Cognitive Therapy and Research

Capone, Christy; Presseau, Candice; Saunders, Elizabeth; Eaton, Erica; Hamblen, Jessica; McGovern, Mark

2018 Cognitive Therapy and Research

doi: 10.1007/s10608-018-9931-8

This study is the first to examine integrated cognitive behavioral therapy (ICBT) in a sample of military veterans with co-occurring posttraumatic stress disorder (PTSD) and substance use disorders (SUD). Generalized linear mixed models were used to examine primary outcomes from a small, randomized clinical trial comparing ICBT plus treatment as usual (TAU) to TAU only in a sample (N = 44) of U.S. veterans who served in Iraq and/or Afghanistan. A significant reduction in PTSD and SUD symptoms over time was detected in both conditions. One significant time-by-condition interaction effect for re-experiencing symptoms was observed, with ICBT showing greater reductions from baseline to post-treatment. Overall, the efficacy of ICBT in this veteran sample was not as robust as outcomes with non-veteran patients. Challenges to engagement and retention in treatment and further intervention adaptations for veterans are discussed.

Niles, Andrea; O’Donovan, Aoife

2018 Cognitive Therapy and Research

doi: 10.1007/s10608-018-9923-8

Experimental paradigms used in affective and clinical science often use stimuli such as images, scenarios, videos, or words to elicit emotional responses in study participants. Choosing appropriate stimuli that are highly evocative is essential to the study of emotional processes in both healthy and clinical populations. Selecting one set of stimuli that will be relevant for all subjects can be challenging because not every person responds the same way to a given stimulus. Machine learning can facilitate the personalization of such stimuli. The current study applied a novel statistical approach called a recommender algorithm to the selection of highly threatening words for a trauma-exposed population (N = 837). Participants rated 513 threatening words, and we trained a user–user collaborative filtering recommender algorithm. The algorithm uses similarities between individuals to predict ratings for unrated words. We compared threat ratings for algorithm-based word selection to a random word set, a word set previously used in research, and trauma-specific word sets. Algorithm-selected personalized words were more threatening compared to non-personalized words with large effects (ds = 2.10–2.92). Recommender algorithms can automate the personalization of stimuli from a large pool of possible stimuli to maximize emotional reactivity in research paradigms. These methods also hold potential for the personalization of behavioral treatments administered remotely where a provider is not available to tailor an intervention to the individual. The word personalization algorithm is available for use online ( https://threat-word-predictor.herokuapp.com/ ).

Bryan, Craig; Oakey, D.; Harris, Julia

2018 Cognitive Therapy and Research

doi: 10.1007/s10608-018-9932-7

Reasons for living are associated with reduced suicide risk, but have not received much empirical attention among U.S. military personnel, a population with elevated suicide risk. The present study examined the factor structure, reliability, and validity of the Brief Reasons for Living Inventory (BRFLI) in a clinical sample of 97 treatment-seeking Army personnel with recent suicide ideation and/or a history of suicide attempts. Results supported a five-factor structure for the BRFLI. Each factor had good internal consistency (ω’s > 0.94) and demonstrated convergent and divergent validity. Survival and coping beliefs and responsibility to family subscale scores were negatively correlated with recent suicidal thinking. Responsibility to family subscale scores were associated with significantly reduced risk of suicide attempts during follow-up. BRFLI subscale scores showed little to no clinical responsivity following intervention. Results suggest survival and coping beliefs and responsibility to family may be protective for high-risk military personnel.

Roeder, Kathryn; Cole, David

2018 Cognitive Therapy and Research

doi: 10.1007/s10608-018-9939-0

The current study combines models about the effects of peer victimization on negative self-cognitions with models about the effects of negative cognitions on suicidal ideation. In a two-wave longitudinal investigation of high schoolers (N = 192) and college students (N = 142), the study examined perceived burdensomeness, thwarted belongingness, and hopelessness as mediators of the prospective relation between peer victimization and suicidal ideation. Path analyses yielded three findings: (a) peer victimization predicted perceived burdensomeness but not thwarted belongingness or hopelessness; (b) perceived burdensomeness, thwarted belongingness, and hopelessness each predicted suicidal ideation; and (c) perceived burdensomeness mediated part of the relation between peer victimization and suicidal ideation. These patterns were consistent across samples and did not differ significantly by gender. Results are consistent with aspects of all three original models and provide support for a new cognitive mediation model regarding the relation of peer victimization to suicidal ideation.

