Eva Gilboa-Schechtman

Maternal Depression and Anxiety Across the Postpartum Year and Infant Social Engagement, Fear Regulation, and Stress Reactivity

OBJECTIVE To examine the effects of maternal depression on infant social engagement, fear regulation, and cortisol reactivity as compared with maternal anxiety disorders and controls and to assess the role of maternal sensitivity in moderating the relations between maternal depression and infant outcome. METHOD Using an extreme-case design, 971 women reported symptoms of anxiety and depression after childbirth and 215 of those at the high and low ends were reevaluated at 6 months. At 9 months, mothers diagnosed with a major depressive disorder (n = 22) and anxiety disorders (n = 19) and matched controls reporting no symptoms across the postpartum year (n = 59) were visited at home. Infant social engagement was observed during mother-infant interaction, emotion regulation was microcoded from a fear paradigm, and mothers and infants cortisol were sampled at baseline, reactivity, and recovery. RESULTS The infants of depressed mothers scored the poorest on all three outcomes at 9 months-lowest social engagement, less mature regulatory behaviors and more negative emotionality, and highest cortisol reactivity-with anxious dyads scoring less optimally than the controls on maternal sensitivity and infant social engagement. Fear regulation among the children of anxious mothers was similar to that of the controls and their stress reactivity to infants of depressed mothers. Effect of major depressive disorder on social engagement was moderated by maternal sensitivity, whereas two separate effects of maternal disorder and mother sensitivity emerged for stress reactivity. CONCLUSIONS Pathways leading from maternal depression to infant outcome are specific to developmental achievement. Better understanding of such task-specific mechanisms may help devise more specifically targeted interventions.

Attentional Biases for Facial Expressions in Social Phobia: The Face-in-the-Crowd Paradigm

The present study examines the attentional bias hypothesis for individuals with generalised social phobia (GSPs). Socially phobic individuals were hypothesised to exhibit attentional bias towards threat stimuli relevant to interpersonal situations. This hypothesis was tested using the face-in-the-crowd paradigm. GSPs and nonanxious controls (NACs) detected an angry, happy, neutral, or disgust target face in a crowd of 12 distracter photographs. Results indicated that, compared to NACs, GSPs exhibited greater attentional biases for angry than for happy faces in a neutral crowd. GSPs were more slowed down in their performance by happy and angry versus neutral distracters; NACs did not exhibit such sensitivity to distracter type. Finally, GSPs were faster in detecting anger than disgust expressions; NACs detected both types of faces equally quickly. Implications of these findings for the maintenance of social phobia are discussed.

Memory Bias in Generalized Social Phobia: Remembering Negative Emotional Expressions

In two experiments, the authors examined memory for facial emotional expressions in patients with generalized social phobia (GSP) and in nonanxious control (NAC) participants. Three main questions were addressed. First, do patients with GSP differ from NAC participants in their overall memory for facial expressions? Second, do patients with GSP exhibit a memory bias for negative versus nonnegative expressions? Third, if such a bias exists, is it specific to angry expressions? The results of both experiments indicated that patients with GSP have better memory for all facial expressions than do NAC participants. Results of experiment 2 suggest that patients with GSP exhibit enhanced recognition for negative compared with nonnegative expressions; in contrast, NAC participants did not exhibit such enhancement. Results concerning specificity were equivocal. The importance of examining cognitive biases in patients with GSP via the use of facial expression is discussed.

Prolonged exposure versus dynamic therapy for adolescent PTSD: a pilot randomized controlled trial.

OBJECTIVE To examine the efficacy and maintenance of developmentally adapted prolonged exposure therapy for adolescents (PE-A) compared with active control time-limited dynamic therapy (TLDP-A) for decreasing posttraumatic and depressive symptoms in adolescent victims of single-event traumas. METHOD Thirty-eight adolescents (12 to 18 years old) were randomly assigned to receive PE-A or TLDP-A. RESULTS Both treatments resulted in decreased posttraumatic stress disorder and depression and increased functioning. PE-A exhibited a greater decrease of posttraumatic stress disorder and depression symptom severity and a greater increase in global functioning than did TDLP-A. After treatment, 68.4% of adolescents beginning treatment with PE-A and 36.8% of those beginning treatment with TLDP-A no longer met diagnostic criteria for posttraumatic stress disorder. Treatment gains were maintained at 6- and 17-month follow-ups. CONCLUSIONS Brief individual therapy is effective in decreasing posttraumatic distress and behavioral trauma-focused components enhance efficacy. CLINICAL TRIAL REGISTRY INFORMATION: Prolonged Exposure Therapy Versus Active Psychotherapy in Treating Post-Traumatic Stress Disorder in Adolescents, URL: http://clinicaltrials.gov, unique identifier: NCT00183690.

