Examining the Temporal Relation between Posttraumatic Stress Symptoms and Heavy Drinking among Veterans Receiving Mental Health Treatment in Primary Care.

OBJECTIVE: Evidence for the use of integrated treatments targeting co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorders is steadily growing. However, limited work has evaluated the temporal association between posttraumatic stress symptoms (PTSS) and alcohol misuse over the course of integrated treatment, with no studies examining such interventions in primary care (PC). The current study examined temporal changes in PTSS and heavy drinking among individuals who received a brief treatment for co-occurring PTSD and alcohol misuse in PC (Primary Care Treatment Integrating Motivation and Exposure; PC-TIME) compared with those who received PC treatment as usual (PC-TAU). METHOD: A total of 63 veterans (33 randomized to PC-TIME and 30 randomized to PC-TAU) presenting to PC with co-occurring PTSD and alcohol misuse were included in this study. PTSS and heavy drinking were examined at each treatment session for those in PC-TIME. Veterans in both conditions provided reports of PTSS and heavy drinking at baseline, 8-weeks (post-treatment), 14-weeks, and 20-week follow-ups. RESULTS: Session-by-session findings for PC-TIME demonstrated that PTSS at Session 1 predicted a greater decrease in heavy drinking from Session 1 to Session 2. Moreover, heavy drinking at baseline predicted greater decreases in PTSS at 8-weeks for those in PC-TIME, whereas the reverse association was found for those randomized to PC-TAU. Additionally, heavy drinking at 8-weeks predicted decreased PTSS at 14-weeks for those randomized to PC-TAU. CONCLUSIONS: The current study evidenced mixed support for the temporal precedence of PTSS and alcohol misuse. Relations between PTSS and heavy drinking appeared to be linked to treatment targets within PC-TIME and varied between treatment condition (PC-TIME versus PC-TAU). Notably, those with greater than average heavy drinking at the initiation of integrated treatment appeared to have greater reductions in PTSS at post-treatment. Results suggest a mutual maintenance model may best characterize the association between co-occurring PTSS and heavy drinking among treatment-seeking individuals.

Exploring the temporal associations between avoidance behavior and cognitions during the course of cognitive behavioral therapy for clients with symptoms of social anxiety disorder.

OBJECTIVES: In cognitive behavioral therapy (CBT) for social anxiety disorder (SAD), avoidance behavior (AB) and cognitions (COG) are two important targets of intervention, but so far no studies have directly examined their relative importance. By means of cross-lagged panel models (CLPM), we examined their temporal associations and impacts on outcome in clients with symptoms of SAD while addressing typical methodological challenges. METHOD: We used data from the first six therapy sessions in a sample of 428 primary care clients (mean [SD] age = 34.6 [12.2], 34.3% men), participating in the Prompt Mental Health Care trial. Session-by-session data was collected on AB, COG, depression and general anxiety. Competing multiple indicator CLPMs were tested. RESULTS: The Random Intercept-CLPM provided best fit, and indicated that AB predicted COG at subsequent time points (.39 ≤ ß ≤ .42 for T2-T5, p < .05), but not vice versa. In addition, AB, but not COG, predicted clients' general anxiety score at subsequent time points. Results were both robust to the inclusion of depressive symptoms as a within-level covariate, and sensitivity tests for stationarity and missing data assumptions. CONCLUSION: Targeting avoidance behavior for primary care clients with symptoms of SAD may be more vital for the optimal effect of CBT than targeting cognitions. Methodological considerations and limitations of the study are discussed.Trial registration: ClinicalTrials.gov identifier: NCT03238872.

Age-varying Bi-directional Associations Between Momentary Affect and Movement Behaviors in Children: Evidence From a Multi-wave Ecological Momentary Assessment Study.

