Dane Jensen

Domain-Specific Intolerance of Uncertainty in Socially Anxious and Contamination-Focused Obsessive–Compulsive Individuals

Intolerance of uncertainty (IU) has been increasingly recognized as a transdiagnostic factor across anxiety disorders and depression and is associated with substantial cognitive, behavioral, and emotional impairment. IU is typically construed as a dispositional tendency to view ambiguous stimuli and unknown outcomes as unacceptably threatening regardless of context, but recent findings suggest that the domain in which uncertainty is encountered may be relevant. Taking that research to the next step, the aim of the present study was to determine whether IU is more salient in concern-congruent versus incongruent domains and whether domain-specific IU is a better predictor of anxiety symptoms than trait IU. A total of 102 undergraduates were recruited into analog socially anxious (SA), obsessive–compulsive contamination (OCC), and nonanxious control (NAC) groups based on responses to measures of SA and OCC symptoms. Both groups reported more domain-congruent IU than trait IU or domain-incongruent IU. The SA group reported more social interaction IU than the OCC and NAC groups; the OCC group reported more cleanliness IU than the SA and NAC groups. Domain-specific IU predicted social anxiety and OCC fears above and beyond trait IU. Results suggest that IU has a substantial context-specific component and should be examined both transdiagnostically and transsituationally.

Structural invariance of General Behavior Inventory (GBI) scores in Black and White young adults.

In the United States, Black and White individuals show discrepant rates of diagnosis of bipolar disorder versus schizophrenia and antisocial personality disorder, as well as disparate access to and utilization of treatment for these disorders (e.g., Alegria, Chatterji, et al., 2008; Chrishon, Anderson, Arora, & Bailey, 2012). Such diagnostic discrepancies might stem from racially related cognitive biases in clinical judgment or from racial biases in measurements of bipolar disorder. The General Behavior Inventory (GBI) is among the most well-validated and widely used measures of bipolar mood symptoms, but the psychometric properties of the GBI have been examined primarily in predominantly White samples. In this study, we used multigroup confirmatory factor analyses (CFA) to examine the invariance of GBI scores across racial groups with a nonclinical sample. Fit was acceptable for tests of configural invariance, equal factor loadings, and equal intercepts, but not invariance of residuals. Findings indicate that GBI scores provide functionally invariant measurement of mood symptoms in both Black and White samples. The use of GBI scores may contribute consistent information to clinical assessments and could potentially reduce diagnostic discrepancies and associated differences in access to and utilization of mental health services.

Intolerance of Uncertainty and Immediate Decision-Making in High-Risk Situations

Given evidence that individuals high in intolerance of uncertainty (IU; the tendency to experience unknown outcomes as unacceptably threatening) exhibit poorer decision-making strategies and are more behaviorally inhibited in unpredictable situations than those low in IU, the present study sought to elucidate the relationship between IU and decision-making by studying confidence and speed in making repeated decisions in high-risk scenarios with an immediate threat given limited but changing information. Seventy undergraduates high or low in IU completed a repeated decision-making task involving hypothetical risk scenarios and rated their confidence in their decisions, given first two options or then three options from which to select. Response times for each decision were recorded. Individuals high in IU became less confident in their decisions across blocks of decision-making trials, whereas individuals low in IU became more confident in their decisions. Response times did not significantly differ between high IU and low IU individuals. However, individuals high in IU tended to be less likely to change their decision when presented with new information and an additional response option than participants low in IU, although this trend fell just short of statistical significance. Implications for the role of IU in the maintenance of anxiety and depression are discussed.

Clarifying the unique associations among intolerance of uncertainty, anxiety, and depression*

Abstract Increasing evidence suggests that intolerance of uncertainty (IU) may be a transdiagnostic factor across the anxiety disorders, and to a lesser extent, unipolar depression. Whereas anxiety inherently involves uncertainty regarding threat, depression has traditionally been associated with certainty (e.g. the hopelessness theory of depression). Some theorists posit that the observed relationship between depression and IU may be due to the relationship between depression and anxiety and the relationship between anxiety and IU. The present study sought to elucidate the unique relationships among trait anxiety, depression, and IU in undergraduate (N = 554) and clinical (generalized anxiety disorder; N = 43) samples. Findings suggest that IU may play a larger role in anxiety than depression, although some evidence indicates that inhibitory IU and depression may have a modest but independent relationship.

Computerized Tool to Manage Dental Anxiety: A Randomized Clinical Trial

Anxiety regarding dental and physical health is a common and potentially distressing problem, for both patients and health care providers. Anxiety has been identified as a barrier to regular dental visits and as an important target for enhancement of oral health–related quality of life. The study aimed to develop and evaluate a computerized cognitive-behavioral therapy dental anxiety intervention that could be easily implemented in dental health care settings. A cognitive-behavioral protocol based on psychoeducation, exposure to feared dental procedures, and cognitive restructuring was developed. A randomized controlled trial was conducted (N = 151) to test its efficacy. Consenting adult dental patients who met inclusion criteria (e.g., high dental anxiety) were randomized to 1 of 2 groups: immediate treatment (n = 74) or a wait-list control (n = 77). Analyses of covariance based on intention-to-treat analyses were used to compare the 2 groups on dental anxiety, fear, avoidance, and overall severity of dental phobia. Baseline scores on these outcomes were entered into the analyses as covariates. Groups were equivalent at baseline but differed at 1-mo follow-up. Both groups showed improvement in outcomes, but analyses of covariance demonstrated significant differences in dental anxiety, fear, avoidance, and overall severity of dental phobia in favor of immediate treatment at the follow-up assessment. Of the patients who met diagnostic criteria for phobia at baseline, fewer patients in the immediate treatment group continued to meet criteria for dental phobia at follow-up as compared with the wait-list group. A new computer-based tool seems to be efficacious in reducing dental anxiety and fear/avoidance of dental procedures. Examination of its effectiveness when administered in dental offices under less controlled conditions is warranted (ClinicalTrials.gov NCT02081365).

