Feeling more confident to encounter negative emotions: The mediating role of distress tolerance on the relationship between self-efficacy and outcomes of exposure and response prevention for OCD

BACKGROUND

While exposure and response prevention (ERP) is the first-line treatment for obsessive-compulsive disorder (OCD), up to half of patients do not effectively respond. In an effort to better understand the mechanisms behind ERP, the inhibitory learning model emphasizes the roles of increasing perceived self-efficacy and distress tolerance. While self-efficacy and distress tolerance have separately been shown to predict OCD symptoms and treatment outcomes, no studies have assessed their joint effects in ERP. The current study examined distress tolerance as a mediator of the relationship between self-efficacy and ERP outcomes.

METHODS

Patients in an intensive ERP-based treatment program (N = 116) completed weekly self-report measures.

RESULTS

Over the course of treatment, as OCD symptoms reduced, self-efficacy and distress tolerance both significantly increased. Importantly, increases in self-efficacy and distress tolerance mediated each other in explaining symptom reduction, suggesting a possible bi-directional effect.

LIMITATIONS

The temporal relationship between changes in self-efficacy and distress tolerance is worthy of further investigation. In addition, the current sample had limited racial diversity and might not be representative of patients receiving lower levels of care. Findings merit replication to be ascertained of their reliability.

CONCLUSIONS

Findings suggest that during ERP, patients gain confidence in their abilities both to cope with general challenges and to withstand distress, potentially helping them engage with exposures and overcome initial fears. These findings provide support for the inhibitory learning model and highlight the mechanistic roles of self-efficacy and distress tolerance in ERP. Clinical implications to target both in treatment are discussed.

Collective action mitigates the negative effects of COVID-19 threat and anti-abortion restrictions on mental health

BACKGROUND

The COVID-19 pandemic changed our lives in many different domains, forcing people to adapt to countrywide lockdowns, school shutdowns, and business closures. The burden of the COVID-19 pandemic resulted also in deterioration of mental health. At the same time, political conflicts and social inequalities was reinforced and many people engaged in demonstrations to fight for their rights. This study examines whether collective acting for an important cause during the pandemic might mitigate the impact of both political tension related to anti-abortion restrictions and COVID-19 threats on mental health.

METHODS

We conducted a two-wave study with a representative sample of the Polish population, investigating the effect of participating in Polish pro-choice demonstrations on depressive and anxiety symptoms.

RESULTS

Participating in protests attenuated the negative effects of COVID-19 threat and anti-abortion restrictions on mental health. Moreover, we found that the feeling of solidarity with other demonstrators and sense of agency derived from such demonstrations led to lower levels of depressive and anxiety symptoms.

CONCLUSION

The results of the study indicate that participating in meaningful and value-oriented collective action may serve as a buffer against the detrimental effects of social and health threats.

Trait Depression and Subjective Well-Being: The Chain Mediating Role of Community Feeling and Self-Compassion

Although subjective well-being has been widely discussed as being one of the important indicators of clinical depression, few studies have explored how it relates to trait depression. In particular, increasing the number of positive experiences has long been a potential goal for depression-related clinical interventions, but the mechanisms by which such interventions work in countering depression have been poorly studied. Grounded in the cognitive theory of depression, the current study aimed to address this specific gap by testing the mediating effects of community feeling and self-compassion between trait depression and subjective well-being. A survey of 783 college students found that trait depression was not only able to directly and negatively predict individual subjective well-being but also indirectly predict individual subjective well-being through the mediating role of community feeling and self-compassion alone and through the chain mediating role of self-compassion from community feeling. These findings reveal the internal mechanisms of trait depression that, to some extent, impede subjective well-being and offer certain guiding significance for the self-regulation of interventions for clinical and non-clinical individuals with trait depression.

