Ulrike Feske

Cognitive behavioral versus exposure only treatment for social phobia: A meta-analysis

A meta-analytic comparison of studies testing cognitive behavior therapy (CBT; n = 12) and exposure treatment (n = 9) for social phobia indicates that the treatment modalities are equally effective. Compared to exposure, CBT did not lead to greater pretest-posttest or pretest-follow-up improvement on self-report measures of social anxiety, cognitive symptoms, or depressed/anxious mood. Length of treatment was generally unrelated to outcome, although a larger number of exposure sessions produced better results on measures of social anxiety at posttest.

Anxiety as a predictor of response to interpersonal psychotherapy for recurrent major depression: An exploratory investigation

Major depression and anxiety frequently co‐occur, but the implications for psychological treatments have rarely been studied. We examined predictors of acute response to interpersonal psychotherapy in 134 consecutively treated female outpatients with recurrent unipolar depression. Women who failed to remit with interpersonal psychotherapy alone experienced higher levels of somatic anxiety, were more likely to meet criteria for lifetime panic disorder, were more likely to meet criteria for nonendogenous or nonmelancholic depression, and reported greater vocational impairment, higher levels of global severity, a longer duration of the index episode, and, somewhat surprisingly, lower levels of social impairment at pretreatment evaluation. A series of backwards stepping logistic regression analyses showed higher levels of baseline somatic anxiety and social functioning to be the most consistent predictors of nonresponse. Our findings strengthen existing evidence that concomitant anxiety can adversely affect the outcome of interpersonal therapy for depression. Depression and Anxiety 8:135–141, 1998.

Modeling the pathways linking childhood hyperactivity and substance use disorder in young adulthood.

This study modeled direct and mediated pathways linking childhood hyperactivity and substance use disorder (SUD). Boys (n = 112) were administered the revised Drug Use Screening Inventory at age 12-14 years and the Structured Clinical Interview for DSM-IV at age 22 years. Six newly derived scales having established heritability were conceptually organized into internalizing and externalizing pathways to SUD emanating from childhood hyperactivity. Hyperactivity directly predicts SUD. Neuroticism, conduct problems, and their respective manifestations of social withdrawal and school problems mediated the association between hyperactivity and SUD. Hyperactivity also predicted neuroticism that, in turn, predicted low self-esteem leading to social withdrawal and SUD. These results indicate that hyperactivity is a diathesis for both internalizing and externalizing disturbances that, in turn, portend differential expression of psychosocial maladjustment presaging SUD.

Interpersonal and emotional experiences of social interactions in borderline personality disorder.

General Aim: We examined interpersonal experiences of patients with borderline personality disorder (BPD) using a time-contingent diary procedure to collect information about social interactions for 7 days. Method: We examined the (1) quantity of social interactions and (2) interpersonal and emotional experiences during social interactions for patients with BPD (BPD; N = 42) compared with those with another personality disorder (OPD; N = 46) and those without significant personality pathology (NOPD; N = 23). Results: Results suggested that BPD patients have fewer social contacts compared with those in the NOPD group. Additionally, the BPD patients characterized their social interactions as more disagreeable, ambivalent, angry, empty, and sad compared with the OPD and NOPD groups. BPD patients reported experiencing more anxiety and less positive affect compared with the NOPD but not the OPD group. Conclusion: These findings highlight aspects of day-to-day interpersonal functioning that are specific to BPD.

