Judith M. Laposa

Impact of Social Developmental Experiences on Cognitive-Behavioral Therapy for Generalized Social Phobia

The current study examined how the social developmental experiences of people with generalized social phobia (GSP) affect their therapeutic relationships and treatment response. GSP patients (N = 27) completed measures of social learning experiences, and then participated in a 12-session group cognitive-behavioral treatment program. Both patients and therapists completed the Working Alliance Inventory (WAI) and rated their perceptions of each other at sessions 3 and 8. Self-reported childhood parental abuse was associated with a weaker working alliance and a more negative patient-therapist relationship. Childhood abuse also increased the risk of a poor treatment outcome, as reflected in less change in symptoms of social phobia and depression.

The prediction of intrusions following an analogue traumatic event: Peritraumatic cognitive processes and anxiety-focused rumination versus rumination in response to intrusions

Intrusions are often considered the hallmark of posttraumatic stress disorder (PTSD). Despite this, relatively little is known about factors that give rise to intrusions. Cognitive models of PTSD highlight the importance of pre-existing cognitive vulnerabilities, cognitive processing and anxiety during a traumatic event, as well as negative responses to trauma sequelae. However, few studies have examined multiple forms of peritraumatic processes, and rumination in response to trauma intrusions using analogue trauma tasks, and none have examined whether broader anxious ruminative processes contribute to intrusion development. In addition, little work has investigated the role of post-state anxiety in intrusions, and anxiety may be related to both peritraumatic processing and rumination. The current study employed a distressing film paradigm to examine key tenets of cognitive models of PTSD. Ninety-one female university students completed measures of anxiety, rumination in response to anxious symptoms, peritraumatic dissociation, data driven processing, lack of self referent processing, intrusions, and rumination in response to intrusions of the distressing film. Results revealed that peritraumatic dissociation, data driven processing, and self referent processing were associated with intrusion development, with lack of self referent processing being a strong predictor of intrusion development. Post-state anxiety and rumination in response to intrusions also predicted intrusion development. Discussion focuses on implications of cognitive processes and anxiety in theories of intrusion development.

Is Post-Event Processing a Social Anxiety Specific or Transdiagnostic Cognitive Process in the Anxiety Spectrum?

BACKGROUND Research on post-event processing (PEP), where individuals conduct a post-mortem evaluation of a social situation, has focused primarily on its relationship with social anxiety. AIMS The current study examined: 1) levels of PEP for a standardized event in different anxiety disorders; 2) the relationship between peak anxiety levels during this event and subsequent PEP; and 3) the relationship between PEP and disorder-specific symptom severity. METHOD Participants with primary DSM-IV diagnoses of social anxiety disorder (SAD), obsessive compulsive disorder (OCD), panic disorder with/without agoraphobia (PD/A), or generalized anxiety disorder (GAD) completed diagnosis specific symptom measures before attending group cognitive behavioural therapy (CBT) specific to their diagnosis. Participants rated their peak anxiety level during the first group therapy session, and one week later rated PEP in the context of CBT. RESULTS The results indicated that all anxiety disorder groups showed heightened and equivalent PEP ratings. Peak state anxiety during the first CBT session predicted subsequent level of PEP, irrespective of diagnostic group. PEP ratings were found to be associated with disorder-specific symptom severity in SAD, GAD, and PD/A, but not in OCD. CONCLUSIONS PEP may be a transdiagnostic process with relevance to a broad range of anxiety disorders, not just SAD.

Cognitive bias to symptom and obsessive belief threat cues in obsessive-compulsive disorder.

The current study examined the extent to which patients with obsessive compulsive disorder (OCD) demonstrate cognitive biases to OCD symptom or inflated responsibility threat cues. Participants with either primary contamination-washing or doubting/harming-checking OCD, non-OCD anxiety disorders, and student controls completed a primed lexical decision task. Following either neutral or OCD-threat priming conditions, participants made lexical decisions regarding different sets of word stimuli: nonwords, OCD symptoms, OCD inflated responsibility, and depression. Following the OCD primes, the primary contamination-washing symptom subgroup showed increased interference on OCD symptom words compared with the harming symptom and student groups. The primary contamination-washing subgroup also showed increased interference on responsibility words compared with the harming, non-OCD anxious and student groups. However, subsidiary analyses comparing patients with contamination obsessions with and without associated fears of harming others through the spreading of contaminants, demonstrated that it was the latter group that evidenced cognitive biases to responsibility threat cues. These results are considered in relation to cognitive models of OCD.

