All by Myself: Loneliness in Social Anxiety DisorderOren-Yagoda, Roni; Melamud-Ganani, Iron; Aderka, Idan M.
doi: 10.1037/abn0000705pmid: 34843268
In the present study we examined loneliness among individuals with and without social anxiety disorder (SAD), contexts that may moderate the experience of loneliness, and the temporal relationship between loneliness and social anxiety. We examined 88 individuals (44 with SAD and 44 without SAD) and used experience sampling (ES) methods, comprising of real-time measurement of naturally occurring events and participants’ emotional reactions to them during participants’ daily lives over the course of 21 days. Hierarchical linear models indicated that individuals with SAD reported significantly more loneliness compared to individuals without SAD. We also found that characteristics of social situations (negativity, positivity, and meaningfulness) were all positively and significantly associated with loneliness among individuals with SAD. Thus, social situations that were experienced as more negative, more positive, and more meaningful all resulted in increased loneliness for individuals with SAD. We also found a significant Positivity × Meaningfulness interaction that indicated that the effect of positivity was attenuated when meaningfulness was high. Notably, none of these effects were found for individuals without SAD. Finally, we found that for individuals with SAD, both anxiety and loneliness predicted changes in each other and combined to form a deleterious cycle. However, evidence for such a cycle was not found for individuals without SAD. The role of loneliness in the psychopathology of SAD and its maintenance, as well as clinical implications are discussed.
Young Children With Suicidal Thoughts and Behaviors More Likely to Resolve Conflicts With Violence, Homicide, or Suicide: A Study of Internal Working Models Using NarrativesHennefield, Laura; Hao, Jessica M.; Joiner, Thomas E.; Whalen, Diana J.; Giorio, Cristal; Luby, Joan L.
doi: 10.1037/abn0000723pmid: 35230126
There is mounting evidence that young children who express suicidal ideation (SI) have a different conceptualization of death than their peers. This study characterizes 3- to 6-year-olds’ depictions of violence, death, and suicidal themes in a story completion task as a function of their history of SI. Participants were 228 children with depression (3.0–6.9 years) who completed a comprehensive psychiatric assessment and four story stem narratives. For each narrative, an interviewer began a story with a conflict that the child was encouraged to resolve. Children’s resolutions were coded for standard themes and negative atypical themes including violence and homicide, accidental harm or death, and suicidal ideation/acts. Themes were examined as a function of children’s SI status: active-SI (n = 25), passive-SI (n = 28), or no history of SI (n = 175). Across the narratives, 89 children described at least one negative atypical theme: violence or homicide (n = 78), accidental harm or death (n = 22), and suicide (n = 13). The responses of children with active-SI included significantly more violence or homicide than children without SI. Moreover, current active-SI predicted suicidal themes. There were no group differences in accidental harm or death, nor in common aggressive or punitive acts (e.g., hitting, yelling, spanking), indicating specificity between active-SI and more intense violence and death-related themes. In sum, young children with active SI are more likely than their depressed peers without SI to incorporate violence, homicide, and suicide into their narratives around conflict resolution. These themes appear more salient to depressed children with SI and pervasive in their thoughts and problem-solving strategies.
Delay Discounting in Suicidal Behavior: Myopic Preference or Inconsistent Valuation?Tsypes, Aliona; Szanto, Katalin; Bridge, Jeffrey A.; Brown, Vanessa M.; Keilp, John G.; Dombrovski, Alexandre Y.
doi: 10.1037/abn0000717pmid: 34843269
Prior studies sought to explain the predisposition to suicidal behavior in terms of myopic preference for immediate versus delayed reward, generating mixed evidence. Data from gambling and bandit tasks, however, suggest that suboptimal decisions in suicidal individuals are explained by inconsistent valuation rather than myopic preferences. We tested these two alternative hypotheses using a delay discounting task in 622 adults (suicide attempters with depression, suicide ideators with depression, nonsuicidal participants with depression, and healthy controls) recruited across three sites through inpatient psychiatric units, mood disorders clinics, primary care, and advertisements. Multilevel models revealed group differences in valuation consistencies in all three samples, with high-lethality suicide attempters exhibiting less consistent valuation than all other groups in Samples 1 and 3 and less consistent valuation than the healthy controls or participants with depression in Sample 2. In contrast, group differences in preference for immediate versus delayed reward were observed only in Sample 1 and were due to the high-lethality suicide attempters displaying a weaker preference for immediate reward than low-lethality suicide attempters. The findings were robust to confounds such as cognitive functioning and comorbidities. Seemingly impulsive choices in suicidal behavior are explained by inconsistent reward valuation rather than a true preference for immediate reward. In a suicidal crisis, this inconsistency may result in a misestimation of the value of suicide relative to constructive alternatives and deterrents.