Enmeshment Schema and Quality of Life Deficits: The Mediating Role of Social Anxiety

Social anxiety is associated with significant functional impairment and poor quality of life. However, there is a paucity of research on how early childhood and family dynamics may be related to social anxiety and its impact on quality of life. We investigated the role of enmeshment schemas, cognitive structures associated with emotional over-involvement with and lack of differentiation from family. Enmeshment is associated with considerable functional impairment, including elevated anxiety and depression and impaired relationship satisfaction. As enmeshment schemas predict withdrawal from stressful social interactions, they may facilitate the development of social anxiety and, through that mechanism, lead to reduced quality of life. Participants completed measures of these constructs. Social anxiety mediated the negative association between enmeshment and quality of life, particularly within the domains of personal growth, social functioning, and achievement. Implications for novel etiological conceptualizations of social anxiety and subsequent treatment interventions are discussed.

Social anxiety and vulnerability for problematic drinking in college students: the moderating role of post-event processing.

Abstract Socially anxious college students are at increased risk for engaging in problematic drinking (i.e. heavy or risky drinking) behaviors that are associated with the development of an alcohol use disorder. The present study examined whether post-event processing (PEP), repeatedly thinking about and evaluating one’s performance in a past social situation, strengthens the association between social anxiety and vulnerability to problematic drinking among college students. Eighty-three college drinkers with high or low social anxiety participated in a social interaction task and were exposed to a manipulation that either promoted or inhibited PEP about the social interaction. Among participants randomized to the PEP promotion condition, those with high social anxiety exhibited a greater urge to use alcohol after the social interaction and greater motivation to drink to cope with depressive symptoms over the week following the manipulation than did those with low social anxiety. These findings suggest that targeting PEP in college drinking intervention programs may improve the efficacy of such programs for socially anxious students.

The Empirical Examinability of Psychodynamic Psychotherapy: A Reply to Hoffart and Johnson

This commentary serves as a reply to Hoffart and Johnson’s article contending that psychodynamic psychotherapy (PDT) models cannot be examined with regard to mechanism of change or represent within-person causal relationships. Hoffart and Johnson cite purportedly paradigmatic examples of PDT and cognitive therapy and examine them with respect to Kazdin’s requirements for investigation of mechanisms of change. We highlight inaccuracies in Hoffart and Johnson’s representation of PDT and, in doing so, provide reasoning in support of the empirical examinability of PDT. We conclude by recommending a metatheoretical system (i.e., functionalism) and empirical methodologies that clinical scientists may consider when investigating mechanisms of PDT in the future.

Social Anxiety and Misinterpretation of the Five Facet Mindfulness Questionnaire Describe Subscale

The Five Facet Mindfulness Questionnaire is a widely used measure assessing 5 aspects of mindfulness. The Describe subscale is intended to assess the ability to put one’s inner experience into words for one’s own understanding, but subscale items contain language that may be ambiguous in that regard. The current study investigated whether social anxiety is associated with a tendency to misinterpret Describe items as referring to describing one’s experiences to others rather than oneself. Participants were randomized to receive one of 3 versions of the Describe subscale: the original version or one of two variants orienting participants to describe inner experience for self-communication or interpersonal communication. Social anxiety was negatively associated with Describe scores for the Standard Describe subscale and the interpersonal communication variant, but not for the self-communication variant. Results suggest that high levels of social anxiety are associated with misinterpretation of statements on the Describe subscale as probing for interpersonal communication.

Single-Session Computerized Cognitive Behavioral Therapy for Dental Anxiety A Case Series

Therapy interventions for dental anxiety that can be easily implemented in dental health care settings are needed. A series of six case studies is presented to demonstrate the feasibility, acceptability, and initial efficacy of a single-session computerized cognitive behavioral therapy intervention for dental anxiety. Six patients at a community dental clinic (five females, Mage = 49.50, SD = 10.48) who were identified as having high dental anxiety on the Modified Dental Anxiety Scale (MDAS) participated in this uncontrolled pilot trial. All patients completed pre-treatment assessments of dental anxiety and the computerized therapy during the hour before a scheduled dental appointment, and five of six patients completed a 1-month follow-up assessment. All six of the patients were able to complete the intervention with minimal assistance and reported that they were very satisfied with the therapy. Three of the five patients available for follow-up assessment demonstrated clinically significant reductions in their dental anxiety, with MDAS scores dropping from the high range to the low range. Findings provide preliminary support for the feasibility, acceptability, and efficacy of this computerized dental anxiety intervention. Implications for the dissemination of this intervention within dental health care settings and improvement of anxious patients’ access to dental care are discussed.