Cognitive-Behavioral Therapy for Depression Using Mind Over Mood: CBT Skill Use and Differential Symptom Alleviation

Cognitive-behavioral therapy (CBT) for depression is highly effective. An essential element of this therapy involves acquiring and utilizing CBT skills; however, it is unclear whether the type of CBT skill used is associated with differential symptom alleviation. Outpatients (N = 356) diagnosed with a primary mood disorder received 14 two-hour group sessions of CBT for depression, using the Mind Over Mood protocol. In each session, patients completed the Beck Depression Inventory and throughout the week they reported on their use of CBT skills: behavioral activation (BA), cognitive restructuring (CR), and core belief (CB) strategies. Bivariate latent difference score (LDS) longitudinal analyses were used to examine patterns of differential skill use and subsequent symptom change, and multigroup LDS analyses were used to determine whether longitudinal associations differed as a function of initial depression severity. Higher levels of BA use were associated with a greater subsequent decrease in depressive symptoms for patients with mild to moderate initial depression symptoms relative to those with severe symptoms. Higher levels of CR use were associated with a greater subsequent decrease in depressive symptoms, whereas higher levels of CB use were followed by a subsequent increase in depressive symptoms, regardless of initial severity. Results indicated that the type of CBT skill used is associated with differential patterns of subsequent symptom change. BA use was associated with differential subsequent change as a function of initial severity (patients with less severe depression symptoms demonstrated greater symptom improvement), whereas CR use was associated with symptom alleviation and CB use with an increase in subsequent symptoms as related to initial severity.

Can I Really Do This? An Examination of Anticipatory Event Processing in Social Anxiety Disorder

Clark and Wells (1995) posit that anticipatory processing before a social situation serves to maintain social anxiety. More specifically, ruminative processes similar to post-event processing (PEP) may occur in anticipation of anxiety provoking social events, and in this article, we have labelled this type of anticipatory rumination anticipatory event processing (AnEP). Participants (n = 75) with social anxiety disorder (SAD) completed measures of anticipatory event processing, trait anxious rumination, social anxiety, state anxiety, and PEP, in the context of completing videotaped exposures twice as part of manual-based group cognitive behavioral therapy. AnEP was significantly positively associated with trait anxious rumination and social anxiety and was associated with state anxiety during the first videotaping. AnEP at the two time points was significantly correlated and decreased across the two taped exposures. Greater AnEP at the first taping was associated with greater PEP the following week. PEP after the first videotaped exposure then significantly related to AnEP for the second videotaped exposure several weeks later. Discussion focuses on the similarities between PEP and AnEP as well as implications for cognitive models and treatment of SAD.

The interaction of distress tolerance and intolerance of uncertainty in the prediction of symptom reduction across CBT for social anxiety disorder

Abstract Distress tolerance (DT) and intolerance of uncertainty (IU) have been identified as transdiagnostic processes that predict symptom severity across a range of distinct anxiety disorders. However, the joint effect of these two variables on therapeutic outcome has not yet been examined. It is possible that DT and IU may both impact on treatment response to cognitive-behavioural therapy (CBT) in clients with anxiety, as clients with weak DT and strong IU may be less likely to engage in exposure and cognitive restructuring tasks across treatment due to their associated distress. The purpose of this study was to examine the interaction of DT and IU as predictors of post-treatment symptom severity and treatment response to group CBT in participants with primary DSM-IV-TR diagnosed social anxiety disorder (SAD). Participants (N = 95) with SAD completed 12 weeks of manualized group CBT. Results of multilevel longitudinal analysis demonstrated an interaction effect, such that lower DT and higher IU predicted higher SAD symptom severity across the course of therapy. The findings are discussed in terms of clinical implications for the disorder-specific and transdiagnostic treatment of anxiety disorders.

Social Anxiety and Fear of Causing Discomfort to Others: Diagnostic Specificity, Symptom Correlates and CBT Treatment Outcome

BACKGROUND Patients with social anxiety disorder (SAD) report fear content relating to the perceived aversive consequences of their anxiety for others in their social environment. However, no studies to date have examined the diagnostic specificity of these fears to SAD as well as predictors to treatment response of these fears. AIMS To examine relative specificity of fears related to causing discomfort to others, as measured by Social Anxiety-Fear of Causing Discomfort to Others (SA-DOS), among patients with anxiety disorders, obsessive compulsive disorder (OCD) and major depressive disorder (MDD), in addition to relation between dysfunctional attitudes and treatment response among patients with SAD. METHOD In study 1, a large (n=745) sample of DSM diagnosed OCD, MDD and anxiety disorder participants completed the SA-DOS. In study 2, patient participants with SAD (n=186) participated in cognitive behavioural group therapy (CBGT) and completed measures of social anxiety symptoms and dysfunctional attitudes. RESULTS In study 1, the SAD group demonstrated significantly elevated SA-DOS scores compared with participants with generalized anxiety disorder (GAD), OCD and panic disorder with or without agoraphobia (PD/A), but not the MDD group. In study 2, CBGT treatment was found to lead to significant reductions in SA-DOS scores. Need for approval (NFA) but not perfectionism, predicted treatment response to fears related to causing discomfort to others, with greater change in NFA relating to greater change in SA-DOS scores. CONCLUSIONS These findings extend previous research linking allocentric fears to the phenomenology and treatment of SAD.