Cognitive Therapy and Research

Profiles of Emotion Regulation in Young People Accessing Youth Mental Health and Drug Treatment Abstract Deficits regulating emotions are a core process underlying both substance use and mental health disorders. Research has focused on identifying one-to-one associations between individual emotion regulation (ER) strategies and mental health symptoms. Consequently, little is known about how patterns of ER relate to a broad range of psychopathology, in treatment seeking young people. Latent class analysis was used to examine patterns of ER strategies and their relationship with symptoms of depression, anxiety, eating disorders, substance use and borderline personality disorder, in a sample of young treatment seekers. Participants were young people (N = 306, M = 20.8 years) accessing youth advocacy and support or mental health services in Australia. Participants recalled an emotionally-arousing event experienced when on their own and indicated their use of 14 possible ER responses in an online questionnaire. Symptoms of mental health and substance use were measured. The LCA identified three distinct classes of ER responses: Ruminators/avoiders (n = 76), active regulators (n = 81), and low regulators (n = 129). The ruminators/avoiders endorsed the most severe symptom picture across all disorders except alcohol use. Within this cohort, distinct patterns of ER responding had unique relationships with symptoms of psychopathology. The deleterious impact of heightened maladaptive ER strategies (rumination and avoidance) in the absence of adaptive strategies was highlighted.

Feasibility and Impact of a Guided Symptom Exposure Augmented Cognitive Behavior Therapy Protocol to Prevent Symptoms of Pharmacologically Induced Depression: A Pilot Study Abstract Depression is the leading cause of disability and a major cause of morbidity worldwide, with societal costs now upwards of 1 trillion dollars across the globe. Hence, extending current efforts to augment prevention outcomes is consistent with global public health interests. Although many prevention programs have been developed and have demonstrated efficacy, studies have yet to demonstrate that CBT is effective in preventing symptoms in populations at risk for developing depression induced by pharmacological substances. Using a randomized, controlled design, this pilot study reports on the feasibility and preliminary effects of a novel, guided symptom exposure augmented cognitive behavioral prevention intervention (GSE-CBT) in a sample diagnosed with Hepatitis C at risk for developing medication induced depression. Results demonstrated that the guided symptom exposure augmented CBT (GSE-CBT) was feasible in this population and was delivered with high integrity. Although not statistically different, we observed a pattern of lower depression levels in the GSE-CBT group versus those in the control group throughout. This pilot study demonstrates that a psychosocial prevention intervention is feasible for use in patients at risk for developing pharmacologically induced depression and that a guided symptom exposure augmented CBT protocol has the potential to prevent symptoms of depression that develop as a side effect to taking these medications. Results are preliminary and future studies should use larger samples and test the intervention in other populations.

Early Versus Later Improvements in Dialectical Behavior Therapy Skills Use and Treatment Outcome in Eating Disorders Abstract Dialectical behavior therapy (DBT) has demonstrated initial efficacy for the treatment of eating disorders (EDs). However, no study has examined potential processes that may contribute to observed improvements in DBT for EDs. The present study sought to investigate changes in DBT skills use throughout treatment as a predictor of symptom change in a DBT-based partial hospital program (PHP) for adults with EDs. Adults [n = 135; M(SD) age = 25.08 (7.88)] with EDs completed self-report measures at treatment admission, one-month post-admission, and discharge from PHP. DBT skills use, as measured by the DBT Ways of Coping Checklist, increased by 12.65% from admission to one-month post-admission and increased by 24.10% from admission to discharge. Early (admission to month 1) and later (month 1 to discharge) improvements in DBT skills use predicted greater improvements in ED, depressive, and emotion dysregulation symptoms from treatment admission to discharge. Notably, early versus later change in skills use was a stronger predictor of outcome. Results are consistent with the theoretical model of DBT and add to a growing literature on DBT for EDs.

