Jennifer L. Trew

Exploring the roles of approach and avoidance in depression: an integrative model.

Human behavior can be organized around two fundamental motivational principles: the desire to approach positive outcomes and the desire to avoid negative outcomes. Both approach and avoidance motivation are relevant to a range of psychopathology, including depression. However, with some notable exceptions, avoidance processes have been underemphasized in the literature on motivational processes in depression. This review will examine the roles that approach and avoidance play in depression and will present an integrative model of approach and avoidance processes in depression. Both approach deficits and avoidance motivation are argued to play a role in limiting positive experiences and reinforcement for non-depressed behavior, contributing to the onset and maintenance of depression. In addition, avoidance processes are argued to play a role in negative information processing biases that may increase vulnerability to the onset and recurrence of depression. Lastly, avoidance processes and dysregulation in the connections between the approach and avoidance systems may contribute to depression by promoting inappropriate perseveration in the pursuit of unattainable approach goals. Theoretical rationales and empirical evidence for each of these roles are presented. Understanding the roles that both approach and avoidance play in depression may help to inform current conceptualizations of depression and improve treatment outcomes.

If it makes you happy: Engaging in kind acts increases positive affect in socially anxious individuals.

Social anxiety is associated with low positive affect (PA), a factor that can significantly affect psychological well-being and adaptive functioning. Despite suggestions that individuals with high levels of social anxiety would benefit from PA enhancement, the feasibility of doing so remains an unanswered question. Accordingly, in the current study, individuals with high levels of social anxiety (N = 142) were randomly assigned to conditions designed to enhance PA (Kind Acts), reduce negative affect (NA; Behavioral Experiments), or a neutral control (Activity Monitoring). All participants engaged in the required activities for 4 weeks and completed prepost questionnaires measuring mood and social goals, as well as weekly email ratings of mood, anxiety, and social activities. Both the prepost and weekly mood ratings revealed that participants who engaged in kind acts displayed significant increases in PA that were sustained over the 4 weeks of the study. No significant changes in PA were observed in the other conditions. The increase in hedonic functioning was not due to differential compliance, frequency of social activities, or an indirect effect of NA reduction. In addition, participants who engaged in kind acts displayed an increase in relationship satisfaction and a decrease in social avoidance goals, whereas no significant changes in these variables were observed in the other conditions. This study is the first to demonstrate that positive affect can be increased in individuals with high levels of social anxiety and that PA enhancement strategies may result in wider social benefits. The role of PA in producing those benefits requires further study.

Predicting anger in social anxiety: The mediating role of rumination

Anger and the way that anger is expressed have been linked to attrition and poorer treatment outcomes in patients with Social Anxiety Disorder (e.g., Erwin, B. A., Heimberg, R. G., Schneier, F. R. & Liebowitz, M. R. (2003). Anger experience and expression in social anxiety disorder: Pretreatment profile and predictors of attrition and response to cognitive-behavioral treatment. Behavior Therapy, 34, 331-350). Understanding the connection between social anxiety and anger may be one way to improve outcomes in this population. A cross-sectional regression design was used in a sample of 363 undergraduates to examine the suggestion that ruminative thought is a critical factor linking social anxiety to anger. In support of this hypothesis, brooding fully mediated the relationship between social anxiety and trait anger and partially mediated the relationship between social anxiety and outward anger expression. The relationship between brooding and anger suppression became non-significant after depression was controlled. In contrast, reflective pondering partially mediated the relationship between social anxiety and anger suppression. These results suggest that addressing rumination may be useful in the treatment of socially anxious patients who struggle with anger. They also support the utility of considering multiple forms of rumination and multiple anger outcomes in a single study.

Adapting Social Work in Working with Muslim Clients

Current social work education programmes and textbooks often underestimate the hypothesis that providing effective services to different cultural groups requires cultural understanding. One approach that has been recommended is the localization of social work: using a fundamentally different social work knowledge base and approach with different cultural groups. To date, however, little scholarship considers how to localize social work in working with Muslim communities. On the basis of interviews with over 50 social service providers in Canada who work with Muslim clients, the present article provides insight into strategies and methods that involve localizing social work in Muslim communities, focusing on possible client characteristics, challenges, and needs from the perspective of the practising social worker. Issues of racism, spirituality, acculturation, help seeking, and client expectations of service are particularly relevant. Properly responding to these factors ultimately involves the coordinated efforts of educational institutions, agencies, and social workers, but none of this will be possible without a thorough understanding of cultural values meaningful to Muslim clients.

Addressing Cultural Barriers with Muslim Clients: An Agency Perspective

Social service agencies face challenges in balancing the provision of culturally sensitive service with government mandates and policies. This article provides insight into some of the issues around culturally sensitive service delivery that agencies face when working specifically with clients who are Muslim. Qualitative interviews were conducted with 50 Canadian Muslim and non-Muslim social work practitioners in three Canadian cities to identify these specific issues. Respondents identified barriers to service provision for some Muslim clients and identified ways in which agencies can be responsive in addressing these barriers. Implications for social work practice are discussed.

