Stability of Attachment Style in Adolescence: An Empirical Test of Alternative Developmental Processes.

Few studies have examined stability and change in attachment during adolescence. This 5-year longitudinal study (a) examined whether prototype or revisionist developmental dynamics better characterized patterns of stability and change in adolescent attachment (at T1, N = 176; Mage  = 14.0 years, SD = 0.9), (b) tested potential moderators of prototype-like attachment stability, and (c) compared attachment stability in adolescence to stability in adulthood. The results supported the prototype model, which assumes that there is a stable, enduring factor underlying stability and change in attachment. Exploratory moderation analyses revealed that family conflict, parental separation or divorce, minority status, and male sex might undermine the prototype-like stability of adolescent attachment. Stability of attachment was lower in adolescence relative to adulthood.

Development and Preliminary Feasibility Study of a Brief Behavioral Activation Mobile Application (Behavioral Apptivation) to Be Used in Conjunction With Ongoing Therapy.

Depressive symptoms are the most frequently treated psychiatric condition in the United States. Brief behavioral activation treatment for depression (BATD) is a popular, evidence-based psychotherapy with strong research support for the treatment of depression. In this paper, we describe the development and initial pilot feasibility testing of a BATD mobile application (Behavioral Apptivation) to be used by patients and therapists in conjunction with BATD therapy. We present information regarding the app development process as well as results from a small open-label feasibility trial of the app utilized in conjunction with individual BATD. We include a case series from the open-label trial highlighting how Behavioral Apptivation can be utilized in clinical practice.

A Prospective Examination of the Relations Between Emotional Abuse and Anxiety: Moderation by Distress Tolerance.

Anxiety, the most common and impairing psychological problem experienced by youth, is associated with numerous individual and environmental factors. Two such factors include childhood emotional abuse (CEA) and low distress tolerance (DT). The current study aimed to understand how CEA and low DT impacted anxiety symptoms measured annually across 5 years among a community sample of youth. We hypothesized DT would moderate the relationship between CEA and anxiety, such that youth with higher levels of CEA and lower levels of DT would have elevated anxiety over time. Community youth (N = 244) were annually assessed across 5 years using the Revised Child Anxiety and Depression Scale, Childhood Trauma Questionnaire, and Behavioral Indicator of Resiliency to Distress. Higher CEA at baseline was associated with higher anxiety at baseline, higher anxiety at each annual assessment, and with greater overall decreases in anxiety over time. Lower DT was associated with higher anxiety at baseline, but did not predict changes in anxiety over time. Baseline DT significantly moderated the relationship between baseline CEA and anxiety, such that youth with both higher CEA and lower DT had the highest anxiety at each annual assessment. Youth with lower DT and higher CEA scores had the highest level of anxiety symptoms across time.

Moodivate: A self-help behavioral activation mobile app for utilization in primary care-Development and clinical considerations.

Depressive symptoms are highly prevalent and are associated with considerable functional impairment, significant public health costs, and heightened mortality risk. Individuals experiencing impairment due to depressive symptomatology are most likely to report their symptoms to a primary care provider. As such, national guidelines highlight the need to assess and effectively treat depression via primary care. Despite these guidelines, the dissemination of evidence-based psychotherapy via primary care is limited, likely due to both provider- and patient-level treatment barriers. Mobile health (mHealth) technologies are promising for addressing these barriers and for promoting uptake of evidence-based depression treatment. Among evidence-based psychotherapies for depression, brief Behavioral Activation Treatment for Depression (BATD) has shown great promise and is particularly amenable to mHealth delivery. Herein, we discuss the development of a BATD mobile application, Moodivate, that was developed in order to disseminate BATD via primary care. This paper focuses on description of (1) rationale for Moodivate treatment development, (2) Moodivate treatment components, (3) ongoing clinical trial evaluation of Moodivate, and (4) clinical considerations for incorporating Moodivate into clinical practice.

When Parents and Adolescents Disagree About Disagreeing: Observed Parent-Adolescent Communication Predicts Informant Discrepancies About Conflict.

