A mixed methods investigation of reasons underlying fear of positive evaluation.

Fear of negative evaluation (FNE) is a hallmark feature of social anxiety disorder (SAD). There is also evidence that people with SAD fear receiving positive evaluation and that fear of positive evaluation (FPE) is distinct from FNE. However, researchers have speculated that concerns related to negative evaluation may actually underlie FPE. This study sought to advance our understanding of FPE by employing both quantitative and qualitative methods to assess the reasons underlying participants' endorsement of FPE on the Fear of Positive Evaluation Scale and the extent to which these reasons reflect FNE versus FPE in a sample of individuals with SAD (n = 47) and a nonclinical comparison group (n = 49). Results indicated that responses to the FPES items primarily reflected an underlying FNE. Consistent with contemporary cognitive-behavioural theories of SAD, fear of proximal or eventual negative judgement emerged as the most common reason for participants' responses on the FPES. However, participants reported other reasons that did not reflect FNE, such as fear of hurting people's feelings and uncertainty associated with positive evaluation. All of the reasons underlying participants' ratings on the FPES were reported by both the SAD group and the nonclinical comparison group; however, individuals with SAD endorsed each of the reasons to a greater extent. These findings suggest that the FPES does not exclusively assess FPE as intended; however, the emergence and endorsement of reasons other than FNE suggest that FPE exists as a distinct construct.

Interpersonal dysfunction in individuals high in chronic worry: relations with interpersonal problem-solving.

BACKGROUND: Interpersonal dysfunction has been proposed as an important maintenance factor in chronic worry and generalized anxiety disorder (GAD). Perceptions of problems and the problem-solving process as threatening, and unhelpful (e.g. avoidant, impulsive) problem-solving styles are implicated in worry and have also been suggested to be associated with dysfunctional interpersonal styles. AIMS: The present study assessed the relationships between interpersonal dysfunction and problem-solving orientation, approach, and effectiveness in a sample of individuals high in chronic worry and investigated the indirect effect of interpersonal dysfunction on GAD symptom severity through negative problem-solving beliefs and approaches. METHOD: Fifty-nine community participants completed questionnaires and an interpersonal problem-solving task. RESULTS: Greater interpersonal dysfunction was significantly associated with greater negative problem-solving orientation and greater habitual avoidant and impulsive/careless problem-solving styles. Greater interpersonal dysfunction was associated with poorer effectiveness of solutions when the task problem involved conflict with a romantic partner. Negative problem-solving orientation fully mediated the relationship between interpersonal dysfunction and GAD symptoms. CONCLUSIONS: These findings support that problem-solving processes are implicated in interpersonal dysfunction and that negative beliefs about problem-solving account for the relationship between interpersonal dysfunction and GAD symptoms. Theoretical implications are discussed.

Mechanisms and moderators of behavioural couples therapy for alcohol and substance use disorders: an updated review of the literature.

INTRODUCTION: Behavioural couples therapy (BCT) and alcohol behavioural couples therapy (ABCT) are couples-based interventions for substance use disorders (SUDs) that have been deemed a 'gold standard' treatment. Despite the substantial amount of promising research, there is a lack of research on the active components of treatment and treatment mechanisms and moderators. Since the most recent meta-analysis, a number of studies have been conducted that advance our understanding of the efficacy of BCT and ABCT. AIMS: The purpose of the present review was to provide an update on the current knowledge of these treatments and to investigate mediators and moderators of treatment. METHOD: A systematic search strategy of relevant databases from 2008 to 2021 identified 20 relevant articles that were coded for relevant information including study design, treatment, outcomes, as well as mechanisms and moderators. RESULTS: The results indicated that BCT and ABCT are successful in reducing alcohol and substance use for both male and female clients, dual problem couples, and for reducing post-traumatic stress symptoms and intimate partner violence. The reviewed studies discussed a number of treatment mechanisms, with the most studied mechanism being relationship functioning. Moderators included relationship functioning and patient gender. CONCLUSIONS: The results point to the need for additional research on active treatment components, mechanisms and moderators, in order to provide a more efficient and cost-effective treatment.

Look before you leap: the role of negative urgency in appraisals of ambiguous and unambiguous scenarios in individuals high in generalized anxiety disorder symptoms.

Negative interpretation bias, the propensity to make threatening interpretations of ambiguous information, is associated with symptoms of generalized anxiety disorder (GAD). Apart from its relationship with intolerance of uncertainty (IU), little is known about what explains the presence of this cognitive bias in GAD. One factor may be negative urgency (NU), the tendency to take rash action when distressed, which is related to GAD symptoms and to cognitive biases in nonclinical populations. The aim of the present study was to examine the relationship between NU and interpretation bias in individuals high in GAD symptoms (N = 111). IU, trait anxiety, and other forms of impulsivity were examined concurrently as competing correlates of interpretation bias. Greater NU and IU were found to be unique correlates of greater threatening interpretations of ambiguous scenarios. Greater NU was also a unique correlate of greater threatening interpretations of negative and positive scenarios. No other forms of impulsivity were uniquely related to interpretation bias. The findings suggest that greater NU may have a role in the tendency for individuals high in GAD symptoms to make threatening interpretations in response to ambiguous scenarios, overtly threatening situations, and situations without indication of threat or danger. Theoretical implications of these findings are discussed.

