Examining the Factor Structure and Incremental Utility of the Contrast Avoidance Questionnaires via Bifactor Analysis.

The negative emotional contrast avoidance model posits that pathological worry is maintained by the avoidance of negative emotional shifts. The Contrast Avoidance Questionnaires (CAQ-Worry and CAQ-General Emotion) aim to assess contrast avoidance beliefs and behaviors. Questions remain around the factor structures of the CAQs, whether such structures replicate in nonundergraduate samples, and whether their domain-specific factors are valid for independent use. This study used bifactor analysis in a large community sample (N = 827) to address these gaps in the literature. Results supported bifactor models of both measures. Complementary analyses supported the multidimensionality of the CAQ-Worry, including its strong general factor and independent use of two domain-specific factors, rather than the original three domain-specific factors. The CAQ-General Emotion's general factor was strong, but the merits of the Discomfort domain-specific factor require more exploration, and use of the Avoidance domain-specific factor is discouraged.

The interactive effect of mental contamination and cognitive fusion on anxiety.

OBJECTIVES: Mental contamination and cognitive fusion have been identified as risk factors for anxiety. The purpose of this study was to examine the moderating effect of cognitive fusion on the relationship between mental contamination and anxiety. METHOD: Participants (N = 504 community adults), recruited via Amazon's Mechanical Turk (MTurk), completed measures of mental contamination, cognitive fusion, and anxiety. RESULTS: Results from a regression analysis showed that the interaction between mental contamination and cognitive fusion predicted anxiety (ß = 0.15, p < 0.001). Simple slopes analysis revealed a positive association between mental contamination and anxiety that was significant at higher (ß = 0.25, p < 0.001), but not lower (ß = 0.01, p = 0.88), levels of cognitive fusion. CONCLUSION: The development of risk profiles that incorporate mental contamination and cognitive fusion may be beneficial for early identification of individuals at high risk for anxiety.

Examining the Factor Structure and Incremental Validity of the Barkley Deficits in Executive Functioning Scale - Short Form in a Community Sample.

The Barkley Deficits in Executive Functioning Scale - Short Form (BDEFS-SF; Barkley, 2011) was developed to assess deficits in five facets of executive functioning. Theoretical assumptions surrounding the BDEFS-SF presume that executive dysfunction is an overarching construct that consists of five domain-specific factors (i.e., a hierarchical model; Barkley, 2011). Prior research has supported a correlated five-factor model, but the tenability of hierarchical or bifactor models of the BDEFS-SF have not yet been tested. In the present study (N = 1,120 community adults), confirmatory factor analysis was used to compare four theoretically relevant models of the BDEFS-SF (i.e., one-factor, correlated five-factor, hierarchical, and bifactor models). The bifactor model provided the best fit to the data. However, the general factor accounted for the overwhelming majority of variance in BDEFS-SF scores and none of the domain-specific factors exhibited adequate construct replicability or factor determinancy. Further, the general factor accounted for the overhelming majority of variance in criterion variables (i.e., executive attention and health anxiety); the Organization and Emotion factors accounted for a small amount of unique variance in executive attention and the Emotion factor accounted for a small amount of unique variance in health anxiety. Taken together, study findings suggest that the BDEFS-SF has a strong general factor and independent use of the domain-specific factors is contraindicated.

The interactive effect of emotional reactivity and maladaptive metacognitive beliefs on anxiety.

Emotional reactivity has been implicated in the development and maintenance of anxiety. The metacognitive model suggests that maladaptive metacognitive beliefs (i.e. beliefs about thinking) may increase the impact of emotional reactivity on anxiety. As such, the purpose of the present study was to examine maladaptive metacognitive beliefs as a moderator of the relationship between emotional reactivity and anxiety in an undergraduate student sample (N = 78). Participants completed a battery of self-report measures and a negative emotion induction procedure during a single laboratory session. As predicted, higher levels of maladaptive metacognitive beliefs strengthened the relationship between emotional reactivity and anxiety. This effect was found in relation to negative (e.g. "My thoughts are uncontrollable"), but not positive (e.g. "Worrying will keep me safe"), metacognitive beliefs. Study results support the proposal that maladaptive metacognitive beliefs potentiate the effect of emotional reactivity on anxiety and suggest that preemptive efforts to reduce negative metacognitive beliefs may be beneficial among individuals prone to emotional reactivity.