Social Worker's Understanding of the Immigrant Muslim Client's Perspective

The evolution of social work knowledge, theory, and methods is necessary to be applicable to the multicultural component of the Canadian population. The effectiveness and importance of social work education and practice is largely tied to the ability to provide culturally sensitive service to clients. In this instance, we sought to identify what issues were specific for Muslim clients. Interviews were conducted with 50 Canadian Muslim and non-Muslim social work practitioners who work closely with Muslim clients. Practitioners identified a number of potential cultural factors and social issues that should be taken into consideration when working with Muslim clients.

Getting the Most out of Audience Response Systems: Predicting Student Reactions.

Audience response systems (ARS) are effective tools for improving learning outcomes and student engagement in large undergraduate classes. However, if students do not accept ARS and do not find them to be useful, ARS may be less effective. Predicting and improving student perceptions of ARS may help to ensure positive outcomes. The present study expands on previous work by simultaneously evaluating several student and practice variables that may predict student perceptions of ARS. Perceived learning outcomes, engagement, interaction in class, enjoyment of ARS, attendance, and preparation for class were examined using multivariate regression analysis in two undergraduate samples. Student variables, including gender, grade, and year of program predicted student perceptions of ARS. Practice variables, including the consistency of ARS use, question type, question difficulty, and ease of use also predicted student perceptions. The nature and implications of these findings are discussed.

Positive Affect Predicts Avoidance Goals in Social Interaction Anxiety: Testing a Hierarchical Model of Social Goals

Models of self-regulation suggest that social goals may contribute to interpersonal and affective difficulties, yet little research has addressed this issue in the context of social anxiety. The present studies evaluated a hierarchical model of approach and avoidance in the context of social interaction anxiety, with affect as a mediating factor in the relationship between motivational tendencies and social goals. This model was refined in one undergraduate sample (N = 186) and cross-validated in a second sample (N = 195). The findings support hierarchical relationships between motivational tendencies, social interaction anxiety, affect, and social goals, with higher positive affect predicting fewer avoidance goals in both samples. Implications for the treatment of social interaction anxiety are discussed.

Cognitive Specificity and Affective Confounding in Social Anxiety: Does Depression Exacerbate Judgmental Bias?

Social anxiety is associated with judgmental biases, wherein individuals overestimate the probability that negative social events will occur and the costs associated with these events. Researchers have suggested that these biases may be central to social anxiety and treatment techniques that target judgmental biases are being evaluated (e.g. Hofmann, J Consult Clin Psychol 72:392–399, 2004; Voncken and Bögels, J Cogn Psychother 20:59–73, 2006). The present study investigated whether judgmental biases are specific to social anxiety or are also associated with depression. Four hundred and eighteen undergraduates completed measures of social anxiety, depression, and judgmental bias. Hierarchical regression analyses indicated that both social anxiety and depression make significant independent contributions to the prediction of judgmental biases. The interaction between social anxiety and depression did not contribute significantly to prediction, suggesting that depression has an additive rather than an interactive effect on bias. This carries potential implications for treatments that target judgmental bias and for research on affective confounding.

Treatment of social approach processes in adults with social anxiety disorder.

Objective: Despite the social impairment associated with social anxiety disorder (SAD), little research has examined the impact of treatment on positive relational functioning. Accordingly, the authors conducted a treatment outcome study to evaluate a cognitive behavior therapy (CBT) regimen augmented by a relational focus (CBT-R) relative to a graduated exposure-applied relaxation (GEAR) regimen and wait list (WL) control. To examine the mechanism(s) that underlies treatment effects, they used structural equation modeling (SEM) to evaluate two potential mediators, change in judgment biases and in safety behaviors. Method: Treatment-seeking adults who met SAD diagnostic criteria (n = 100; 50% women; mean age = 32.9 years.; 36% ethnic minority) were randomly assigned to CBT-R, GEAR, or WL. CBT-R and GEAR participants received 14 group treatment sessions. Social initiation, relationship satisfaction, and a SAD symptom composite were assessed at pre- and postassessment, and 6- and 12-month follow-ups. Results: Intent-to-treat multilevel modeling analyses indicated that the CBT-R regimen resulted in significantly greater improvement relative to GEAR on relationship satisfaction and SAD symptoms. SEM results revealed that change in safety behaviors partially mediated the superior performance of CBT-R on both variables with confidence intervals set at .90. Conclusions: These findings indicate that CBT-based regimens can improve social approach processes in individuals with SAD and that safety behavior reduction contributes to positive outcomes.