Functional connectivity of hippocampal subregions in PTSD: relations with symptoms.

BACKGROUND: Posttraumatic stress disorder (PTSD) is associated with abnormal hippocampal activity; however, the functional connectivity (FC) of the hippocampus with other brain regions in PTSD and its relations with symptoms warrants further attention. We investigated subregional hippocampal FC in PTSD during a resting state compared with a trauma-exposed control (TEC) group. Based on extant research, we targeted the FCs of the anterior and posterior hippocampal subregions with the amygdala, medial prefrontal cortex (mPFC), and the posterior cingulate (PCC). METHODS: Resting-state functional magnetic resonance images were acquired from 11 individuals with PTSD and 13 trauma-exposed controls. Anterior and posterior hippocampal FC was compared between groups. Within the PTSD and TEC groups, subregional hippocampal FC was correlated with scores on the Clinician-Administered PTSD Scale (CAPS) at time of scan and 4 months post-scan. RESULTS: Those with PTSD had significantly greater FC compared with the TEC group between the left posterior hippocampus and the bilateral PCC (g's > .96). Direct contrasts of the Fisher z-transformed coefficients indicated that the correlations between CAPS scores 4 months post scan and the FC between the left hippocampal head and the right PCC (z = - 2.07, p = .039) as well as the FC between the right hippocampal tail and the right mPFC (z = - 2.19, p = .029) were significantly greater in the PTSD group compared to the TEC group. CONCLUSIONS: These results support between-group differences in posterior hippocampal FC and different relations with PTSD future symptoms, underscoring associations with the anterior and posterior hippocampus. These findings enrich our understanding of PTSD pathophysiology and provide support for future investigations of imaging biomarkers predictive of disease progression.

An examination of worry and self-distancing as coping strategies for anxiety-provoking experiences in individuals high in worry.

OBJECTIVES: This preliminary online study investigated the short-term effects of self-distancing, worry, and distraction on anxiety and worry-related appraisals among individuals high in worry. DESIGN AND METHODS: N = 104 community members high in trait worry were randomly assigned to think about a personally identified worry-provoking situation using self-distancing (SC), worry (WC), or distraction (DC). Participants rated their anxiety (Visual Analogue Scale for Anxiety) and appraisals of the situation (Perceived Probability, Coping, and Cost Questions) at post-task and one-day follow-up. RESULTS: Mixed factorial ANOVAs revealed an increase in anxiety within the WC (d = .475) and no difference in anxiety within the SC (d = .010) from pre- to post-task. There was no difference in anxiety within the DC (p = .177). Participants within the SC reported a decrease in the perceived cost associated with their identified situation from pre- to post-task (d = .424), which was maintained at one-day follow-up (d = .034). Participants reported an increase in perceived ability to cope from post-task to one-day follow-up (d = .236), and from pre-task to one-day follow-up (d = .338), regardless of condition. CONCLUSIONS: Self-distancing may prevent increases in anxiety and catastrophizing while reflecting on a feared situation.

Correlates of Dampening and Savoring in Generalized Anxiety Disorder.

Chronic worry and generalized anxiety disorder (GAD) symptoms are associated with infrequent savoring, and high dampening, of positive emotions. The goal of the present study was to investigate the indirect role of GAD-relevant processes, including intolerance of uncertainty (IU), fear of negative emotional contrasts, and negative beliefs about positive emotion and its regulation, in the relationship between GAD symptom severity and the tendency to engage in dampening and not savor positive emotions. Community participants (N = 233) completed questionnaires online. In separate models, IU, fear of negative emotional contrasts, and negative beliefs about positive emotion and its regulation fully mediated the relationships between GAD symptom severity and greater dampening and lower savoring. However, controlling for depression, only IU remained a significant mediator. A post hoc latent analysis of the mediators provided support for an underlying construct that may reflect intolerance of uncomfortable states. Intolerance of uncomfortable states was found to significantly mediate the relationship between GAD symptoms and greater dampening and lower savoring. Difficulty withstanding uncertainty may be particularly relevant in understanding why people with elevated GAD symptoms engage in efforts to avoid experiencing positive emotions. Further, the findings suggest that there may be a common factor underlying a variety of GAD-associated constructs reflecting a broad intolerance of uncomfortable inner states. Theoretical and clinical implications are discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s41811-022-00145-x.

Family and Couple Integrated Cognitive-Behavioural Therapy for Adults with OCD: A Meta-Analysis.

Reprinted with permission from Elsevier.

Family and couple integrated cognitive-behavioural therapy for adults with OCD: A meta-analysis.

