Amanda W. Calkins

The Effects of Computerized Cognitive Control Training on Community Adults with Depressed Mood

BACKGROUND Depression is frequently characterized by patterns of inflexible, maladaptive, and ruminative thinking styles, which are thought to result from a combination of decreased attentional control, decreased executive functioning, and increased negative affect. Cognitive Control Training (CCT) uses computer-based behavioral exercises with the aim of strengthening cognitive and emotional functions. A previous study found that severely depressed participants who received CCT exhibited reduced negative affect and rumination as well as improved concentration. AIMS The present study aimed to extend this line of research by employing a more stringent control group and testing the efficacy of three sessions of CCT over a 2-week period in a community population with depressed mood. METHOD Forty-eight participants with high Beck Depression Inventory (BDI-II) scores were randomized to CCT or a comparison condition (Peripheral Vision Training; PVT). RESULTS Significant large effect sizes favoring CCT over PVT were found on the BDI-II (d = 0.73, p < .05) indicating CCT was effective in reducing negative mood. Additionally, correlations showed significant relationships between CCT performance (indicating ability to focus attention on CCT) and state affect ratings. CONCLUSIONS Our results suggest that CCT is effective in altering depressed mood, although it may be specific to select mood dimensions.

Psychosocial predictors of sleep dysfunction: the role of anxiety sensitivity, dysfunctional beliefs, and neuroticism.

The present study examined the relationship of anxiety sensitivity, dysfunctional beliefs about sleep and neuroticism on sleep disturbance. Previous research of these three related concepts—each describing a different kind of reactivity to interoceptive or environmental events—have served as predictors of insomnia and insomnia-related distress; however, it is not known how these concepts have distinctive prediction of sleep outcomes. We completed an Internet survey of 149 undergraduate student participants, a population with elevated risk for disturbed sleep. Participants completed a demographics questionnaire, the Anxiety Sensitivity Index (ASI), the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16), the NEO Five-Factor Inventory, and the Pittsburgh Sleep Quality Index (PSQI). Results revealed a significant association between PSQI total score and the three variables of interest, ASI, DBAS, and neuroticism. However, in a stepwise regression, neuroticism was the statistically most important predictor of sleep disturbance. The DBAS was a statistically more important predictor than ASI total score; however, when the ASI was examined by subscale, DBAS was replaced in the model by the ASI Mental Incapacitation Concerns subscale. Our findings highlight the continued value of higher order concepts like neuroticism in the development of disorder-specific measures like the DBAS, as well as indicate that distress in response to cognitive symptoms (AS-mental incapacitation) may play a role in maintaining sleep dysfunction.

Recent Advances in Research on Cognition and Emotion in OCD: A Review

The cognitive model of OCD suggests that misinterpreting intrusive thoughts as unacceptable leads to increased anxiety and attempts to suppress or ignore the thoughts through avoidance or compulsive rituals. An insidious negative feedback loop develops as one’s attention focuses on these thoughts and in turn the unwanted thoughts do not respond to efforts to avoid or suppress. This article is a current review of the research on cognitive processes in obsessive-compulsive disorder (OCD). We review research that has (1) empirically validated the theoretical underpinnings of the cognitive model, (2) altered maladaptive cognitive processes through state-of-the-art experimental procedures, (3) refined our understanding of the relationship between obsessive beliefs and OC symptoms and (4) examined how underlying traits (e.g., anxiety and disgust sensitivity) relate to the development and maintenance of OCD. We discuss the clinical implications of this research.

Psychosocial predictors of the onset of anxiety disorders in women: Results from a prospective 3-year longitudinal study

In a prospective, longitudinal, population-based study of 643 women participating in the Harvard Study of Moods and Cycles we examined whether psychosocial variables predicted a new or recurrent onset of an anxiety disorder. Presence of anxiety disorders was assessed every 6 months over 3 years via structured clinical interviews. Among individuals who had a new episode of anxiety, we confirmed previous findings that history of anxiety, increased anxiety sensitivity (the fear of anxiety related sensations), and increased neuroticism were significant predictors. We also found trend level support for assertiveness as a predictor of anxiety onset. However, of these variables, only history of anxiety and anxiety sensitivity provided unique prediction. We did not find evidence for negative life events as a predictor of onset of anxiety either alone or in interaction with other variables in a diathesis-stress model. These findings from a prospective longitudinal study are discussed in relation to the potential role of such predictors in primary or relapse prevention efforts.

Anxiety sensitivity and illicit sedative use among opiate-dependent women and men.

