Christopher R. Berghoff

Evaluating the Effectiveness of ACT for Anxiety Disorders in a Self-Help Context: Outcomes From a Randomized Wait-List Controlled Trial☆

Rigorous evaluations of cognitive behavioral self-help books for anxiety in pure self-help contexts are lacking. The present study evaluated the effectiveness of an Acceptance and Commitment Therapy (ACT) self-help workbook for anxiety-related concerns, with no therapist contact, in an international sample. Participants (N=503; 94% mental health diagnosis) were randomized to an immediate workbook (n=256) or wait-list condition (n=247). Assessments at pretreatment, 12weeks, 6months, and 9months evaluated anxiety and related symptoms, quality of life, and ACT treatment processes (e.g., psychological flexibility). Participants in the wait-list arm crossed over to the workbook following the 12-week assessment. The workbook condition yielded significant improvements on all assessments from pre- to posttreatment relative to wait-list, and these gains were maintained at follow-ups. The pattern observed in the wait-list condition was virtually identical to the active treatment arm after receiving the workbook, but not before. Attrition was notable, but supplemental analyses suggested dropout did not influence treatment effects for all but one measure. Overall, findings provide preliminary support for the effectiveness of this self-help workbook and suggest ACT-based self-help bibliotherapy might be a promising low-cost intervention for people experiencing significant anxiety-related concerns.

Emotional lability and affective synchrony in borderline personality disorder.

Extant research on emotional lability in borderline personality disorder (BPD) has focused almost exclusively on lability of individual emotions or emotion types, with limited research considering how different types of emotions shift together over time. Thus, this study examined the temporal dynamics of emotion in BPD at the level of both individual emotions (i.e., self-conscious emotions [SCE], anger, and anxiety) and mixed emotions (i.e., synchrony between emotions). One hundred forty-four women from the community completed a diagnostic interview and laboratory study involving 5 emotion induction tasks (each of which was preceded and followed by a 5-min resting period or neutral task). State ratings of SCE, anger, and anxiety were provided at 14 time points (before and after each laboratory task and resting period). Hierarchical linear modeling results indicate that women with BPD reported greater mean levels of SCE and Anxiety (but not Anger), and greater lability of Anxiety. Women with BPD also exhibited greater variability in lability of all 3 emotions (suggestive of within-group differences in the relevance of lability to BPD). Results also revealed synchrony (i.e., positive relations) between each possible pair of emotions, regardless of BPD status. Follow-up regression analyses suggest the importance of accounting for lability when examining the role of synchrony in BPD, as the relation of SCE-Anger synchrony to BPD symptom severity was moderated by Anger and SCE lability. Specifically, synchronous changes in SCE and Anger were associated with greater BPD symptom severity when large shifts in SCE were paired with minor shifts in Anger. (PsycINFO Database Record

Factor structure and gender stability in the multidimensional condom attitudes scale.

Sexually transmitted infections continue to trouble the United States and can be attenuated through increased condom use. Attitudes about condoms are an important multidimensional factor that can affect sexual health choices and have been successfully measured using the Multidimensional Condom Attitudes Scale (MCAS). Such attitudes have the potential to vary between men and women, yet little work has been undertaken to identify if the MCAS accurately captures attitudes without being influenced by underlying gender biases. We examined the factor structure and gender invariance on the MCAS using confirmatory factor analysis and item response theory, within-subscale differential item functioning analyses. More than 770 participants provided data via the Internet. Results of differential item functioning analyses identified three items as differentially functioning between the genders, and removal of these items is recommended. Findings confirmed the previously hypothesized multidimensional nature of condom attitudes and the five-factor structure of the MCAS even after the removal of the three problematic items. In general, comparisons across genders using the MCAS seem reasonable from a methodological standpoint. Results are discussed in terms of improving sexual health research and interventions.

Emotional lability and affective synchrony in posttraumatic stress disorder pathology

This study examined the relations of PTSD pathology to both the lability of three specific emotions (anxiety, anger, self-conscious emotions [SCE]) and the extent to which changes in one emotional state co-occur with changes in another emotional state (i.e. affective synchrony). Moreover, given evidence that emotional responding in PTSD may be heightened in response to trauma-related cues, these relations were explored in the context of a trauma cue versus neutral cue. Trauma-exposed patients in residential substance use disorder treatment (N=157) completed a diagnostic interview and two laboratory sessions involving presentation of neutral and individualized trauma scripts. State anxiety, anger, and SCE were assessed at five points throughout each laboratory session. Hierarchical linear modeling indicated that participants (regardless of PTSD status) exhibited greater lability of all emotions following the trauma script versus neutral script. Only anger lability was elevated among those with (versus without) a current PTSD diagnosis following the neutral script. Results also revealed synchrony (i.e., positive covariation) between each possible pair of emotions, regardless of PTSD status. Findings suggest that concurrent changes in anxiety and anger may be especially relevant to PTSD symptom severity.

An Initial Open Trial of a Brief Behavioral Activation Treatment for Depression and Medication Adherence in HIV-Infected Patients.

