Ethan Moitra

The Assessment of Present-Moment Awareness and Acceptance The Philadelphia Mindfulness Scale

The purpose of this project was to develop a bidimensional measure of mindfulness to assess its two key components: present-moment awareness and acceptance. The development and psychometric validation of the Philadelphia Mindfulness Scale is described, and data are reported from expert raters, two nonclinical samples (n = 204 and 559), and three clinical samples including mixed psychiatric outpatients (n = 52), eating disorder inpatients (n = 30), and student counseling center outpatients (n = 78). Exploratory and confirmatory factor analyses support a two-factor solution, corresponding to the two constituent components of the construct. Good internal consistency was demonstrated, and relationships with other constructs were largely as expected. As predicted, significant differences were found between the nonclinical and clinical samples in levels of awareness and acceptance. The awareness and acceptance subscales were not correlated, suggesting that these two constructs can be examined independently. Potential theoretical and applied uses of the measure are discussed.

A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression

Acceptance and commitment therapy (ACT) has a small but growing database of support. One hundred and one heterogeneous outpatients reporting moderate to severe levels of anxiety or depression were randomly assigned to traditional cognitive therapy (CT) or to ACT. To maximize external validity, the authors utilized very minimal exclusion criteria. Participants receiving CT and ACT evidenced large, equivalent improvements in depression, anxiety, functioning difficulties, quality of life, life satisfaction, and clinician-rated functioning. Whereas improvements were equivalent across the two groups, the mechanisms of action appeared to differ. Changes in “observing” and “describing” ones experiences appeared to mediate outcomes for the CT group relative to the ACT group, whereas “experiential avoidance,” “acting with awareness,” and “acceptance” mediated outcomes for the ACT group. Overall, the results suggest that ACT is a viable and disseminable treatment, the effectiveness of which appears equivalent to that of CT, even as its mechanisms appear to be distinct.

Cognitive behavior therapy for generalized social anxiety disorder in adolescents: A randomized controlled trial

Early identification and treatment of social anxiety disorder (SAD) is critical to prevent development of a chronic course of symptoms, persistent functional impairment, and progressive psychiatric comorbidity. A small but growing literature supports the effectiveness of cognitive behavior therapy (CBT) for anxiety disorders, including SAD, in adolescence. The present randomized controlled trial evaluated the efficacy of group vs. individual CBT for adolescents with generalized SAD in relation to an educational/supportive psychotherapy that did not contain specific CBT elements. All three treatments were associated with significant reductions in symptoms and functional impairment, and in improved social skills. No differences between treatments emerged on measures of symptoms, but the CBT conditions demonstrated greater gains on behavioral measures. The implications of the findings are discussed.

Behavioral avoidance mediates the relationship between anxiety and depressive symptoms among social anxiety disorder patients

This study investigated the relationship between social anxiety, depressive symptoms, and behavioral avoidance among adult patients with Social Anxiety Disorder (SAD). Epidemiological literature shows SAD is the most common comorbid disorder associated with Major Depressive Disorder (MDD), though the relationship between these disorders has not been investigated. In most cases, SAD onset precedes MDD, suggesting symptoms associated with SAD might lead to depression in some people. The present study addressed this question by investigating the mediational role of behavioral avoidance in this clinical phenomenon, using self-report data from treatment-seeking socially anxious adults. Mediational analyses were performed on a baseline sample of 190 individuals and on temporal data from a subset of this group. Results revealed behavioral avoidance mediated this relationship, and supported the importance of addressing such avoidance in the therapeutic setting, via exposure and other methods, as a possible means of preventing depressive symptom onset in socially anxious individuals.

