Neil A. Rector

Examination of the convergent validity of looming vulnerability in the anxiety disorders

The looming vulnerability model proposes that individuals with anxiety generate dynamic mental scenarios of threats as intensifying and approaching faster than they can cope or respond. In addition to the looming cognitive style posing a general cognitive vulnerability for anxiety, the looming vulnerability model posits that different anxiety disorders can be distinguished based on the specific content of their looming vulnerability themes. The current study examined whether different anxiety disorders have distinct looming vulnerability content along the lines of disorder-specific themes. A treatment-seeking sample of individuals with DSM-IV anxiety disorders (N=172) completed measures of looming vulnerability prior to treatment initiation. Consistent with the looming vulnerability model, the results indicated that individuals with social phobia, obsessive compulsive disorder, and panic disorder reported significantly greater disorder-specific looming content compared to non-disorder specific looming content. Individuals with generalized anxiety disorder reported the same level of looming social threat as those with social phobia. The results suggest that different anxiety disorders can be distinguished by the specific content of looming vulnerability themes and provide empirical support for the convergent validity of the Looming Vulnerability Scale.

Obsessive-Compulsive Spectrum Disorders: A Review of the Evidence-Based Treatments

Objective: To provide a review of the evidence-based treatments for Obsessive-Compulsive spectrum disorders (OCSD), a group of conditions related to Obsessive-Compulsive disorder (OCD) by phenomenological and etiological similarities, the morbidity of which is increasingly recognized. Method: Literature relating to the following disorders: body dysmorphic disorder, hypochondriasis, trichotillomania, onychophagia, psychogenic excoriation, compulsive buying, kleptomania, and pathological gambling, and published between January 1965 and October 2007, was found using PubMed. Included in this review were 107 treatment reports. Results: Serotonin reuptake inhibitors (SRIs) have shown benefits as first-line, short-term treatments for body dysmorphic disorder, hypochondriasis, onychophagia, and psychogenic excoriation, with some benefits in trichotillomania, pathological gambling, and compulsive buying. There are also suggested benefits for several atypical antipsychotics in disorders with a high degree of impulsivity, including trichotillomania and pathological gambling, and to a lesser extent, kleptomania and psychogenic excoriation. Cognitive-behavioural interventions have generally shown evidence for use as first-line treatment across the spectrum, with some variability in degree of benefit. Conclusions: As in OCD, several conditions in the proposed OCSD benefit from SRIs and (or) cognitive-behavioural interventions. However, the treatment literature is generally limited, and more randomized controlled trials (RCTs) are needed to evaluate individual and combination treatments, for short-term use and as maintenance.

Rumination and distraction periods immediately following a speech task: effect on postevent processing in social anxiety.

The purpose of this study was to investigate social anxiety and the effect of rumination and distraction periods immediately following a speech task on subsequent postevent processing. A secondary aim was to examine the content of postevent rumination. Participants (N = 114 students) completed measures of social anxiety and depression, delivered a 3-minute speech, and were randomly assigned to complete (1) a rumination form about the speech (guided negative rumination condition) or (2) an anagram form (distraction condition). One week later participants completed measures of postevent processing related to the speech task. It was hypothesized that social anxiety would interact with condition in predicting levels of postevent processing. This hypothesis was supported in the prediction of positive thoughts such that at high levels of social anxiety the distraction condition led to more positive thoughts compared with the guided negative rumination condition, whereas at low levels of social anxiety conditions were similar with respect to positive thoughts. Irrespective of condition, both social anxiety and depression predicted greater postevent rumination and negative thoughts 1 week later. With respect to the content of postevent rumination, socially anxious individuals reported being more concerned about some aspects of the presentation (e.g. poor posture), whereas other concerns were equally noted regardless of social anxiety level (e.g. poor content). The present results highlight the potential clinical utility of distracting from social anxiety to allow for greater access to positive thoughts postevent.

Mindfulness and the Attenuation of Post-Event Processing in Social Phobia: An Experimental Investigation

The present experimental study examined the ability of metacognitive strategies to reduce the distress associated with post-event processing (PEP). Individuals with DSM-IV generalized social phobia (N = 57) were randomly allocated to receive brief training in mindfulness, distraction, or no training (control group). Next, they underwent an experimental PEP induction. Following the induction, they were instructed to apply the metacognitive strategy (mindfulness or distraction) they were taught or to continue thinking about the social event the way they typically would following such an event (control). Participants rated their distress on a visual analogue scale prior to the PEP induction, and then every minute for 5 min while applying the metacognitive strategy. They also rated their affect immediately after applying the metacognitive strategy. Results suggest that mindfulness reduces distress significantly over the post-event period and results in significantly more positive affect than when receiving no training. In contrast, distraction does not reduce distress over the post-event period performs comparable to receiving no training. The results of this experimental investigation suggest that mindfulness has the potential to reduce distress associated with PEP and provide further support for the clinical utility of mindfulness in the treatment of generalized social phobia.

The expanding cognitive-behavioural therapy treatment umbrella for the anxiety disorders: disorder-specific and transdiagnostic approaches.

