Alyson K. Zalta

Telomere Shortening and Mood Disorders: Preliminary Support for a Chronic Stress Model of Accelerated Aging

BACKGROUND Little is known about the biological mechanisms underlying the excess medical morbidity and mortality associated with mood disorders. Substantial evidence supports abnormalities in stress-related biological systems in depression. Accelerated telomere shortening may reflect stress-related oxidative damage to cells and accelerated aging, and severe psychosocial stress has been linked to telomere shortening. We propose that chronic stress associated with mood disorders may contribute to excess vulnerability for diseases of aging such as cardiovascular disease and possibly some cancers through accelerated organismal aging. METHODS Telomere length was measured by Southern Analysis in 44 individuals with chronic mood disorders and 44 nonpsychiatrically ill age-matched control subjects. RESULTS Telomere length was significantly shorter in those with mood disorders, representing as much as 10 years of accelerated aging. CONCLUSIONS These results provide preliminary evidence that mood disorders are associated with accelerated aging and may suggest a novel mechanism for mood disorder-associated morbidity and mortality.

Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: meta-analysis

BACKGROUND It is unclear how many children and adolescents develop post-traumatic stress disorder (PTSD) after trauma. AIMS To determine the incidence of PTSD in trauma-exposed children and adolescents as assessed with well-established diagnostic interviews and to examine potential moderators of the estimate. METHOD A systematic literature search identified 72 peer-reviewed articles on 43 independent samples (n = 3563). Samples consisting only of participants seeking or receiving mental health treatment were excluded. Main analyses involved pooled incidence estimates and meta-analyses of variance. RESULTS The overall rate of PTSD was 15.9% (95% CI 11.5-21.5), which varied according to the type of trauma and gender. Least at risk were boys exposed to non-interpersonal trauma (8.4%, 95% CI 4.7-14.5), whereas girls exposed to interpersonal trauma showed the highest rate (32.9%, 95% CI 19.8-49.3). No significant difference was found for the choice of assessment interview or the informant of the assessment. CONCLUSIONS Research conducted with the best available assessment instruments shows that a significant minority of children and adolescents develop PTSD after trauma exposure, with those exposed to interpersonal trauma and girls at particular risk. The estimates provide a benchmark for DSM-5 and ICD-11.

Point prevalence of bulimia nervosa in 1982, 1992, and 2002

Background. Recent epidemiological data suggest a decline in bulimia nervosa (BN) incidence in primary care. We sought to examine BN point prevalence from 1982 to 2002 in a college population.Method. In 1982, 1992, and 2002, 800 women and 400 men were randomly sampled from a university for a study of health and eating patterns. Participation rates were 72% in women and 63% in men, resulting in n=2491 participants.Results. BN point prevalence decreased significantly in women over the period of observation. Eating Disorder Inventory Bulimia scores decreased across cohorts, and these decreases remained significant when male and female and Caucasian and non-Caucasian students were analyzed separately.Conclusion. These data support a decline in BN rates that cannot be attributed to changes in service utilization. Changing socio-cultural factors may explain a true decrease in BN incidence and prevalence.

Change in Negative Cognitions Associated with PTSD Predicts Symptom Reduction in Prolonged Exposure

OBJECTIVE The goal of the current study was to examine mechanisms of change in prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD). Emotional processing theory of PTSD proposes that disconfirmation of erroneous cognitions associated with PTSD is a central mechanism in PTSD symptom reduction; but to date, the causal relationship between change in pathological cognitions and change in PTSD severity has not been established. METHOD Female sexual or nonsexual assault survivors (N = 64) with a primary diagnosis of PTSD received 10 weekly sessions of PE. Self-reported PTSD symptoms, depression symptoms, and PTSD-related cognitions were assessed at pretreatment, each of the 10 PE treatment sessions, and posttreatment. RESULTS Lagged mixed-effect regression models indicated that session-to-session reductions in PTSD-related cognitions drove successive reductions in PTSD symptoms. By contrast, the reverse effect of PTSD symptom change on change in cognitions was smaller and did not reach statistical significance. Similarly, reductions in PTSD-related cognitions drove successive reductions in depression symptoms, whereas the reverse effect of depression symptoms on subsequent cognition change was smaller and not significant. Notably, the relationships between changes in cognitions and PTSD symptoms were stronger than the relationships between changes in cognitions and depression symptoms. CONCLUSIONS To our knowledge, this is the 1st study to establish change in PTSD-related cognitions as a central mechanism of PE treatment. These findings are consistent with emotional processing theory and have important clinical implications for the effective implementation of PE.

Peer Influence on Bulimic Symptoms in College Students

This longitudinal study examined the influence of peer selection and socialization on bulimic symptoms in college students. Ninety-eight participants completed measures of bulimic symptoms, self-esteem, perfectionism, and impulsivity in the spring and fall of 2003. Peer influence was assessed by examining similarity among selected peers, unselected peers, and nonpeers over time. Among selected peers, bulimic symptoms demonstrated patterns of socialization, self-esteem and perfectionism demonstrated patterns of selection, and these personality traits longitudinally predicted changes in bulimic symptoms. Unselected peers demonstrated no similarity for bulimia, self-esteem, or perfectionism, but they did evidence socialization for impulsivity. The findings support an etiological model that integrates social and individual risk factors in creating environments that influence disordered eating among college students.