Gjelsvik, B.; Kappelmann, N.; Soest, T.; Hinze, V.; Baer, R.; Hawton, K.; Crane, C.

2018 Cognitive Therapy and Research

doi: 10.1007/s10608-018-9924-7pmid: 30416229

Although suicidal ideation is one of the most consistent symptoms across recurrent episodes of depression, the mechanisms underpinning its maintenance are poorly understood. In order to develop effective treatments for suicidally depressed patients, understanding what maintains suicidal distress is critical. We hypothesised that Thought–Action Fusion (TAF), i.e., to assume that having a thought has real world consequences, originally described in Obsessive–Compulsive Disorder, might be a bias in recurrently suicidally depressed people. To assess this, we revised the original TAF scale, and assessed TAF in three samples: healthy controls, recurrently depressed individuals with no history of suicidality (D-NS) and individuals with a history of recurrent suicidal depression (D-S). Exploratory and confirmatory factor analyses indicated a three-factor solution of TAF: (1) TAF for uncontrollable events, (2) self-suicidal TAF for suicidal acts related to oneself, and (3) TAF for positive controllable events. Compared to healthy controls, the D-NS group reported significantly higher total TAF, TAF uncontrollable, and TAF self-suicidal subscales, whilst positive controllable TAF was lower compared to healthy controls. Both D-S and D-NS samples reported higher TAF for suicidal thought compared to healthy controls, i.e., believing that having suicidal thoughts means they will act on them, however in the context of low mood this became more pronounced for the D-S group. These findings suggest that targeting TAF both in suicidal and non-suicidal depression has merit.

Weinstock, Lauren; Chou, Tina; Celis-deHoyos, Cintly; Miller, Ivan; Gruber, June

2018 Cognitive Therapy and Research

doi: 10.1007/s10608-018-9945-2

Bipolar disorder (BD) and major depressive disorder (MDD) cannot be reliably differentiated by depression symptom expression alone, suggesting a need to identify processes that may more effectively differentiate the two disorders. To explore this question, currently depressed adults with BD (n = 30) and MDD (n = 30), and healthy control participants with no history of psychiatric illness (CTL; n = 30), completed self-report measures of reward and punishment sensitivity (i.e., behavioral activation and inhibition) and emotion regulation processes (i.e., rumination and avoidance). Results revealed that constructs putatively linked to depression across the mood disorders (i.e., behavioral inhibition, negative rumination, dampening of positive affect, behavioral and experiential avoidance) were significantly higher in both mood disorder groups compared to CTLs. Yet there was also some specificity between mood disorder groups, such that the BD group reported significantly greater reward responsiveness and positive rumination, in addition to greater behavioral inhibition and avoidance, compared to the MDD group. These data suggest that patterns of affective responding previously linked to underlying risk for mania in BD may remain evident during a major depressive episode. Further, current models of reward sensitivity in BD may benefit from the inclusion of punishment sensitivity and behavioral avoidance, particularly with respect to bipolar depression.

McArthur, Brae; Haas, Liza; Burke, Taylor; Johnson, Lisa; Olino, Thomas; Abramson, Lyn; Alloy, Lauren

2018 Cognitive Therapy and Research

doi: 10.1007/s10608-018-9930-9pmid: 33223584

Adolescence is a period of human development associated with increased emotional intensity and heightened vulnerability to developing psychopathology. This study used Latent Class Analysis to identify subgroups of youth based on emotional clarity and cognitive response styles. Participants were 436 adolescents (51.8% female; 48.2% African-American/Black, 47.4% Caucasian/White) who completed measures of emotional clarity, cognitive response styles, and depression at baseline (M = 13.02 years, SD = .83), and at a 1-year and 4-year follow-up. Four classes were identified and used to predict depression outcomes. Overall, youth with above average emotional clarity who reported using a variety of adaptive cognitive response styles also had the lowest level of depressive symptoms at baseline. Class membership did not predict depressive symptoms at any follow-up. The results suggest that the unique profiles based on youth reported levels of emotional clarity and use of problem solving, distraction, and rumination, may not be more predictive of depression outcomes, beyond earlier assessments of depression or by examining these facets in isolation.