Stop Self-Injuring, Then What? Psychosocial Risk Associated With Initiation and Cessation of Nonsuicidal Self-Injury From Adolescence to Early AdulthoodTurner, Brianna J.; Helps, Carolyn E.; Ames, Megan E.
doi: 10.1037/abn0000718pmid: 34843270
Nonsuicidal self-injury (NSSI) typically begins in adolescence and remits by early adulthood, but few prospective studies have investigated the long-term impact of NSSI initiation and cessation on young people’s wellbeing. We examined changes in psychosocial risk associated with NSSI onset and offset in an accelerated longitudinal study of 662 adolescents (12–18 years old) who were followed biennially for 10 years. Of the 133 participants who reported NSSI, 100 had stopped engaging in NSSI by the study’s end. NSSI initiation was associated with concurrent increases in depression, anxiety, externalizing symptoms, peer victimization, alcohol, tobacco and illicit substance use, and concurrent declines in physical self-concept, parent, and peer support. As NSSI persisted, youth experienced further increases in anxiety and cannabis use, and declines in physical self-concept. NSSI cessation was associated with concurrent increases in alcohol, cannabis, and tobacco use. With sustained cessation, however, youth experienced gradual improvements in depression, anxiety, externalizing symptoms, peer victimization, as well as gradual reductions in alcohol and tobacco use. By early adulthood, participants who reported ongoing NSSI worked fewer hours and were more likely to delay medical treatment for financial reasons versus those without NSSI histories, and reported less environmental mastery versus those who had discontinued NSSI. Youth who had discontinued NSSI, in turn, reported less environmental mastery and self-acceptance versus youth who never engaged in NSSI. These results contextualize NSSI cessation alongside indicators of psychological, social, and behavioral wellbeing, and underscore the persistence of psychosocial vulnerability after NSSI has resolved.
Longitudinal Group and Individual Networks of Eating Disorder Symptoms in Individuals Diagnosed With an Eating DisorderLevinson, Cheri A.; Hunt, Rowan A.; Christian, Caroline; Williams, Brenna M.; Keshishian, Ani C.; Vanzhula, Irina A.; Ralph-Nearman, Christina
doi: 10.1037/abn0000727pmid: 34941316
Eating disorders (EDs) are serious psychiatric illnesses with high mortality and societal cost. Despite their severity, there are few evidence-based treatments, and only 50% of individuals respond to existing treatments. This low response rate may be due to the fact that EDs are highly heterogeneous disorders. Precision treatments are needed that can intervene on individual maintenance factors. The first step in such treatment development is identification of central treatment targets, both at the group (i.e., on average) and individual level. The current study (N = 102 individuals with an ED) utilized intensive longitudinal data to model several types of group-level and individual network models. Overall, we identified several group-level central symptoms, with the most common central symptoms of fear of weight gain, desire for thinness, feeling like one is overeating, thinking about dieting, and feeling guilty. We also found that these symptoms, specifically fear of weight gain, a desire to be thinner, thinking about dieting, feeling like one is overeating, and feeling guilty, predicted ED severity at a 1- and 6-month follow-up. We modeled 97 individual networks and found that central symptoms were highly heterogeneous, regardless of ED diagnosis. This work adds to the growing literature using intensive longitudinal data to model ED pathology and implicates fear of weight gain, thinking about dieting, and feelings of guilt as symptoms needing further treatment development work. Additionally, this work contributes essential knowledge on how group and individual network modeling can be used to conceptualize the maintenance of EDs on average and at the individual level.