Different Patterns of Attention Bias in Worry and Rumination Abstract In two studies with college student participants, we explored the ways in which worry and rumination may be similar or distinct. Towards that end, as part of our research, we developed new laboratory measures of worry and rumination. In Study 1, we examined how the new lab instruments we developed differentiate worry versus rumination and initiation versus termination. We did so by comparing them with two other measurement methods of worry and rumination, ecological momentary assessment and questionnaires. We found that the laboratory measures were reasonably able to differentiate worry from rumination, but not initiation from termination. In Study 2, we further examined the relationship between attentional biases to threat/danger and loss/failure (using the dot probe task) and both worry and rumination to explore the nature of distinctions between worry and rumination. We found different patterns of attentional bias associated with worry and rumination. Worry was associated with bias away from threat. In contrast, rumination was associated with bias toward loss/failure. The results of the two studies suggest that there are some meaningful differences between worry and rumination. The implications of the current findings are discussed.

#Sad: Twitter Content Predicts Changes in Cognitive Vulnerability and Depressive Symptoms Abstract Research shows that social media networks can affect both the physical and mental health of its users. We hypothesized that social media would also be associated with cognitive vulnerability to depression. To test this hypothesis, we used a 3-month pre-post prospective longitudinal design with a sample of undergraduates (n = 105). Results showed that participants who had tweets with a "past focus" (as determined by LIWC software) were more likely to exhibit increases in cognitive vulnerability and depressive symptoms than participants who did not have tweets with a past focus. Increases in cognitive vulnerability were associated with increases in depressive symptoms. However, the effect of Twitter content on future depressive symptoms was not accounted for by increases in cognitive vulnerability. Rather, one's past focus Twitter content had an effect on future depressive symptoms that was independent of its effect on future cognitive vulnerability levels. These results provide further support for the plasticity of cognitive vulnerability in early adulthood as well as corroborate emerging evidence for the association between social media and mental health risk factors.

Symptom-Specific Threat Perception Mediates the Relationship Between Obsessive Beliefs and OCD Symptoms Abstract Cognitive theories of obsessive compulsive disorder (OCD) propose that obsessive beliefs bias individuals' perception of OC-relevant threats, which in turn maintain OCD symptoms. However, no prior research has directly tested this mediational model in a clinical sample. The current study bridges this gap in the literature. Sixty adults with OCD completed a diagnostic interview, self-report questionnaires and a threat perception task. More specifically, participants rated the perceived threat associated with (a) OC-specific stimuli (e.g., toilet) that matched their most interfering symptom dimension (e.g., contamination) and (b) generally negative terms (e.g., pain). Results supported hypotheses, in that the threat associated with OC-specific—but not generally negative—terms significantly mediated the relationship between obsessive beliefs and the severity of participants' most interfering OCD symptom dimension. Findings underscore the importance of targeting inflated perceptions of OC-specific threats in the treatment of OCD. Limitations and future directions are discussed.

Does Modification of Implicit Associations Regarding Contamination Affect Approach Behavior and Attentional Bias? Abstract Individuals with contamination concerns show aberrant interpretational and attentional processes. Yet, it is unclear whether threat-related associations play a causal role in anxiety symptoms and attentional bias. The objective of our study was to investigate if training implicit associations affects stress reactivity and attention in the context of contamination concerns. In a double-blind randomized design, we used a modified Implicit Associations Task (IAT) to train associations between contamination and danger in a non-clinical sample (N = 121). Dependent measures were a brief-IAT to assess changes in associations, contamination-related behavior approach tasks, and a spatial cueing task to measure attentional bias. Results show that training successfully modified implicit associations. However, there were no transfer effects on approach behavior or attention. Findings suggest that the modified IAT is a useful task for training implicit associations, but that transfer to other domains (attention and behavior) is limited. Limitations and future implications are discussed.