Cognitive-behavioural therapy (CBT) is an empirically supported treatment for anxiety disorders. CBT treatments are based on disorder-specific protocols that have been developed to target individual anxiety disorders, despite that anxiety disorders frequently co-occur and are comorbid with depression. Given the high rates of diagnostic comorbidity, substantial overlap in dimensional symptom ratings, and extensive evidence that the mood and anxiety disorders share a common set of psychological and biological vulnerabilities, transdiagnostic CBT protocols have recently been developed to treat the commonalities among the mood and anxiety disorders. We conducted a selective review of empirical developments in the transdiagnostic CBT treatment of anxiety and depression (2008–2013). Preliminary evidence suggests that theoretically based transdiagnostic CBT approaches lead to large treatment effects on the primary anxiety disorder, considerable reduction of diagnostic comorbidity, and some preliminary effects regarding the impact on the putative, shared psychological mechanisms. However, the empirical literature remains tentative owing to relatively small samples, limited direct comparisons with disorder-specific CBT protocols, and the relative absence of the study of disorder-specific compared with shared mechanisms of action in treatment. We conclude with a treatment conceptualization of the new transdiagnostic interventions as complementary, rather than contradictory, to disorder-specific CBT.

Disgust recognition in obsessive-compulsive disorder: diagnostic comparisons and posttreatment effects.

Objective: To examine whether disgust recognition deficits are present and specific to obsessive-compulsive disorder (OCD), and the extent to which this deficit, if present, can be reduced in cognitive-behavioural therapy (CBT). Method: Responses to the Pictures of Facial Affect (POFA) were examined in patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosed OCD (n = 20), panic disorder with agoraphobia (PDA; n = 15), and generalized social phobia (GSP; n = 15) and a second, independent OCD sample of treatment responders to CBT (n = 11). Results: There were signifcant and statistically large disgust recognition differences between the OCD group and comparison PDA and GSP groups. However, patients with OCD treated with CBT showed disgust recognition scores that were equivalent to the PDA and GSP groups, significantly better than the untreated OCD sample, and equivalent to scores from the original POFA nonaffected standardization sample. Conclusions: These results provide support for the presence of disgust recognition impairment in OCD, and provide preliminary evidence that disgust recognition impairments may improve with treatment.

A Pilot Test of the Additive Benefits of Physical Exercise to CBT for OCD

The majority of “responders” to first-line cognitive-behavioural therapy (CBT) and pharmacological treatments for obsessive-compulsive disorder (OCD) are left with residual symptoms that are clinically relevant and disabling. Therefore, there is pressing need for widely accessible efficacious alternative and/or adjunctive treatments for OCD. Accumulating evidence suggests that physical exercise may be one such intervention in the mood and anxiety disorders broadly, although we are aware of only two positive small-scale pilot studies that have tested its clinical benefits in OCD. This pilot study aimed to test the feasibility and preliminary efficacy of adding a structured physical exercise programme to CBT for OCD. A standard CBT group was delivered concurrently with a 12-week customized exercise programme to 11 participants. The exercise regimen was individualized for each participant based on peak heart rate measured using an incremental maximal exercise test. Reports of exercise adherence across the 12-week regimen exceeded 80%. A paired-samples t-test indicated very large treatment effects in Yale-Brown Obsessive-Compulsive Scale scores from pre- to post-treatment in CBT group cohorts led by expert CBT OCD specialists (d = 2.55) and junior CBT clinician non-OCD specialists (d = 2.12). These treatment effects are very large and exceed effects typically observed with individual and group-based CBT for OCD based on leading meta-analytic reviews, as well as previously obtained treatment effects for CBT using the same recruitment protocol without exercise. As such, this pilot work demonstrates the feasibility and significant potential clinical utility of a 12-week aerobic exercise programme delivered in conjunction with CBT for OCD.

Interactions between childhood maltreatment and brain-derived neurotrophic factor and serotonin transporter polymorphisms on depression symptoms

This study represents the first replication of the BDNF Val66Met ⁎ 5-HTTLPR ⁎ childhood maltreatment effect on self-reported depression symptoms using a rigorous maltreatment interview. Participants included a community sample of 339 adolescents/young adults (age 12-33; 265 female). In the context of childhood neglect, among BDNF Met-carriers, s-allele carriers of 5-HTTLPR reported significantly higher depression than l/l homozygotes, whereas a differential relation of 5-HTTLPR genotype to depression was not seen among BDNF Val/Val homozygotes.

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.

Examining Autobiographical Memory Content in Patients with Depression and Anxiety Disorders

The purpose of this study was to move beyond the traditional specificity model of autobiographical memory (ABM) and to examine the content of memories with a focus on disorder and schema-relevant content. The sample (N = 82) included 25 patients with major depressive disorder (MDD), 24 with social phobia (SP), and 33 with panic disorder with agoraphobia (PDA) who were referred to a large outpatient clinic for group treatment of depression or anxiety. Participants completed the Autobiographical Memory Test (AMT) and Beck Depression Inventory–II as part of the clinical intake process. Responses to the AMT were coded for disorder-specific content based on diagnostic criteria for each disorder as well as for schema-relevant (sociotropy vs. autonomy) content. A repeated measures multiple analysis of variance demonstrated significant differences in disorder-specific content, with patients in the MDD group reporting more depressotypic ABMs than those in the PDA group but not the SP group. Similarly, in the analysis of schema-relevant content, significant differences were found between MDD and PDA regarding the presence of autonomy-based ABM ratings. Study results provide partial support for the cognitive specificity hypothesis with ABM content. The results are discussed in relation to the cognitive models of depression and anxiety.