Impulsivity as key bridge symptoms in cross-sectional and longitudinal networks of ADHD and ODD.

BACKGROUND: Impulsivity is viewed as key to attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders (DBD). Yet, to date, no work has provided an item-level analysis in longitudinal samples across the critical developmental period from childhood into adolescence, despite prior work suggesting items exhibit differential relevance with respect to various types of impairment. The current study conducted a novel longitudinal network analysis of ADHD and oppositional defiant disorder (ODD) symptoms between childhood and adolescence, with the important applied prediction of social skills in adolescence. METHODS: Participants were 310 children over-recruited for clinical ADHD issues followed longitudinally for six years in total with gold standard diagnostic procedures and parent and teacher ratings of symptoms and social outcomes. RESULTS: Findings from baseline, Year 3, and Year 6 suggested Difficulty waiting turn, Blurts, and Interrupts/intrudes were key bridge items across cross-sectional and longitudinal parent-reported DBD networks. Furthermore, shortened symptom lists incorporating these symptoms were stronger predictors of teacher-rated social skills 5 years later compared to total DBD scores. CONCLUSIONS: Such findings are consistent with the trait impulsivity theory of DBD and ADHD and may inform useful screening tools and personalized intervention targets for children at risk for DBD during adolescence.

BPD Compass: Using a dimensional model of psychopathology to treat co-occurring borderline personality disorder and posttraumatic stress symptoms.

BPD Compass is a transdiagnostic psychotherapy that includes cognitive, behavioral, and mindfulness skills targeting the personality dimensions of negative affectivity, disinhibition, and antagonism. Given considerable symptom comorbidity and overlap in etiology between borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD), this study investigated whether BPD Compass holds promise as an integrated approach to simultaneously treating co-occurring BPD features and PTSD symptoms. Participants included 84 trauma-exposed adults who participated in a two-phase clinical trial (Phase 1: randomized controlled trial of BPD Compass vs. waitlist [n = 43]; Phase 2: open trial of BPD Compass [n = 41]). Compared to waitlist, BPD Compass led to medium-to-large-sized, significant improvements in BPD features, ßs = -.57 -.44, and facets of neuroticism, ßs < -.55--.73, as well as small, nonsignificant improvements in self-reported, ß = -.20, and clinician-rated PTSD symptom severity, ß = -.19. During treatment, within-person improvements in PTSD symptoms predicted subsequent improvements in BPD features, ß = .13, but not vice versa, ß = .07. Within-person PTSD symptom reduction also predicted subsequent improvement in all personality dimensions, whereas only within-person improvement in despondence, ß = .12, affective dysregulation, ß = .11, and dissociative tendencies, ß = .12, predicted PTSD symptom reductions. Findings offer preliminary support for the potential of BPD Compass to target BPD features and aspects of neuroticism and agreeableness among trauma-exposed adults. Moreover, PTSD symptom change predicting subsequent improvement in BPD features runs counter to current stage-based treatment models that emphasize BPD feature stabilization before engaging in trauma-focused therapy.

Seeing is believing: The effect of subtle communication in social media on viewers' beliefs about depression and anxiety symptom trajectories.

OBJECTIVE: One barrier to treatment seeking, uptake, and engagement is the belief that nothing can be done to reduce symptoms. Given the widespread use of social media to disseminate information about important issues, including psychological health, we sought to understand how the influence of social media communication regarding mental health impacts viewers' beliefs about psychopathology recovery. METHOD: Undergraduate participants from a large Midwestern university (N = 322) were randomized to view a series of Tweets characterizing psychopathology from a fixed mindset perspective, a growth mindset perspective, or, in the control condition, Tweets unrelated to psychopathology. Afterward, they completed a series of questionnaires designed to assess beliefs about recovery from depression and anxiety. RESULTS: Participants in the growth mindset condition endorsed less pessimistic beliefs about their ability (i.e., self-efficacy) to alleviate symptoms of depression and anxiety, and they believed these symptoms to be less stable and innate relative to those in the fixed mindset condition. CONCLUSION: Social media communication that characterizes psychopathology from a growth mindset perspective may be a viable intervention for improving beliefs around mental health self-efficacy and the malleable nature of mental illness, particularly depression and anxiety. Clinicians may be able to use social media platforms to promote functional beliefs around mental illness.