Interpersonal deficits meet cognitive biases: memory for facial expressions in depressed and anxious men and women.

Memory biases for negatively vs. positively valenced linguistic information in depression are well documented. However, no study so far has examined the relationship between depression and memory for facial expressions. We examined memory for neutral, happy, sad, and angry facial expressions in individuals suffering from comorbid depression and anxiety (COMs, N=23) or from anxiety disorders (ANXs, N=20) and in normal controls (NACs, N=23). Two main hypotheses were examined. First, we expected COMs, but not NACs, to exhibit an enhanced memory for sad and angry vs. happy expressions (negativity hypothesis). Second, we postulated that this bias would be specific to depression (disorder-specificity hypothesis). Data supported both these hypotheses. Specifically, COMs exhibited enhanced recognition of angry compared to happy expressions; in contrast, ANXs and NACs did not exhibit such enhancement. We also found that men showed a significantly better memory for angry vs. sad expressions, whereas women did not exhibit such a difference. The implications of these findings for the interpersonal processes involved in the maintenance of depression and anxiety are discussed.

Patterns of recovery from trauma: the use of intraindividual analysis.

Patterns of recovery from sexual and nonsexual assault were examined. Two studies containing data from female victims of these assaults were analyzed. In Study 1, victims (N = 101) underwent 12 weekly assessments with measures of posttraumatic stress disorder (PTSD), depression, and state anxiety. In Study 2, victims (N = 108) underwent monthly assessments on the same measures. The authors examined the effects of type of trauma and time of peak reaction on long-term recovery using intraindividual analysis of change. In both studies, initial and peak reactions of rape victims were more severe than were those of nonsexual assault victims on all measures of psychopathology. Victims with delayed peak reaction exhibited more severe pathology at the final assessment than did victims with early peak reaction. Results of Study 2 indicated a slower recovery rate from sexual than nonsexual assault; in Study 1 a similar pattern of recovery emerged. The advantages of an individual-focused, longitudinal approach to recovery from a trauma are discussed.

Functional impairment in social anxiety disorder

The present study examined functional impairment among treatment seekers with social anxiety disorder (SAD). We investigated the effects of diagnostic subtypes of SAD and comorbidity with mood and anxiety disorders on impairment. In addition, we used cluster analysis procedures to empirically identify subgroups of individuals with distinct patterns of impairment. Participants were 216 treatment-seeking individuals with SAD. Clinical interviews were undertaken to determine diagnoses of anxiety disorders and major depressive disorder, and a battery of self-report measures was administered to index symptoms of social anxiety, depression and extent of impairment. Results indicated that individuals with the generalized subtype of SAD had greater impairment in all three life domains compared to individuals with the nongeneralized subtype. Comorbidity with mood disorders was associated with greater impairment than SAD alone, but comorbidity with anxiety disorders was not. Four distinct impairment profiles emerged from the cluster analysis: primary work/studies impairment, primary social life impairment, both work/studies and social impairment, and impairment in all domains. Findings from this study suggest that SAD is associated with substantial impairment across multiple domains, and that individuals with SAD present diverse impairment profiles. These profiles may inform subtyping of the disorder as well as therapeutic interventions.

Social rank and affiliation in social anxiety disorder.

