Dan V. Blalock

Trait and Daily Emotion Regulation in Social Anxiety Disorder

Emotion regulation strategies vary widely in use and effectiveness across psychological diagnostic categories. However, little data exists on (1) the use of these strategies in social anxiety disorder (SAD), and (2) how trait measures compare with actual daily use of emotion regulation strategies. We collected trait and daily assessments of emotion suppression, cognitive reappraisal, and positive and negative emotions from 40 adults with SAD and 39 matched healthy controls. Participants with SAD reported greater trait suppression and less cognitive reappraisal than healthy controls, and exhibited this same pattern of emotion regulation in daily life. Participants overall reported worse emotional experiences when suppressing positive (vs. negative) emotions, and better emotional experiences when reappraising to feel more positive (vs. less negative) emotions. However, SAD participants exhibited greater benefits (specifically increased positive emotions) from reappraising to feel less negative than healthy controls. These findings highlight the importance of positive emotion regulation strategies, particularly for individuals with SAD.

Anxiety symptoms and functional impairment: A systematic review of the correlation between the two measures

Researchers and clinicians assume a strong, positive correlation between anxiety symptoms and functional impairment. That assumption may be well-justified since diagnostic criteria typically include functional impairment. Still, the relationship remains largely unavailable in any systematic review. Our aim with this paper was to provide empirical evidence for this assumed relationship and to document the observed correlations between anxiety symptom measures and functional impairment measures. Correlations existed for symptoms of six anxiety disorders (Panic Disorder, Agoraphobia, Social Anxiety Disorder, Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, Obsessive Compulsive Disorder) across four functional domains (global, social, occupational, and physical). Overall, the mean of 497 correlations across all disorders and functional domains was modest (r=.34); since the variability between disorders and functional domains tended to be rather large, we explored these correlations further. We presented these results and the potential explanations for unexpected findings along with the clinical and research implications.

Stability amidst turmoil: Grit buffers the effects of negative life events on suicidal ideation

The goal of the current study is to examine the role of grit as a resilience factor that reduces the risk for suicidal ideation conferred by negative life events. Participants (N=209) completed measures of negative life events and grit at baseline and a measure of suicidal ideation at follow-up four weeks later. Poisson regression analyses found that higher levels of grit buffered the relationship between negative life events and suicidal ideation such that negative life events only predicted suicidal ideation if grit was low. These results suggest that high grit can abate the increased suicidal ideation associated with negative life events. Aside from absolute levels of suicidal ideation, being able to predict or buffer dramatic shifts in suicidal ideation can be a useful diagnostic tool during interventions.

The Ketogenic Diet: Initiation at Goal Calories Versus Gradual Caloric Advancement

BACKGROUND Inpatient initiation of the ketogenic diet has historically involved fasting followed by gradual advancement of calories and/or diet ratio. Complications during this initiation period are common. We sought to determine if the initiation of the diet at goal calories would reduce these complications while maintaining efficacy. METHODS Sixty patients were admitted to a tertiary care hospital for elective initiation of the ketogenic diet between October 2007 and January 2013. All patients were placed on a ketogenic diet initiation pathway. In 2010, the pathway was modified from gradual caloric advancement to initiation at goal calories. We selected 30 consecutive patients before and after the change for comparison. Each childs record was reviewed for the occurrence of hypoglycemia, number of days to reach full ketosis (defined as 4 + urine ketones), acidosis requiring commencement of sodium citrate, length of admission, and long-term efficacy. RESULTS Both methods of initiation had similar rates of dehydration, vomiting, lethargy, and irritability. More patients initiated at goal received sodium citrate (P = 0.005); however, mean daily values of carbon dioxide were not significantly different. Onset of ketosis was slightly delayed (P = 0.009) in patients initiated at goal, but length of stay was not affected (P > 0.1). Hypoglycemia was uncommon and rates were similar between the groups. Efficacy at 3 months was better in patients initiated at full calories (P < 0.05). CONCLUSION Initiation of the ketogenic diet full calories is a reasonable alternative to the current standard practice of gradual advancement of calories and/or diet ratio.