Adolescence is accompanied by increased stress in the parent-adolescent relationship, which frequently results in conflict. Researchers often rely on self-reports to measure conflict, but these reports are frequently discrepant from one another. In two studies, we examined the extent to which communication observed during parent-adolescent discussions of conflict were associated with discrepancies in reports about conflict. We also examined links between informant depressive symptoms and discrepancies. Across studies, observed parent-adolescent conflict behaviors consistently predicted absolute discrepancies in reports of conflict. Informant depressive symptoms sometimes predicted directional discrepancies in reports. Results suggest that informant discrepancies about conflict may stem, in part, from a lack of open communication in the relationship.

Integrating Motivational Interviewing and Brief Behavioral Activation Therapy: Theoretical and Practical Considerations.

Behavioral Activation and specifically the Brief Behavioral Activation Therapy for Depression (BATD) has a strong record of empirical support but its focus on practical out of session activation-based assignments can lead to poor levels of adherence if efforts to enhance motivation are not prioritized. Towards this end, this manuscript describes the assimilative integration of Motivational Interviewing (MI) and BATD to improve clinical outcomes by integrating MI's focus on building and maintaining motivation to change into BATD. The manuscript provides an overview of MI and BATD, theoretical issue raised in integrating the two approaches, and examples of how this integration results in a nondirective and motivation-focused approach to conducting BATD.

Can behavioral theory inform the understanding of depression and medication nonadherence among HIV-positive substance users?

Medication adherence is highly predictive of health outcomes across chronic conditions, particularly HIV/AIDS. Depression is consistently associated with worse adherence, yet few studies have sought to understand how depression relates to adherence. This study tested three components of behavioral depression theory--goal-directed activation, positive reinforcement, and environmental punishment--as potential indirect effects in the relation between depressive symptoms and medication nonadherence among low-income, predominantly African American substance users (n = 83). Medication nonadherence was assessed as frequency of doses missed across common reasons for nonadherence. Non-parametric bootstrapping was used to evaluate the indirect effects. Of the three intermediary variables, there was only an indirect effect of environmental punishment; depressive symptoms were associated with greater nonadherence through greater environmental punishment. Goal-directed activation and positive reinforcement were unrelated to adherence. Findings suggest the importance of environmental punishment in the relation between depression and medication adherence and may inform future intervention efforts for this population.

Testing the temporal relationship between maternal and adolescent depressive and anxiety symptoms in a community sample.

Transactional models have been used to explain the relationship between maternal depression and child behavioral problems; however, few studies have examined transactional models for maternal depression and adolescent depression and anxiety. Using an autoregressive cross-lagged analysis, we examined the longitudinal association between maternal and adolescent depression to determine the extent to which maternal depression influences adolescent depression and anxiety, and vice versa, over the course of a 4-year period. Participants were a community sample of 277 mother-adolescent dyads with offspring 10 to 14 years of age at the 1st year used in the analyses (43.7% female; 35% African American, 2.9% Hispanic/Latino). Depressive symptoms were assessed using maternal self-report (Center for Epidemiological Studies-Depression Scale; Radloff, 1977), and adolescent depression and anxiety were assessed by self-report (Revised Child Anxiety and Depression Scale; Chorpita, Yim, Moffitt, Umemoto, & Francis, 2000). The final model, χ(2)(14) = 23.74, p = .05 (TLI = .97, CFI = .98, RMSEA = .05), indicated that maternal depression was significantly associated with adolescent depression 2 years later. Of interest, adolescent depression did not significantly predict maternal depression, and the association between maternal and adolescent depression was not moderated by gender, age, or ethnicity. The association between maternal depression and adolescent anxiety was weaker than that observed for adolescent depression. Results suggest that the transaction model of maternal depression may not extend to adolescent depression and anxiety. Furthermore, maternal depression can have an enduring effect on adolescent depression, and continued research and clinical monitoring over extended periods is warranted.

One-Year Test-Retest Reliability of the Maryland Resource for the Behavioral Utilization of the Reinforcement of Negative Stimuli (MRBURNS).