Mechanism engagement as a potential evidence-based approach to personalized treatment termination.

Objective: This study explores whether early change on a putative mechanism maintaining symptoms can serve as a proximal indicator of response to prompt discontinuation. Method: Patients (N = 70; Mage = 33.74, 67% female, 74% white) with heterogeneous anxiety and depressive disorders completed a sequential multiple assignment randomized trial (SMART). Patients received 6 sessions of skill modules from the Unified Protocol and then underwent a second-stage randomization to either receive the remaining 6 sessions (Full duration) or discontinue treatment (Brief duration). All participants completed weekly self-report measures of anxiety and depressive symptoms and distress aversion for the full 12-week treatment window. We used structural equation modeling to test (1) if distress aversion demonstrated significant variability during the first-stage randomization and (2) if distress aversion during the first-stage randomization predicted second-stage changes in anxiety and depression. Results: Participants demonstrated significant variability in first-stage distress aversion. Latent distress aversion slopes significantly predicted latent second-stage anxiety slopes, whereas latent distress aversion intercepts significantly predicted latent second-stage depression slopes. Conclusions: These results suggest that early mechanism engagement may have potential as a trigger to prompt personalized termination. Shorter courses of care may reduce patient costs and increase the mental health service system's capacity.

Defining the p-factor: an empirical test of five leading theories.

BACKGROUND: Despite statistical evidence of a general factor of psychopathology (i.e., p-factor), there is little agreement about what the p-factor represents. Researchers have proposed five theories: dispositional negative emotionality (neuroticism), impulsive responsivity to emotions (impulsivity), thought dysfunction, low cognitive functioning, and impairment. These theories have primarily been inferred from patterns of loadings of diagnoses on p-factors with different sets of diagnoses included in different studies. Researchers who have directly examined these theories of p have examined a subset of the theories in any single sample, limiting the ability to compare the size of their associations with a p-factor. METHODS: In a sample of adults (N = 1833, Mage = 34.20, 54.4% female, 53.3% white) who completed diagnostic assessments, self-report measures, and cognitive tests, we evaluated statistical p-factor structures across modeling approaches and compared the strength of associations among the p-factor and indicators of each of these five theories. RESULTS: We found consistent evidence of the p-factor's unidimensionality across one-factor and bifactor models. The p-factor was most strongly and similarly associated with neuroticism (r = .88), impairment (r = .88), and impulsivity (r = .87), χ2(1)s < .15, ps > .70, and less strongly associated with thought dysfunction (r = .78), χ2(1)s > 3.92, ps < .05, and cognitive functioning (r = -.25), χ2(1)s > 189.56, ps < .01. CONCLUSIONS: We discuss a tripartite definition of p that involves the transaction of impulsive responses to frequent negative emotions leading to impairment that extends and synthesizes previous theories of psychopathology.

Within-person changes in aversive reactivity predict session-to-session reductions in anxiety and depression in the unified protocol.

ABSTRACTThe Unified Protocol (UP) theoretically leads to reductions in emotional disorder symptoms by reducing aversive reactions to emotions. However, aversive reactions can take many forms (e.g., non-acceptance, behavioral avoidance). We examined if (1) multiple aspects of aversive reactivity predicted session-to-session changes in anxiety and depression in the UP, (2) these aspects reflected a single latent construct, and (3) changes in this latent construct predicted changes in anxiety and depression. Participants (N = 70, Mage = 33.74, 67.1% female, 74.3% white) completed six sessions of UP modules and measures of aversive reactivity, anxiety, and depression before each session. We used hierarchical linear modeling and random-intercept cross-lagged panel models to test aspects of aversive reactivity and a latent factor of aversive reactivity, respectively, as predictors of session-to-session changes in anxiety and depression. Within-person improvements in four of five aspects of aversive reactivity predicted decreases in anxiety, and improvements in two aspects predicted decreases in depression. However, within-person improvements in latent aversive reactivity predicted decreases in anxiety at five sessions and in depression across all sessions. These results add to the growing literature highlighting the role of aversive reactivity as a potential transdiagnostic process involved in improvements in emotional disorder symptoms during treatment.