Characteristics and predictors of social phobia course in a longitudinal study of primary‐care patients

Background: Social Phobia (SP) is a prevalent disorder in primary‐care settings. To date, few researchers have examined the natural course of SP in primary care. We examined the natural course and predictors of recovery in a large sample of primary‐care patients. Methods: Data are obtained from the Primary Care Anxiety Project, a naturalistic, longitudinal study of anxiety disorders in primary‐care patients. This report pertains to 182 patients with SP at intake. We examined intake demographic and clinical variables as predictors of recovery within the 5 years of follow‐up. Results: The probability of recovery from SP during the 5‐year follow‐up period was .40. At intake, a longer duration of SP episode, comorbid Panic Disorder with Agoraphobia, and lower psychosocial functioning predicted lower rates of recovery. Conclusions: These findings highlight the chronicity of SP, as well as factors that may affect its naturalistic course. It is imperative that primary‐care physicians and mental health specialists assess for and treat SP in their practices. Future research is warranted to further examine the effect of medical and psychiatric comorbidity on SP course. Depression and Anxiety, 2010.

Acceptance-based behavior therapy to promote HIV medication adherence

A significant number of adults with HIV in the USA do not maintain adherence to highly active antiretroviral therapy (HAART) at adequate levels. Although traditional cognitive behavioral interventions have shown promise in promoting HAART adherence, acceptance-based behavior therapy (ABBT) may be particularly useful in this population. ABBT has the potential to overcome common avoidance-based barriers associated with poor adherence, including denial of various illness-related factors and avoidance of stigmatization. We describe the rationale for promoting psychological and behavioral acceptance in HIV-positive populations; outline an ABBT to promote HAART adherence targeting primary care patients from urban, minority, low socioeconomic backgrounds; and report preliminary qualitative observations of treatment feasibility and acceptability.

Psychometric properties of the Liebowitz Social Anxiety Scale (LSAS) in a longitudinal study of African Americans with anxiety disorders

The Liebowitz Social Anxiety Scale (LSAS) is a widely used measure of social anxiety. However, no study has examined the psychometric properties of the LSAS in an African American sample. The current study examined the LSAS characteristics in 97 African Americans diagnosed with an anxiety disorder. Overall, the original LSAS subscales showed excellent internal consistency and temporal stability. Similar to previous reports, fear and avoidance subscales were so highly correlated that they yielded redundant information. Confirmatory factor analyses for three previously proposed models failed to demonstrate an excellent fit to our data. However, a four-factor model showed minimally acceptable fit. Overall, the LSAS performed similarly in our African American sample as in previous European American samples. Exploratory factor analyses are warranted to determine whether a better factor structure exists for African Americans.

The impact of stressful life events on relapse of generalized anxiety disorder

Stressful life events (SLEs) are associated with the onset of psychiatric disorders but little is known about the effects of SLEs on individuals already diagnosed with an anxiety disorder, particularly generalized anxiety disorder (GAD) in which worry about life events is a defining characteristic. This study examined the impact of SLEs on relapse in adults already diagnosed with GAD.

Occupational impairment and Social Anxiety Disorder in a sample of primary care patients

BACKGROUND Social Anxiety Disorder (SAD) is the second most prevalent psychiatric condition in the US. Because of the inherent nature of SAD, it may cause impairments in workplace functioning, particularly compared to other anxiety disorders that do not necessarily lead to social impairments. In this study, we compared workplace functioning in primary care patients with SAD to patients with other anxiety disorders and comorbid Major Depressive Disorder (MDD). METHODS Data are obtained from the Primary Care Anxiety Project (PCAP), a naturalistic, longitudinal study of anxiety disorders in 539 primary care patients. We examined intake demographic and interviewer-assessed ratings of workplace functioning. RESULTS Results revealed that patients with SAD and MDD had significantly decreased workplace functioning, compared to individuals with other anxiety disorders. Furthermore, results showed that patients with SAD were greater than two-times more likely to be unemployed, but expected to work, than all other patients. LIMITATIONS Workplace functioning was not measured objectively and the sample may not be representative of the general population. CONCLUSIONS These findings highlight the particular need to assess for the presence of undereducation and underperformance at work and/or underemployment in individuals with SAD, as they are at most risk for these impairments. Additionally, early detection and intervention in individuals with or at risk for SAD may curb the future impact of social anxiety on occupational attainment.

Adequacy of treatment received by primary care patients with anxiety disorders.

We examined the adequacy of pharmacotherapy and psychotherapy received by primary care patients with anxiety disorders over up to 5 years of follow‐up.