Joshua J. Broman-Fulks

Internet-Based Interventions for Traumatic Stress-Related Mental Health Problems: A Review and Suggestion for Future Research

Exposure to potentially traumatic events is a common occurrence. Most individuals exposed to such an event are resilient or recover rapidly, although some individuals develop psychological problems that warrant treatment. However, a small percentage of individuals seek traditional treatment, thereby calling for novel approaches or methodologies of treatment. The present paper provides a comprehensive and critical review of the extant literature on computerized and internet-based interventions (IBIs) for traumatic stress-related conditions (i.e., panic disorder, posttraumatic stress disorder/complicated grief, depression, comorbid anxiety and depression, alcohol abuse, smoking cessation). Generally, computerized or IBIs for depression and anxiety are yielding effect sizes that are comparable to traditional psychosocial treatment. Interventions aimed at alcohol and smoking cessation generally have lower effect sizes than do IBIs for anxiety and depression. Most interventions reviewed in this paper included common components (e.g., were developed through a cognitive behavioral framework and included psychoeducation, cognitive restructuring, goal setting, exposure). Therefore, it is possible that these shared features may in part account for symptom reduction. Little is known regarding mechanisms of change. Future directions for novel web-based approaches to treatment are provided.

Effects of Aerobic Exercise on Anxiety Sensitivity

Anxiety sensitivity is a known precursor to panic attacks and panic disorder, and involves the misinterpretation of anxiety-related sensations. Aerobic exercise has been shown to reduce generalized anxiety, and may also reduce anxiety sensitivity through exposure to feared physiological sensations. Accordingly, 54 participants with elevated anxiety sensitivity scores completed six 20-min treadmill exercise sessions at either a high-intensity aerobic ( n = 29 ) or low-intensity ( n = 25 ) level. Self-ratings of anxiety sensitivity, fear of physiological sensations associated with anxiety, and generalized anxiety were obtained at pre-treatment, post-treatment, and one-week follow-up. Results indicated that both high- and low-intensity exercise reduced anxiety sensitivity. However, high-intensity exercise caused more rapid reductions in a global measure of anxiety sensitivity and produced more treatment responders than low-intensity exercise. Only high-intensity exercise reduced fear of anxiety-related bodily sensations. The implications of these findings are discussed.

Evaluation of a brief aerobic exercise intervention for high anxiety sensitivity

Abstract Anxiety sensitivity, or the belief that anxiety-related sensations can have negative consequences, has been shown to play an important role in the etiology and maintenance of panic disorder and other anxiety-related pathology. Aerobic exercise involves exposure to physiological cues similar to those experienced during anxiety reactions. The present study sought to investigate the efficacy of a brief aerobic exercise intervention for high anxiety sensitivity. Accordingly, 24 participants with high anxiety sensitivity scores (Anxiety Sensitivity Index-Revised scores >28) were randomly assigned to complete either six 20-minute sessions of aerobic exercise or a no-exercise control condition. The results indicated that individuals assigned to the aerobic exercise condition reported significantly less anxiety sensitivity subsequent to exercise, whereas anxiety sensitivity scores among non-exercisers did not significantly change. The clinical research and public health implications of these findings are discussed, and several potential directions for additional research are recommended.

A Taxometric Study of Hypochondriasis Symptoms

Hypochondriasis has been conceptualized as both a distinct category that is characterized by a disabling illness preoccupation and as a continuum of health concerns. Empirical support for one of these theoretical models will clarify inconsistent assessment approaches and study designs that have impeded theory and research. To facilitate progress, taxometric analyses were conducted to determine whether hypochondriasis is best understood as a discrete category, consistent with the DSM, or as a dimensional entity, consistent with prevailing opinion and most self-report measures. Data from a large undergraduate sample that completed 3 hypochondriasis symptom measures were factor analyzed. The 4 factor analytically derived symptom indicators were then used in these taxometric analyses. Consistent with our hypotheses and existing theory, results supported a dimensional structure for hypochondriasis. Implications for the conceptualization of hypochondriasis and directions for future study are discussed.

A Taxometric Investigation of the Latent Structure of Worry: Dimensionality and Associations With Depression, Anxiety, and Stress

Worry has been described as a core feature of several disorders, particularly generalized anxiety disorder (GAD). The present study examined the latent structure of worry by applying 3 taxometric procedures (MAXEIG, MAMBAC, and L-Mode) to data collected from 2 large samples. Worry in the first sample (Study 1) of community participants (n=1,355) was operationalized by worry engagement, absence of worry, and the worry feature of trait anxiety. Worry in the second sample (Study 2) of undergraduate participants (n=1,171) was operationalized by the tendency to experience worry, intolerance of uncertainty, beliefs about worry, and symptoms of GAD. Results across both samples provided converging evidence that worry is best conceptualized as a dimensional construct, present to a greater or lesser extent in all individuals. Findings from Study 2 also indicated that the latent dimension of worry generally has an equal association with symptoms of depression, anxiety, and stress across the entire continuum. These findings are discussed in relation to the conceptualization and assessment of worry in GAD and related disorders.