Addressing Psychometric Limitations of the Attentional Control Scale via Bifactor Modeling and Item Modification.

The purpose of this three-part study was to identify and correct psychometric limitations of the Attentional Control Scale (ACS; Derryberry & Reed, 2002) via bifactor modeling and item modification. In Study 1 (N = 956), results from exploratory factor analyses (EFAs) and confirmatory factor analyses (CFAs) suggested that the multidimensionality of the ACS might be a function of a method effect (i.e., reverse coding). In Study 2 (N = 478), reverse-coded items were recoded in a straightforward manner and submitted to EFA. Results supported retention of 15 items and 2 factors. In Study 3 (N = 410), CFA was used to test the model identified in Study 2 and compare it to competing models (i.e., 1-factor, bifactor). The bifactor model exhibited the best fit to the data. However, results from bifactor analysis suggested that the structure of the ACS is more consistent with a unidimensional rather than multidimensional model. Additionally, the second domain-specific factor appears to be redundant with the general factor and both domain-specific factors are poorly defined and might be of little practical value. Taken together, results caution the use of the ACS subscales independent of the total score. Moreover, they support coding ACS items in a straightforward manner.

Executive attention moderates the effect of trait anxiety on hyperarousal symptoms.

The majority of individuals exposed to trauma do not go on to develop posttraumatic stress disorder (PTSD); thus, researchers have sought to identify individual difference variables that make one particularly susceptible to posttraumatic stress symptoms. Trait anxiety is one individual difference variable implicated in the pathogenesis of posttraumatic stress symptoms. Following from cognitive theories of anxiety and extant data, the purpose of the present study was to examine executive attention as a moderator of the relation between trait anxiety and posttraumatic stress symptoms, particularly hyperarousal symptoms, among undergraduate women reporting trauma exposure (N = 88). As predicted, executive attention moderated the association between trait anxiety and hyperarousal symptoms, such that there was a significantly weaker relation as executive attention increased. Study results further support the potential buffering effect of executive attention in relation to posttraumatic stress symptoms, as well as the possible importance of targeting executive attention following trauma exposure.

Factor Structure and Incremental Validity of the Original and Modified Versions of the Difficulties in Emotion Regulation Scale.

The Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004) is a self-report measure that assesses six facets of emotion dysregulation. A modified version of the DERS (M-DERS) was developed to address psychometric limitations of the original measure (Bardeen, Fergus, Hannan, & Orcutt, 2016). Although the factor structure of the M-DERS (i.e., two models: correlated trait and second-order models) has been supported via confirmatory factor analysis (CFA), the tenability of a bifactor model of the M-DERS has yet to be examined. Preliminary research suggests that a bifactor model of the M-DERS is tenable. In this study (Ns of 993 and 578), results from a series of CFAs indicated adequate fit of the M-DERS and poor fit of the original DERS across several tested models (e.g., correlated trait, second-order, bifactor). Although a considerable amount of variance was accounted for by the general factor, statistical indexes from the bifactor model supported a multidimensional conceptualization of the M-DERS. The Nonacceptance and Goals subscales evidenced incremental utility, after accounting for the general factor, in predicting general distress (Nonacceptance only) and intolerance of uncertainty. Implications for future use of the DERS and M-DERS are discussed.

Anxiety sensitivity and attentional bias to threat interact to prospectively predict anxiety.

