Lata K. McGinn

The Relationship Between Parenting Style, Cognitive Style, and Anxiety and Depression: Does Increased Early Adversity Influence Symptom Severity Through the Mediating Role of Cognitive Style?

Despite the central role accorded to cognitive style in mediating the relationship between negative parenting and the development of anxiety and depression, few studies have empirically examined this relationship. Using a clinical sample, this study examined the relationship between early experiences with low care, increased control, abuse and neglect, and symptoms of anxiety and depression, via the mediating effects of cognitive style. It was found that individuals who rate their parents as being more abusive and neglectful reported a greater degree of depression and that this relationship was mediated by dysfunctional cognitive style. These findings contribute to the growing literature by providing support for the role of cognitions in mediating the link between negative parenting and psychopathology.

History of child abuse and severity of adult depression: the mediating role of cognitive schema

ABSTRACT The link between childhood abuse, adult depression, and anxiety has been well studied, but few studies have empirically explored the mechanism of that link. Using a clinical sample of women, this study examined the relationship between retrospectively measured childhood abuse and neglect and current adult symptoms of anxiety and depression, via the mediating effects of cognitive style. This study found that women who reported a positive abuse history were significantly more depressed and exhibited more maladaptive schemas than women who did not report a history of abuse. Specifically, it would appear that cognitive styles marked by interpersonal disconnection and rejection are particularly pathogenic. These findings contribute to the growing literature by providing support for the role of cognitions in mediating the link between childhood abuse and psychopathology.

Biological and clinical validation of atypical depression

Depressed patients with (a) mood reactivity alone (MR group), (b) mood reactivity plus one or more associated features (atypical depression, AD group), and (c) patients with neither mood reactivity nor atypical depression (non-MR/AD group) were compared on their cortisol response to 75 mg of desipramine (DMI), a relatively selective norepinephrine reuptake inhibitor. AD patients exhibited a significantly higher cortisol response to DMI compared with MR and non-MR/AD patients, suggesting that atypical depression may be associated with a less impaired norepinephrine system. MR and non-MR/AD patients did not differ, suggesting that mood reactivity alone is not associated with the biological profile observed in atypical depression. Results indicate that while mood reactivity may be necessary for the diagnosis of atypical depression, the additional presence of at least one associated symptom is required for a distinct biological profile. Our findings provide further biological validation of the concept of atypical depression.

Cognitive Therapy for Generalized Anxiety Disorder: Significance of Comorbid Personality Disorders

Thirty-two patients diagnosed with generalized anxiety disorder were treated with cognitive therapy. Patients attended weekly one-hour sessions and there was no predetermined duration of treatment. Prior to treatment, each patient was evaluated for a comorbid personality disorder (PD) using the Structured Clinical Interview for the DSM-ffi-R Personality Disorders (SCID-II). Patients completed the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) at the intake evaluation and at their final session. Sixteen of the 32 patients were diagnosed with a comorbid PD at the intake evaluation. A total of 22 patients completed a minimum course of cognitive therapy, which was defined as six sessions. Overall, there was a significant reduction of BAI and BDI scores for patients with and without a PD. There was no significant difference between the two groups. However, patients with a comorbid PD were more likely to drop out of treatment Seven of the 10 dropouts had a comorbid PD as compared to only 9 out of the 22 completers.

Atypical depression among psychiatric inpatients: clinical features and personality traits

OBJECTIVE This study investigates the frequency and characteristics of Atypical Depression (AD) among depressed inpatients. METHOD Twenty-one depressed inpatients received DSM-IV diagnoses, were rated on the Hamilton Depression Rating Scale (HAMD), and assessed for AD using the Atypical Depressive Disorder Scale. AD was defined as the presence of mood reactivity and two of four associated features: hyperphagia, hypersomnia, leaden paralysis, rejection sensitivity. Mood reactivity was defined as the ability to reach 50% of a non-depressed mood. All subjects completed the SCL-90, MCMI-II, and a suicide survey. RESULTS Seven patients (33%) met criteria for AD. AD and non-AD patients did not differ in terms of severity of depression, history of suicide attempts, levels of clinical symptomatology, age of onset of depression, prior hospitalizations, and most personality characteristics. However, AD patients scored significantly higher than non-AD patients on the SCL-90 Interpersonal Sensitivity and MCMI-II Avoidant scales, and were more likely to be single. CONCLUSION AD is fairly prevalent on an inpatient service, comparable to the frequency found in outpatient settings. AD is not a milder form of depression. The only differences between AD and non-AD patients reflect the personality trait of rejection sensitivity which is a defining feature of AD.