How Do I Say This? An Experimental Comparison of the Effects of Partner Feedback Styles on Reassurance Seeking Behaviour Abstract Interventions for reassurance seeking (RS) in obsessive–compulsive disorder typically include reducing accommodation by asking partners to not provide reassurance, which may decrease RS but increase distress and be perceived as unhelpful. Alternatively, having partners provide support to encourage coping may be effective and associated with greater perceived helpfulness and lower negative affect. This experiment tested hypotheses that compared with no reassurance, supportive feedback would be associated with higher ratings of intervention helpfulness, fewer requests for reassurance, and lower ratings of RS urges and negative affect. Participants completed a threat-inducing kitchen task while observed by a partner, and afterwards sought reassurance to make a decision about safety. Partners' feedback was manipulated such that half (n = 51) provided typical accommodation reduction-focused feedback and half (n = 51) provided support-focused feedback. Results suggest that individuals who received support-focused feedback versus accommodation reduction-focused feedback rated their partner's feedback as significantly more helpful (d = 1.22). There was also a small-to-moderate effect size and trend suggesting that support was associated with less RS (d = 0.33). Overall, support provision may be associated with less RS behaviour and greater perceived helpfulness, and holds promise as an alternative intervention technique to strict accommodation reduction for problematic RS.

Intergenerational Transfer of Early Maladaptive Schemas in Mother–Daughter Dyads, and the Role of Parenting Abstract Expanding limited research on the origins of early maladaptive schemas, this study investigated relations between parental (mother) schemas and parenting styles with child (adult daughter) schemas using cross-sectional methodology. One hundred women (aged 18–88) participated in the study and 39 matched mother–daughter dyads were analysed. The Young Schema Questionnaire, Depression Anxiety and Stress Scale, Parental Bonding Instrument and Parental Authority Questionnaire were used to assess individual schemas, parenting styles from the daughters' perspective, and depression as a mood-state control variable. Mother schemas predicted a range of daughter schemas. There was also evidence of direct transference ('selective internalisation') of some schemas between mothers and daughters. Daughter schemas were associated with parenting styles. In particular, high authoritative parenting predicted lower levels of daughter schemas and high overprotective parenting predicted higher levels of daughter schemas. There was no firm evidence that authoritative parenting mediated the relationship between mother and daughter schemas in this domain. The major limitations of this study are the cross-sectional design and relatively small sample. In conclusion, mother maladaptive schemas and style of parenting predict daughter schemas. The results provide support for interpersonal, intergenerational influences on schema development. In highlighting the possible intergenerational sources of maladaptive core beliefs, this research may open new avenues of therapist–client dialogue.

Effects of Mindfulness-Based Cognitive Therapy on a Behavioural Measure of Rumination in Patients with Chronic, Treatment-Resistant Depression Abstract It has been found that Mindfulness-based cognitive therapy (MBCT) reduces rumination in remitted and currently depressed patients. However, less is known about the effects of MBCT on rumination in chronically and treatment-resistant depressed patients. Typically, questionnaires are used to assess rumination, but this introduces the risk of response and recall biases. A recent systematic review (van der Velden et al. Clinical Psychology Review 37:26–39, 2015) proposes to also include behavioural measures. A behavioural measure that has previously been used to assess rumination in dysphoric students is the breathing focus task (BFT). The first aim of this research was to investigate whether the BFT can be used in chronically, treatment-resistant depressed patients to measure rumination. We therefore administered the BFT in patients with chronic, treatment-resistant depression (n = 73) and compared them with never-depressed controls (n = 106). Patients reported significantly more negative thought intrusions and subsequent sad mood. Secondly we tested in a randomized-controlled trial whether MBCT in combination with treatment-as-usual (MBCT + TAU, n = 26) compared with TAU (n = 36) reduces rumination assessed with the BFT in chronically, treatment-resistant depressed patients. Negative thought intrusions significantly decreased in the MBCT + TAU condition, compared with TAU. The results show that MBCT reduces rumination assessed with the BFT in chronically, treatment-resistant depressed patients.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com