The effects of the Unified Protocol and Unified Protocol skills on loneliness in the COVID-19 pandemic.

BACKGROUND: Loneliness is a significant public health concern with no established first-line intervention although modular, transdiagnostic, cognitive-behavioral interventions, such as the Unified Protocol (UP), are promising candidates. The UP contains skill modules to target anxiety, depression, and related conditions, although it is unclear if the UP can reduce loneliness and if UP skill use contributes to these reductions. METHODS: Using data from the first-stage randomization of a sequential multiple assignment randomized trial, we tested whether the UP led to reductions in loneliness and whether specific dimensions of UP skill use predicted session-to-session changes in loneliness. Participants (N = 70; Mage = 33.74, 67% female, 74% white) completed six sessions of core UP modules, reporting how frequently they felt lonely and used UP skills before each session. Using hierarchical linear modeling, we examined the trajectory of change in loneliness and disaggregated between- from within-person variability to test session-to-session effects of skill use. RESULTS: Loneliness significantly decreased during treatment with the UP. Using more UP skills than one's personal average, but not frequency of skill use, predicted session-to-session decreases in loneliness. CONCLUSIONS: Therapists may be encouraged to guide patients toward using a large quantity of different skills to specifically address loneliness.

Coping self-efficacy, perceived helpfulness of coping, and distress: a longitudinal investigation of breast and gynecologic cancer patients undergoing chemotherapy.

We examined changes in coping self-efficacy (CSE) pre- and post-chemotherapy and whether these changes predicted depressive symptoms and perceived stress after chemotherapy among women breast and gynecological cancers. We further tested whether perceived helpfulness of coping strategies used during chemotherapy influenced these effects. In a longitudinal design, participants (n = 79) provided data on CSE, depressive symptoms, and perceived stress pre-chemotherapy, post-chemotherapy (~ 4 months later), and at 8 and 12-month follow-up. During chemotherapy, participants completed a one-week daily diary on use and helpfulness of coping strategies in managing side effects. CSE decreased during chemotherapy, returning to baseline levels at follow-up. Higher problem-focused CSE pre- and post-chemotherapy predicted increases in distress among women who appraised their coping strategies as low or average in helpfulness during chemotherapy; problem-focused CSE was unrelated to changes in distress at high levels of perceived helpfulness. Increases in coping self-efficacy without concomitant helpful coping strategies may be markers for poor adjustment post-chemotherapy and identify patients who could benefit from psychosocial services. Combined education and skills-based interventions to align self-efficacy beliefs with coping strategies may reduce psychological burden.

Integrating and differentiating personality and psychopathology in cognitive behavioral therapy.

A large body of literature supports the strong association between personality features and psychopathology. This research has, however, had little influence on day-to-day therapeutic practice, particularly in cognitive behavioral approaches that have traditionally focused on addressing the symptoms of categorically defined diagnoses. Indeed, there are few CBT protocols aimed at altering the personality features. Recently, however, the CBT literature has displayed an increased focus on identifying alternative higher-order, dimensional mechanisms that may underscore the development and maintenance of broad classes of psychopathology (e.g., aversive reactivity to emotions, reward sensitivity, and performance expectancies). There is ample evidence linking these processes to DSM disorder severity; however, they may also represent a functional link between the personality domains and the disorder symptoms organized beneath them. The functional mechanisms through which an individual's personality confers risk for psychopathology may be naturally amenable to cognitive behavioral elements, and targeting these processes in treatment has the potential to address both disorder symptoms and underlying personality vulnerabilities. Thus, the identification of intermediate functional mechanisms may help bridge the gap between personality science and clinical practice.

