Ohad Szepsenwol

Mindfulness-Based Cognitive Therapy Improves Emotional Reactivity to Social Stress: Results from a Randomized Controlled Trial ☆

The high likelihood of recurrence in depression is linked to a progressive increase in emotional reactivity to stress (stress sensitization). Mindfulness-based therapies teach mindfulness skills designed to decrease emotional reactivity in the face of negative affect-producing stressors. The primary aim of the current study was to assess whether Mindfulness-Based Cognitive Therapy (MBCT) is efficacious in reducing emotional reactivity to social evaluative threat in a clinical sample with recurrent depression. A secondary aim was to assess whether improvement in emotional reactivity mediates improvements in depressive symptoms. Fifty-two individuals with partially remitted depression were randomized into an 8-week MBCT course or a waitlist control condition. All participants underwent the Trier Social Stress Test (TSST) before and after the 8-week trial period. Emotional reactivity to stress was assessed with the Spielberger State Anxiety Inventory at several time points before, during, and after the stressor. MBCT was associated with decreased emotional reactivity to social stress, specifically during the recovery (post-stressor) phase of the TSST. Waitlist controls showed an increase in anticipatory (pre-stressor) anxiety that was absent in the MBCT group. Improvements in emotional reactivity partially mediated improvements in depressive symptoms. Limitations include small sample size, lack of objective or treatment adherence measures, and non-generalizability to more severely depressed populations. Given that emotional reactivity to stress is an important psychopathological process underlying the chronic and recurrent nature of depression, these findings suggest that mindfulness skills are important in adaptive emotion regulation when coping with stress.

A Pilot Investigation of Emotion‐Focused Two‐Chair Dialogue Intervention for Self‐Criticism

UNLABELLED Self-criticism plays a key role in many psychological disorders and predicts poor outcome in psychotherapy. Yet, psychotherapy research directly targeting self-critical processes is limited. In this pilot study, we examined the efficacy of an emotion-focused intervention, the two-chair dialogue task, on self-criticism, self-compassion and the ability to self-reassure in times of stress, as well as on depressive and anxiety symptoms among nine self-critical clients. Results showed that the intervention was associated with significant increases in self-compassion and self-reassuring, and significant reductions in self-criticism, depressive symptoms and anxiety symptoms. Effect sizes were medium to large, with most clients exhibiting low and non-clinical levels of symptomatology at the end of therapy, and maintaining gains over a 6-month follow-up period. Although preliminary, these finding suggest that emotion-focused chair work might be a promising intervention addressing self-criticism. KEY PRACTITIONER MESSAGE Self-criticism is an important process in a variety of clinical disorders and predicts poor outcome in brief therapy for depression. Yet, little is known about how self-criticism can be effectively addressed in psychological treatment. Practitioners can benefit from increasing their awareness of self-critical processes in their clinical work, and from directly working with emotions in addressing self-criticisim. Emotion-focused two-chair dialogue intervention can be effective in reducing self-criticism, increasing self-compassion, and decreasing depressive and anxiety symptoms, and these improvements are largely maintained six months after therapy.

When sex goes wrong: a behavioral systems perspective on individual differences in sexual attitudes, motives, feelings, and behaviors.

In the research program summarized here, we adopted a behavioral systems approach to explain individual differences in human sexual behavior. In the 1st stage, we developed the Sexual System Functioning Scale (SSFS)-a self-report instrument for assessing hyperactivation and deactivation of the sexual system. Sexual hyperactivation involves intense but anxious expressions of sexual desire, whereas sexual deactivation includes inhibition of sexual inclinations. In subsequent stages, we administered the SFSS to 18 samples to determine its structural, convergent, discriminant, and predictive validity as well as its nomological network. We found that SSFS deactivation and hyperactivation scores are meaningfully associated with existing measures of sexual attitudes, motives, feelings, and behaviors and with measures of personal and interpersonal well-being. Moreover, the scores predict cognitive, affective, physiological, and behavioral responses to sexual stimuli. Implications of our findings for understanding the potential of sex for both joy and distress are discussed.

