reflect trait-like patterns of attention. The present study used the Emotional Interrupt paradigm, and examined the stability and trajectory of behavioral (i.e., reaction time to targets following task-irrelevant appetitive, neutral, and aversive images), and neural responses to images (i.e., the late positive potential or LPP), across five sessions separated by one week in 86 individuals. Additionally, we examined the extent to which the LPP and behavioral measures were sensitive to naturally occurring daily fluctuations in positive and negative affect. Results indicate that, though the magnitude of the conditional LPP waveforms decreased over time, the degree of emotional modulation (i.e., differentiation of emotional from neutral) did not; in fact, differentiation of appetitive from neutral increased over time. Behavioral responses were similarly stable across sessions. Additionally, we largely did not observe significant effects of state positive and negative affect on the LPP or behavior over time. Finally, the LPP elicited by appetitive images significantly predicted reaction time to targets following these images. These data suggest that neural and behavioral markers of attention to motivationally salient cues may be trait-like in nature, and may be helpful in future studies seeking to identify markers of vulnerability for diverse forms of psychopathology.

Posttraumatic Stress Disorder Symptom Cluster Structure in Prolonged Exposure Therapy and Virtual Reality Exposure.

The emotional processing theory of posttraumatic stress disorder (PTSD) posits that avoidance is central to PTSD development and maintenance. Prolonged exposure (PE) therapy, which clinically focuses on avoidance reduction, has strong empirical support as a PTSD treatment. Virtual reality exposure (VRE) has been utilized to accelerate avoidance reduction by increasing multisensory engagement. Although some exposure therapy studies have found associations between avoidance and PTSD symptoms, others have indicated that reexperiencing or hyperarousal symptoms drive symptom trajectories. Using a cross-lagged panel design, the present secondary data analysis examined temporal associations between clinician-assessed PTSD symptom clusters during treatment with PE, VRE, or a waitlist control condition. There were no significant differences between PE and VRE regarding symptom clusters at any assessment. Compared to the waitlist condition, individuals who received VRE or PE exhibited earlier reductions in avoidance/numbing symptoms, ß = -.19, 95% CI [-.33, -.05], followed by reductions in hyperarousal symptoms, ß = -.21, 95% CI [-.33, -.09]. Hyperarousal symptoms predicted changes in later avoidance/numbing and reexperiencing outcomes across treatment: pretreatment to midtreatment, ß = .29, 95% CI [.17, .42]; midtreatment to posttreatment, ß = .23, 95% CI [.07, .39]. Reexperiencing symptoms predicted changes in hyperarousal outcomes earlier in treatment, ß = .22, 95% CI [.02, .37], whereas avoidance/numbing symptoms predicted changes in hyperarousal outcomes later in treatment, ß = .18, 95% CI [.04, .32]. These findings support the efficacy of exposure therapy in addressing avoidance/numbing symptoms and highlight the potential importance of hyperarousal symptoms in relation to other symptom clusters.

Concreteness of thoughts and images during suppression and expression of worry.

The avoidance theory of worry (Borkovec, Alcaine, & Behar, 2004) posits that the verbal-linguistic (versus imagery-based) nature of worry elicits abstract (versus concrete) processing, which inhibits affective responding and generates a host of negative consequences. Although suppression of worrisome thinking is maladaptive (Purdon, 1999), expression of worry using vivid imagery may increase concreteness of worrisome thinking and facilitate more adaptive emotional responding. The present study examined whether the valence, content, and expression of mentation impacts concreteness of thought. Participants (N = 62) were randomly assigned to verbalize their thoughts while engaging in either verbal-linguistic- or imagery-based mentation about both worrisome and neutral topics. Participants were also randomly assigned to engage in a 5-min period of suppressing or expressing the target stimuli before engaging in 5-min of freely expressing the targets. Verbalizations of mental content were coded for level of abstractness/concreteness. For neutral stimuli, imagery-based mentation led to greater concreteness than did verbal-linguistic mentation; however, for worrisome stimuli, imagery-based mentation did not enhance concreteness. In addition, for neutral (but not worrisome) stimuli, an initial period of suppression was associated with increased concreteness during subsequent expression. Imagery-based mentation about worrisome stimuli may not enhance concreteness; moreover, unlike suppression of neutral stimuli, suppression of worrisome stimuli may maintain, rather than ameliorate, abstractness of thought.