The purpose of the present study was to examine anxiety sensitivity, attentional bias to threat (ABT), and the aggregate influence of these constructs as prospective predictors of anxiety. Participants (N = 176) completed a baseline assessment session which included the completion of self-report measures of anxiety and anxiety sensitivity, as well as an eye-tracking task in which eye movements were recorded during the viewing of neutral and threat images. Measures of anxiety and anxiety sensitivity were completed again as part of an online questionnaire battery at a 1-year follow-up session. As predicted, baseline anxiety sensitivity and ABT predicted anxiety at 1-year follow-up even after accounting for baseline anxiety. However, these main effects were qualified by a significant interaction effect such that those high in anxiety sensitivity at baseline reported relatively higher anxiety at the 1-year follow-up, but only if they also exhibited higher levels of ABT at baseline. Results suggest that individuals with this combination of vulnerability factors (high levels of both anxiety sensitivity and ABT) may be at particularly high risk for developing anxiety and may benefit from preemptive efforts to reduce ABT.

Examining the specific dimensions of distress tolerance that prospectively predict perceived stress.

We examined five dimensions of distress tolerance (i.e. uncertainty, ambiguity, frustration, negative emotion, physical discomfort) as prospective predictors of perceived stress. Undergraduate students (N = 135) completed self-report questionnaires over the course of two assessment sessions (T1 and T2). Results of a linear regression in which the five dimensions of distress tolerance and covariates (i.e. T1 perceived stress, duration between T1 and T2) served as predictor variables and T2 perceived stress served as the outcome variable showed that intolerance of uncertainty was the only dimension of distress tolerance to predict T2 perceived stress. To better understand this prospective association, we conducted a post hoc analysis simultaneously regressing two subdimensions of intolerance of uncertainty on T2 perceived stress. The subdimension representing beliefs that "uncertainty has negative behavioral and self-referent implications" significantly predicted T2 perceived stress, while the subdimension indicating that "uncertainty is unfair and spoils everything" did not. Results support a growing body of research suggesting intolerance of uncertainty as a risk factor for a wide variety of maladaptive psychological outcomes. Clinical implications will be discussed.

Addressing Psychometric Limitations of the Difficulties in Emotion Regulation Scale Through Item Modification.

Through its frequent use, a pattern has emerged showing psychometric limitations of the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004). This 3-part study sought to (a) determine whether these limitations are due to a method effect by rewording all reverse-coded items in a straightforward manner and submitting them to exploratory factor analysis (EFA), and (b) examine the tenability of an adaptation of the original measure. EFA results from Study 1 (N = 743) supported retention of 29 modified items across 5 factors. Consistent with the original theoretical underpinnings of the DERS, Awareness and Clarity items loaded on the same factor. In Study 2 (N = 738), confirmatory factor analysis (CFA) was used to examine the factor structure of the pool of items identified in Study 1. All of the modified subscales clustered strongly with one another and evidenced large loadings on a higher-order emotion regulation construct. These results were replicated in Study 3 (N = 918). Results from Study 3 also provided support for the reliability and validity of scores on the modified version of the DERS (i.e., internal consistency, convergent and criterion-related validity). These findings provide psychometric support for a modified version of the DERS.

A Factor Analytic Evaluation of the Difficulties in Emotion Regulation Scale.

OBJECTIVES: The present study aimed to elucidate the factor structure of the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004)-a widely used measure of emotion dysregulation. METHOD: Participants were 3 undergraduate samples (N = 840, 78.33% female, mean age = 20.30). RESULTS: We began by using confirmatory factor analysis (CFA) to examine 3 existing models, finding that none consistently demonstrated adequate fit across samples. Subsequently, we conducted an exploratory factor analysis, identifying a novel 5-factor model that consistently resulted in adequate fit across samples. We also ran several CFA models after removing the Awareness subscale items-which have performed inconsistently in prior research-finding that a reduced-measure variant of the model retained by Gratz and Roemer (2004) resulted in adequate fit across samples. No higher-order models consistently resulted in adequate fit across samples. CONCLUSIONS: Our findings are consistent with previous work in suggesting use of a DERS total score may not be appropriate. Additionally, further work is needed to examine the novel 5-factor model and the effect of reverse-scored items on the DERS factor structure.

Emotion regulation and posttraumatic stress symptoms: a meta-analysis.