When and how to do longer term therapy … without feeling guilty

Although short-term cognitive behavior therapies (CBT) are widely effective, we have noticed that patients with personality disorders do not make sufficient progress with these treatments. We contend that optimal treatment can only be accomplished for these patients if it is modified to address the personality disorder. Schema-focused therapy (SFT) was developed by Young (1990) to specifically address the needs of these patients and combines cognitive, behavioral, interpersonal, and experiential techniques in treatment. Compared to short-term cognitive therapy (CT) 1 , SFT emphasizes the therapeutic relationship as a vehicle of change, utilizes emotive techniques to address early issues and later life problems, involves less guided discovery, more active confrontation of cognition and behavior patterns, and a greater concern with identifying and overcoming cognitive and behavioral avoidance. Finally, because there is far more resistance to change, the course of treatment is longer in SFT. Assessment, treatment strategies, and an illustrative case example will be provided in the present paper.

The Role of Early Experience and Cognitive Vulnerability: Presenting a Unified Model of the Etiology of Panic

Cognitive vulnerability models have been developed to explicate the etiology of panic and other anxiety disorders. This study takes a step forward by presenting a unified vulnerability model that incorporates a continuum of proximal and distal factors involved in the etiology of panic. The present study tested distal elements of the model, including childhood histories of vicarious and instrumental learning, and cognitive constructs such as anxiety sensitivity and perceived control. Our study found that parental modeling of the dangerousness of anxiety symptoms accounted for more model variance than from direct experiences with arousal-reactive symptoms or from parental reinforcement of the child’s own sick role behavior when experiencing arousal reactive symptoms. We found that parental modeling independently predicted model variance even when perceived control was included in the model. Our results indicated that low perceived anxiety control and anxiety about bodily symptoms uniquely accounted for variance in the model. Our findings add to the growing body of research and suggest that anxiety about bodily symptoms and low perceived control together may interact to create a stronger distal vulnerability construct for panic than either construct alone in individuals whose childhood caregivers may have modeled fear of anxiety symptoms. The results of this study provide support for the inclusion of distal factors in unified cognitive vulnerability models of panic disorder as well as for future prospective research of these constructs.

Lessons Learned in Looking Back: Perspectives from Trailblazers

Although this is in many ways a good era for women, many things have yet to improve. Women continue to lag behind men with regard to salaries, are under-represented in position of leadership, and still take on greater responsibility for child rearing and family responsibilities. Careers dominated by women tend to be associated with lower salaries and lower prominence and by the same token, women tend to dominate leadership positions when the field becomes less prestigious. Although women now outnumber men in graduating classes, the feminization of clinical psychology brings new challenges. This special series comes out of the 2009 trailblazer panel held at the ABCT convention in New York City, which explored the experiences faced by pioneering women in behavior therapy and discussed ways to help women overcome the glass ceiling. This introductory paper summarizes the lessons learned by these trailblazers with a view toward helping women in academia today.

Identical symptomatology but different diagnosis: Treatment implications of an OCD versus schizophrenia diagnosis

Background: Individuals with identical symptomatology may receive conflicting diagnoses, potentially leading to different treatments. The aims of this study were to assess diagnostic impressions and treatment recommendations for obsessive–compulsive disorder (OCD) versus schizophrenia-spectrum disorders (SSD). Methods: Participants (N = 82) were recruited from accredited doctoral programs. All participants were randomized to assess diagnostic impressions and treatment recommendations for 15 vignettes. These were measured across three separate testing sessions. Results: Large discrepancies in treatment recommendations were found. All participants who selected OCD recommended psychotherapy while only 15.4% of participants who identified the same vignette as schizophrenia suggested psychotherapy. More than half the participants who reported schizophrenia selected antipsychotics as the primary response; medication was not a primary recommendation when the vignette was identified as OCD. Conclusion: Symptoms conceptualized as SSDs were recommended medication; those same symptoms conceptualized as OCD were recommended psychotherapy. Greater awareness regarding the efficacy of psychosocial treatments for SSDs is needed.

Inspiration From Role Models and Advice for Moving Forward

This Behavior Therapy series on overcoming the glass ceiling followed from a highly attended panel at ABCT on the same topic. The current paper summarizes the common themes across the various papers in this series with respect to obstacles prominent women have faced, and how we can learn from their stories to help inform the future. These themes include the importance of role models, messages from a supportive environment, difficulties balancing careers with children, coordinating careers with family, importance of taking charge of ones career, moving forward despite negative internal and external messages, and questions about whether things have changed substantially. In addition, this paper contains a summary of the helpful advice from accomplished women in academia for navigating the academic waters. It is our aspiration that going forward this series will stimulate other conversations as well as increase thought, behavior, solidarity, and awareness about this topic so that we can continue to work toward a future when things will continue to improve for women.