Obsessing about intimate-relationships: Testing the double relationship-vulnerability hypothesis

BACKGROUND AND OBJECTIVES Obsessive preoccupation and doubts centering on ones intimate relationship may have a negative impact on the romantic dyad and lead to significant distress. In this research we investigated whether the co-occurrence of attachment anxiety and overreliance on intimate relationships for self-worth-what we call double relationship-vulnerability-is linked with relationship-centered obsessions and obsessive-compulsive tendencies. METHODS Study 1 employed a correlational design to examine the link between double relationship-vulnerability and relationship-centered obsessions. Study 2 employed an experimental design to assess response to subtle threats to the relationship self-domain among individuals with double relationship-vulnerability. RESULTS Study 1 supported the link between double relationship-vulnerability and relationship-centered obsessions. Study 2 showed that when confronted with subtle threats to the relationship self-domain, individuals with double relationship-vulnerability are more likely to experience distress and engage in mitigating behavior in response to relationship doubts and fears. LIMITATIONS Our studies were conducted with non-clinical samples. CONCLUSIONS These findings suggest that double relationship-vulnerability may make individuals more susceptible to the development and maintenance of relationship-centered obsessions and compulsions.

The effect of unpredictable early childhood environments on parenting in adulthood.

Life history theory suggests that individual differences in parenting are partially rooted in environmental conditions experienced early in life. Whereas certain conditions should promote increased investment in parenting, unpredictable and/or harsh environments should promote decreased investment in parenting, especially in men. We tested this hypothesis in 3 studies. In Study 1a, we conducted analyses on 112 parents taking part in the Minnesota Longitudinal Study of Risk and Adaptation (MLSRA), all of whom have been continuously studied starting before they were born. Parenting orientations were assessed at age 32 via an interview. Findings showed that experiencing more unpredictability at ages 0-4 (i.e., frequent changes in parental employment status, cohabitation status, and residence) prospectively forecasted more negative parenting orientations among men, but not women. This effect was serially mediated by lower early maternal supportive presence measured at ages 0-4 and insecure attachment assessed at ages 19 and 26. In Study 1b, we replicated these findings on 96 parents from the MLSRA using behavioral observations of their parental supportive presence. In Study 2, we replicated the effect of early-life unpredictability on mens parenting orientations with a sample of 435 parents. This effect was mediated by adult attachment anxiety and avoidance. Across all studies, greater early-life harshness (low socioeconomic status [SES]) did not predict adult parenting outcomes. These findings suggest that greater early-life unpredictability may be conveyed to children through less supportive parenting, which results in insecure attachment representations in adulthood. Among men, this process culminates in less positive adult parenting orientations and less supportive parenting.

Childhood Maltreatment, Shame‐Proneness and Self‐Criticism in Social Anxiety Disorder: A Sequential Mediational Model

UNLABELLED Previous research has shown a robust link between emotional abuse and neglect with social anxiety symptoms. However, the mechanisms through which these links operate are less clear. We hypothesized a model in which early experiences of abuse and neglect create aversive shame states, internalized into a stable shame-based cognitive-affective schema. Self-criticism is conceptualized as a safety strategy designed to conceal flaws and prevent further experiences of shame. However, self-criticism maintains negative self-perceptions and insecurity in social situations. To provide preliminary, cross-sectional support for this model, a nonclinical community sample of 219 adults from Israel (110 females, mean age = 38.7) completed measures of childhood trauma, shame-proneness, self-criticism and social anxiety symptoms. A sequential mediational model showed that emotional abuse, but not emotional neglect, predicted shame-proneness, which in turn predicted self-criticism, which in turn predicted social anxiety symptoms. These results provide initial evidence supporting the role of shame and self-criticism in the development and maintenance of social anxiety disorder. The clinical implications of these findings are discussed. KEY PRACTITIONER MESSAGE Previous research has shown that histories of emotional abuse and emotional neglect predict social anxiety symptoms, but the mechanisms that underlie these associations are not clear. Using psycho-evolutionary and emotion-focused perspectives, the findings of the current study suggest that shame and self-criticism play an important role in social anxiety and may mediate the link between emotional abuse and symptoms. These findings also suggest that therapeutic interventions specifically targeting shame and self-criticism should be incorporated into treatments for social anxiety, especially with socially anxious patients with abuse histories.