The Maryland Resource for the Behavioral Utilization of the Reinforcement of Negative Stimuli (MRBURNS) is a novel behavioral task designed to measure individual differences in negative reinforcement-based risk taking propensity. Performance on the MRBURNS has been linked with alcohol-related problems and negative reinforcement-based drinking motives, as well as symptoms of anxiety and depression; however, it is unclear if performance on the task represents a stable measure of negative reinforcement-based risk taking over time. As such, the current study aimed to examine the test-retest reliability of the MRBURNS over a period of one year. Results indicate that the correlation between year 1 and year 2 risk behavior (average number of pumps) on the MRBURNS was .43 across all trials. With the one year test-retest reliability of the MRBURNS established, the MRBURNS may be a useful approach to measuring the relative contribution of negative reinforcement-based risk taking in the development of risky behaviors over time, and may be used to monitor the effects of novel interventions that aim to reduce negative reinforcement based risk taking in the real world.

Analogue study of peer influence on risk-taking behavior in older adolescents.

This experimental study aimed to examine whether adolescents act in a riskier manner in the presence of peers and whether peer presence alone influences risk behavior or if a direct influence process is necessary. Utilizing a behavioral task assessing risk-taking, 183 older adolescents (18­20 year olds) came to the laboratory alone once and then were randomized to one of three conditions as follows: alone, peers present, and peers encouraging. An interaction was found such that at baseline, there were no significant differences between the three conditions, but at the experimental session, there was a significant increase in risk task scores particularly for the encouraging condition. These findings challenge proposed models of the interaction between peer influence and risk taking by providing evidence that adolescents take more risks when being encouraged by peers, but that the presence of peers on its own does not lead to more risks than when completing the task alone.

Gender and social rejection as risk factors for engaging in risky sexual behavior among crack/cocaine users.

Crack/cocaine and engagement in risky sexual behavior represent important contributors to the escalation of the HIV infection among women. Several lines of research have emphasized the role of social factors in women's vulnerability for such practices and stressed the importance of understanding such factors to better inform prevention efforts and improve their effectiveness and efficiency. However, few studies have attempted to pinpoint specific social/contextual factors particularly relevant to high-risk populations such as female crack/cocaine users. Extensive previous research has related the experience of social rejection to a variety of negative outcomes including, but not limited to, various forms of psychopathology, self-defeating, and self-harm behavior. Motivated by this research, the current study explored the role of laboratory-induced social rejection in moderating the relationship between gender and risky sexual behavior among a sample of crack/cocaine users (n = 211) at high risk for HIV. The results showed that among women, but not among men, experiencing social rejection was significantly associated with a greater number of sexual partners. Further, experiencing social rejection was not related to the frequency of condom use. Implications for future research, prevention, and treatment are discussed.

Brief report: The interaction of impulsivity with risk-taking is associated with early alcohol use initiation.

Early alcohol use initiation is a well-established risk factor for the subsequent development of alcohol abuse and dependence. Separate lines of research indicate that impulsivity and risk-taking each are associated with early alcohol use. In this research, the association of the interaction of risk-taking and impulsivity with early alcohol initiation was examined. Results suggest the interaction between impulsivity and risk-taking was related to early alcohol initiation. Among children with lower levels of risk-taking, level of impulsivity was associated with beginning to drink. By contrast, among children with higher levels of risk-taking, level of impulsivity was not associated with the likelihood of initiating alcohol use. These findings suggest that early adolescence is a critical developmental period in which implementing an intervention to reduce impulsivity and risk-taking may be particularly effective to prevent the early initiation of alcohol use.

The Relationship between Puberty and Risk Taking in the Real World and in the Laboratory.

Adolescence is marked by the emergence and escalation of risk taking. Puberty has been long-implicated as constituting vulnerability for risk behavior during this developmental period. Sole reliance on self-reports of risk taking however poses limitations to understanding this complex relationship. There exist potential advantages of complementing self-reports by using the BART-Y laboratory task, a well-validated measure of adolescent risk taking. Toward this end, we examined the association between self-reported puberty and both self-reported and BART-Y risk taking in 231 adolescents. Results showed that pubertal status predicted risk taking using both methodologies above and beyond relevant demographic characteristics. Advantages of a multimodal assessment toward understanding the effects of puberty in adolescent risk taking are discussed and future research directions offered.

Prospective study of substance-induced and independent major depressive disorder among individuals with substance use disorders in a nationally representative sample.