All Goals are Equal: No Interactions Between Depressive Symptoms and Goal Characteristics on Goal Progress

Introduction. Depression is related to poor achievement and impacts people's capacity to attain their goals (American Psychiatric Association, 2013; Johnson et al., 2010; Street, 2002). But do depressive symptoms impact goal pursuit differently depending on the kinds of goals that people pursue? Methods. Across three studies (total N = 666 undergraduate students, total goals = 2,546), we examine the role of up to 16 goal characteristics as moderators in the relationship between depressive symptoms and goal progress. Depressive symptoms and goal characteristics were assessed at baseline, and participants reported on goal progress at a follow-up 1 month (Study 1), 4 months (Study 2), or 8 months (Study 3) later. Results. The effect of depressive symptoms on goal progress was nonsignificant in two out of three studies (including one with low power), but an internal meta-analysis presented a small negative effect. Most goal characteristics did not moderate the relationship between depressive symptoms and goal progress, with Bayes factors suggesting substantial to very strong evidence in favor of the null hypotheses. Discussion. The kinds of goals students pursue may not matter in the presence of depressive symptoms. On one hand, this may provide a bleak outlook in highlighting that depressive symptoms impact all goals regardless of how well they are selected. On the other hand, the effects were small, which may offer a hopeful outlook for undergraduate students experiencing depressive symptoms, who may still be able to progress on their personal goals.

Employing Contemporary Integrative Interpersonal Theory to Understand Dysfunction in Those at Clinical High Risk for Psychosis

Poor social functioning is related to the development of psychosis; however, our current understanding of social functioning in those at-risk for psychosis is limited by (a) poor conceptual models of interpersonal behavior and (b) a reliance on comparisons to healthy controls (e.g., vs. clinical controls). In this study, we introduce Contemporary Integrated Interpersonal Theory (CIIT) and use its Interpersonal Circumplex (IPC) model to compare interpersonal behavior traits in those at clinical high-risk (CHR) for psychosis, clinical controls, and healthy controls. A community sample (N = 3460) was used to derive estimates of IPC dimensions (i.e., affiliation and dominance), which were then compared among a large subsample that completed diagnostic interviews (N = 337), which included a CHR group, as well as several control groups ranging on degree of psychosis vulnerability and internalizing disorders. CHR individuals were distinguished from healthy controls by low affiliation (d = –1.31), and from internalizing disorder groups by higher dominance (d = 0.64). Negative symptoms were consistently associated with low affiliation and low dominance, whereas positive symptoms were related primarily to coldness. These results connect social functioning in psychosis risk to a rich theoretical framework and suggest a potentially distinct interpersonal signature for CHR individuals. More broadly, this study suggests that CIIT and the IPC may have utility for informing diagnostics and treatment development in psychosis risk research.

The Effect of Perceived Over-Qualification on Turnover Intention From a Cognition Perspective

Employee turnover caused by over-qualification has become a new problem in organizational management. The mechanism underpinning the boundaries between perceived over-qualification and employee turnover, however, remains unclear. To address this gap, the current study employed multi-factor ANOVA, hierarchical regression analysis and the bootstrap method to analyze the relationship between perceived over-qualification and employee turnover intention based on the survey data of 396 respondents in China. Overall, the results revealed that perceived over-qualification was positively correlated with turnover intention. It was also found that self-efficacy had a mediating effect on the relationship between perceived over-qualification and turnover intention. Further, professional identity had a moderating effect on the relationship between perceived over-qualification and turnover intention. Our findings expand the boundary of influence around perceived over-qualification and provide theoretical support for employee management.

An Interpersonal Approach to Social Preference: Examining Patterns and Influences of Liking and Being Bothered by Interpersonal Behaviors of Others

Personality disorders are rooted in maladaptive interpersonal behaviors. Previously, researchers have assessed interpersonal behaviors using self-ratings of one's own behaviors and third-person ratings of dyadic interactions. Few studies have examined individuals' perceptions of others' interpersonal behaviors. Using a sample of 470 undergraduate students, the authors examined patterns of interpersonal perception as well as influences of these patterns on psychological functioning. Findings showed that people tend to like interpersonal behaviors that are similar to their own and become bothered by behaviors that are the opposite of their own. Such a pattern is particularly characteristic on the warmth dimension and is consistent across different levels of closeness of the relationship. The authors also found small but significant effects of interpersonal perception on personality and general psychological functioning, above and beyond effects of individuals' own interpersonal traits. Such findings highlight the importance of including perceptions of others in investigating interpersonal dynamics when understanding personality disorders.

