Blaise L. Worden

Psychometric Properties of a Structured Diagnostic Interview for DSM-5 Anxiety, Mood, and Obsessive-Compulsive and Related Disorders:

Three hundred sixty-two adult patients were administered the Diagnostic Interview for Anxiety, Mood, and OCD and Related Neuropsychiatric Disorders (DIAMOND). Of these, 121 provided interrater reliability data, and 115 provided test–retest reliability data. Participants also completed a battery of self-report measures that assess symptoms of anxiety, mood, and obsessive-compulsive and related disorders. Interrater reliability of DIAMOND anxiety, mood, and obsessive-compulsive and related diagnoses ranged from very good to excellent. Test–retest reliability of DIAMOND diagnoses ranged from good to excellent. Convergent validity was established by significant between-group comparisons on applicable self-report measures for nearly all diagnoses. The results of the present study indicate that the DIAMOND is a promising semistructured diagnostic interview for DSM-5 disorders.

Effectiveness of a Feedback-Based Brief Intervention to Reduce Alcohol Use in Community Substance Use Disorders

Feedback brief interventions for alcohol use problems have been highly effective with undergraduate populations. However, there has been little research on the effectiveness of administering feedback alone to community treatment populations. The goal of this study was to assess the effectiveness of a feedback brief intervention in a community treatment setting with patients characterized largely by dependence on alcohol and drugs, ethnic diversity, and low socioeconomic status. It was hypothesized that pretreatment brief individualized feedback would reduce alcohol consumption and increase participation in subsequent substance use disorder (SUD) treatment. Participants were recruited from a public hospitals SUD clinic. After the intake but prior to entry into the treatment as usual, 121 participants were randomized to receive personalized feedback or a condition without feedback. Eighty-seven participants completed post-intervention follow-up interviews and were included in the final analyses. Repeated-measures ANOVAs and MANCOVAs were used to examine variables obtained from the Addiction Severity Index of drinking quantity and frequency, and motivation for treatment. Results indicated that personalized feedback delivered no benefit beyond that of pretreatment assessment procedures (phone screening and intake interview) alone. Intervention conditions did not differ on other outcomes at follow-up, including days of heavy drinking, motivation for treatment, or drug use frequency. Therefore, feedback-based brief interventions may be not helpful in reducing the drinking frequency and intensity of individuals presenting to community-based substance use treatment.

Randomized Pilot of an Anxiety Sensitivity-Based Intervention for Individuals in a Substance Use Day Program

ABSTRACT Anxiety sensitivity (AS), or the tendency to appraise physical symptoms as intolerable or dangerous, may maintain the cycle between co-occurring anxiety and substance use disorders. This study examined preliminary efficacy of a brief intervention targeting AS for individuals with heterogeneous substance use disorders. Forty-one patients with high AS entering an addictions day program were randomized to treatment as usual (TAU) or to TAU plus a nine-hour AS-focused intervention that consisted of interoceptive exposures, psychoeducation about the cycle of problematic substance use and anxiety, and a single session of cognitive challenging (e.g., reviewing common cognitive distortions and decatastrophizing anxiety symptoms). Mixed-effects intent-to-treat models suggested that participants in the AS condition showed greater decreases in AS at post-treatment, but this effect was lost at follow-up three months later. Intervention conditions did not differ in change in percent days abstinent or self-reported anxiety, with both conditions showing significant improvement at post-treatment. Results suggest that the nine-hour AS-focused intervention led to a short-term benefit over TAU alone, but this benefit was not sustained at three months’ follow-up. Future AS interventions may need to target specific subconstructs of AS for selected populations, or target emotional distress tolerance more broadly.

Changes in saving cognitions mediate hoarding symptom change in cognitive-behavioral therapy for hoarding disorder

Cognitive-behavioral therapy (CBT) is an empirically-supported treatment for hoarding disorder (HD). However, meta-analytic studies suggest that CBT is only modestly effective, and a significant number of individuals with HD remain symptomatic following treatment. To inform the development of more effective and targeted treatments, it will be important to clarify the mechanisms of treatment response in CBT for HD. To this end, the current study examined whether change in maladaptive saving beliefs mediated symptom change in CBT for HD. Sixty-two patients with primary HD completed measures of maladaptive saving cognitions and hoarding severity at pre-, mid-, and post-CBT. Results showed that change in saving cognitions mediated change in all three domains of HD symptoms (i.e., acquiring, difficulty discarding, and excessive clutter), suggesting that cognitive change may be a mechanism of treatment response in CBT. The findings indicate that cognitive change may have an impact on treatment outcomes, and are discussed in terms of cognitive-behavioral theory of HD and potential ways in which to enhance belief change in treatment.