Natalie E. Hundt

An analysis of reinforcement sensitivity theory and the five-factor model

Reinforcement Sensitivity Theory (RST) and the Five‐Factor Model (FFM) are two prominent personality accounts that have emerged from different backgrounds. Although the two accounts are applied to similar research topics, there is limited empirical work examining the correspondence between them. The current study explored the relationship between RST‐based personality traits and the FFM domains and facets in an undergraduate sample (n = 668). Regression analyses indicated that Sensitivity to Punishment (SP) was positively associated with Neuroticism and Agreeableness, and negatively associated with Extraversion, Openness, and Conscientiousness. In contrast, Sensitivity to Reward (SR) was positively associated with Extraversion and Neuroticism, and negatively associated with Agreeableness and Conscientiousness. Exploratory analyses at the facet level specified the relationship between SP, SR, and each domain. A factor analysis was also conducted to explore the higher‐order factor structure of RST and the FFM domains. Three factors emerged, which we labelled SP, Stability‐Impulsivity, and Sensation Seeking. Taken together, these findings suggest that there is substantial overlap between these two accounts of personality. Copyright

The Relationship Between Use of CBT Skills and Depression Treatment Outcome: A Theoretical and Methodological Review of the Literature

Cognitive and behavioral therapies emphasize the importance of skill acquisition and use, and these skills are proposed to mediate treatment outcomes. Despite its theoretical importance, research on skill use as a mechanism of change in CBT and its measurement is still in its infancy. A search of online databases was conducted to identify and review the literature testing the meditational effect of CBT skills on treating depression in adults. Additionally, we reviewed the various methods to assess a patients use of CBT skills. We identified 13 studies examining the frequency of CBT skill use and 11 studies examining the quality of CBT skill use. While the literature provides preliminary evidence for the mediational role of CBT skill use frequency and quality on depression treatment outcomes, methodological limitations in much of the existing literature prevent firm conclusions about the role of skills use on treatment outcomes.

Changes in Psychotherapy Utilization Among Veterans With Depression, Anxiety, and PTSD

OBJECTIVE Large-scale health care systems such as the Veterans Health Administration (VHA) have recently invested heavily in the expansion of psychotherapy services. This study examined longitudinal changes in use of psychotherapy at the VHA during a period of substantial programmatic change targeting increased availability and quality of mental health care. METHODS This retrospective cohort study used data from the VHA National Patient Care Database outpatient treatment files to identify patients with a new-onset diagnosis of depression, anxiety, or posttraumatic stress disorder during fiscal years (FYs) 2004 (N=424,428), 2007 (N=494,318), and 2010 (N=583,733). Use of psychotherapy during the 12 months after diagnosis was assessed. RESULTS The proportion of patients receiving any psychotherapy increased across the three study time points (FY 2004, 21%; FY 2007, 22%; and FY 2010, 27%). Amount of psychotherapy also increased such that with time a growing proportion of patients received eight or more psychotherapy sessions. The median time between diagnosis and start of psychotherapy decreased from 56 to 47 days from FY 2004 to FY 2010. Consistent with VHA expansion efforts, more substantial increases in psychotherapy reach, amount, and timeliness occurred between FY 2007 and 2010 than between FY 2004 and FY 2007. CONCLUSIONS These findings highlight recent increases in the use of VHA psychotherapy and correspond to substantial efforts to improve access to mental health services. Despite these advances, most newly diagnosed patients received no psychotherapy or a low-intensity amount of psychotherapy. Additional efforts to promote veteran engagement in needed mental health services appear warranted.

