Amy R. Goetz

A Randomized Waitlist-controlled Pilot Trial of Voice Over Internet Protocol-delivered Behavior Therapy for Youth with Chronic Tic Disorders

Introduction Comprehensive Behavioral Intervention for Tics (CBIT) has been shown to be efficacious for chronic tic disorders (CTDs), but utilization is limited by a lack of treatment providers and perceived financial and time burden of commuting to treatment. A promising alternative to in-person delivery is voice over Internet protocol (VoIP), allowing for remote, real-time treatment delivery to patients’ homes. However, little is known about the effectiveness of VoIP for CTDs. Therefore, the present study examined the preliminary efficacy, feasibility, and acceptability of VoIP-delivered CBIT (CBIT-VoIP). Methods Twenty youth (8–16 years) with CTDs participated in a randomized, waitlist-controlled pilot trial of CBIT-VoIP. The main outcome was pre- to post-treatment change in clinician-rated tic severity (Yale Global Tic Severity Scale). The secondary outcome was clinical responder rate (Clinical Global Impressions – Improvement Scale), assessed using ratings of ‘very much improved’ or ‘much improved’ indicating positive treatment response. Results Intention-to-treat analyses with the last observation carried forward were performed. At post-treatment (10-weeks), significantly greater reductions in clinician-rated, (F(1,18) = 3.05, p < 0.05, partial η2 = 0.15), and parent-reported tic severity, (F(1,18) = 6.37, p < 0.05, partial η2 = 0.26) were found in CBIT-VoIP relative to waitlist. One-third (n = 4) of those in CBIT-VoIP were considered treatment responders. Treatment satisfaction and therapeutic alliance were high. Discussion CBIT can be delivered via VoIP with high patient satisfaction, using accessible, low-cost equipment. CBIT-VoIP was generally feasible to implement, with some audio and visual challenges. Modifications to enhance treatment delivery are suggested.

Guilt and Compulsive Washing: Experimental Tests of Interrelationships

Recent evidence suggests a potentially important relationship between guilt and compulsive washing. The present studies sought to clarify this relationship. In Study 1, we examined whether washing reduced guilt. Following guilt induction, 132 non-clinical participants were randomized to one of three conditions: hand-wiping, straightening of clutter, or a control task. Contrary to predictions, analyses indicated no differences between conditions in post-task guilt. Moderator analyses indicated that among those in the straightening task, higher ordering symptoms were associated with greater increases in guilt. Study 2 examined whether guilt increased washing behavior. Sixty-one non-clinical participants were randomized to either a guilt induction or neutral condition. Afterwards, participants were timed as they cleansed their hands. Individuals in the guilt induction condition washed significantly longer than those in the neutral condition. These findings suggest that hand-washing does not lead to unique reductions in guilt, but guilt may prolong hand-washing behavior. Theoretical and clinical implications are discussed.

The association between health anxiety and disgust reactions in a contamination-based behavioral approach task.

Abstract Existing evidence suggests that disgust is an important affective process related to health anxiety. The present study sought to determine the contribution of health anxiety symptoms in the prediction of disgust and behavioral avoidance in a large, nonclinical sample (N=156). Regression analyses showed that overall health anxiety symptoms predicted disgust on a behavioral approach task independent of gender, negative affect, and fear of contamination. Particularly, health anxiety-related reassurance seeking was found to be uniquely associated with disgust and behavioral avoidance after controlling for the aforementioned covariates. In addition, the interaction between health anxiety and contamination fear was tested, and remained significant when controlling for gender and negative affect. These results suggest that heightened contamination fear is associated with elevated disgust reactions such that high levels of health anxiety leads even those low in contamination fear to be disgusted during a behavioral task. These results are in line with previous research on the role of disgust in health anxiety.

The functional value of preventive and restorative safety behaviors: A systematic review of the literature.