The Impact of Exposure Therapy on Resting Heart Rate and Heart Rate Reactivity Among Active-Duty Soldiers With Posttraumatic Stress Disorder.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is linked to poor health, including cardiovascular disease. These effects may be a result of increased tonic cardiovascular function and cardiovascular reactivity. Despite PTSD's negative health burden, relatively little is known about whether frontline treatments for PTSD may alleviate cardiovascular risk. METHODS: The current study was a secondary analysis of a larger intervention study of active-duty soldiers with PTSD (n = 104; mean [SD] age = 30.6 [6.7] years; 6% women) randomized to an exposure therapy-either prolonged exposure (PE) or virtual reality exposure (VRE)-or a waitlist control condition. We examined change in participants' resting heart rate (HR) and HR reactivity from baseline (before randomization) to midtreatment and posttreatment using residualized change regression models. RESULTS: The results of the study demonstrated decreased resting HR (B = -5.06, p = .024) and HR reactivity (B = -2.46, p = .005) from baseline to posttreatment of PE and VRE relative to waitlist. Exploratory analyses found that changes in resting HR and HR reactivity were not significantly correlated with either self-reported or clinician-rated PTSD symptom change. CONCLUSIONS: These results suggest that PE and VRE for PTSD may alleviate some cardiovascular health risk associated with PTSD, improving cardiovascular functioning.RCT Registration: ClinicalTrials.gov (identifier: NCT01193725).

Relationship between change in in-vivo exposure distress and PTSD symptoms during exposure therapy for active duty soldiers.

OBJECTIVE: The current study sought to examine the relationship between changes in distress for items on in-vivo exposure hierarchies and posttraumatic stress disorder (PTSD) symptom change over the course of exposure therapy. METHODS: Active duty army soldiers (N = 108) were recruited from a military base in the U.S. and were enrolled in a randomized clinical trial comparing Prolonged Exposure (PE), Virtual Reality Exposure (VRE), and a wait-list control for the treatment of PTSD stemming from deployments to Iraq or Afghanistan. PTSD diagnosis followed DSM-IV-TR criteria. Outcome measures were assessed via self-report and clinician interview. The relationships between in-vivo exposure distress, imaginal exposure distress, and PTSD symptoms, were examined in a factor of curves model for participants in the treatment conditions. RESULTS: Analyses revealed that, when controlling for one another, changes in in-vivo exposure distress were significantly associated with changes in PTSD symptoms (ß = 0.75, 95% CI [0.60, 0.90]), while changes in imaginal exposure distress were not (ß = 0.03, 95% CI [-0.27, 0.33]). The model also revealed that after accounting for the shared variation in trajectories of change, symptom clusters did not have unique variation, meaning that symptom clusters did not change independently. CONCLUSION: Results suggest the possibility that in-vivo exposures are more closely tied to changes in overall PTSD symptoms than imaginal exposures during exposure therapy. Furture research should incorporate more frequent measurement of in-vivo exposure distress to better elucidate these relations over the course of treatment.

Startle during threat longitudinally predicts functional impairment independent of DSM diagnoses.

Heightened responsivity to unpredictable, and perhaps predictable, threat characterizes some internalizing disorders and may be vulnerability factors for psychopathology as well. However, few studies have directly tested whether individual differences in unpredictable and/or predictable threat responding longitudinally predict symptoms of psychopathology and functional outcomes. Examining functioning is particularly important given that functioning is separable from symptoms of psychopathology. The present study examined whether electromyography startle measures of predictable and/or unpredictable threat responding was associated with interviewer-assessed symptoms of internalizing psychopathology and functional impairment at baseline (n = 409) and one-year follow-up (n = 104). Elevated startle responding to unpredictable and predictable threat longitudinally predicted a worsening of functioning over time and this effect was independent of change of symptoms over time. Importantly, threat responding at baseline predicted functional impairment during the follow-up independent of the effects of DSM-defined fear-based (e.g., panic disorder) or distress-misery (e.g., major depressive disorder) internalizing disorders. These findings provide initial support for the incremental validity of neurobiological vulnerability markers of threat responding over and above DSM disorders and highlight the importance of distinguishing functional outcomes from symptom outcomes.

Enhancing the Efficacy of Cognitive Bias Modification for Social Anxiety.

Cognitive bias modification for interpretation (CBM-I) is a promising treatment modality for social anxiety disorder, but effect sizes are relatively small across investigations (Hallion & Ruscio, 2011). Additionally, the extent to which CBM-I impacts other cognitive, emotional, and behavioral outcomes is unclear. This study investigated whether two empirically supported treatment components for anxiety disorders, imaginal exposure (IE) and relaxation, augment the effects of CBM-I and increase the extent to which the effects of CBM-I generalize to behavioral and affective outcomes. We randomly assigned 111 undergraduate students with social anxiety to undergo IE, relaxation, or neutral thinking prior to CBM-I, then measured their interpretation biases, as well as their speaking time, anxiety, and subjective evaluations of performance during a speech task. Results indicated that individuals who received IE prior to CBM-I evidenced more adaptive interpretation biases and less behavioral avoidance during the speech task than did individuals who engaged in relaxation or neutral thinking. However, they did not report differential anxiety, habituation, or evaluations of their performance on the speech task. These findings suggest that the combination of CBM-I with adjunct components that target behavioral, rather than cognitive, mechanisms can facilitate transfer of the effects of CBM-I to reducing behavioral avoidance.

