Berta J. Summers

Hostile interpretation bias in depression

BACKGROUND Research suggests an important relationship between interpretation bias, hostility and Major Depressive Disorder (MDD). Extant literature has yet to examine hostile interpretation bias in clinically depressed samples; the current studies sought to fill this gap. METHOD Study 1 participants included undergraduates who met criteria for MDD (n=36) or no anxiety or mood diagnosis (n=35). Each participant completed a structured clinical interview along with measures of depression, hostile interpretation bias, and trait hostility. In Study 2, a sample of treatment-seeking individuals with elevated trait anger completed measures of depression, hostile interpretation bias, and trait anger. RESULTS Study 1 demonstrated that, relative to the non-depressed group, individuals with depression displayed greater hostile interpretation bias but comparable levels of trait hostility. In Study 2, greater hostile interpretation bias was associated with greater depressive symptoms, and this relationship was independent of co-occurring trait anger. LIMITATIONS The correlational nature of these studies precludes interpretation of causal relationships between constructs. Additionally, replication of these results should be sought in a larger, more diverse sample. CONCLUSION Overall, the findings suggest hostile interpretation bias may play a unique role in depression and could be a treatable feature of interpersonal mechanisms maintaining MDD.

Hostile interpretation training for individuals with alcohol use disorder and elevated trait anger: A controlled trial of a web-based intervention

High trait anger is associated with more severe alcohol use problems, and alcohol has been found to facilitate aggressive behavior among individuals with high trait anger. Treatments focused on a sample with alcohol use disorder with elevated anger could reduce alcohol use problems, as well as violence and aggression. We sought to examine the efficacy of interpretation bias modification for hostility (IBM-H) in a sample with high trait anger and alcohol use disorder (AUD). Fifty-eight individuals with AUD and elevated trait anger were randomly assigned to eight web-based sessions (two per week) of IBM-H or a healthy video control condition (HVC). Measures of interpretation bias, anger, and alcohol use were administered at pre- and post-treatment and at one-month follow-up. IBM-H led to greater improvements in interpretation bias compared to HVC at post and follow-up. IBM-H also led to greater reductions in trait anger than HVC, though this was an indirect effect mediated by changes in interpretation bias. Further, IBM-H led to lower anger expression than HVC; this was a direct (non-mediated) effect. Lastly, both conditions reported decreases in alcohol use and consequences following treatment, though there were no significant differences between them. These findings provide initial support for the utility of IBM-H as a brief non-confrontational intervention for AUD with elevated trait anger. Limitations and future research directions are discussed.

Intolerance of uncertainty in body dysmorphic disorder

Intolerance of uncertainty (IU) is a transdiagnostic construct associated with several anxiety and related disorders. Three studies were conducted to explore the potential relationship between IU and body dysmorphic disorder (BDD). Study 1 revealed a positive relationship between IU and BDD symptoms above symptoms of anxiety and depression in an unselected student sample (N=88). Study 2 demonstrated a similar relationship between IU and BDD symptoms above negative affectivity and intolerance of ambiguity in a community sample (N=116). Study 3 found that a clinical BDD sample (N=23) reported greater IU than healthy controls (N=20), though this relationship was accounted for by symptoms of anxiety and depression. Greater IU predicted functional impairment in the clinical sample above BDD symptoms and past-week anxiety and depression. The observed relationship between IU and BDD symptoms provides preliminary support for the relevance of IU to this population.

Contamination-Focused Exposure as a Treatment for Disgust-Based Fears: A Preliminary Test in Spider-Fearful Women.

BACKGROUND Disgust is thought to play a prominent role in multiple anxiety disorders and fears, including spider phobia, though little attention has been given to specific treatment strategies that may be effective for multiple disgust-based fears. AIMS In the present study, we evaluated contamination-focused exposure as a potential transdiagnostic treatment strategy for disgust-based fears in a spider fearful sample. METHOD Women with significant spider fear were randomized to three 30-minute sessions of exposure therapy involving repeated contact with a dirt mixture (n=17) or a waitlist control condition (n=17). Assessments of spider fear and disgust were administered at baseline and at one-week posttreatment. RESULTS At high (but not low) levels of pretreatment disgust propensity, exposure led to lower in vivo spider fear and perceived danger than waitlist, though exposure had no effects on spider-related disgust. Similar effects of exposure on spider fear were found at high levels of pretreatment spider-related disgust. Exposure also reduced fear and danger perceptions, but not disgust, related to a separate contamination assessment (touching a toilet). No effects of treatment were found on self-report measures of spider fear or disgust propensity. CONCLUSIONS These findings suggest contamination-focused exposure therapy may be an effective transdiagnostic treatment strategy for individuals with elevated disgust propensity. Limitations and directions for future research are discussed.

