Julia K. Langer

Unreliability as a threat to understanding psychopathology: The cautionary tale of attentional bias.

The use of unreliable measures constitutes a threat to our understanding of psychopathology, because advancement of science using both behavioral and biologically oriented measures can only be certain if such measurements are reliable. Two pillars of the National Institute of Mental Healths portfolio-the Research Domain Criteria (RDoC) initiative for psychopathology and the target engagement initiative in clinical trials-cannot succeed without measures that possess the high reliability necessary for tests involving mediation and selection based on individual differences. We focus on the historical lack of reliability of attentional bias measures as an illustration of how reliability can pose a threat to our understanding. Our own data replicate previous findings of poor reliability for traditionally used scores, which suggests a serious problem with the ability to test theories regarding attentional bias. This lack of reliability may also suggest problems with the assumption (in both theory and the formula for the scores) that attentional bias is consistent and stable across time. In contrast, measures accounting for attention as a dynamic process in time show good reliability in our data. The field is sorely in need of research reporting findings and reliability for attentional bias scores using multiple methods, including those focusing on dynamic processes over time. We urge researchers to test and report reliability of all measures, considering findings of low reliability not just as a nuisance but as an opportunity to modify and improve upon the underlying theory. Full assessment of reliability of measures will maximize the possibility that RDoC (and psychological science more generally) will succeed. (PsycINFO Database Record

Psychological Sequelae of Surgery in a Prospective Cohort of Patients from Three Intraoperative Awareness Prevention Trials

BACKGROUND:Elective surgery can have long-term psychological sequelae, especially for patients who experience intraoperative awareness. However, risk factors, other than awareness, for symptoms of posttraumatic stress disorder (PTSD) after surgery are poorly defined, and practical screening methods have not been applied to a broad population of surgical patients. METHODS:The Psychological Sequelae of Surgery study was a prospective cohort study of patients previously enrolled in the United States and Canada in 3 trials for the prevention of intraoperative awareness. The 68 patients who experienced definite or possible awareness were matched with 418 patients who denied awareness based on age, sex, surgery type, and awareness risk. Participants completed the PTSD Checklist-Specific (PCL-S) and/or a modified Mini-International Neuropsychiatric Interview telephone assessment to identify symptoms of PTSD and symptom complexes consistent with a PTSD diagnosis. We then used structural equation modeling to produce a composite PTSD score and examined potential risk factors. RESULTS:One hundred forty patients were unreachable; of those contacted, 303 (88%) participated a median of 2 years postoperatively. Forty-four of the 219 patients (20.1%) who completed the PCL-S exceeded the civilian screening cutoff score for PTSD symptoms resulting from their surgery (15 of 35 [43%] with awareness and 29 of 184 [16%] without). Nineteen patients (8.7%; 5 of 35 [14%] with awareness and 14 of 184 [7.6%] without) both exceeded the cutoff and endorsed a breadth of symptoms consistent with the Diagnostic and Statistical Manual Fourth Edition diagnosis of PTSD attributable to their surgery. Factors independently associated with PTSD symptoms were poor social support, previous PTSD symptoms, previous mental health treatment, dissociation related to surgery, perceiving that one’s life was threatened during surgery, and intraoperative awareness (all P ⩽ 0.017). Perioperative dissociation was identified as a potential mediator for perioperative PTSD symptoms. CONCLUSIONS:Events in the perioperative period can precipitate psychological symptoms consistent with subsyndromal and syndromal PTSD. We not only confirmed the high rate of postoperative PTSD in awareness patients but also identified a significant rate in matched nonawareness controls. Screening surgical patients, especially those with potentially mediating risk factors such as intraoperative awareness or perioperative dissociation, for postoperative PTSD symptoms with the PCL-S is practical and could promote early referral, evaluation, and treatment.