Tuijl, Lonneke; Glashouwer, Klaske; Bockting, Claudi; Penninx, Brenda; Jong, Peter

2018 Cognitive Therapy and Research

doi: 10.1007/s10608-018-9926-5

Self-esteem has not only been observed to be generally low in depression and anxiety, but also unstable. Few studies have looked at unstable self-esteem in clinical samples. The present study compared self-reported self-esteem instability across current depression (n = 60), anxiety (n = 111), and comorbid depression/anxiety (n = 71), remitted depression (n = 41), and anxiety (n = 29), recovered depression (n = 136) and anxiety (n = 98), and a never clinically depressed or anxious comparison group (n = 382). The comparison group had more stable self-esteem than all groups. Once controlling for overall levels of self-esteem, differences with current depression or anxiety, remitted depression, and recovered depression or anxiety remained, but disappeared for the comorbid group. The current findings are consistent with the view that not only enduring low self-esteem per se, but also high self-esteem reactivity may contribute to the aetiology of affective disorders.

Woodward, Emma; Viana, Andres; Raines, Elizabeth; Hanna, Abigail; Zvolensky, Michael

2018 Cognitive Therapy and Research

doi: 10.1007/s10608-018-9943-4

The present investigation examined the underlying role of anxiety sensitivity and its facets in the association between emotion dysregulation and three of the most prevalent and debilitating symptom classes among trauma-exposed psychiatric inpatient youth: posttraumatic stress disorder (PTSD), anxiety, and depression symptoms. Participants (N = 50; 52.0% female; M age  = 15.1 years, SD = .51, range 12–17 years) completed an assessment battery that included measures of emotion dysregulation anxiety sensitivity, PTSD, anxiety, and depression symptoms. Consistent with hypotheses, the global construct of anxiety sensitivity, as well as its mental incapacitation concerns and disease concerns facets, explained, in part, associations between emotion dysregulation and the three symptom classes. The study results provide novel and clinically meaningful findings regarding the potential mechanistic role of anxiety sensitivity in the relation of emotion dysregulation to PTSD and internalizing symptoms among trauma-exposed inpatient adolescents. As such, findings underscore the potential value of targeting anxiety sensitivity in general, and mental incapacitation and disease concerns specifically, as a means of reducing risk for internalizing psychopathology among trauma-exposed inpatient youth.

Edwards, Cierra; Portnow, Sam; Namaky, Nauder; Teachman, Bethany

2018 Cognitive Therapy and Research

doi: 10.1007/s10608-018-9922-9

Cognitive Bias Modification to reduce threat interpretations (CBM-I) is a computer-based paradigm designed to train a less negative interpretation bias that has shown some success in the lab, but results for web-based CBM-I are often mixed. To test possible explanations for the poorer results online, participants high in social anxiety (N = 379) were recruited from Amazon’s Mechanical Turk to complete a single-session, proof-of-principle study to investigate: (1) whether web-based CBM-I can shift interpretations of social situations to be less negative and reduce anticipatory social anxiety, (2) whether a common “control” condition used in CBM-I studies is in fact inert by incorporating an alternate control condition, and (2) whether priming anxious imagery prior to training moderates CBM-I’s effects. Participants were randomly assigned to one of three training conditions: all positive, half positive/half negative, or neutral unemotional scenarios. Participants also received an anxious or neutral imagery prime before training. Although results were somewhat mixed across outcome measures, findings generally suggested that participants exhibited less negative interpretations of ambiguous social scenarios following positive training with an anxious imagery prime. There was also some evidence that the neutral training condition was associated with less negative interpretations, and evidence that the half positive/half negative training condition led to the least anticipatory anxiety, especially when paired with anxious imagery. Findings are discussed in light of different training effects for near- and far-transfer outcomes.