The Three Domains of Disgust Scale: Factor Structure, Psychometric Properties, and Conceptual Limitations.

This investigation examined the measurement properties of the Three Domains of Disgust Scale (TDDS). Principal components analysis in Study 1 (n = 206) revealed three factors of Pathogen, Sexual, and Moral Disgust that demonstrated excellent reliability, including test–retest over 12 weeks. Confirmatory factor analyses in Study 2 (n = 406) supported the three factors. Supportive evidence for the validity of the Pathogen and Sexual Disgust subscales was found in Study 1 and Study 2 with strong associations with disgust/contamination and weak associations with negative affect. However, the validity of the Moral Disgust subscale was limited. Study 3 (n = 200) showed that the TDDS subscales differentially related to personality traits. Study 4 (n = 47) provided evidence for the validity of the TDDS subscales in relation to multiple indices of disgust/contamination aversion in a select sample. Study 5 (n = 70) further highlighted limitations of the Moral Disgust subscale given the lack of a theoretically consistent association with moral attitudes. Lastly, Study 6 (n = 178) showed that responses on the Moral Disgust scale were more intense when anger was the response option compared with when disgust was the response option. The implications of these findings for the assessment of disgust are discussed.

A Taxometric Exploration of the Latent Structure of Hoarding.

Despite controversy regarding the classification and diagnostic status of hoarding disorder, there remains a paucity of research on the nosology of hoarding that is likely to inform the classification debate. The present investigation examined the latent structure of hoarding in three, large independent samples. Data for three well-validated measures of hoarding were subjected to taxometric procedures, including MAXimum EIGenvalue, Mean Above Minus Below A Cut, and Latent-Mode factor. Two symptom measures, one of which closely mirrors the proposed diagnostic criteria for hoarding disorder, and a measure of hoarding beliefs were analyzed. Sample 1 (n=2,501) was representative of the general German population, while Samples 2 (n=1,149) and 3 (n=500) consisted of unselected undergraduate students. Findings across all three samples and taxometric procedures provided converging evidence that hoarding is best conceptualized as a dimensional construct, present in varying degrees in all individuals. Results have implications across research and treatment domains, particularly with respect to assessment approaches, treatment response determination, and policy decisions. These findings underscore the need for further investigations on the nosology of hoarding, to help validate this construct as we move forward with respect to our research and treatment efforts, as well as the potential inclusion of hoarding disorder in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2012).

Incremental specificity of disgust sensitivity in the prediction of obsessive-compulsive disorder symptoms: Cross-sectional and prospective approaches ☆

The present study examines the association between disgust sensitivity (DS) and obsessive-compulsive disorder (OCD) symptoms in two non-clinical samples. Findings from Study 1 (n=270) revealed a significant association between DS and OCD symptoms even after controlling for negative affect and anxiety sensitivity. Subsequent analysis also revealed a specific association between DS and the washing subtype of OCD symptoms when controlling for other OCD symptom dimensions. DS did not significantly predict residual change in total symptoms of OCD over a 12-week period (n=300) when controlling for risk factors for anxiety disorder symptoms in general (e.g., negative affect, anxiety sensitivity) and OCD specifically (e.g., obsessive beliefs) in Study 2. However, exploratory analyses suggest that DS may be predictive of residual change in some OCD symptom subtypes but not others. Implications of these findings for future research on the role of disgust in OCD are discussed.

The Latent Structure of Anxiety Sensitivity—Revisited

Anxiety sensitivity has been implicated as a risk factor for the development and maintenance of panic and other anxiety disorders. Although researchers have generally assumed that anxiety sensitivity is a dimensional, rather than categorical, variable, recent taxometric research has raised questions concerning the accuracy of this assumption. The present study examined the latent structure of anxiety sensitivity by applying four taxometric procedures (MAXEIG, MAXCOV, MAMBAC, and L-Mode) to data collected from two large nonclinical samples (n = 1,025 and n = 744) using two distinct measures of anxiety sensitivity (Anxiety Sensitivity Profile and Anxiety Sensitivity Index—Revised). In contrast to previous taxometric analyses of anxiety sensitivity, results of the present research provided convergent evidence for a latent anxiety sensitivity dimension. Several potential explanations for the discrepancy between these findings and those of previous research are discussed, as well as the implications of these findings for the conceptualization and measurement of anxiety sensitivity.

The Latent Structure of Posttraumatic Stress Disorder Among Adolescents

Debate has arisen over whether posttraumatic stress disorder (PTSD) is most accurately conceptualized as representing a discrete clinical syndrome or an extreme reaction to traumatic life events. Recent taxometric research using predominantly adult samples appears to support a dimensional model of PTSD, raising questions about the utility of current psychiatric nosology which depicts PTSD as a distinct entity. The present study sought to use taxometric procedures to examine the latent structure of posttraumatic stress reactions among a national epidemiologic sample of 2,885 adolescents. Results were consistent with previous taxometric studies in supporting a dimensional model of posttraumatic stress reactions. The implications of these findings for public policy, as well as the etiology and assessment of posttraumatic stress reactions, are discussed.