Interpersonal Constraint Conferred by Generalized Social Anxiety Disorder Is Evident on a Behavioral Economics Task

Although social anxiety disorder appears to confer impairment in friendships, evidence beyond self-report is minimal. We used the flexible iterated prisoners dilemma as a simulated interaction with a friend with 27 individuals with the generalized type of social anxiety disorder and 23 demographically equivalent individuals without the disorder. Participants with generalized social anxiety disorder were less giving on the task. Lower giving was also moderately associated with interpersonal variables (e.g., coldness). A trend was also found for participants with generalized social anxiety disorder to show lower assertiveness on the task. The connection between generalized social anxiety disorder and friendship impairment appears likely to be partially explained by interpersonal constraint that is perceived by others as coldness and manifests in a behavioral economics task.

Self and friend's differing views of social anxiety disorder's effects on friendships.

Social anxiety disorder is known to be associated with self-report of global friendship quality. However, information about specific friendships, as well as information beyond self-report, is lacking. Such information is crucial, because known biases in information processing related to social anxiety disorder render global self-ratings particularly difficult to interpret. We examined these issues focusing on diagnosed participants (n = 77) compared with community control participants (n = 63). We examined self-report regarding global (i.e., overall) friendship quality and a specific friendships quality; in addition, we examined friend-report of that friendships quality. Results suggested that social anxiety disorder has a negative impact on self-perception of friendship quality for a specific friendship, but that this effect is less evident as reported by the friends. Specifically, social anxiety disorder was associated with a tendency to report worse friendship quality in comparison to friend-report, particularly in participants who were younger or had less long-lasting friendships. However, friend-report did show clear differences based on diagnostic group, with friends reporting participants with social anxiety disorder to be less dominant in the friendship and less well-adjusted. Overall, the findings are consistent with results of other studies indicating that social anxiety disorder has a strong association with self-ratings of impairment, but that these ratings appear out of proportion with the report of observers (in this case, friends).

Reactivity to Exclusion Prospectively Predicts Social Anxiety Symptoms in Young Adults

Peer victimization leads to negative outcomes such as increased anxiety and depression. The prospective relationship between peer victimization and social anxiety in children and adolescents is well established, and adults with social anxiety disorder (SAD) are more likely than individuals with other anxiety disorders to report a history of teasing. However, a crucial bridge between these findings (peer victimization in young adults) is missing. We manipulated perceptions of peer exclusion in a young adult sample (N=108) using the Cyberball Ostracism Task. Reactivity to exclusion prospectively predicted social anxiety symptoms at a 2-month follow-up, whereas self-reported teasing during high school and current relational victimization did not. This research suggests that reactions to peer victimization may be a worthwhile target for clinical interventions in young adults. Targeting how young adults react to stressful social interactions such as exclusion may help prevent the development of SAD. Future research should test if reactivity to exclusion plays a role in the relationship between other disorders (e.g., depression) and peer victimization.

Measuring social anxiety related interpersonal constraint with the flexible iterated prisoner's dilemma

Data from self-report and observational studies make it clear that problematic social anxiety confers interpersonal constraint that may contribute to the interpersonal dysfunction reported by individuals with social anxiety disorder. Direct observation of interpersonal behavior in established relationships is rare and difficult to obtain for practical reasons. We tested a flexible iterated prisoners dilemma computer task to examine whether it might capture interpersonal constraint related to social anxiety. Our first study suggested that, at least for men, the task directly captures social anxietys constraint on responses to friendly giving. Our second study more strongly supported the assertion that the task directly assesses interpersonal constraint. The data support a model in which social anxiety directly confers trait-like tendencies toward interpersonal constraint and indirectly constrains behavior in specific interactions. These studies provide further evidence that constrained responses to positive social behaviors are characteristic of people with problematic social anxiety and may be particularly important to dysfunctions in the close relationships of these individuals.