The effect of panic disorder versus anxiety sensitivity on event-related potentials during anticipation of threat.

Attention-related abnormalities are key components of the abnormal defensive responding observed in panic disorder (PD). Although behavioral studies have found aberrant attentional biases towards threat in PD, psychophysiological studies have been mixed. Predictability of threat, an important feature of threat processing, may have contributed to these mixed findings. Additionally, anxiety sensitivity, a dimensional trait associated with PD, may yield stronger associations with cognitive processes than categorical diagnoses of PD. In this study, 171 participants with PD and/or depression and healthy controls completed a task that differentiated anticipation of predictable vs. unpredictable shocks, while startle eyeblink and event-related potentials (ERPs [N100, P300]) were recorded. In all participants, relative to the control condition, probe N100 was enhanced to both predictable and unpredictable threat, whereas P300 suppression was unique to predictable threat. Probe N100, but not P300, was associated with startle eyeblink during both threatening conditions, and was strongest for unpredictable threat. PD was not associated with ERPs, but anxiety sensitivity (physical concerns) was positively associated with probe N100 (indicating reduced responding) in the unpredictable condition independent of PD diagnosis. Vulnerability to panic-related psychopathology may be characterized by aberrant early processing of threat, which may be especially evident during anticipation of unpredictable threats.

The Effects of Worry and Relaxation on Flexibility During Cognitive Restructuring.

Worry is associated with inflexibility in cognitive, emotional, and physiological functioning. In addition, worry's negative valence and abstract level of construal are rigid characteristics that contribute to its nonadaptive consequences. Relaxation and cognitive therapy aim to increase flexibility in chronic worriers, and may have greater efficacy when administered in combination. We examined the extent to which relaxation enhances and/or worry inhibits cognitive flexibility during a cognitive restructuring exercise in which participants generated alternative predictions for their worries. Participants ( n = 189) were randomly assigned to engage in relaxation, worry, or neutral thinking prior to cognitive restructuring. We measured the number and perceived likelihood of alternative predictions generated by participants, and coded those alternative predictions for their degree of positive valence, negative valence, and level of construal (abstractness to concreteness). Worry and relaxation did not lead to different numbers or perceived likelihood of alternative predictions. However, compared with participants with minimal symptoms of generalized anxiety disorder (GAD), those with elevated symptoms of GAD who engaged in prior worry generated alternative predictions characterized by greater negative valence and more abstractness (i.e., less concreteness). We also found that greater negative valence of alternative predictions was associated with more abstractness, whereas greater positive valence of alternative predictions was associated with more concreteness. These findings suggest that after engaging in worry, individuals with GAD may be less able to flexibly shift from the use of nonadaptive characteristics (negative valence, abstractness) associated with feared outcomes to the use of more adaptive characteristics (positive valence, concreteness) when considering alternative predictions.

How many blinks are necessary for a reliable startle response? A test using the NPU-threat task.

Emotion-modulated startle is a frequently used method in affective science. Although there is a growing literature on the reliability of this measure, it is presently unclear how many startle responses are necessary to obtain a reliable signal. The present study therefore evaluated the reliability of startle responding as a function of number of startle responses (NoS) during a widely used threat-of-shock paradigm, the NPU-threat task, in a clinical (N=205) and non-clinical (N=92) sample. In the clinical sample, internal consistency was also examined independently for healthy controls vs. those with panic disorder and/or major depression and retest reliability was assessed as a function of NoS. Although results varied somewhat by diagnosis and for retest reliability, the overall pattern of results suggested that six startle responses per condition were necessary to obtain acceptable reliability in clinical and non-clinical samples during this threat-of-shock paradigm in the present study.

Concreteness of idiographic worry and anticipatory processing.