Impact of concurrent naturalistic pharmacotherapy on psychotherapy of complicated grief

Complicated grief (CG) is a debilitating syndrome that can be reliably identified, but there is a paucity of research examining treatment of CG. A targeted psychotherapy for complicated grief (CGT) was recently shown to be efficacious [Shear, K., Frank, E., Houck, P.R., Reynolds, C.F., 3rd, 2005. Treatment of complicated grief: a randomized controlled trial. Journal of the American Medical Association 293, 2601-2608]. We provide a detailed examination of the association of naturalistic pharmacotherapy use with treatment response and study completion in the psychotherapy study. Patients on an antidepressant medication were more likely to complete a full course of CGT (91% vs. 58% completed), while antidepressant use had no effect on completion rates for the comparator, interpersonal psychotherapy (70% vs. 77%). Our naturalistic data underscore the need for prospective, randomized controlled studies of CG pharmacotherapy and psychotherapy alone and in combination.

The relationship of anxiety disorders, anxiety sensitivity and pulmonary dysfunction with dyspnea-related distress and avoidance.

Little is known about factors that mediate the relationship between anxiety and respiratory-related distress and disability. We hypothesized that elevations in anxiety sensitivity would be associated with greater severity of dyspnea, greater dyspnea-related avoidance, and poorer subjective assessment of health in patients with dyspnea referred for pulmonary function testing, regardless of objective evidence of pulmonary dysfunction. A total of 182 consecutive patients receiving pulmonary function tests to evaluate dyspnea were screened with a patient-rated Primary Care Evaluation of Mental Disorders and completed the Anxiety Sensitivity Index and questionnaires assessing symptom severity and avoidance. Anxiety Sensitivity Index score predicted more severe subjective dyspnea and greater dyspnea-related avoidance, even after adjustment for anxiety disorders and pulmonary dysfunction. Despite some limitations, these data provide preliminary support that strategies to identify, measure, and address high levels of anxiety sensitivity should be examined to reduce subjective distress and improve functioning for patients with dyspnea.

Expanding the Science of Resilience: Conserving Resources in the Aid of Adaptation.

In considering resilience to stress there are several key organizing principles that will aid both research and understanding. Understanding resilience is critical to illumination of the stress process, be it for purposes of research, policy, or intervention. Bonanno, Romero, and Klein (this issue) provide an excellent review of thinking on resilience and delineate several key foci that require future attention. In particular, Bonanno et al. (this issue) aid the study and understanding of resilience by outlining the temporal elements of resilience. They also insightfully push the focus of resilience beyond just the individual level, to the level of the family and community. In their paper, they state that their “elemental approach provides a ready framework for integrating the various meanings of psychological resilience into a single unfolding process.” What we think can further guide this field is the introduction of several key constructs that help describe key organizing principles about resilience that map out the critical constructs and processes that characterize resilience. To be clear, many of these concepts have been discussed in some form by Bonanno in his seminal work on resilience (Bonanno, 2004; 2005; Bonanno, Galea, Bucciarelli, & Vlahov, 2006; Bonanno, Brewin, Kaniasty & La Greca, 2010), or have been spurred on our part by considering his thoughts and studies of resilience carefully (Hobfoll, 2011). However, we think we have mined, refined, and polished some of the ideas in a way that may further contribute to the field. Together with the contributions of Bonanno et al. (this issue), these might aid the advancement of knowledge on withstanding major and traumatic stressors and recovery in the face of major and traumatic stressors.

EXPLORING SEX DIFFERENCES IN WORRY WITH A COGNITIVE VULNERABILITY MODEL

A multivariate model was developed to examine the relative contributions of mastery, stress, interpretive bias, and coping to sex differences in worry. Rumination was incorporated as a second outcome variable to test the specificity of these associations. Participants included two samples of undergraduates totaling 302 men and 379 women. A path analysis of the full sample demonstrated good overall fit and revealed that low mastery, high stress, and high interpretive bias predicted increases in both worry and rumination. There proved to be no interactive effect of sex with the model. Comparisons of mean differences indicated that women reported significantly lower mastery and significantly higher stress, worry, and rumination than men. Results suggest similar processes confer risk for worry and rumination in men and women; however, lower levels of mastery and higher levels of stress in women may contribute to the female preponderance of anxiety and depression.

Understanding Gender Differences in Anxiety: The Mediating Effects of Instrumentality and Mastery

Developing a better understanding of modifiable psychological factors that account for gender differences in anxiety may provide insight into interventions that can be used to target these risk processes. The authors developed a mediational model to examine the degree to which gender differences in anxiety are explained by instrumentality and mastery while controlling for the influence of environmental stress and social desirability. Undergraduates (159 men and 239 women) completed an online questionnaire including measures of mastery, instrumentality, daily hassles, social desirability, and anxiety. Women reported significantly lower levels of instrumentality and mastery and higher levels of anxiety than men. Path analyses indicated that instrumentality and mastery were both significant mediators of the relationship between gender and anxiety after controlling for social desirability and hassles. The addition of a direct path from gender to anxiety was not significant and did not improve the fit of the model. These findings suggest that differences in gender socialization and mastery learning experiences for men and women help account for the female preponderance of anxiety. Interventions aimed at building instrumentality and mastery, particularly among girls, may help buffer against anxiety.