Characteristics of U.S. Veterans Who Begin and Complete Prolonged Exposure and Cognitive Processing Therapy for PTSD

This retrospective chart-review study examined patient-level correlates of initiation and completion of evidence-based psychotherapy (EBP) for posttraumatic stress disorder (PTSD) among treatment-seeking U.S. veterans. We identified all patients (N = 796) in a large Veterans Affairs PTSD and anxiety clinic who attended at least 1 individual psychotherapy appointment with 1 of 8 providers trained in EBP. Within this group, 91 patients (11.4%) began EBP (either Cognitive Processing Therapy or Prolonged Exposure) and 59 patients (7.9%) completed EBP. The medical records of all EBP patients (n = 91) and a provider-matched sample of patients who received another form of individual psychotherapy (n = 66) were reviewed by 4 independent raters. Logistic regression analyses revealed that Iraq and Afghanistan veterans were less likely to begin EBP than veterans from other service eras, OR = 0.48, 95% CI = [0.24, 0.94], and veterans who were service connected for PTSD were more likely than veterans without service connection to begin EBP, OR = 2.33, 95% CI = [1.09, 5.03]. Among those who began EBP, Iraq and Afghanistan veteran status, OR = 0.09, 95% CI = [0.03, 0.30], and a history of psychiatric inpatient hospitalization, OR = 0.13, 95% CI = [0.03, 0.54], were associated with decreased likelihood of EBP completion.

Sensitivity to punishment and low maternal care account for the link between bulimic and social anxiety symptomology.

OBJECTIVE The current study examined the joint effect of personality and parenting factors on the prediction of bulimia nervosa (BN) and social anxiety disorder (SAD) symptomology in a sample of female college students. The study also tested whether personality and parenting factors might account for the association between BN and SAD symptoms. METHOD One-hundred twenty-eight participants completed self-report measures assessing maternal care (MC), maternal overprotection, sensitivity to punishment (SP), sensitivity to reward (SR), and BN and SAD symptomology. RESULTS SP, SR, and MC each uniquely predicted BN symptoms, whereas only SP and MC predicted SAD symptoms. High SP interacted with low MC to predict BN and SAD symptoms over the main effects. In addition, SP, MC, and the interaction term SP x MC mediated the association between SAD and BN symptoms. CONCLUSION High SP and low MC appear to account for the link between BN and SAD symptomology, whereas high SR appears to distinguish the disorders.

Coping mediates the relationship between disease severity and illness intrusiveness among chronically ill patients

Reducing perceptions of illness intrusiveness may improve quality of life and mental health among patients with cardiopulmonary disease. To better understand relationships between coping style, locus of control, perceived illness intrusiveness, and disease severity, we analyzed data from 227 older Veterans with chronic obstructive pulmonary disease or congestive heart failure. Regressions revealed illness intrusiveness to be associated with younger age and greater disease severity, less internal locus of control, and avoidant/emotion-focused coping. Avoidant/emotion-focused coping but not active coping mediated the relationship between illness severity and illness intrusiveness. Findings suggest that supportive psychological interventions may reduce illness intrusiveness by targeting an avoidant/emotion-focused coping style and associated behaviors.

Diagnostic specificity and mental health service utilization among veterans with newly diagnosed anxiety disorders

OBJECTIVE This study examined rates of specific anxiety diagnoses (posttraumatic stress disorder, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, social anxiety disorder, and specific phobia) and anxiety disorder not otherwise specified (anxiety NOS) in a national sample of Veterans and assessed their mental health service utilization. METHOD This study used administrative data extracted from Veteran Health Administration outpatient records to identify patients with a new anxiety diagnosis in fiscal year 2010 (N = 292,244). Logistic regression analyses examined associations among diagnostic specificity, diagnostic location, and mental health service utilization. RESULTS Anxiety NOS was diagnosed in 38% of the sample. Patients in specialty mental health were less likely to receive an anxiety NOS diagnosis than patients in primary care (odds ratio [OR] = 0.36). Patients with a specific anxiety diagnosis were more likely to receive mental health services than those with anxiety NOS (OR = 1.65), as were patients diagnosed in specialty mental health compared with those diagnosed in primary care (OR = 16.29). CONCLUSION Veterans diagnosed with anxiety NOS are less likely to access mental health services than those with a specific anxiety diagnosis, suggesting the need for enhanced diagnostic and referral practices, particularly in primary care settings.

