Meghan W. Cody

Baclofen for alcohol dependence: a preliminary open-label study.

BACKGROUND Recent preclinical and clinical studies have shown that the gamma-aminobutyric acid-B agonist baclofen may be an effective treatment for reducing alcohol consumption. This preliminary open-label investigation examined the tolerability and effect of a 30-mg daily baclofen dose for reducing drinking, subclinical anxiety and depressive symptoms, and craving in alcohol-dependent subjects. METHODS Nine men and three women participated in a 12-week trial during which they took baclofen on a 10 mg thrice-daily regimen and received four sessions of motivational enhancement therapy. Each participant received a comprehensive physical and psychiatric screening before being enrolled. At each visit, side effects were monitored with a revised version of the Systematic Assessment of Treatment Emergent Events-General Inquiry, and drinking data were collected via the timeline follow-back interview. Participants also completed the Beck Depression Inventory, the Beck Anxiety Inventory, and the Penn Alcohol Craving Scale at each visit. RESULTS Baclofen was reasonably tolerated. Two participants discontinued because of side effects. No serious adverse events were noted. Six other individuals did not complete the trial. Overall, there were statistically significant reductions in the number of drinks per drinking day and the number of heavy-drinking days, and there was an increase in the number of abstinent days. Significant decreases in anxiety and craving were also shown. CONCLUSIONS These findings suggest that baclofen is reasonably tolerated in an alcohol-dependent population, although the high dropout rate in the study is of concern. Baclofen may be effective for the reduction of drinking, anxiety, and craving for some alcohol-dependent individuals. A larger-scale placebo-controlled study is needed to further explore these effects and to determine the characteristics of those who respond to this medication.

A New Mode of Fear Expression: Perceptual Bias in Height Fear

Emotion and psychopathology researchers have described the fear response as consisting of four main components--subjective affect, physiology, cognition, and behavior. The current study provides evidence for an additional component in the domain of height fear (perception) and shows that it is distinct from measures of cognitive processing. Individuals High (N = 35) and Low (N = 36) in acrophobic symptoms looked over a two-story balcony ledge and estimated its vertical extent using a direct height estimation task (visual matching), and an indirect task (size estimation); the latter task seems to exhibit little influence from cognitive factors. In addition, implicit and explicit measures of cognitive processing were obtained. Results indicated that, as expected, the High Fear group showed greater relative, implicit height fear associations and explicit threat cognitions. Of primary interest, the High (compared to Low) Fear group estimated the vertical extent to be higher, and judged target sizes to be greater, even when controlling for the cognitive bias measures. These results suggest that emotional factors such as fear are related to perception.

Sweet liking phenotype, alcohol craving and response to naltrexone treatment in alcohol dependence.

AIMS To investigate the relationship between the sweet liking/sweet disliking phenotype (a putative probe of brain opioid function), craving for alcohol and response to treatment with naltrexone in individuals with alcohol dependence. METHODS Forty individuals with alcohol dependence were enrolled in a 12-week open-label study of 50 mg of naltrexone with four sessions of motivational enhancement therapy. Prior to treatment, individuals completed a sweet preference test and the Penn Alcohol Craving Scale. Subjects were categorized as sweet liking (SL), n = 15, or sweet disliking (SDL), n = 25, via a standard sweet tasting paradigm. The sweet tasting results were blinded to the subjects and to treatment staff. SL status, pretreatment craving and their interaction were examined as predictors of frequency of abstinent days and heavy drinking days during treatment with naltrexone. RESULTS SL and SDL subjects achieved similar reductions in percent heavy drinking days with treatment. During treatment, SDL subjects had 48% abstinent days compared to 30% for SL subjects (P = 0.034). Pretreatment craving did not predict % heavy drinking days or % abstinent days. An interaction effect was found between the SL/SDL phenotype and pretreatment craving such that SL subjects with high craving demonstrated higher rates of percent abstinent days whereas SDL subjects with high craving demonstrated lower rates of percent abstinent days, P < 0.001. CONCLUSIONS These findings indicate that the SL/SDL phenotype may predict variation in response to naltrexone and/or counseling treatment. Furthermore, the SL/SDL phenotype may interact with craving to provide a more robust prediction of outcome with naltrexone or counseling.