Emotion regulation (ER) has been identified as a critical factor in the development and maintenance of posttraumatic stress symptoms (PTS; Bardeen, Kumpula, & Orcutt, 2013 [Journal of Anxiety Disorders, 27, 188-196]; Marx & Sloan, 2005 [Behaviour Research and Therapy, 43, 569-583]; Nightingale & Williams, 2000 [British Journal of Clinical Psychology, 39, 243-254]). The current meta-analysis aimed to provide a thorough, quantitative examination of the associations between PTS and several aspects of ER. A search of the PsychINFO database resulted in 2557 titles, of which 57 met full inclusion criteria (the cross-sectional association between PTS symptoms and ER was reported, participants were 18 years or older, the article was written in English, and sufficient information was reported to calculate effect sizes). From the 57 studies that were included, 74 effect sizes were obtained. All studies were independently coded by two of the study authors for the following: citation, sample type, total N size (and group n's if applicable), mean age of participants, type of traumatic event, study design, PTS measure(s), ER measure(s), and effect size information. Eight random effects models were conducted: seven for individual ER strategies (e.g., rumination) and one for general emotion dysregulation. The largest effects were observed for general emotion dysregulation (r = 0.53; k = 13), rumination (r = 0.51; k = 5), thought suppression (r = 0.47; k = 13), and experiential avoidance (r = 0.40; k = 20). Medium effects were observed for expressive suppression (r = 0.29; k = 3) and worry (r = 0.28; k = 6). Significant effects were not observed for acceptance or reappraisal. Moderator analyses (sample and trauma type) were conducted for general emotion dysregulation, experiential avoidance, and thought suppression; no significant differences were observed. Findings from the current analysis suggest that several aspects of ER are associated with PTS symptoms across a variety of samples. Additionally, the current study highlights a number of limitations in the existing ER and PTS symptom literature.

The contribution of health anxiety to retrospectively-recalled emergency department visits within a sample of patients in residential substance abuse treatment.

With the burden of emergency department (ED) use increasing, research examining the factors associated with ED visits among individuals who use the ED most frequently is needed. Given that substance use is strongly linked to ED visits, this study sought to examine the factors associated with greater ED visits among patients with substance use disorders (SUD). More precisely, we examined whether health anxiety incrementally contributes to the prediction of ED visits for medical care among adult patients (N = 118) in a residential substance abuse disorder treatment facility. As predicted, health anxiety was significantly positively correlated with ED visits during the past year. Furthermore, health anxiety remained a significant predictor of ED visits after accounting for sociodemographic variables, frequency of substance use, and physical health status. These results suggest that health anxiety may contribute to increased ED visits for medical care among individuals with SUD.

An investigation of the relationship between borderline personality disorder and cocaine-related attentional bias following trauma cue exposure: the moderating role of gender.

Elevated rates of borderline personality disorder (BPD) have been found among individuals with substance use disorders (SUDs), especially cocaine-dependent patients. Evidence suggests that cocaine-dependent patients with BPD are at greater risk for negative clinical outcomes than cocaine-dependent patients without BPD and BPD-SUD patients dependent on other substances. Despite evidence that cocaine-dependent patients with BPD may be at particularly high risk for negative SUD outcomes, the mechanisms underlying this risk remain unclear. The present study sought to address this gap in the literature by examining cocaine-related attentional biases among cocaine-dependent patients with (n = 22) and without (n = 36) BPD. On separate days, participants listened to both a neutral and a personally-relevant emotionally evocative (i.e., trauma-related) script and then completed a dot-probe task with cocaine-related stimuli. Findings revealed a greater bias for attending to cocaine-related stimuli among male cocaine-dependent patients with (vs. without) BPD following the emotionally evocative script. Study findings suggest the possibility that cocaine use may have gender-specific functions among SUD patients with BPD, with men with BPD being more likely to use cocaine to decrease contextually induced emotional distress. The implications of our findings for informing future research on cocaine use among patients with BPD are discussed.