Objectives: Research has suggested that individuals with elevated anxiety sensitivity (AS) (the fear of benign bodily sensations associated with anxiety) are more likely to use substances to cope with distress, particularly substances with arousal-dampening effects such as benzodiazepines and other sedatives. Such coping motives may also vary as a function of gender, with women more likely to use substances for coping (self-medicating) purposes. Given these findings, we hypothesized that AS would be associated with illicit sedative use in an opioid-dependent sample and that gender would moderate this relationship, with a greater association among women. Method: Participants were 68 opioid-dependent patients recruited from a methadone maintenance clinic. A logistic regression was used to determine whether AS was associated with presence or absence of a history of illicit sedative use. Results: AS was significantly associated with sedative use and this relationship was moderated by gender; elevated AS was associated with greater sedative use only in women. Conclusion: The presence of elevated AS is related to greater illicit use of sedatives in women but not in men. Women may be more susceptible to seek sedatives as a means of coping with unpleasant, anxious sensations.

Clarifying the Link Between Distress Intolerance and Exercise: Elevated Anxiety Sensitivity Predicts Less Vigorous Exercise

Anxiety sensitivity, one measure of distress intolerance, has been increasingly shown to play a role in a variety of health behaviors. A number of reports now suggest that individuals with higher levels of anxiety sensitivity (AS) are less likely to engage in exercise. However, this finding has been inconsistent across sex and limited by measurement strategy. This study examined the relationship between AS and self-reported exercise in a mixed-sex sample of 233 individuals. Consistent with prediction, AS was negatively associated with engagement in vigorous-intensity exercise; however, the strength of this association when covarying for sex was dependent on the measurement strategy used (continuous vs. categorical ASI scores). Sex did not moderate the AS-vigorous exercise association. AS was not associated with moderate-intensity exercise or walking. Results suggest a role of distress intolerance in exercise behavior and confirm the importance of continued research on this topic.

The role of perceived belongingness to a drug subculture among opioid-dependent patients.

Illicit drug use frequently occurs in a context of a drug subculture characterized by social ties with other drug users, feelings of excitement and effectiveness deriving from illicit activities, and alienation from mainstream society. Identification with this subculture is recognized anecdotally as a barrier to recovery, but clear quantification of individual differences in perceived belongingness to the drug subculture has been absent from the literature. The purpose of this study was to describe the development and psychometric properties of a brief self-report measure designed to assess this construct, the Belongingness to Drug Culture Questionnaire (BDCQ). Ninety-six opioid-dependent, methadone-maintained participants completed the BDCQ, related self-report measures, and assessment of drug use patterns. The BDCQ demonstrated high internal consistency (α = .88) and was significantly associated with self-reported days of drug use in the past 30 days, desire to quit, impulsivity, psychopathy, and social, enhancement, and coping drug use motives. These findings encourage continued psychometric evaluation of the BDCQ and study of the role of belongingness in the development and maintenance of substance use disorders.

A Randomized, Controlled Trial of the Efficacy of an Interoceptive Exposure-Based CBT for Treatment-Refractory Outpatients with Opioid Dependence

Abstract Many patients diagnosed with opioid dependence do not adequately respond to pharmacologic, psychosocial, or combination treatment, highlighting the importance of novel treatment strategies for this population. The current study examined the efficacy of a novel behavioral treatment focusing on internal cues for drug use (Cognitive Behavioral Therapy for Interoceptive Cues; CBT-IC) relative to an active comparison condition, Individual Drug Counseling (IDC), when added to methadone maintenance treatment (MMT) among those who had not responded to MMT. Participants (N=78) were randomly assigned to receive 15 sessions of CBT-IC or IDC as an adjunct to ongoing MMT and counseling. Oral toxicology screens were the primary outcome. Results indicated no treatment differences between CBT-IC and IDC and a small, significant reduction of self-reported drug use, but no change on toxicology screens. Tests of potential moderators, including sex, anxiety sensitivity, and coping motives for drug use, did not yield significant interactions. Among opioid-dependent outpatients who have not responded to MMT and counseling, the addition of IDC or CBT-IC did not result in additive outcome benefits. These results highlight the need for more potent treatment strategies for opioid dependence, particularly among those who do not fully respond to frontline treatment.

Evaluating Strategies for Combining Pharmacotherapy with Cognitive Behavioral Therapy

This chapter provides an overview of the rationale for combining cognitive-behavioral therapies and pharmacologic treatments. Relevant research literature is presented across a range of disorders including anxiety and related disorders, mood disorders, eating disorders, schizophrenia, and substance use disorders. In addition, practical considerations are discussed related to how the combination approach may be utilized and applied in clinical practice including a case example to highlight how a combination approach may be completed successfully in a clinical setting. Finally, novel treatment approaches are discussed as a means of highlighting future directions for the use of combined treatments.

Basic Principles and Practice of Cognitive Behavioral Therapy

In this chapter, the basic principles and fundamentals of practicing cognitive behavioral therapy (CBT) are discussed. The general structure of treatment is outlined and examples from sessions in each phase of treatment are provided. Initially, emphasis is placed on assessment, case conceptualization and treatment planning. Psychoeducation and goal setting are substantial parts of the orientation to CBT treatment. Later in treatment the focus shifts toward relapse prevention and booster sessions. The structure of individual sessions is also discussed with an emphasis on agenda setting, homework review/practice, teaching of new skills, and providing summary/feedback.