Iftah Yovel

Attentional biases in PTSD: More evidence for interference

Attentional biases to trauma-related stimuli have been widely demonstrated in individuals with posttraumatic stress disorder (PTSD). However, the majority of these studies used methods not suited to differentiating difficulty disengaging attention from threatening stimuli (interference) from facilitated detection of threat. In the current study, a visual search task (VST) with a lexical decision component was used to differentiate between attentional interference and facilitation. Forty-six sexual assault survivors with High PTSD or Low PTSD symptoms completed the VST with three types of stimuli (trauma-related, general threat-related, and semantically-related neutral words), to examine the specificity of attentional biases associated with PTSD symptoms. High PTSD participants showed increased interference to trauma-related words relative to Low PTSD participants. Furthermore, the increased attentional interference in High PTSD participants was specific to trauma-related stimuli. No evidence was found for facilitated detection of threatening stimuli in PTSD. These results provide additional support for attentional biases in PTSD relating to attentional interference with trauma-related cues rather than facilitated detection of threat. The implications for this pattern of results are discussed in relation to anxiety disorders that are characterized by rumination and/or intrusions (e.g., PTSD, GAD) rather than those more circumscribed to fight or flight response (e.g., phobias).

Idiosyncratic Severity Profiles of Obsessive Compulsive Dysfunction: A Detailed Self Report Assessment of a Multifaceted Syndrome

In this paper we present an assessment method designed to detect specific individual severity profiles of obsessive–compulsive areas of dysfunction. This method is based on the Obsessive Compulsive Symptoms Rating Scale (OCSRS; Wilhelm and Steketee 2006), a comprehensive self-report instrument that measures the severity of a wide variety of symptom categories associated with obsessive compulsive disorder (OCD). A total of 127 patients diagnosed with OCD completed the OCSRS and other measures of OCD, anxiety, and depression. Statistical analyses confirmed the convergent and discriminant validity of the OCSRS symptom categories, and indicated that each of these symptom clusters contains internally-consistent symptoms that can be meaningfully measured by a single severity score. Additional analyses demonstrated the clinical utility of this fine-grained severity assessment of OCD. The findings indicate that the severity profile of the OCSRS provides unique information that may be useful for a variety of research and clinical purposes.

Measuring regulation in the here and now: The development and validation of the State Emotion Regulation Inventory (SERI).

The relationship between context and emotion regulation is currently at the center of a burgeoning area of research. Commonly used emotion regulation questionnaires, however, are predominantly trait-based, and insensitive to situational choice of regulatory strategy. The current work describes the development and validation of the State Emotion Regulation Inventory (SERI), a brief measure of situational use of distraction, reappraisal, brooding and acceptance. In Study 1, an initial item pool was constructed, based on commonly used trait-based emotion regulation surveys. Then, the psychometric properties of the items were examined with a group of 181 participants who recalled a saddening autobiographical event, identified a distressing thought it triggered, and then waited for 3 minutes without instruction, as an opportunity to allow for spontaneous emotion regulation. Participants then completed the initial item pool, and other relevant trait-based scales. Exploratory factor analysis suggested a 4-factor solution, corresponding to the 4 regulatory strategies measured in the SERI. The 4 items to exclusively load highest on each factor were selected for the final measure. Assembled subscales correlated with relevant trait-based subscales in the expected directions. In Study 2, another sample of 155 participants completed the same procedure and the new SERI, and confirmatory factor analysis supported the 4-factor structure of this instrument. As a brief, validated instrument, the SERI may be a useful measure for studies of state emotion regulation, in protocols that use repeated measures in a single session, over the course of multiple sessions, or via ecological momentary assessments.

Predictors and Moderators of Cognitive and Behavioral Therapy Outcomes for OCD: A Patient-Level Mega-Analysis of Eight Sites

Cognitive (CT) and behavioral treatments (BT) for OCD are efficacious separately and in combination. Tailoring treatment to patient-level predictors and moderators of outcome has the potential to improve outcomes. The present study combined data from eight treatment clinics to examine the benefits of BT (n = 125), CT (n = 108), and CBT (n = 126), and study predictors across all treatments and moderators of outcome by treatment type. All three methods led to large benefits for OCD and depression symptoms. Residual gain scores for OCD symptoms were marginally smaller for BT compared to treatments containing CT. For depression, significantly more gains were evident for CBT than BT, and CT did not differ from either. Significantly fewer BT participants (36%) achieved clinically significant improvement compared to CT (56%), and this was marginally evident for CBT (48%). For all treatments combined, no predictors were identified in residual gain analyses, but clinically improved patients had lower baseline depression and stronger beliefs about responsibility/threat and importance/control of thoughts. Moderator analyses indicated that higher baseline scores on depression adversely affected outcomes for BT but not CT or CBT, and lower OCD severity and more education were associated with positive outcomes for CT only. A trend was evident for higher responsibility/threat beliefs to moderate clinical improvement outcomes for those receiving cognitive (CT and CBT), but not behavioral (BT) treatment. Medication status and comorbidity did not predict or moderate outcomes. Findings are discussed in light of models underlying behavioral and cognitive treatments for OCD.

Pushed by Symptoms, Pulled by Values: Promotion Goals Increase Motivation in Therapeutic Tasks

While many therapies focus on the reduction of disturbing symptoms, others pursue behavior consistent with personally held values. Based on regulatory focus theory (Higgins, 1997), reducing symptoms is a type of prevention goal while pursuing values is a promotion goal. In the current study, 123 undergraduate students elicited a negative, self-focused emotion-laden cognition. They were then randomly assigned to construe their negative thought as either (a) an impediment to valued behaviors, (b) a cause of unpleasant symptoms, or to one of two control conditions: (c) distraction or (d) no intervention. Then, participants in all groups completed a series of repetitive therapeutic tasks that targeted their elicited negative cognitions. Results showed that participants who construed treatment in terms of valued behavior promotion spent more time on a therapeutic task than all other groups. The group in the unpleasant symptom promotion condition did not differ from either control group. The motivational advantage of value promotion was not accounted for by differences in mood. The present findings suggest that clients may be better motivated through value promotion goals, as opposed to symptom prevention goals.