A multi-method analysis of distress tolerance in body dysmorphic disorder

Distress tolerance (DT) is a transdiagnostic construct linked to multiple psychiatric disorders. We conducted three studies using different methods to investigate the relationship between DT and body dysmorphic disorder (BDD). Study 1 found a significant relationship between low DT and more severe BDD symptoms in an adult community sample (N=81). In Study 2, we found a similar relationship between lower DT and greater BDD symptoms in a student sample (N=192). Furthermore, we found a unique relationship between greater BDD symptoms and lower self-reported tolerance of anger and sadness mood induction tasks. Greater BDD symptoms were not significantly associated with lower self-reported tolerance of a fear mood induction task. In Study 3, a clinical sample of individuals with BDD (N=40) reported lower DT than a sample of healthy controls (N=36). Findings suggest that low DT is a broad vulnerability factor related to BDD.

An initial investigation of the unique relationship between disgust propensity and body dysmorphic disorder

Disgust is a universal emotion that has received recent empirical attention for its potential role in various forms of psychopathology. We conducted two studies using varying methods to explore the relationship between disgust propensity, a construct related to obsessive-compulsive symptomatology, and symptoms of body dysmorphic disorder (BDD). Study 1 found a significant and unique (i.e., above and beyond co-occurring depression and anxiety) relationship between higher disgust propensity and more severe BDD symptoms, as measured by a standardized self-report and via an in-vivo task aimed at eliciting BDD-related concerns (N = 200). In Study 2, a clinical sample of individuals with BDD (N = 50) reported higher disgust propensity compared to mentally healthy controls (N = 36). This finding remained significant when controlling for depression and anxiety. Findings are the first to our knowledge to demonstrate a relationship between disgust propensity and BDD symptoms and provide directions for future research exploring the role of disgust in BDD.

An experimental test of the role of appearance-related safety behaviors in body dysmorphic disorder, social anxiety, and body dissatisfaction.

Individuals with appearance concerns engage in “safety behaviors” (SBs) aimed at checking, hiding, fixing, and reducing threat associated with their perceived flaw in appearance. Appearance-related SBs are important in contemporary accounts of body dysmorphic disorder (BDD), though they are also relevant to social anxiety (SAD) and eating disorders. The present study examined the extent to which appearance-related SBs contribute to the development of disorder-specific symptoms and maladaptive cognitions. Female undergraduates without clinically elevated appearance concerns (N = 99) were randomly assigned to 1 week of (a) increasing the frequency and duration of appearance-related SBs (SB+), (b) decreasing these behaviors (SB−), or (c) a control in which they increased their academic studying behaviors. Generally, SB+ participants demonstrated greater BDD symptoms, SAD symptoms, body dissatisfaction, disorder-relevant threat interpretations, beliefs about the importance of appearance, and reactivity to an in vivo appearance-related task following the manipulation, relative to the other groups, with some exceptions. The SB− and control conditions largely did not differ from one another in these outcomes. SB+ participants also reported greater anxiety and depressive symptoms postmanipulation relative to other conditions. Groups no longer differed from one another at a follow-up assessment. Overall, these findings suggest that engagement in appearance-related SBs may play an instrumental role in symptoms and maladaptive cognitions across a range of disorders.

“Not just right” experiences account for unique variance in eating pathology

ABSTRACT “Not just right” experiences (NJREs) are uncomfortable sensations of incompleteness linked to obsessive–compulsive disorder; however, NJREs may be transdiagnostic and play a role in eating pathology. The current study examined relations between NJREs and eating pathology in undergraduate students. Participants (n = 248) completed self-report and behavioral assessments. Controlling for obsessive–compulsive symptoms, negative affect, and perfectionism, NJRE frequency was associated with greater drive for thinness, body dissatisfaction, and bulimic symptoms. Discomfort in response to a visual in vivo NJRE task was positively associated with drive for thinness and body dissatisfaction. The present study provides initial evidence for NJREs in eating pathology. Theoretical implications are discussed.

Six In Vivo Assessments of Compulsive Behavior A Validation Study Using the Obsessive–Compulsive Inventory–Revised

Due to the complex and heterogeneous nature of obsessive–compulsive disorder (OCD), movement toward multimodal assessment has become necessary to more precisely understand the nature of the disorder and interrelations between symptom clusters. Thus, the present study utilized large undergraduate samples (total N = 800) to test the validity of six in vivo assessments of OC symptoms (i.e., one ordering/arranging task, two contamination fear/washing tasks, and three checking tasks). Associations between task-specific variables and self-reported symptom scores (as measured by the Obsessive–Compulsive Inventory–Revised [OCI-R]) were examined. The majority of the in vivo task variables (those presented in Studies 1-4) exhibited significant relationships with the corresponding OCI-R symptom subscale (i.e., ordering, washing, checking). However, many of the task variables demonstrated relationships with other OCI-R symptom subscales, as well. Some evidence for discriminant validity was found, as task variables were generally unrelated to past-week symptoms of depression or anxiety. While continued research is necessary to further establish the validity and utility of the tasks discussed in the current article, findings have implications for improving future empirical examination of OC symptoms.