BACKGROUND: Depression and substance use disorders (SUDs) commonly co-occur, which presents diagnostic challenges in classifying independent major depressive disorder (MDD) versus substance-induced depressive disorder (SIDD). It remains unclear if distinct characteristics and/or patterns in temporal course distinguish MDD-SUD and SIDD to guide these decisions. Further, evidence suggests that a significant portion of individuals with SIDD are later reclassified as having independent MDD. Continued research to improve our understanding of differences between these two and changes in reclassification over time is necessary for diagnostic clarification and to guide clinical decisions when treating depression in the context of SUDs. METHODS: The current study compared individuals with MDD-SUD versus SIDD at baseline and examined reclassification of DSM-IV Axis I diagnoses over a 3-year follow up in a large, nationally representative epidemiological sample (n = 2,121). RESULTS: Findings demonstrated that SIDD was extremely rare at both time points. At baseline, individuals with SIDD were more likely to be non-White, have less education, less likely to have insurance, less likely to have dysthymia or alcohol abuse, and more likely to have drug dependence compared to those with independent MDD. Of individuals with SIDD at Wave 1 who had a depressive episode between Waves 1 and 2, the overwhelming majority (>95%) had an independent MDD, not SIDD, episode. There were no significant group differences in the incidence of other mood disorders or SUDs at Wave 2. CONCLUSIONS: Findings have important etiological and treatment implications for the classification and treatment of depression in the context of SUDs.

Meditative therapies for reducing anxiety: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Anxiety disorders are among the most common psychiatric disorders and meditative therapies are frequently sought by patients with anxiety as a complementary therapy. Although multiple reviews exist on the general health benefits of meditation, no review has focused on the efficacy of meditation for anxiety specifically. METHODS: Major medical databases were searched thoroughly with keywords related to various types of meditation and anxiety. Over 1,000 abstracts were screened, and 200+ full articles were reviewed. Only randomized controlled trials (RCTs) were included. The Boutron (Boutron et al., 2005: J Clin Epidemiol 58:1233-1240) checklist to evaluate a report of a nonpharmaceutical trial (CLEAR-NPT) was used to assess study quality; 90% of the authors were contacted for additional information. Review Manager 5 was used for meta-analysis. RESULTS: A total of 36 RCTs were included in the meta-analysis (2,466 observations). Most RCTs were conducted among patients with anxiety as a secondary concern. The study quality ranged from 0.3 to 1.0 on the 0.0-1.0 scale (mean = 0.72). Standardized mean difference (SMD) was -0.52 in comparison with waiting-list control (p < .001; 25 RCTs), -0.59 in comparison with attention control (p < .001; seven RCTs), and -0.27 in comparison with alternative treatments (p < .01; 10 RCTs). Twenty-five studies reported statistically superior outcomes in the meditation group compared to control. No adverse effects were reported. CONCLUSIONS: This review demonstrates some efficacy of meditative therapies in reducing anxiety symptoms, which has important clinical implications for applying meditative techniques in treating anxiety. However, most studies measured only improvement in anxiety symptoms, but not anxiety disorders as clinically diagnosed.

Temperamental exuberance and executive function predict propensity for risk taking in childhood.

The present study utilized a multilevel approach to examine developmental trajectories in risk-taking propensity. We examined the moderating role of specific executive function components, attention shifting and inhibitory control, on the link between exuberant temperament in infancy and propensity for risk taking in childhood. Risk taking was assessed using a task previously associated with sensation seeking and antisocial behaviors. Two hundred ninety-one infants were brought into the lab and behaviors reflecting exuberance were observed at 4, 9, 24, and 36 months of age. Executive function was assessed at 48 months of age. Risk-taking propensity was measured when children were 60 months of age. The results indicated that exuberance and attention shifting, but not inhibitory control, significantly interacted to predict propensity for risk taking. Exuberance was positively associated with risk-taking propensity among children who were relatively low in attention shifting but unrelated for children high in attention shifting. These findings illustrated the multifinality of developmental outcomes for temperamentally exuberant young children and pointed to the distinct regulatory influences of different executive functions for children of differing temperaments. Attention shifting likely affords a child the ability to consider both positive and negative consequences and moderates the relation between early exuberance and risk-taking propensity.

An experimental investigation of emotional willingness and physical pain tolerance in deliberate self-harm: the moderating role of interpersonal distress.