BACKGROUND: The bi-directional associations between affective states and movement behaviors (e.g., physical activity, sedentary behavior) have been observed in children. It is unclear if the strength of these bi-directional associations varies with age as children transition from childhood to adolescence. PURPOSE: This multi-wave ecological momentary assessment (EMA) study investigates the acute time-varying associations between affect and movement behaviors among youth. METHODS: Children (N = 195, baseline mean age = 10.72, range = 8-12 years, mean BMI-z = 0.49, 51% female) participated in a six-wave EMA study across three years. Each EMA survey captured momentary positive and negative affect. Time spent in moderate-to-vigorous physical activity (MVPA) and sedentary time in the 15-min window before and after each EMA survey was calculated using accelerometry data. Time-varying effect models (TVEM) examined the acute bi-directional associations between momentary positive/negative affect and MVPA/sedentary time across ages 8 to 14. RESULTS: Children provided 14,246 valid activity-matched EMA surveys across all waves. TVEM plots revealed that the directionality and the strength (time-varying slopes) of associations between momentary affect and activity levels vary across ages. Positive affect was associated with higher MVPA levels and lower sedentary time at younger ages, whereas negative affect linked to lower MVPA levels and more sedentary time at older ages. CONCLUSIONS: The acute associations between momentary affect and (in)activity levels may vary as a function of children's age. Applying TVEM to intensive longitudinal data could provide valuable information for developing age-tailored interventions that promote healthy lifestyles among children and adolescents.

The temporal relationship between parental concern of overeating and childhood obesity considering genetic susceptibility: longitudinal results from the IDEFICS/I.Family study.

BACKGROUND: Many genes and molecular pathways are associated with obesity, but the mechanisms from genes to obesity are less well known. Eating behaviors represent a plausible pathway, but because the relationships of eating behaviors and obesity may be bi-directional, it remains challenging to resolve the underlying pathways. A longitudinal approach is needed to assess the contribution of genetic risk during the development of obesity in childhood. In this study we aim to examine the relationships between the polygenic risk score for body mass index (PRS-BMI), parental concern of overeating and obesity indices during childhood. METHODS: The IDEFICS/I.Family study is a school-based multicenter pan-European cohort of children observed for 6 years (mean ± SD follow-up 5.8 ± 0.4). Children examined in 2007/2008 (wave 1) (mean ± SD age: 4.4 ± 1.1, range: 2-9 years), in 2009/2010 (wave 2) and in 2013/2014 (wave 3) were included. A total of 5112 children (49% girls) participated at waves 1, 2 and 3. For 2656 children with genome-wide data we constructed a PRS based on 2.1 million single nucleotide polymorphisms. Z-score BMI and z-score waist circumference (WC) were assessed and eating behaviors and relevant confounders were reported by parents via questionnaires. Parental concern of overeating was derived from principal component analyses from an eating behavior questionnaire. RESULTS: In cross-lagged models, the prospective associations between z-score obesity indices and parental concern of overeating were bi-directional. In mediation models, the association between the PRS-BMI and parental concern of overeating at wave 3 was mediated by baseline z-BMI (ß = 0.16, 95% CI: 0.10, 0.21) and baseline z-WC (ß = 0.17, 95% CI: 0.11, 0.23). To a lesser extent, baseline parental concern of overeating also mediated the association between the PRS-BMI and z-BMI at wave 3 (ß = 0.10, 95% CI: 0.07, 0.13) and z-WC at wave 3 (ß = 0.09, 95% CI: 0.07, 0.12). CONCLUSIONS: The findings suggest that the prospective associations between obesity indices and parental concern of overeating are likely bi-directional, but obesity indices have a stronger association with future parental concern of overeating than vice versa. The findings suggest parental concern of overeating as a possible mediator in the genetic susceptibility to obesity and further highlight that other pathways are also involved. A better understanding of the genetic pathways that lead to childhood obesity can help to prevent weight gain. TRIAL REGISTRATION: Registry number: ISRCTN62310987 Retrospectively registered 17 September 2018.

Spatio-temporal association mining of intercity PM2.5 pollution: Hubei Province in China as an example.

The complex interaction between emissions, meteorology, and atmospheric chemistry makes accurate predictions of particulate pollution difficult. Advanced data mining techniques can reveal potential laws, providing new possibilities for understanding the evolution and causes of air pollution. Based on the Granger method and block modeling analysis, this paper explored the intercity spillover effects of hourly PM2.5 in Hubei Province, China, to determine the specific role (i.e., overflow, limited overflow, bilateral, inflow, and limited inflow) of each city on regional pollution formation. Furthermore, a dynamic Apriori algorithm considering time-lag effects was used to mine the spatio-temporal associations of extreme PM2.5 pollution events among different cities. Results suggest that the northern and central cities with high-level PM2.5 concentration in Hubei have a significant spillover effect, whereas the eastern and southern cities generally play a role as the sink of pollutants. Based on the association rules of extreme PM2.5 pollution, four main pollutant transport channels were excavated and well matched with the trajectories extracted by the atmospheric model. This paper provides new insights for exploring the interaction of intercity particulate pollution, which is a supplement and cross-validation of the model results.