Social Anxiety and Gaze Avoidance: Averting Gaze but not Anxiety

Despite preliminary evidence that individuals with higher social anxiety tend to avoid eye contact during at least some social encounters, the function of this behavior remains unknown. Cognitive theories of social anxiety suggest that gaze avoidance may function as an attempt to avoid signs of social threat. However, it is unclear whether this behavior is effective for reducing anxiety and, if it is effective, whether this benefit is only present in the short-term. The goal of the current study was to test whether gaze avoidance is effective in reducing anxiety for individuals with higher social anxiety during short social conversations among peers. Participants completed a short social interaction with another undergraduate participant in which eye contact was manipulated halfway through the interaction. Recordings of the interactions were later coded for amount of eye contact; this allowed us to obtain an objective measure of adherence to the manipulation instructions. Participants were instructed to make either more or less eye contact, or continue as before. Being asked to make less eye contact was the most anxiety-provoking condition for participants with higher social anxiety. We propose, in line with previous research on safety behaviors, that avoiding eye contact in an effort to regulate state anxiety is an ineffective strategy over time for individuals with higher social anxiety. Therefore gaze avoidance may be a particularly important safety behavior to target in treatment for social anxiety disorder.

A Network Analysis of Developmental Change in ADHD Symptom Structure From Preschool to Adulthood

Although there is substantial support for the validity of the diagnosis of attention-deficit/hyperactivity disorder (ADHD), there is considerable disagreement about how to best capture developmental changes in the expression of ADHD symptomatology. This article examines the associations among the 18 individual ADHD symptoms using a novel network analysis approach, from preschool to adulthood. The 1,420 participants were grouped into four age brackets: preschool (ages 3–6, n = 109), childhood (ages 6–12, n = 548), adolescence (ages 13–17, n = 357), and young adulthood (ages 18–36, n = 406). All participants completed a multistage, multi-informant diagnostic process, and self and informant symptom ratings were obtained. Network analysis indicated ADHD symptom structure became more differentiated over development. Two symptoms, often easily distracted and difficulty sustaining attention, appeared as central, or core, symptoms across all age groups. Thus, a small number of core symptoms may warrant extra weighting in future diagnostic systems.

Psychometric properties of the gaze anxiety rating scale: convergent, discriminant, and factorial validity.

Fear and avoidance of gaze are two features thought to be associated with problematic social anxiety. Avoidance of eye contact has been linked with such undesirable traits as deceptiveness, insincerity, and lower self-esteem. The Gaze Anxiety Rating Scale (GARS) is a self-report measure designed to assess gaze anxiety and avoidance, but its psychometric properties have only been assessed in one preliminary study. We further investigated psychometric properties of the GARS by assessing convergent and factorial validity. We obtained a two-factor solution: gaze anxiety and avoidance across situations (1) in general (GARS-General) and (2) related to dominance communication (GARS-Dominance). The GARS-General factor related more strongly to social anxiety than the GARS-Dominance, and convergent validity of the factors was supported by expected relationships with personality and social anxiety variables. Our results indicate that the GARS subscales are psychometrically valid measures of gaze aversion, supporting their use in future study of the relationship between social anxiety and eye contact behavior.

The structure of vulnerabilities for social anxiety disorder

Social anxiety disorder symptoms are generally proposed to be related to broad temperamental vulnerabilities (e.g., a low level of approach and high level of avoidance temperament), specific psychological vulnerabilities (e.g., fears of negative and positive evaluation), and additional disorders (e.g., major depressive disorder). However, existing tests of such a model have either not considered depressive symptoms or relied on samples of undergraduates. We examined these and related questions via a latent variable model in a large dataset (N=2253) that combined participants across a variety of studies. The model had adequate fit in the whole sample, and good fit in a subsample in which more participants completed the depression measure. The model indicated that low level of approach and high level of avoidance temperament contributed to fears of evaluation and social anxiety symptoms, and that fears of evaluation additionally contributed independently to social anxiety symptoms. The relationship between social anxiety and depressive symptoms was entirely accounted for by these vulnerabilities: Depressive symptoms were only predicted by avoidance temperament.