Although theoretical and clinical literature emphasize the role of both an unwillingness to experience emotional distress and physical pain tolerance in deliberate self-harm (DSH), research on their associations with DSH remains limited. This study sought to examine the relationships between DSH and the willingness to experience emotional distress and tolerate physical pain, including the moderating role of interpersonal distress in these relationships. To this end, young adults with recent DSH (n = 43) and controls without any DSH (n = 52) were randomly assigned to 1 of 2 emotion-induction conditions (distressing or neutral), after which behavioral measures of both the willingness to experience distress and physical pain tolerance were obtained. Consistent with hypotheses, findings indicated heightened physical pain tolerance among self-harming individuals only under conditions of interpersonal distress. Furthermore, findings provided some support for the hypothesized association between DSH and the unwillingness to experience emotional distress, suggesting that self-harming women evidence less willingness to experience emotional distress only under conditions of depleted regulatory capacity (eg, following an interpersonal stressor).

Enhancing infant attachment security: an examination of treatment efficacy and differential susceptibility.

This randomized controlled trial examined (a) the efficacy of a brief intervention designed to increase the rate of secure infant attachment, (b) the differential susceptibility hypothesis, and (c) whether maternal attachment styles moderated the expected Treatment x Irritability interaction in predicting infant attachment outcomes. Although there was no main effect of treatment, a significant Treatment x Irritability interaction revealed intervention effects for the highly irritable infants only, thus supporting one of two predictions of the differential susceptibility hypothesis: highly irritable infants would have disproportionately better outcomes than moderately irritable infants in better conditions (i.e., with intervention). When separate analyses were conducted with maternal attachment styles, we found significant three-way interactions among treatment, irritability, and each of the examined maternal attachment style dimensions (i.e., secure-fearful and dismissing-preoccupied). Specifically, with more secure mothers, beneficial effects of intervention emerged for highly irritable infants. For more dismissing mothers, the results revealed support for both predictions of the differential susceptibility hypothesis: highly irritable infants, compared to moderately irritable infants, were both more likely to be secure with intervention and less likely to be secure when in the control group. It is interesting that, for more preoccupied mothers, a treatment effect emerged only for moderately irritable infants. We discuss the implications of these findings for the differential susceptibility hypothesis as well as for early intervention.

Discrepancy between mother and child reports of parental knowledge and the relation to risk behavior engagement.

The study examined discrepancies in mother and child reports of parental knowledge (PK) of a child's whereabouts, activities, and companions, as well as the extent to which discrepancies in reports of PK are related to child risk-taking behavior concurrently and prospectively across two time points. The sample consisted of 219 mother and early adolescent youth (M age = 11.0, SD = .8) dyads. Mother and child reports of PK significantly differed and, at both waves, scores on the risk taking composite related negatively to both mother and child reports of PK and positively to the discrepancy between the two reports. A significant interaction between mother and child reports was found at Wave 2, such that the relation between child reported PK and risk behavior was stronger when mothers reported high levels of parental knowledge versus low levels of parental knowledge. Prospective analyses indicated a main effect of mother report.

Integration of the brief behavioral activation treatment for depression (BATD) into a college orientation program: depression and alcohol outcomes.

College freshmen face a variety of academic and social challenges as they adjust to college life that can place them at risk for a number of negative outcomes, including depression and alcohol-related problems. Orientation classes that focus on teaching incoming students how to better cope with college-oriented stress may provide an opportunity to prevent the development of these adjustment problems. This article outlines a program based on behavioral activation that can be integrated into college orientation programs to provide a more comprehensive orientation experience. Data are presented from an initial pilot study in which 71 first-semester freshman at the University of Maryland participated in a 15-week, 2 hr per week orientation class (n = 37 in the behavioral activation-enhanced orientation classes and n = 34 in the control orientation as usual classes). Students' depression and alcohol use were evaluated at the beginning, middle, and end of the course. Results indicated a Time × Group interaction such that problem drinking (but not consumption) was significantly reduced across assessments in the behavioral activation classes and largely unchanged in the standard classes. No difference was observed in depression scores; however, fairly low depression scores across the 3 time points may have limited the opportunity to observe any meaningful impact of the orientation classes on depression. The authors conclude with a discussion of the implications of their findings for preventing adjustment problems among incoming college students and future directions.