The Temporal Associations of Therapeutic Alliance and Manual Adherence With Depressive Symptom Change in Cognitive Behavioral Therapy for Adult Outpatient Major Depression.

Background: The therapeutic alliance is considered an important causal agent of psychotherapy efficacy. However, studies in cognitive behavioral therapy (CBT) for depression have suggested that alliance might be more of a consequence rather than a cause of depressive symptom change, while adherence to CBT specific techniques was found to be associated with subsequent depression change. We aimed to add to this body of literature by assessing the temporal associations of both therapeutic alliance and manual adherence with depressive symptom change in a relatively large sample of depressed adult outpatients over the full course of CBT. Methods: Adults with a major depressive episode (n = 98) participating in a randomized clinical trial were offered 22 weeks of CBT and rated the Penn Helping Alliance Questionnaire (HAq-I) at weeks 5 and 22. Therapists rated their adherence to the CBT manual after each session and observers assessed the Hamilton Depression Rating Scale scores at weeks 0, 5, 10, and 22. Linear mixed model analyses were used to assess the associations of alliance and adherence with prior and subsequent depression change. Results: HAq-I Relationship and manual adherence ratings were not significantly associated with prior nor with subsequent depression change (p > 0.14). Prior depression change was associated with the HAq-I subscale Perceived helpfulness at the end of treatment (r = 0.30, CI = 0.03-0.56, p = 0.03). Conclusion: We were not able to replicate prior depression change in CBT for depression to be associated with improved quality of the therapeutic alliance when using a more "pure" measure of the therapeutic relationship. Limitations of this study include the subjective alliance and adherence assessments. Our findings indicate the need to appropriately distinguish between the perceived helpfulness and the relationship factors when examining therapeutic alliance.

Spatio-temporal associations with memory cues are linked to analogue traumatic intrusions.

Trauma survivors with post-traumatic stress disorder (PTSD) frequently experience intrusive trauma memories associated with a feeling of "nowness". Information-processing models of PTSD ascribe these symptoms to an insufficient integration of memories with their spatio-temporal context in the past, turning them into powerful stressors. Here, we tested the idea that automatic associations of trauma reminders with the present or the past predict intrusive memories. We instructed 96 healthy participants to view two different traumatic films. Participants then underwent a computerized training that established implicit contingencies between film reminder pictures with the verbal responses "now" or "past" to increase and reduce intrusions, respectively. The training successfully altered implicit spatio-temporal associations for film reminder stimuli on a subsequent Implicit Association Test (IAT). There were no additional transfer effects for tense usage during a free recall task after one week and for the development of intrusion symptoms (one-week diary, retrospective questionnaire). However, participants who associated one film more strongly with the present and the other with the past consistently reported relatively more intrusive memories related to the former film. Thus, our results lend support to information processing models of PTSD and warrant further investigation of the causal role of implicit associations with spatio-temporal information.

Temporal Memory and Its Enhancement by Estradiol Requires Surface Dynamics of Hippocampal CA1 N-Methyl-D-Aspartate Receptors.

BACKGROUND: Identifying the underlying cellular mechanisms of episodic memory is an important challenge, since this memory, based on temporal and contextual associations among events, undergoes preferential degradation in aging and various neuropsychiatric disorders. Memory storage of temporal and contextual associations is known to rely on hippocampal N-methyl-D-aspartate receptor (NMDAR)-dependent synaptic plasticity, which depends ex vivo on dynamic organization of surface NMDARs. Whether NMDAR surface trafficking sustains the formation of associative memory, however, remains unknown. METHODS: We tested this hypothesis, using single nanoparticle imaging, electrophysiology, and behavioral approaches, in hippocampal networks challenged with a potent modulator of NMDAR-dependent synaptic plasticity and memory, 17ß-estradiol (E2). RESULTS: We demonstrate that E2 modulates NMDAR surface trafficking, a necessary condition for E2-induced potentiation at hippocampal cornu ammonis 1 synapses. Strikingly, cornu ammonis 1 NMDAR surface trafficking controls basal and E2-enhanced mnemonic retention of temporal, but not contextual, associations. CONCLUSIONS: NMDAR surface trafficking and its modulation by the sex hormone E2 is a cellular mechanism critical for a major component of episodic memory, opening a new and noncanonical research avenue in the physiopathology of cognition.

Bidirectional relations between work-related stress, sleep quality and perseverative cognition.