Multilevel associations of daily skill use and effectiveness with anxiety, depression, and stress in a transdiagnostic sample undergoing dialectical behavior therapy skills training.

Dialectical Behavior Therapy (DBT) is effective at treating disorders of emotion dysregulation. However, it is unclear which mechanisms contribute to these effects. The aim of this study was to characterize the within-person associations of two theoretically relevant mechanisims of change, skill use and skill effectiveness, with anxiety, stress, and depression. Participants (n = 19, Mage = 31.8, 68% female) with a primary anxiety or depressive disorder completed daily reports (N = 1344) of DBT skill use, perceived effectiveness, anxiety, stress, and depression during a 16-session DBT skills training group. DBT skill use increased across treatment, p < .01, but effectiveness did not, p = .64. Within persons, participants used more skills on days with greater stress and anxiety, p < .01, which predicted next-day decreases in stress and anxiety, p = .03. On days when participants reported higher effectiveness, they used more skills than their personal average when experiencing more intense negative affect, p < .01. These results suggest using more skills, especially when used more effectively, is a mechanism by which DBT skills groups address emotional dysfunction for those with transdiagnostic emotional disorders.

A SMART approach to personalized care: preliminary data on how to select and sequence skills in transdiagnostic CBT.

Given that over 20 million adults each year do not receive care for their mental health difficulties, it is imperative to improve system-level capacity issues by increasing treatment efficiency. The present study aimed to collect feasibility/acceptability data on two strategies for increasing the efficiency of cognitive behavioral therapy: (1) personalized skill sequences and (2) personalized skill selections. Participants (N = 70) with anxiety and depressive disorders were enrolled in a pilot sequential multiple assignment randomized trial (SMART). Patients were randomly assigned to receive skill modules from the Unified Protocol in one of three sequencing conditions: standard, sequences that prioritized patients' relative strengths, and sequences that prioritized relative deficits. Participants also underwent a second-stage randomization to either receive 6 sessions or 12 sessions of treatment. Participants were generally satisfied with the treatment they received, though significant differences favored the Capitalization and Full duration conditions. There were no differences in trajectories of improvement as a function of sequencing condition. There were also no differences in end-of-study outcomes between brief personalized treatment and full standard treatment. Thus, it may be feasible to deliver CBT for personalized durations, though this may not substantially impact trajectories of change in anxiety or depressive symptoms.

Evaluating interactions between emotion regulation strategies through the interpersonal context of female friends.

INTRODUCTION: There is a growing interest in examining how interpersonal relationships may shape associations between emotion regulation (ER) strategies and psychopathology. METHODS: We used multilevel modeling to test if respondents' self-reported intrapersonal ER, friends' self-reported intrapersonal ER, and their interaction were associated with psychopathology in a sample of 120 female friend dyads. RESULTS: Respondents' use of brooding rumination, expressive suppression, and worry were positively associated with respondent psychopathology. Friend reappraisal moderated the association between respondent reappraisal and respondent psychopathology. Consistent with an interference hypothesis, respondent cognitive reappraisal was only associated with respondent psychopathology when friend cognitive reappraisal was low. Consistent with a compensatory hypothesis, respondent reappraisal was primarily associated with respondent psychopathology when friend repetitive negative thought was high. DISCUSSION: Results support the extension of models of ER strategy interactions from intrapersonal to interpersonal contexts. Future research is needed to replicate the interference and compensatory interactions observed in the data.

Hope attenuates the negative impact of general psychological distress on goal progress.

OBJECTIVE: Symptoms of general psychological distress disrupt goal pursuit; however, not everyone is equally impacted by distress when pursuing goals. We tested whether hope, self-efficacy, and/or grit buffered the impact of symptoms of general psychological distress on longitudinal goal progress. METHOD: Undergraduate students reported on these constructs and, 2 months later, their progress toward five personal goals (N = 117). RESULTS: Although greater levels of baseline psychological distress predicted less goal progress, the impact of psychological distress on goal progress was moderated by hope, ß = .20, SE = 0.07, p < .01. More specifically, at higher hope, participants reported similar goal progress regardless of baseline distress symptoms, while at lower hope, baseline distress was negatively associated with goal progress. CONCLUSION: Hope may function as a buffer against the association between general psychological distress and impaired goal progress.