Systematic assessment of social phobia in clinical practice

The purpose of this review is to propose a systematic approach to the assessment of social phobia for monitoring treatment outcome in clinical settings. A selection of measures is available, including questionnaires and structured interviews varying in length, complexity, and content. To design an assessment protocol for a particular patient or patient population, the clinician needs to be familiar with the characteristics of these available measures. The measures selected for detailed description and discussion here: (a) are specifically designed to assess social anxiety and social phobia, (b) have been demonstrated to have acceptable psychometric characteristics, and

Treating Low-Income and Minority Women With Posttraumatic Stress Disorder A Pilot Study Comparing Prolonged Exposure and Treatment as Usual Conducted by Community Therapists

Twenty-one female psychiatric outpatients with chronic posttraumatic stress disorder (PTSD) are randomly assigned to prolonged exposure (PE; n = 9) for PTSD or treatment as usual (TAU; n = 12). Participants are predominately low income and African American with complex trauma and psychiatric histories. Treatment is delivered by community therapists with no prior training in behavior therapy for anxiety disorders. Clients who completed PE show a greater improvement in PTSD symptoms, general anxiety, and depression than clients who completed TAU. These findings provide preliminary evidence suggesting that PE is an effective treatment for core PTSD symptoms, even when delivered by community therapists in a front-line services clinic.

Assessment of risk for substance use disorder consequent to consumption of illegal drugs: psychometric validation of the neurobehavior disinhibition trait.

Previous research has shown that the trait neurobehavior disinhibition (ND), which consists of affect, behavior, and cognitive indicators of self-regulation, is a significant predictor of substance use disorder (SUD) between childhood and young adulthood. The authors evaluated the psychometric properties of the ND trait in 278 boys evaluated at ages 10-12 and 16 years. ND score significantly predicted SUD and outcomes that commonly manifest in tandem with SUD by age 19, such as violence, arrests, committing crime while intoxicated, and concussion injury. In addition to predictive validity, the ND trait was found to have good construct, discriminative, and concurrent validity, as well as good test-retest and internal reliability. The ND trait may be useful for detecting youths at high risk for developing SUD and related outcomes.

Anger, preoccupied attachment, and domain disorganization in borderline personality disorder

Emotional dysregulation and attachment insecurity have been reported in borderline personality disorder (BPD). Domain disorganization, evidenced in poor regulation of emotions and behaviors in relation to the demands of different social domains, may be a distinguishing feature of BPD. Understanding the interplay between these factors may be critical for identifying interacting processes in BPD and potential subtypes of BPD. Therefore, we examined the joint and interactive effects of anger, preoccupied attachment, and domain disorganization on BPD traits in a clinical sample of 128 psychiatric patients. The results suggest that these factors contribute to BPD both independently and in interaction, even when controlling for other personality disorder traits and Axis I symptoms. In regression analyses, the interaction between anger and domain disorganization predicted BPD traits. In recursive partitioning analyses, two possible paths to BPD were identified: high anger combined with high domain disorganization and low anger combined with preoccupied attachment. These results may suggest possible subtypes of BPD or possible mechanisms by which BPD traits are established and maintained.

Borderline Personality and Substance Use in Women

The association between borderline personality disorder (BPD) and substance use disorder (SUD) was examined in a predominantly psychiatric (77.6%) sample of 232 women. BPD proved to be a significant predictor of a lifetime diagnosis of SUD across four different categories: any SUD (including alcohol); alcohol use; drug use; and heroin, cocaine, or poly-substance use. BPD continued to be a predictor of SUD even when the effects of other cluster B and all cluster C PDs were controlled statistically. Antisocial personality disorder generally yielded larger odds ratios than BPD and emerged as a partial mediator of the relation between BPD and SUD. Histrionic PD was the only other PD that showed meaningful relations with SUD.

Treating low-income and African-American women with posttraumatic stress disorder: A case series

The present uncontrolled case series was designed to examine the feasibility of prolonged exposure (PE) for posttraumatic stress disorder (PTSD) with low-income and African-American women. Five of 10 eligible women completed PE and showed significant improvements in symptoms of PTSD, general anxiety, and depression. Clinical observations suggest that the addition of interventions aimed at improving interpersonal problems might lead to a more complete recovery in this population of women with complex trauma and psychiatric histories and that a priming intervention focused on teaching affect-regulation skills might enhance the effectiveness of PE. The removal of structural barriers (e.g., lack of transportation and child care) appears to be necessary in order to boost the benefits of traditional treatment interventions in disadvantaged women.