OBJECTIVE: In this longitudinal two-wave study, bidirectional relations between work-related stress and sleep quality were examined. Moreover, it was investigated whether perseverative cognition is a potential underlying mechanism in this association, related to both work-related stress and sleep quality. METHODS: A randomly selected sample of Dutch employees received an online survey in 2012 and 2013. Of all invited employees, 877 participated in both waves. Structural equation modeling was performed to analyze the data. RESULTS: We found evidence for reversed relations between work-related stress and sleep quality. Specifically, when controlling for perseverative cognition, work-related stress was not directly related to subsequent sleep quality, but low sleep quality was associated with an increase in work-related stress over time. Moreover, negative bidirectional associations over time were found between perseverative cognition and sleep quality, and positive bidirectional associations were found between work-related stress and perseverative cognition. Lastly, a mediation analysis showed that perseverative cognition fully mediated the relationship between work-related stress and sleep quality. CONCLUSION: The study findings suggest that perseverative cognition could be an important underlying mechanism in the association between work-related stress and sleep quality. The bidirectionality of the studied relationships could be an indication of a vicious cycle, in which work-related stress, perseverative cognition, and sleep quality mutually influence each other over time.

Temporal associations between substance use and delinquency among youth with a first time offense.

OBJECTIVE: Substance use and delinquency among adolescents have been shown to be positively associated; however, the temporal relationship is not well understood. Examining the association between delinquency and substance use is especially relevant among adolescents with a first-time substance use related offense as they are at-risk for future problems. METHOD: Data from 193 adolescents at time of diversion program entry and six months later was examined using cross-lagged path analysis to determine whether substance use and related consequences were associated with other types of delinquency across time. RESULTS: Results demonstrated that delinquency at program entry was related to subsequent reports of heavy drinking and alcohol consequences, but not marijuana use or its consequences. In contrast, alcohol and marijuana use at program entry were not related to future reports of delinquency. CONCLUSIONS: Findings emphasize the need to build in comprehensive assessments and interventions for youth with a first time offense in order to prevent further escalation of substance use and criminal behaviors.

Developmental Trajectories of Emotion Regulation Across Infancy: Do Age and the Social Partner Influence Temporal Patterns?

The ability to effectively regulate emotions is a critical component of early socio-emotional development. This longitudinal study examined the developmental trajectories of emotion regulation in a sample of 3-, 5-, and 7-month-olds during an interaction with mothers and fathers. Infants' negative affect and use of behavioral strategies, including distraction, self-soothing, and high intensity motor behaviors were rated during the still-face episode of the Still-Face Paradigm. Longitudinal mixed-effects models were tested to determine whether strategies were followed by an increase or decrease in negative affect. Results from mother-infant and father-infant dyads indicated that focusing attention away from the unresponsive parent and engaging in self-soothing behaviors were associated with a subsequent decline in negative affect and the strength of these temporal associations were stable across infancy. In contrast, high-intensity motor behaviors were followed by an increase in negative affect and this effect declined over time. No significant effects were found for the behavioral strategy of looking at the parent. Results underscore the importance of considering infant age and the social partner when studying the effectiveness of emotion regulatory strategies in early infancy.

Temporal associations for spatial events: the role of the dentate gyrus.

Previous research suggests that the dorsal dentate gyrus (DG) hippocampal subregion mediates spatial processing functions. However, a novel role for the DG in temporal processing for spatial information has begun to emerge based on the development of a computational model of neurogenesis. According to this model, adult born granule cells in the DG contribute to a temporal associative integration process for events presented closer in time. Currently, there is a paucity of behavioral evidence to support the temporal integration theory. Therefore, we developed a novel behavioral paradigm to investigate the role of the dDG in temporal integration for proximal and distal spatial events. Male Long-Evans rats were randomly assigned to a control group or to receive bilateral intracranial infusions of colchicine into the dDG. Following recovery from surgery, each rat was tested on a cued-recall of sequence paradigm. In this task, animals were allowed to explore identical objects placed in designated spatial locations on a cheeseboard maze across 2 days (e.g., Day 1: A and B; Day 2: C and D). One week later, animals were given a brief cue (A or C) followed by a preference test between spatial location B and D. Control animals had a significant preference for the spatial location previously paired with the cue (the temporal associate) whereas dDG lesioned animals failed to show a preference. These findings suggest that selective colchicine-induced dDG lesions are capable of disrupting the formation of temporal associations between spatial events presented close in time.