More (of the right strategies) is better: disaggregating the naturalistic between- and within-person structure and effects of emotion regulation strategies.

Although people often use multiple strategies to regulate their emotions, it is unclear if using more strategies effectively changes emotional outcomes. This may be because there is no clear, data-driven structure to organise which strategies people use together, so strategies with opposing impacts are modelled together. We first conducted a multilevel factor analysis of negative- and positive-emotion regulation strategies among undergraduates (n = 92) completing ecological momentary assessment three times per day for 10 days. Solutions including 3-within/3-between factors were most interpretable. Using more between-person Adaptive Engagement strategies and within-person Adaptive Engagement, Enhancement, and Behavioural strategies predicted improved mood, whereas using more between-person Aversive Cognitive and within-person Aversive Cognitive and Disengagement strategies predicted worse mood, ps < .05. Using a greater quantity of strategies may thus promote better, or worse, emotional outcomes, depending on the class of strategies used.

Emotions as context: Do the naturalistic effects of emotion regulation strategies depend on the regulated emotion?

Researchers have examined how several contexts impact the effectiveness of emotion regulation strategies. However, few have considered the emotion-to-be-regulated as a context of interest. Specific emotions are important contexts because they may require particular responses to internal and external stimuli for optimal regulation. Ninety-two undergraduates completed 10 days of ecological momentary assessment, reporting their current mood, recent emotions, and emotion regulation strategies three times per day. The frequency with which certain emotion regulation strategies were used (i.e., acceptance, positive refocusing, reappraisal, problem-solving, and other-blame) differed by the specific emotion experienced. Acceptance and positive refocusing were associated with better mood regardless of emotion, while substance use was associated with worse mood regardless of emotion. Reappraisal was associated with better mood in response to anger than anxiety or sadness, while emotional suppression and other-blame were associated with worse mood in response to anger. These results suggest some emotion regulation strategies exhibit emotion-invariant effects while others depend on the emotion-to-be-regulated.

Flexible, yet firm: A model of healthy emotion regulation.

We propose a model of healthy intentional emotion regulation that includes (1) a large repertoire of (2) adaptive strategies that (3) one persists with despite initial negative feedback. One hundred forty-four undergraduates (average age = 19.20 years; 68% female, 79% Caucasian) completed a novel performance task indicating what they would think or do to feel better in response to eleven stressful vignettes. After their initial response, participants indicated four more times how they would respond if their previous strategy was not working. Raters categorized each response as an emotion regulation strategy and coded the adaptiveness of each strategy. Participants self-reported Neuroticism, Extraversion, Conscientiousness, Borderline Personality Disorder (BPD) symptoms, and depressive symptoms. We regressed each personality dimension and psychopathology symptom on our model of healthy emotion regulation. Neuroticism was negatively associated with adaptiveness and persistence. Extraversion was positively associated with adaptiveness. Conscientiousness was positively associated with repertoire, adaptiveness, and persistence, while BPD symptoms were negatively associated with all three variables. Depressive symptoms were negatively associated with persistence. These preliminary findings suggest that people with larger repertoires of more adaptive emotion regulation strategies who persist with these strategies despite initial negative feedback report less personality pathology and psychological distress.

Assessing the Relation Between Flexibility in Emotional Expression and Symptoms of Anxiety and Depression: The Roles of Context Sensitivity and Feedback Sensitivity.