The role of shame in distinguishing perpetrators of intimate partner violence in U.S. veterans

Increasing attention is being paid to the fact that exposure to traumatic stressors in military combat may lead to perpetration of intimate partner violence (IPV). Because shame has been identified as a factor in posttraumatic stress disorder (PTSD), the current cross-sectional study examined the relationship in U.S. veterans between IPV and PTSD, depression, guilt, and shame. We hypothesized that shame would be the strongest correlate of perpetration of IPV and that shame would mediate the relationship between PTSD and IPV. Participants were 264 primarily male and Caucasian mixed-era veterans presenting for psychological treatment at a Veterans Affairs hospital. They completed standard measures of depression, PTSD symptoms, shame, and guilt and a local checklist was used to dichotomize the sample regarding IPV. Discriminant analysis indicated that shame contributed most (standardized canonical discriminant function coefficient = .44) to distinguishing perpetrators of IPV. In addition, the results were consistent with shame as a mediator of the relationship between PTSD and IPV. These results are in line with studies indicating that shame is linked to IPV perpetration in nonveteran samples (Harmon, 2002; Rand, 2004; Schibik, 2002) and suggests that shame may be an important aspect of the relationship between PTSD and IPV.

BIS and BAS Interact with Perceived Parental Affectionless Control to Predict Personality Disorder Symptomatology

The objective of this study was to examine if and how two basic dimensions of temperament-behavioral inhibition system (BIS) and behavioral approach system (BAS) sensitivity-might interact with exposure to perceived parental affectionless control (AFC) to predict personality disorder (PD) symptomatology. Measures of BIS, BAS, AFC, and PD symptomatology were administered to a large nonclinical sample (n = 318). As predicted, exposure to AFC was positively associated with PD symptoms in general, BIS was positively associated with Cluster A and C symptoms, and BAS was positively associated with Cluster B symptoms. BIS and BAS were also found to interact with each other to predict Cluster B symptomatology. In addition, BIS, BAS, and maternal AFC interacted to predict Cluster A symptomatology. In the latter case, it was found that individuals who reported high BIS, high BAS, and high maternal AFC reported the highest overall level of Cluster A symptoms.

Behavioral health coaching for rural veterans with diabetes and depression: a patient randomized effectiveness implementation trial

BackgroundDepression and diabetes cause significant burden for patients and the healthcare system and, when co-occurring, result in poorer self-care behaviors and worse glycemic control than for either condition alone. However, the clinical management of these comorbid conditions is complicated by a host of patient, provider, and system-level barriers that are especially problematic for patients in rural locations. Patient-centered medical homes provide an opportunity to integrate mental and physical health care to address the multifaceted needs of complex comorbid conditions. Presently, there is a need to not only develop robust clinical interventions for complex medically ill patients but also to find feasible ways to embed these interventions into the frontlines of existing primary care practices.Methods/designThis randomized controlled trial uses a hybrid effectiveness-implementation design to evaluate the Healthy Outcomes through Patient Empowerment (HOPE) intervention, which seeks to simultaneously address diabetes and depression for rural veterans in Southeast Texas. A total of 242 Veterans with uncontrolled diabetes and comorbid symptoms of depression will be recruited and randomized to either the HOPE intervention or to a usual-care arm. Participants will be evaluated on a host of diabetes and depression-related measures at baseline and 6- and 12-month follow-up. The trial has two primary goals: 1) to examine the effectiveness of the intervention on both physical (diabetes) and emotional health (depression) outcomes and 2) to simultaneously pilot test a multifaceted implementation strategy designed to increase fidelity and utilization of the intervention by coaches interfacing within the primary care setting.DiscussionThis ongoing blended effectiveness-implementation design holds the potential to advance the science and practice of caring for complex medically ill patients within the constraints of a busy patient-centered medical home.Trial registrationBehavioral Activation Therapy for Rural Veterans with Diabetes and Depression: NCT01572389.