Advances in HIV treatment through highly active antiretroviral therapy (HAART) have led to a steady decline in HIV-related mortality rates. However, HAART requires adherence to strict and often complicated medication regimens, and nonadherence to HAART can significantly decrease its effectiveness. Depression has consistently shown a robust association with medication nonadherence; consequently, numerous psychological interventions have been developed to target depression and increase medication adherence among HIV-infected individuals. The length of these interventions, however, may be prohibitive for certain HIV-infected populations, such as patients in rural areas. Therefore, this study provides an initial investigation of a one-session behavioral activation treatment for depression designed specifically for HIV-infected patients (BATD-HIV) at a community infectious disease clinic serving a largely rural population. In this initial uncontrolled open trial, BATD-HIV was administered to 10 HIV-infected patients with elevated symptoms of depression following their clinic appointment. Depression, anxiety, and stress symptom severity; behavioral activation processes; medication adherence; and CD4 T-cell count were assessed pre- and 1 month postintervention. Participants exhibited significant reductions in anxiety symptom severity and avoidance of negative aversive states and rumination from pre- to 1 month posttreatment. Although nonsignificant, participants also showed medium effect size reductions in depression and stress symptoms and work/school and social impairment, and medium effect size improvements in medication adherence and CD4 T-cell counts. Despite the preliminary nature of this study, results suggest that BATD-HIV may have utility as a brief treatment for HIV-infected patients with depression and warrants further investigation in larger scale randomized controlled trials.

The Role of Emotional Avoidance, the Patient–Provider Relationship, and Other Social Support in ART Adherence for HIV+ Individuals

Adherence to antiretroviral therapy (ART) is associated with positive health outcomes among HIV+ patients. However, non-adherence remains high. Though factors that account for non-adherence remain unclear, social support has been consistently associated with ART adherence. As such, identifying malleable factors that hinder patients’ ability to form supportive relationships may have consequence for improving ART adherence. Emotional avoidance (EA) may be one such factor given that it has been linked to difficulties in social situations. The present study examined relations among EA, the patient–provider relationship, other sources of social support, and ART adherence within a sample of HIV+ ART-prescribed patients. High EA was related to poor adherence and patient–provider relationships. EA was indirectly related to poor adherence through poorer patient–provider interactions. The indirect relation of EA to ART adherence through other sources of social support was not significant. Implications for developing targeted behavioral interventions focused on improving ART adherence are discussed.

The role of experiential avoidance in the relation between anxiety disorder diagnoses and future physical health symptoms in a community sample of young adult women

Individuals diagnosed with an anxiety disorder report more physical health problems than those without an anxiety disorder. Few studies have examined the relation of anxiety disorders to later physical health symptoms, or the processes that may explain this relation. One process of interest is experiential avoidance (EA), which is commonly reported in populations characterized by high anxiety and often leads to health-compromising behaviors. The present study examined the relations between anxiety disorder diagnostic status, EA, and physical health symptoms in a community sample of young adult women. Results revealed a significant association between an anxiety disorder diagnosis and physical health problems four months later. Furthermore, levels of EA accounted for this relation. Findings highlight the potential utility of targeting EA as a method for improving health outcomes among individuals with anxiety disorders.

Borderline Personality Disorder Symptoms and Pain in College Students: The Role of Emotional Suppression

Borderline personality disorder (BPD) is associated with higher rates of pain conditions and greater pain impairment. Past research implicates emotional suppression in acute pain tolerance; thus, emotional suppression may contribute to pain interference among those with high BPD features. Participants were 89 university students who completed measures of BPD features, and complied with 2-week daily diary procedures assessing suppression of emotional thoughts associated with social and nonsocial stressors, distress, pain severity, and interference. Multilevel models revealed a BPD × Suppression × Distress interaction, such that suppression in response to social (but not nonsocial) stressors in the context of high distress was related to pain interference when controlling for pain severity among those with high, but not low, BPD features. These findings suggest. that suppression of emotionally relevant thoughts in response to high distress may contribute to the functional impairment from pain among those with high BPD symptoms.

PTSD Symptom Severity and Emotion Regulation Strategy Use During Trauma Cue Exposure Among Patients With Substance Use Disorders: Associations With Negative Affect, Craving, and Cortisol Reactivity

The co-occurrence of posttraumatic stress disorder (PTSD) pathology with a substance use disorder (SUD) is associated with emotion regulation deficits. However, studies in this area generally rely on trait-based emotion regulation measures, and there is limited information on the relation of PTSD pathology to the use of specific emotion regulation strategies in response to trauma-related distress among SUD patients or the consequences of these strategies for trauma cue reactivity. This study examined the relation of PTSD symptom severity to the use of specific emotion regulation strategies during trauma cue exposure among trauma-exposed SUD patients, as well as the indirect relations of PTSD symptom severity to changes in negative affect, cravings, and cortisol levels pre- to posttrauma cue exposure through different emotion regulation strategies. Participants were 133 trauma-exposed SUD patients. Participants listened to a personalized trauma script and reported on emotion regulation strategies used during the script. Data on negative affect, cravings, and cortisol were collected pre- and postscript. PTSD symptom severity related positively to the use of more adaptive (e.g., distraction) and maladaptive (e.g., suppression) regulation strategies. Moreover, evidence for the indirect effects of PTSD symptom severity on negative affect and cortisol reactivity through both adaptive and maladaptive emotion regulation strategies was found. Implications of findings are discussed.

Using panicogenic inhalations of carbon dioxide enriched air to induce attentional bias for threat: Implications for the development of anxiety disorders

The tendency for anxious individuals to selectively attend to threatening information is believed to cause and exacerbate anxious emotional responding in a self-perpetuating cycle. The present study sought to examine the relation between differential interoceptive conditioning (IC) using carbon dioxide inhalation as a panicogenic unconditioned stimulus (US) and the development of Stroop colour-naming interference to various non-word conditioned stimuli (CSs). Healthy university students (N = 27) underwent the assessment of colour-naming interference to reinforced CS+ and non-reinforced CS− non-words prior to and following differential fear conditioning. Participants showed greater magnitude electrodermal and verbal-evaluative responses to the CS+ over the CS− non-word following IC, and demonstrated the expected slower colour-naming latencies to the CS+ compared to the CS− non-word from baseline to post-conditioning. We discuss the relation between fear learning and the emergence of attentional bias for threat to further understand the maintenance of anxiety disorders.