Stressor-Elicited Smoking and Craving During a Smoking Cessation AttemptSchultz, Megan E.; Fronk, Gaylen E.; Jaume, Natalie; Magruder, Katherine P.; Curtin, John J.
doi: 10.1037/abn0000702pmid: 34881919
Stressors can undermine smokers’ attempts to quit smoking. Although contemporary theories and animal models support this idea, human research has struggled to demonstrate definitively the relationship between stressors and smoking. Researchers have employed more ecologically valid methods like ecological momentary assessment to address this question, but studies focusing explicitly on stressors remain sparse and findings inconsistent. The purpose of this study was to examine the effect of stressful event intensity on smoking and craving among cigarette smokers during a quit attempt. We conducted preregistered, complementary concurrent and prospective (i.e., 8-hour lag window between stressful event and outcomes) analyses to maximize statistical power and provide temporal ordering, respectively. We also conducted follow-up moderation (Lag × Stressful Event Intensity) analyses. We hypothesized that smokers would be more likely to report both smoking and craving as the intensity of stressful events increased. Cigarette smokers (N = 125; 77 male) were randomly assigned to take nicotine replacement therapy (NRT) or placebo and provided 4x daily self-reports during the first 2 weeks of a quit attempt. Stressful events increased craving and the probability of smoking in concurrent analyses, and lag moderated the effect of stressful event intensity in follow-up prospective lagged analyses. NRT reduced the probability of smoking but not craving and did not moderate the effect of stressful events on smoking or craving. This study supports a prospective relationship between stressful events and smoking/craving in situ and demonstrates that NRT does not reduce the impact of stressors on smoking or craving.
Estimating the Symptom Structure of Bipolar Disorder via Network Analysis: Energy Dysregulation as a Central SymptomMcNally, Richard J.; Robinaugh, Donald J.; Deckersbach, Thilo; Sylvia, Louisa G.; Nierenberg, Andrew A.
doi: 10.1037/abn0000715pmid: 34871024
Using network analysis, we estimated the structure of relations among manic and depressive symptoms, respectively, in 486 patients (59% women; age: M = 37, SD = 12.1) with bipolar disorder prior to their entering a clinical trial. We computed three types of networks: (a) Gaussian graphical models (GGMs) depicting regularized partial correlations, (b) regression-based GGMs depicting nonregularized partial correlations, and (c) directed acyclic graphs (DAGs) via a Bayesian hill-climbing algorithm. Low energy and elevated energy were consistently identified as central nodes in the GGMs and as key parent nodes in the DAGs. Across analyses, pessimism about the future and depressed mood were the symptoms most strongly associated with suicidal thoughts and behavior. These exploratory analyses provide rich information about how bipolar disorder symptoms relate to one another, thereby furnishing a foundation for investigating how bipolar disorder symptoms may operate as a causal system.
A Time-Lagged Study of Predictors of Paranoia and Psychotic-Like Experiences in Daily Life Across the Schizotypy ContinuumMonsonet, Manel; Kwapil, Thomas R.; Barrantes-Vidal, Neus
doi: 10.1037/abn0000726pmid: 34914404
Leading theoretical models of psychosis implicate a wide range of psychological factors in the development of positive symptoms. Ambulatory assessment allows us to repeatedly assess people’s mental experiences within and across days to explore putative moment-to-moment prospective relationships that impact the onset and exacerbation of positive symptoms. This study used experience sampling methodology to examine the putative temporal associations of both risk and protective factors (negative emotional states, stress, self-esteem, and social appraisals) with the experience of paranoia and other positive psychotic-like experiences (PLE) in daily-life. A combined sample of 178 participants including 65 high-schizotypy, 74 at-risk mental states for psychosis, and 39 first-episode psychosis individuals was assessed repeatedly over seven consecutive days. Sadness, anxiety, stress, and negative social appraisals predicted higher levels of subsequent paranoia and PLE. In contrast, self-esteem and subjective appraisals of social support and social closeness predicted lower levels of paranoia and PLE. Most findings did not vary across subclinical, at-risk, and clinical levels of psychosis expression. Results support psychological models of psychosis and provide new evidence to disentangle psychological factors involved in the mechanistic pathways to positive symptoms. The findings can help the design of ecological momentary interventions delivered in real-time aimed at buffering psychological mechanisms that promote psychotic symptoms and strengthening causal mechanisms that protect from the development of positive symptoms. Finally, findings suggest that highly similar psychological mechanisms are implicated in the development of psychotic experiences across nonclinical, subclinical, and clinical expressions of schizotypy.