BACKGROUND: Integrating family into the treatment of obsessive-compulsive disorder (OCD) is standard in pediatric populations; however, in adult populations, patients are typically treated independent of their family. Yet, there is compelling evidence to suggest that family members exacerbate OCD symptoms, and thus there is a strong rationale for integrating family members into the treatment of adult OCD. The present meta-analysis examined whether family treatment is effective for OCD in adult populations as well as moderators of treatment outcome. METHODS: Fifteen studies were reviewed (16 independent samples). RESULTS: Family treatment for adult OCD was found to improve patient OCD symptoms, depression, anxiety, and functional impairment. There was also improvement in patient and family-reported general relationship satisfaction, antagonism, accommodation, and family member's mental health. Individual treatment format and targeting family accommodation were especially beneficial for improving patient depression. Family members reported greater relational improvements than patients. Fewer patient treatment sessions were associated with greater improvement in antagonism, as was female gender. Fewer sessions for family members was associated with greater improvement in family member mental health. FIT outperformed controls with individual ERP on reduction of OCD and depression symptoms, accommodation, and improvement in functional impairment. LIMITATIONS: Limitations of the present review include a relatively small sample size, lenient study inclusion criteria, and the subjectivity of some moderator categories. CONCLUSIONS: Family-integrated treatment appears to be effective for adult OCD, related symptoms, and relationship factors. There is preliminary support that family-integrated treatments lead to better outcomes than individual treatment. Clinical recommendations are discussed.

Interpersonal dysfunction and treatment outcome in GAD: A systematic review.

Interpersonal dysfunction is posited to maintain worry and generalized anxiety disorder (GAD). It has been suggested that the low remission rates in psychotherapy for GAD may be attributable, in part, to inadequately addressing interpersonal dysfunction. This paper systematically reviewed the literature examining the moderating role of interpersonal dysfunction on GAD psychotherapy outcomes and change in interpersonal dysfunction over the course of GAD treatment. Thirteen studies were identified, seven of which examined the relationship between interpersonal dysfunction or distress and treatment outcome and nine investigated change in interpersonal dysfunction over the course of psychotherapy. The majority of studies indicated that interpersonal dysfunction improves following psychotherapy. However, there is preliminary evidence that not all subscales of interpersonal dysfunction improve, including subscales relevant to GAD pathology such as overly-nurturant dysfunction. Further, greater interpersonal dysfunction predicted worse treatment outcomes. As such, interpersonal dysfunction may hinder treatment success and further research is needed to delineate for whom additional or integrated interpersonal interventions may be needed. Approaches to target interpersonal dysfunction in GAD are discussed.

An examination of emotion dysregulation in maladaptive perfectionism.

Maladaptive perfectionism has been shown to be associated with undesirable outcomes, such as elevated negative emotions and psychopathological traits. Perhaps unsurprisingly, there is preliminary evidence that maladaptive perfectionism is also related to emotion dysregulation. However, the nature of emotion dysregulation in perfectionism has not been characterized. In this review, Gross and Jazaieri's (2014) clinically-informed framework of emotion dysregulation is used to review the evidence of emotion dysregulation in maladaptive perfectionism. Specifically, this paper reviews evidence of problematic emotional experiences and unhelpful emotion regulation strategies in maladaptive perfectionism and discusses how poor emotional awareness and emotion regulation goals may also contribute to emotion dysregulation. A conceptual model of these components of emotion dysregulation in maladaptive perfectionism is proposed in which heightened negative affect in response to threatened perfectionistic standards is posited to be at the core of emotion dysregulation, and implicit and explicit unhelpful emotion regulation strategies and poor emotion regulation goals are suggested to contribute to further dysregulation and elevated negative affect. Clinical implications, limitations in the extant research, and future directions are discussed.

Psychological symptoms and perceived cognitive impairment in multiple sclerosis: The role of rumination.

PURPOSE/OBJECTIVE: Perceived cognitive impairment is a common concern among individuals with multiple sclerosis (MS) and is associated with prevalent psychological symptoms, namely depression and anxiety. The mechanisms by which these psychological symptoms are associated with perceived cognitive impairment among people diagnosed with MS have been unexplored. A possible mechanism is rumination, a maladaptive form of self-reflection that is commonly associated with anxiety and depression. The purpose of this study was to examine the associations of symptoms of anxiety and depression with perceived cognitive impairment, and to examine whether anxiety and depression indirectly affect cognitive impairment through rumination. Research Method/Design: The study utilized a cross-sectional observational design. People diagnosed with MS (N = 111) were recruited from an MS clinic in Toronto, and through the community. Participants completed self-report questionnaires that included the Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ), the Hospital Anxiety and Depression Scale (HADS), and the Rumination-Reflection Questionnaire (RRQ). Two indirect effect statistical analyses were conducted using bootstrapping techniques. RESULTS: We found a positive association between both symptoms of depression and anxiety and perceived cognitive impairment. Moreover, psychological symptoms were related to perceived cognitive impairment indirectly through rumination, indicating ruminative thinking style may be implicated in the relationship between anxiety, depression, and perceived cognitive impairment. CONCLUSIONS/IMPLICATIONS: These findings provide additional support for previous research examining the relationship between psychological symptoms (e.g., anxiety and depression) and perceived cognitive impairment, and enrich our understanding of a potential mechanism driving these relationships. (PsycINFO Database Record