Imagery and Fear Influence Height Perception

The current study tested whether height overestimation is related to height fear and influenced by images of falling. To assess perceptual biases, participants high (n=65) versus low (n=64) in height fear estimated the vertical extents of two balconies using a visual matching task. On one of the balconies, participants engaged in an imagery exercise designed to enhance the subjective sense that they were acting in a dangerous environment by picturing themselves falling. As expected, we found that individuals overestimated the balconys height more after they imagined themselves falling, particularly if they were already afraid of heights. These findings suggest that height fear may serve as a vulnerability factor that leads to perceptual biases when triggered by a stressor (in this case, images of falling).

Global and Local Evaluations of Public Speaking Performance in Social Anxiety

Differences in the relative use of global and local information (seeing the forest vs. the trees) may explain why people with social anxiety often do not benefit from corrective feedback, even though they pay close attention to details in social situations. In the current study, participants high (n=43) or low (n=47) in social anxiety symptoms gave a series of brief speeches, and then self-rated their speaking performance on items reflecting global and local performance indicators (self-assessment) and also received standardized performance feedback from an experimenter. Participants then completed a questionnaire asking how they thought the experimenter would rate their performance based on the feedback provided (experimenter assessment). Participants completed the self- and experimenter assessments again after 3 days, in addition to a measure of postevent processing (repetitive negative thinking) about their speech performance. Results showed that, as hypothesized, the High SA group rated their performance more negatively than the Low SA group. Moreover, the High SA groups ratings of global aspects of their performance became relatively more negative over time, compared to their ratings of local aspects and the Low SA groups ratings. As expected, postevent processing mediated the relationship between social anxiety group status and worsening global performance evaluations. These findings point to a pattern of progressively more negative global evaluations over time for persons high in social anxiety.

Correspondence Between Self-Report Measures and Clinician Assessments of Psychopathology in Female Intimate Partner Violence Survivors

Intimate partner violence (IPV) has potentially severe and long-lasting mental health consequences for survivors, including elevated symptoms and diagnoses of posttraumatic stress disorder (PTSD), depression, and generalized anxiety disorder (GAD). The current study examined the relationship between three self-report measures of psychological distress and ratings obtained from the corresponding clinician-administered measures in women seeking assessment for mental health problems following IPV (N = 185). PTSD symptoms were assessed using the self-report Impact of Event Scale–Revised (IES-R) and the interview-based Clinician-Administered PTSD Scale (CAPS). Depression symptoms were assessed using the self-report Beck Depression Inventory–II (BDI-II) and the depressive disorders sections from the clinician-administered Anxiety Disorders Interview Schedule–IV (ADIS-IV). Anxiety symptoms were assessed using the self-report Beck Anxiety Inventory (BAI) and the clinician-administered GAD section from the ADIS-IV. Results indicated that psychological distress was prevalent in the sample, with 27% receiving a PTSD diagnosis, 40% diagnosed with a depressive disorder, and 55% meeting criteria for GAD. Although each self-report measure was significantly and positively correlated with its corresponding clinician-administered measure, rates of diagnostic concordance were mixed. The BDI-II showed a high degree of agreement with the ADIS-IV depression section, but the IES-R and the CAPS were discordant at classifying PTSD. The BAI had acceptable sensitivity but poor specificity in relation to the ADIS-IV GAD section. These findings suggest that multiple assessment modalities should be considered when rating symptoms and estimating the prevalence of diagnoses among survivors of IPV.

Anxiety in musicians: On and off stage

Music performance anxiety (MPA) is a prevalent problem for musicians. MPA has been conceptualized as a type of social anxiety and also as a discrete focal anxiety with normal functioning outside of specific music performance situations. In an effort to examine unique and overlapping components of MPA and social anxiety, 130 professional musicians were assessed concerning self-reported MPA in three different musical performance settings (solo, group, and practice) using the Performance Anxiety Questionnaire and also completed measures of general social anxiety. Results showed that the expression of MPA varies by performance setting, with the most anxiety reported during solo performances. Regression models demonstrated that general measures of social anxiety increasingly predicted MPA from practice, to group, to solo settings, with fear of negative evaluation uniquely predicting anxiety in all three contexts. These results highlight fear of negative evaluation as a core component of MPA. Based on these findings, the relationship between MPA in various performance contexts and social evaluative anxiety is discussed.