The present study examined the interpersonal lives of individuals with social anxiety disorder (SAD). According to evolutionary and interpersonal theories, we construed the interpersonal world using the social rank and the affiliation psychological systems. Two studies assessed measures of social rank, affiliation, social anxiety and depression among a population of treatment-seeking individuals with SAD. In study 1, individuals with SAD without major depressive disorder (MDD; n=42) were compared to healthy controls (n=47). In study 2, individuals with SAD and MDD (n=45) were compared to individuals with other anxiety disorders and MDD (n=31). Results indicated that SAD was related to perceiving oneself as having low social rank, being inferior, and behaving submissively, as well as to low perceived intimacy and closeness among peer relations, friendships and romantic relations. SAD was distinctly associated with these perceptions above and beyond the symptomatic (study 1) and the syndrome-level (study 2) effects of depression. These findings were further supported by a path analysis of the SAD participants from both studies. Our findings highlight the need to address both social rank and affiliation issues in the assessment and treatment of SAD.

Impact of depression on treatment effectiveness and gains maintenance in social phobia: A naturalistic study of cognitive behavior group therapy.

Background: The impact of depression on cognitive behavioral group therapy (CBGT) for social phobia (SP) in a naturalistic outpatient setting was examined after treatment termination and at 1‐year follow‐up. Methods: Consecutive SP outpatients (N=219) were diagnosed using a structured interview. CBGT was provided in 18 1.5‐hr weekly sessions. At pretreatment and posttreatment questionnaires and clinician ratings were administered. Self‐report measures were obtained at 1‐year follow‐up. The main outcome measure was the Liebowitz Social Anxiety Scale. Results: CBGT was found to be effective in reducing both social anxiety (effect size=1.23) as well as depression (effect size=0.94). Individuals with generalized social phobia (GSP) and individuals with specific social phobia (SSP) differed in their presenting psychopathology and in their response to CBGT. Among treatment completers, 44% GSPs and 37% SSPs achieved at least 50% improvement, and 44% GSPs and 87% SSPs reported distress and functioning within the normal range at the end of treatment. Among SPs diagnosed with major depressive disorder (MDD) at the onset of treatment, SP symptoms aggravated during the follow‐up period, whereas SPs not diagnosed with MDD experienced a further alleviation of SP symptoms during follow‐up. CBGT provided in a public clinic to non‐selected, mostly unmedicated and comorbid patients, is an effective treatment for the majority of SP sufferers. Conclusions: MDD at the onset of CBGT was not associated with poorer treatment response, but predicted exacerbation of SP symptoms following treatment termination. Depressed SPs may need additional intervention to maintain CBGT gains. SSPs may benefit from less intensive CBGT than GSPs. Depression and Anxiety, 2009.

Heterogeneity of long-history migration explains cultural differences in reports of emotional expressivity and the functions of smiles

Significance In an age of globalization, emotional understanding is the central problem of human interaction. Here, we show that historical heterogeneity, or the extent to which a country’s present-day population descends from numerous (vs. few) source countries, predicts cultural variation in norms for emotional expressivity. Reanalysis of cultural display rules from 32 countries reveals that historical heterogeneity is associated with norms favoring greater emotional expressivity. In addition, the results of a study of nine countries show that the belief that smiles signal social bonding motives vs. the negotiation of status in a social hierarchy is predicted by historical heterogeneity as well. A small number of facial expressions may be universal in that they are produced by the same basic affective states and recognized as such throughout the world. However, other aspects of emotionally expressive behavior vary widely across culture. Just why do they vary? We propose that some cultural differences in expressive behavior are determined by historical heterogeneity, or the extent to which a country’s present-day population descended from migration from numerous vs. few source countries over a period of 500 y. Our reanalysis of data on cultural rules for displaying emotion from 32 countries [n = 5,340; Matsumoto D, Yoo S, Fontaine J (2008) J Cross Cult Psychol 39(1):55–74] reveals that historical heterogeneity explains substantial, unique variance in the degree to which individuals believe that emotions should be openly expressed. We also report an original study of the underlying states that people believe are signified by a smile. Cluster analysis applied to data from nine countries (n = 726), including Canada, France, Germany, India, Indonesia, Israel, Japan, New Zealand, and the United States, reveals that countries group into “cultures of smiling” determined by historical heterogeneity. Factor analysis shows that smiles sort into three social-functional subtypes: pleasure, affiliative, and dominance. The relative importance of these smile subtypes varies as a function of historical heterogeneity. These findings thus highlight the power of social-historical factors to explain cross-cultural variation in emotional expression and smile behavior.