Safety behaviors are unnecessary actions used to prevent, escape from, or reduce the severity of a perceived threat. Most cognitive-behavioral theorists posit that the use of safety behaviors during exposure is maladaptive because they interfere with fear reduction. However, there is growing evidence suggesting that the use of safety behaviors can facilitate exposure. In general, the findings are mixed as to whether safety behaviors should be made available during exposure-based interventions. The aim of the current review was to evaluate whether safety behaviors should be made accessible during exposure, and whether under certain circumstances, they facilitate or hinder important exposure outcomes. We examined two functional types of safety behaviors: preventive and restorative. A thorough review of the safety behavior literature from the last three decades was conducted. The evidence suggests (restorative) safety behaviors that allow for full confrontation with a core threat do not interfere with meaningful indicators of successful exposure, whereas (preventive) safety behaviors that hinder engagement with the stimulus or experience may weaken exposure outcomes. The theoretical and clinical implications of these findings are discussed and future directions in the investigation of safety behaviors are suggested.

Attentional bias toward personally relevant health-threat words.

Conflicting findings have emerged regarding the presence of attentional biases (ABs) in health anxiety, probably due to methodological limitations in the stimuli used in cognitive tasks and the assessment of health anxiety-relevant factors. The current study sought to examine ABs toward health-related threats using idiographically chosen health-threat words in a non-clinical sample. A modified dot-probe task using idiographically selected health-threat words was administered to an undergraduate sample. Self-report measures were administered to assess somatic, cognitive, and behavioral aspects of health anxiety, in addition to assessing negative affect, anxiety sensitivity, and experience of actual medical conditions. Results showed that behavioral and somatic aspects of health anxiety were significantly associated with AB toward personally relevant threat words, even after controlling for negative affect, anxiety sensitivity, and experience of actual medical conditions. Additional analyses revealed that these biases reflected difficulty disengaging attention from threat rather than a facilitated detection of threat. In contrast, illness-related cognitions were found to be unrelated to ABs. These findings suggest an association between threat-related ABs and excessive health-care seeking efforts.

Computerized attention retraining for individuals with elevated health anxiety

Background and Objectives: Current cognitive-behavioral theorists conceptualize hypochondriasis as excessive health anxiety (HA). Growing evidence suggests that elevated HA is associated with attentional bias (AB) toward potential health-threat information. Design: This study aimed to examine the effects of attention retraining among individuals with elevated HA, using the established attention modification programs (AMP) designed to train participants to disengage attention from ideographically chosen health-threat words. Methods: Thirty-six randomly assigned individuals with elevated HA completed eight twice-weekly sessions of the AMP (n = 18) or the attention control condition (ACC; n = 18). Results: Despite using the well-established AMP protocol widely used within the field of anxiety disorders, we did not find evidence for change in AB following training. Further, AMP did not outperform ACC in reducing HA and other relevant emotional symptoms. However, both AMP and ACC evidenced overall significant symptom reduction in most of the outcome measures, including overall HA, anxiety sensitivity, general depression and anxiety, and somatic complaints. Conclusions: Further research is needed to better understand the effects and mechanisms of AMP as a possible cognitive intervention for HA.

Elevated Affective Lability and Poor Response Inhibition: An Investigation based on Emotional and Non-Emotional Go/No-Go Tasks

The aim of the current study was to test the association between affective lability and the magnitude of response inhibition deficits using four different versions of go/no-go tasks that were composed of (a) affective faces, (b) affective words, (c) neutral faces, or (d) neutral words, with an undergraduate sample that displayed a wide range of emotional instability and impulsivity (N = 45). We hypothesized that heightened affective lability would be significantly associated with deficits in response inhibition, particularly in the context of emotional go/no-go tasks that presented salient and potent emotional materials. Overall findings showed that the magnitude of difficulty in inhibiting potent but irrelevant stimuli on emotional go/no-go tasks was significantly associated with heightened affective lability (characterized by unstable shifts between elated and depressed moods) after taking into consideration the contribution of negative affect and impulsiveness. In contrast, non-emotional go/no-go performance did not significantly predict affective lability. Further, depression-elation mood shifts were significantly associated with greater difficulty in inhibiting irrelevant positive rather than negative emotional information. This line of research may help improve our understanding on the nature of poor inhibitory control associated with conditions characterized by emotional dysregulation.