Understanding the role of dysfunctional post-trauma cognitions in the co-occurrence of Posttraumatic Stress Disorder and Generalized Anxiety Disorder: Two trauma samples

This report focuses on the co-occurrence of PTSD-GAD and examines a factor that could operate to maintain both conditions, specifically negative post-trauma cognitions about the self, the world, and self-blame. Two separate help-seeking samples were examined: (a) a mixed gender sample of 301 individuals who had experienced a serious motor vehicle accident (MVA), a single incident, non-interpersonal trauma; and (b) a sample of 157 women who had experienced intimate partner violence (IPV), a recurrent, interpersonal trauma. When examined at the diagnostic level, posttraumatic cognitions for one diagnosis did not vary as a function of whether the other diagnosis was present. In the MVA sample, both diagnosed PTSD and GAD were associated with elevations in negative thoughts about the self. Diagnosed GAD was also significantly associated with negative thoughts about the world. In the IPV sample, diagnosed PTSD was associated with elevations in negative thoughts about the self only. When continuously measured PTSD and GAD were examined, results indicated that negative thoughts about the self showed significant simultaneous associations with PTSD and GAD in both samples. In the MVA sample, negative thoughts about the world and self-blame showed significant associations with PTSD but not with GAD. In the IPV sample, negative thoughts about the world and self-blame were not significantly associated with either PTSD or GAD. Results are discussed in light of current treatment models for these conditions, with emphasis on the potential for addressing transdiagnostic processes as a more effective approach to treating comorbid conditions following trauma.

The mediating role of state maladaptive emotion regulation in the relation between social anxiety symptoms and self-evaluation bias

ABSTRACT Although social anxiety symptoms are robustly linked to biased self-evaluations across time, the mechanisms of this relation remain unclear. The present study tested three maladaptive emotion regulation strategies – state post-event processing, state experiential avoidance, and state expressive suppression – as potential mediators of this relation. Undergraduate participants (N = 88; 61.4% Female) rated their social skill in an impromptu conversation task and then returned to the laboratory approximately two days later to evaluate their social skill in the conversation again. Consistent with expectations, state post-event processing and state experiential avoidance mediated the relation between social anxiety symptoms and worsening self-evaluations of social skill (controlling for research assistant evaluations), particularly for positive qualities (e.g. appeared confident, demonstrated social skill). State expressive suppression did not mediate the relation between social anxiety symptoms and changes in self-evaluation bias across time. These findings highlight the role that spontaneous, state experiential avoidance and state post-event processing may play in the relation between social anxiety symptoms and worsening self-evaluation biases of social skill across time.

Social Anxiety Disorder and Global/Local Performance on a Visuospatial Processing Task

Few research studies have examined differences in processing “big-picture,” global stimuli versus detailed, local stimuli in individuals with social anxiety disorder (SAD). Similarly, little is known about the impact of a social stressor on cognitive functioning in SAD. This study explores differences in memory for global and local visuospatial information between participants with SAD (n = 37) and non-anxious control participants (n = 40) using the Rey-Osterrieth Complex Figure Test. Half of the participants were exposed to a social stressor (anticipating giving a speech) while they completed the task. Two scoring subscales were used to distinguish between reproduction of global elements and local features on Copy, Immediate Recall, and Delayed Recall trials. Results indicated that participants with SAD who were not exposed to the social stressor performed more poorly at reproducing local elements on the Copy trial, compared to participants in the SAD-stressor present group and both control groups. Additionally, control participants, but not those with SAD, demonstrated improvement in memory for global elements from Immediate to Delayed Recall trials. These results suggest that trait social anxiety impairs consolidation of global visuospatial information over time, and interacts with the presence of a state stressor to affect reproduction of details.