Investigating the specific domains of the cognitive attentional syndrome that predict posttraumatic stress symptoms: The moderating effect of attentional control.

The metacognitive model of posttraumatic stress disorder (PTSD) suggests that persistent use of the maladaptive self-regulation strategies that comprise the cognitive attentional syndrome (CAS) increases the likelihood of developing PTSD symptoms following trauma exposure. The metacognitive model also suggests that flexible regulation of attention might be protective against developing maladaptive outcomes that are associated with the CAS. The aims of this study were to (1) examine associations between all seven domains of the CAS and PTSD symptoms using a recently developed, multidimensional measure of the CAS, and (2) examine the moderating effect of self-reported attentional control on associations between the CAS and PTSD symptoms. Participants were trauma-exposed community adults (N = 237) who completed a battery of self-report measures. Results from linear regression analyses showed that worry, substance use, and internal threat monitoring accounted for unique variance in PTSD symptoms when all seven CAS domains were entered into the same model. Moderation analyses showed that attentional control dampened the effect of the CAS, specifically external threat monitoring, on PTSD symptoms. Study results support attentional control as a protective factor against the maladaptive effects of the CAS on PTSD symptoms.

A prospective examination of the role of psychological (in)flexibility in posttraumatic stress: A cross-lagged panel design.

Functional contextualist models of psychopathology suggest that psychological inflexibility and psychological flexibility are of central importance for understanding the development and maintenance of posttraumatic stress (PTS) symptomatology. To our knowledge, these two constructs and their domain-specific factors (e.g., cognitive fusion, experiential avoidance) have not been assessed in their entirety and examined in relation to PTS symptoms using a longitudinal study design. As such, the primary aim of the present study was to use cross-lagged panel analysis, an analytic approach that allows stronger causal inferences to be made regarding the nature of temporal relations among study variables, to determine the directional relations among PTS symptoms and psychological flexibility and inflexibility over an eight-month time period. Trauma-exposed adults (N = 810), recruited online via Amazon's Mechanical Turk (MTurk), completed a battery of self-report measures via a secure online platform at three time points, spanning eight months. Results suggest that the relationship between psychological inflexibility and PTS symptoms is bidirectional and mutually reinforcing. In contrast, significant prospective relations were not observed between psychological flexibility and PTS symptoms. Results of a follow-up exploratory path analysis showed that cognitive fusion was the only psychological inflexibility subfactor that partially mediated the relationship between PTS symptoms from baseline to the eight-month follow-up assessment. Taken together, these results suggest that psychological inflexibility, and primarily the domain of cognitive fusion, maintains PTS symptoms following trauma exposure. As such, it may important to integrate cognitive defusion techniques into evidence-based treatments for Posttraumatic Stress Disorder (PTSD).

Executive functioning deficits exacerbate posttraumatic stress symptoms: A longitudinal mediation model.

Executive functioning (EF) consists of a set of related, but distinct, higher-level cognitive abilities that are used to organize and integrate lower-level processes in the service of engaging in goal-direct behavior. Evidence suggests that deficits in EF are a vulnerability factor for the development of posttraumatic stress (PTS) symptoms. Less understood, however, is the role that EF plays in symptom maintenance and exacerbation following trauma exposure. As such, the primary purpose of the present study was to determine whether EF deficits exacerbate PTS symptoms over the course of one year. A secondary aim of this study was to use a cross-lagged design to determine the directional relations among EF deficits and PTS. Trauma-exposed adults (N = 98) completed a clinical interview and self-report measures at an initial assessment session (Time 1 [T1]). Participants also completed self-report measures at 6- (Time 2 [T2]; n = 92) and 12-month (Time 3 [T3]; n = 91) follow-up sessions. As predicted, EF deficits at T2 mediated the relationship between PTS symptoms from T1 to T3, thus suggesting that EF deficits exacerbate PTS symptoms following trauma exposure. Results from a cross-lagged path analysis from T2 to T3 suggest that deficits in EF exert a stronger influence on the maintenance of PTS symptoms than vice versa. These results have implications for (a) identifying individuals that are at elevated risk for developing PTS symptoms, (b) developing precision medicine-based approaches for alleviating PTS symptoms, and (c) improving well-established PTSD treatments for those with relative deficits in EF.