BACKGROUND AND OBJECTIVES: Worry and anticipatory processing are forms of repetitive negative thinking (RNT) that are associated with maladaptive characteristics and negative consequences. One key maladaptive characteristic of worry is its abstract nature (Goldwin & Behar, 2012; Stöber & Borkovec, 2002). Several investigations have relied on inductions of worry that are social-evaluative in nature, which precludes distinctions between worry and RNT about social-evaluative situations. The present study examined similarities and distinctions between worry and anticipatory processing on potentially important maladaptive characteristics. METHODS: Participants (N = 279) engaged in idiographic periods of uninstructed mentation, worry, and anticipatory processing and provided thought samples during each minute of each induction. Thought samples were assessed for concreteness, degree of verbal-linguistic activity, and degree of imagery-based activity. RESULTS: Both worry and anticipatory processing were characterized by reduced concreteness, increased abstraction of thought over time, and a predominance of verbal-linguistic activity. However, worry was more abstract, more verbal-linguistic, and less imagery-based relative to anticipatory processing. Finally, worry demonstrated reductions in verbal-linguistic activity over time, whereas anticipatory processing demonstrated reductions in imagery-based activity over time. LIMITATIONS: Worry was limited to non-social topics to distinguish worry from anticipatory processing, and may not represent worry that is social in nature. Generalizability may also be limited by use of an undergraduate sample. CONCLUSIONS: Results from the present study provide support for Stöber's theory regarding the reduced concreteness of worry, and suggest that although worry and anticipatory processing share some features, they also contain characteristics unique to each process.

Using a cultural and RDoC framework to conceptualize anxiety in Asian Americans.

Asian Americans are one of the fastest growing minority groups in the United States; however, mental health within this population segment, particularly anxiety disorders, remains significantly understudied. Both the heterogeneity within the Asian American population and the multidimensional nature of anxiety contribute to difficulties in understanding anxiety in this population. The present paper reviewed two sources of heterogeneity within anxiety in Asian Americans: (1) cultural variables and (2) mechanisms or components of anxiety. Specifically, we examined four cultural variables most commonly found in research related to anxiety in Asian Americans: acculturation, loss of face, affect valuation, and individualism-collectivism. We also discussed ways to parse anxiety through a Research Domain Criteria (RDoC) framework, specifically focusing on sensitivity to acute and potential threat, constructs within the Negative Valence System. Previously unpublished preliminary data were presented to illustrate one way of examining ethnic differences in anxiety using an RDoC framework. Finally, this paper offered recommendations for future work in this area.

Perception of active and passive turning in Parkinson disease.

BACKGROUND: Many individuals with Parkinson disease (PD) experience difficulty with turning, yet little is known about the reasons for this difficulty. OBJECTIVE: The authors sought to determine whether individuals with PD can use visual, vestibular, and proprioceptive cues to estimate how far they have turned. METHODS: Fifteen PD subjects and 11 controls performed active and passive turns to the left and right, with and without vision, with amplitudes of 90, 180, 270, and 360 degrees. For active conditions, subjects were told the direction and amplitude of the desired turn and then attempted to turn in place the specified amount via actively stepping. For passive conditions, subjects were told that the disc they stood on would turn and they were to press a button when they had traveled the specified amplitude. RESULTS: There were no differences between PD and control groups in any of the conditions, suggesting that those with PD effectively used sensory cues available in the different conditions to accurately judge distance turned. The authors found no apparent deficits in the visual, vestibular, or proprioceptive systems or in integration of these senses for performance of the turning task tested. CONCLUSIONS: Turning difficulties associated with PD may more likely relate to motor or sensorimotor integration deficits than to pure sensory or sensory integration deficits. Generalizability of the study may be limited by the fact that subjects were tested at a single velocity for passive rotations, were on medication, and had relatively mild PD (primarily H&Y 2).

Changes in perception of active but not passive turning following stepping on the rotating treadmill.

The purpose of this work was to determine whether walking on a rotating disc would cause changes in perception of active and passive turning. Ten healthy control subjects wore a blindfold and earplugs while completing trials of active and passive turning. For active conditions, subjects were told the direction and amplitude of the desired turn and then attempted to turn in place the specified amount via actively stepping. For passive conditions, subjects were told that the disc they stood on would turn and they were to press a button when they had traveled the specified amplitude. Subjects completed active and passive trials to the left and right with amplitudes of 90, 180, 270, and 360 degrees. Subjects then stepped in place for 15 min on a disc rotating clockwise at 90 degrees /s, after which they repeated the trials of active and passive turning. Following rotating treadmill stimulation, subjects asked to turn in the direction opposite disc rotation (i.e., to the left) consistently and significantly overshot their targets in active trials. There were no changes in accuracy of active turning to the right or passive turning in either direction. This indicates that adaptation to the rotating treadmill is expressed even when subjects have a conscious intent to turn. The positive after-effects of the rotating treadmill add to the intended active turning in the direction of the after-effect but there is no decrement in active turning in the direction opposite the after-effect.