Expressive flexibility (EF), the ability to enhance and suppress emotional expressions, predicts decreases in anxiety and depression symptoms years later (Bonanno, Papa, Lalande, Westphal, & Coifman, 2004). Bonanno and Burton (2013) proposed that knowing the most appropriate strategy for a situation (context sensitivity; CS), and awareness of how well strategies are working (feedback sensitivity; FS), partially explain this effect. We conducted a conditional process analysis to test this theory. One hundred thirty-eight undergraduates completed a behavioral measure of EF and self-reported symptoms of anxiety and depression, CS, and FS over one month. CS moderated the effect of EF on one-month changes in symptoms of anxiety and depression (p = .03): EF only predicted decreased anxiety and depression symptoms among people low in CS. FS mediated the effect of EF (95% CI: -.10, -.01) on changes in anxiety and depression symptoms: higher baseline EF was associated with higher two-week FS, which predicted decreased one-month anxiety and depression symptoms. Results suggest EF and CS may be compensatory skills and FS may be necessary to experience the adaptive effects of emotion regulation flexibility.

Loneliness mediates the relationship between emotion dysregulation and bulimia nervosa/binge eating disorder psychopathology in a clinical sample.

Emotion dysregulation has been linked to binge eating disorder (BED) and bulimia nervosa (BN) although the mechanisms by which it affects BN/BED psychopathology are unclear. This study tested loneliness as a mediator between emotion dysregulation and BN/BED psychopathology. A treatment-seeking sample of 107 women with BN or BED was assessed for loneliness (UCLA Loneliness Scale), emotion dysregulation (Difficulties in Emotion Regulation Scale), and BN/BED psychopathology (Eating Disorder Examination) before treatment. Hierarchical linear regressions and bootstrapping mediation models were run. Greater overall emotion dysregulation was associated with greater BN/BED psychopathology, mediated by loneliness (95 % CI 0.03, 0.09). Emotion dysregulation, however, did not mediate between loneliness and BN/BED psychopathology (95 % CI −0.01, 0.01). Targeting loneliness may effectively treat emotional aspects of BN/BED in women.

Investigating psychiatric symptoms as predictors of the reasons people do not regulate their emotions in daily life.

Investigations into emotion dysregulation predominantly focus on ineffective strategy selection and implementation. However, little empirical attention has been given to the possibility that failure to engage in emotion regulation (ER) may also indicate emotion dysregulation, especially when the reason for not regulating suggests skill or motivational deficits. We randomly sampled ER strategy use up to six times per day for 5 weeks in 113 adults with elevated social anxiety. When participants reported not engaging in any recent ER, they indicated their reason for not regulating. Data were collected between 2018 and 2019. Participants reported not regulating in 60.9% of surveys. The most frequently endorsed reason for not regulating was "I was not experiencing any thoughts/feelings that I wanted to change," followed by "I did not want to put in the effort," then "I did not know what to do," and finally, "I did not think I was capable." After controlling for within- and between-person state affect, participants with lower trait-level social anxiety, depression, and emotion dysregulation scores were more likely to report no ER because they were not experiencing any thoughts/feelings that they wanted to change relative to the other three reasons that might reflect barriers to effective regulation. Trait-level generalized worry and alcohol use did not significantly predict between nonregulation reasons. Findings from these preregistered analyses suggest that not regulating-especially among persons higher in social anxiety, depression, and emotion dysregulation-may indicate ER skill or motivation deficits that point to opportunities for intervention. Results may not generalize to more demographically or clinically diverse samples. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Assessing Theories of State and Trait Change in Neuroticism and Symptom Improvement in the Unified Protocol.

Researchers have shown neuroticism decreases with treatment (Roberts et al., 2017), although it is unclear if this reflects fleeting state-level changes (state-artifact position) or trait-level change (cause-correction hypothesis). These theories further propose that changes in neuroticism predict symptom change (cause-correction hypothesis) or are predicted by symptom change (state-artifact position). We compared these theories in a clinical trial of the Unified Protocol (UP). Participants (N = 38; Mage = 34.55, 71.1% female, 78.9% Caucasian) meeting DSM-5 criteria for a primary emotional disorder completed up to 12 weekly sessions of the UP. Neuroticism exhibited state-level changes by Session 6 but trait-level changes by Session 12. Within-person reductions in neuroticism exhibited bidirectional relations with anxiety symptom change but predicted unidirectional session-to-session reductions in depression. These findings provide relatively more nuanced support for the cause-correction hypothesis that the UP leads to trait changes in neuroticism that tend to precede symptom change.