The Interactive Effect of Anxiety Sensitivity and Metacognitive Beliefs on Anxiety.

Anxiety sensitivity (AS) has been identified as a contributing factor to the development and maintenance of anxiety. Individuals with high AS are sensitive to bodily cues and anxiety-related thoughts and often misinterpret these stimuli as catastrophic or dangerous. Similarly, negative and positive metacognitive beliefs (i.e., beliefs about thinking) are believed to increase internal threat monitoring and the use of maladaptive coping strategies, which may increase the impact of AS on anxiety. As such, the purpose of the present study was to examine the moderating role of metacognitive beliefs on the relationship between anxiety sensitivity and anxiety. Adult participants (N = 417), recruited through an online crowdsourcing website, completed a battery of measures assessing the constructs of interest. Results from multiple linear regression indicated that the relationship between AS and anxiety became significantly stronger as negative and positive metacognitive beliefs increased, thus suggesting that negative and positive metacognitive beliefs may exacerbate the effect of AS on anxiety. The development of risk profiles that incorporate AS and negative and positive metacognitive beliefs may be beneficial for early identification of individuals at high risk for the development of anxiety.

Eye tracking evidence of threat-related attentional bias in anxiety- and fear-related disorders: A systematic review and meta-analysis.

CONTEXT: Cognitive theories of anxiety- and fear-related pathology suggest that individuals with these forms of pathology (versus those without) exhibit greater threat-related attentional bias (AB). However, there are a multitude of mixed and null findings in this area of research. Unlike other commonly used measures of AB, eye-tracking indices of AB exhibit acceptable reliability, and thus, may help clarify the relationship between AB and anxiety- and fear-related symptoms. OBJECTIVE: The purpose of this study was to conduct a meta-analysis, to determine whether there is evidence of a relationship between anxiety and fear-related symptoms and expressions of threat-related AB (i.e., reflexive orienting and maintenance) measured via free-viewing eye- tracking tasks. DATA SYNTHESIS: A total of 40 articles were retained for this meta-analysis. Significant relations were observed between anxiety and fear-related symptoms and both reflexive orienting toward threat (r = 0.13, 95% CI: 0.03, 0.22) and maintenance of attention on threat (r = 0.15, 95% CI: 0.05, 0.25). CONCLUSIONS: Results from the present study suggests that it may be important to develop attention bias modification interventions that target AB at both early (bottom-up) and later (top-down) stages of information processing to reduce anxiety- and fear-related pathology.

Health anxiety and attentional control interact to predict uncertainty-related attentional biases.

BACKGROUND AND OBJECTIVES: Current theories of health anxiety and a growing body of empirical literature suggest that those high in health anxiety symptoms might find uncertainty itself threatening and demonstrate attentional biases for uncertainty-related information (ABU). Moreover, a dual processes model of attention would suggest that individual differences in attentional control might modify such a relationship. The present study was designed to explore this proposed health anxiety-ABU relationship and also to consider attentional control as a moderator of theoretical and clinical relevance. METHODS: Undergraduate participants (N = 148) completed a self-report measure of health anxiety symptoms and two performance-based tasks to assess ABU and attentional control. RESULTS: Hierarchical regression analyses showed a significant interaction between health anxiety and attention control in predicting attentional disengagement from, but not engagement with, uncertainty-related words. Specifically, results of the simple slopes analysis suggested that those with elevated health anxiety symptoms and better attentional control may use top-down attentional control processes to disengage their attention from distressing uncertainty-related stimuli faster than those with worse attentional control. LIMITATIONS: The analogue sample is a study limitation. CONCLUSIONS: Results provide new insights into the nature of attentional biases within health anxiety. Results are discussed in light of recent work on attentional control and avoidance-based psychopathology.