Relationship Obsessive–Compulsive Disorder: Interference, Symptoms, and Maladaptive Beliefs

Background Obsessive preoccupation, doubts, and compulsive behaviors focusing on one’s romantic relationship and partner are receiving increasing clinical, theoretical, and empirical attention. Commonly referred to as relationship obsessive–compulsive disorder (ROCD), such symptoms have been linked with decreased relational and sexual functioning and lower mood, even after controlling for other obsessive–compulsive disorder (OCD) symptoms. To date, however, these symptoms have been studied in community samples alone. In the present study, we compared levels of interference, OCD, and mood symptoms between clinical participants with ROCD, OCD, and community controls. We also examined group differences in maladaptive beliefs previously linked with OCD and ROCD. Method Participants included 22 ROCD clients, 22 OCD clients, and 28 community controls. The Mini International Neuropsychiatric Interview was used to attain clinical diagnoses of OCD and ROCD. The Yale–Brown Obsessive–Compulsive Scale was used to evaluate primary-symptoms severity. All participants completed measures of symptoms and dysfunctional beliefs. Results ROCD clients reported more severe ROCD symptoms than the OCD and control groups. ROCD and OCD clients did not differ in severity of their primary-symptoms. ROCD clients scored higher than the other groups on maladaptive OCD-related and relationship-related beliefs. Finally, ROCD clients showed more severe depression symptoms than community controls. Conclusion ROCD is a disabling presentation of OCD that warrants research attention. Maladaptive OCD-related and relationship-related beliefs may be implicated in the development and maintenance of ROCD.

Right or Flawed: Relationship Obsessions and Sexual Satisfaction

INTRODUCTION Relationship obsessive-compulsive disorder (ROCD) is marked by the presence of obsessions and compulsions focusing on romantic relationships. ROCD symptoms were previously linked with decreased relationship quality and might interfere with sexual functioning. AIM The study aims to examine the association between ROCD symptoms and sexual satisfaction. METHODS Participants completed an online survey assessing ROCD symptoms and relationship and sexual satisfaction levels. Depression, general worry, obsessive-compulsive disorder (OCD) symptoms, and attachment orientation were also measured. MAIN OUTCOME MEASURE The main outcome measures were self reported relationship satisfaction and sexual satisfaction. RESULTS ROCD symptoms were associated with decreased sexual satisfaction over and above symptoms of depression, general worry, OCD, and attachment orientation. The link between ROCD symptoms and sexual satisfaction was mediated by relationship satisfaction. CONCLUSIONS Identifying and addressing ROCD symptoms may be important for treatment of sexual functioning.

Fatal Suppression The Detrimental Effects of Sexual and Attachment Deactivation Within Emerging Romantic Relationships

The attachment and sexual systems operate jointly across partners to affect relationship outcomes. In the present longitudinal investigation of newly dating couples, we tested a dual deactivation hypothesis of relationship dissatisfaction. According to this hypothesis, individuals whose sexual system is chronically deactivated are expected to experience low relationship satisfaction early in their relationships. Their satisfaction should increase with time, but only if their partners are low in attachment avoidance. Newly dating couples (2–4 months; N = 62) completed three waves of individual measures of attachment and sexual deactivation and relationship satisfaction in 4-month intervals. Dyadic growth curves showed that sexual deactivation was negatively associated with relationship satisfaction in the beginning of the relationship. This negative effect gradually disappeared among individuals whose partners were low in attachment avoidance, but persisted among individuals with avoidantly attached partners. These findings suggest that attachment processes can compensate for sexual difficulties.

The effect of predictable early childhood environments on sociosexuality in early adulthood

According to life history theory, sociosexual orientations in adulthood should be affected by an individual’s early childhood environment. Highly predictable (stable) environments should increase the potential fitness benefits of long-term (slow) mating strategies as well as the potential costs of short-term (fast) mating strategies. Experiencing a more predictable childhood environment, therefore, should lead individuals to enact a slower life history strategy characterized by more restricted sociosexual behaviors. We tested this hypothesis in the Minnesota Longitudinal Study of Risk and Adaptation (MLSRA), an ongoing longitudinal study that has followed individuals from before they were born into adulthood. Indicators of sociosexuality in early adulthood were assessed by trained coders based on interviews conducted with participants about their current relationship, their relationship history, and their future relationship aspirations when they were 23 years old. The findings revealed that having experienced more predictable environments during the first 4 years of life (indexed by less frequent changes in parents’ employment status, cohabitation status, and residence) prospectively predicted more restricted sociosexuality at age 23, over and above current levels of predictability (that also uniquely predicted restricted sociosexuality at age 23). This early life predictability effect was partially mediated by greater early maternal support and being securely attached at age 19. Viewed together, these findings suggest that greater predictability early in life may be partially conveyed to children through more supportive parenting, which results in secure attachment in adolescence, which in turn predicts more restricted sociosexuality in early adulthood.