Levetiracetam versus (fos)phenytoin for seizure prophylaxis in pediatric patients with intracranial hemorrhage

OBJECT Seizure prophylaxis is used in a variety of conditions, including supratentorial intracranial hemorrhage (ICH). In adults, studies have demonstrated phenytoin as the drug of choice for seizure prophylaxis; in children, levetiracetam is often provided due to its favorable side effect profile and pharmacokinetics. This study evaluated the difference in efficacy between these treatment options. METHODS This retrospective review included 126 patients between 1 month and 17 years of age with acute supratentorial ICH; all received seizure prophylaxis. Demographic data and outcome assessments were compared. RESULTS Seizure prophylaxis was provided with (fos)phenytoin in 40 children, levetiracetam in 61 children, and both drugs in 25 patients. Baseline characteristics of the treatment groups were similar, except that more patients treated with (fos)phenytoin had seizures on presentation. Patients treated solely with (fos)phenytoin had a higher probability of early seizures (within 7 days of ICH) compared with those treated only with LVT, controlling for relevant variables including seizures on presentation (OR 24.6, p = 0.002). Patients treated with (fos)phenytoin were more likely to need additional antiepileptic drugs for seizure control (p = 0.005). There was no significant difference in the incidence of late seizures (> 7 days after ICH) (p = 0.265). Adverse events necessitating a change in therapy were uncommon. CONCLUSIONS Levetiracetam is a reasonable alternative to (fos)phenytoin for prophylaxis of early posthemorrhagic seizures. Levetiracetam and (fos)phenytoin are well tolerated in children. Prospective studies are needed to determine superiority, optimal dosing, and impact on long-term outcomes.

Personality Strengths in Romantic relationships: Measuring Perceptions of Benefits and Costs and Their Impact on Personal and Relational Well-Being.

Three studies using samples of people in romantic relationships were conducted to create a new individual difference measure of partner strengths in couples. The 2 perceptions of partner strengths included (1) appreciation of their use and effectiveness and (2) recognition of costs associated with their use. Factor analyses supported 2-factors and we found that greater appreciation of partner strengths predicted greater relationship satisfaction, commitment, investment, intimacy, self-expansion, and support for goal pursuit; recognizing significant costs with partner strengths was inversely related to several outcomes. Using a 1-week daily diary, we found that appreciation of partner strength use and recognition of costs associated with these strengths predicted daily relationship satisfaction and whether basic psychological needs were met within the relationship. The explanatory power of partner strength perceptions could not be explained by the actual character strengths or Big Five personality traits of partners, support for positive self-disclosures (capitalization), or gratitude for relationship partners. Finally, we found that the relational consequences of partner strength perceptions were not just “in the head” of the perceiver—influencing partner relational outcomes. This research program provides evidence for the use of a new measure of how strengths are perceived to better understand romantic couples and aspirational targets in clinical interventions.

Predicting treatment course and outcome using a promotion and prevention framework in a community sample of arthritis sufferers

Objective The present study examined the proposition that patients need to focus on something beyond simply “getting better”. In a sample of arthritis sufferers, we distinguished individuals by the goals that motivated them – moving toward aspirational goals and maximizing gains (promotion focus) rather than obligations and minimizing losses (prevention focus) – and how these motivational styles influenced treatment. Methods Patients (N=254) participated in a randomized controlled trial of resistance training and self-management, providing 6 time points of data over 2 years. Promotion and prevention focus at baseline were used to predict the course (compliance and changes in coping self-efficacy) and outcome (changes in physical functioning) of treatment. Results Arthritis sufferers with strong promotion orientations showed significant improvements in physical functioning (a direct positive impact on physical health); there were no significant associations with treatment compliance and coping self-efficacy. Arthritis sufferers with strong prevention orientations complied less with the treatment and showed little change in coping self-efficacy during treatment, which, in turn, predicted worse physical functioning over time (a pernicious, indirect influence on treatment outcome). Conclusion A focus on positive approach-oriented goals may improve overall treatment response, whereas a focus on negative avoidance-oriented goals may degrade treatment response through reduced compliance and self-efficacy.