An Interpersonal Approach to Social Preference: Examining Patterns and Influences of Liking and Being Bothered by Interpersonal Behaviors of Others

Personality disorders are rooted in maladaptive interpersonal behaviors. Previously, researchers have assessed interpersonal behaviors using self-ratings of one's own behaviors and third-person ratings of dyadic interactions. Few studies have examined individuals' perceptions of others' interpersonal behaviors. Using a sample of 470 undergraduate students, the authors examined patterns of interpersonal perception as well as influences of these patterns on psychological functioning. Findings showed that people tend to like interpersonal behaviors that are similar to their own and become bothered by behaviors that are the opposite of their own. Such a pattern is particularly characteristic on the warmth dimension and is consistent across different levels of closeness of the relationship. The authors also found small but significant effects of interpersonal perception on personality and general psychological functioning, above and beyond effects of individuals' own interpersonal traits. Such findings highlight the importance of including perceptions of others in investigating interpersonal dynamics when understanding personality disorders.

Interpersonal Change During Inpatient CBASP Treatment: Focus on Group Therapy

Background: The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has been tailored specifically to the demands of patients with persistent depressive disorder (PDD). According to the CBASP model, PDD patients are supposed to live perceptually disconnected from their social environment, which consequently maintains depression. While initially developed as an individual treatment modality, the adaptation for group therapy yields an important interpersonal space. However, little is known about the specific factors that contribute to patients' benefit from the CBASP group modality. Methods: The analyzed sample comprised N = 87 PDD patients who completed a 12 week multimodal inpatient treatment including 2 weekly CBASP-specific individual and group sessions, respectively, as well as CBASP-unspecific medical contacts, pharmacotherapy and complementary therapies. Group sessions included trainings in situational analysis and interpersonal skills. Interpersonal change over therapy was examined based on the patients' self-perceived interpersonal problems (IIP) and the impact messages as perceived by their individual therapists (IMI). Pre and post-treatment data were compared using within-sample t-tests. Additionally, patients evaluated CBASP group therapy on a feedback form. They were invited to reflect on individual benefits and its helpful and unhelpful aspects. Qualitative content analysis with inductive category development was used to analyze feedback. Inter-rater reliability was computed to confirm categories before summarizing the frequencies of reported factors. Results: Self-perceived interpersonal distress significantly decreased over therapy. Patients reported reduced interpersonal problems and therapists reported more friendly and dominant impact messages. Interestingly, patients who showed a significant depressive symptom reduction described higher change scores. Regarding qualitative data, patients reported five main benefits from group therapy: Gain in social competence, self-confidence, self-reflection, interpersonal dynamics, and optimism/universality. Patients responding to CBASP identified significantly more factors than non-responders. Conclusions: Compared to studies with individual CBASP only, the present findings suggest that CBASP group therapy may contribute to the improvement of interpersonal behavior. Group therapy is discussed as a potential boosting effect for individual CBASP. However, as the present data were collected in a multimodal inpatient setting without competitor, randomized controlled trials are warranted that investigate the specific benefits of the group modality or the combined individual and group therapy over individual CBASP only.

Investigating how self-esteem moderates grandiose narcissism's interpersonal orientation

OBJECTIVE

Most previous research has treated grandiose narcissism and self-esteem as additive predictors of outcomes, but some theory and evidence suggests they may sometimes interact to predict outcomes. Unfortunately, the nature of this interaction is unclear; we suggest a framework to conceptualize the interaction and test it vis-à-vis the interpersonal circumplex framework.

METHOD

Participants (N = 598; M_age  = 38.39; 327 females; 72.1% White) reported their levels of grandiose narcissism and self-esteem and completed interpersonal circumplex measures of efficacies, values, problems, and sensitivities.

RESULTS

As self-esteem decreased, grandiose narcissism related (a) more negatively to communal efficacies and values and (b) more positively to sensitivity to others' communal behaviors. Also as self-esteem decreased, unexpectedly, grandiose narcissism related (a) more positively to agentic efficacies and problems and (b) more negatively to sensitivity to others' agentic behaviors.

CONCLUSION

Overall, the present findings generally support using interaction models over additive models of grandiose narcissism and self-esteem in interpersonal contexts, suggesting that grandiose narcissism becomes generally less communal, more agentic, and more interpersonally problematic as self-esteem decreases.

Group Cognitive Behavioural Analysis System of Psychotherapy (CBASP) for persistently depressed outpatients: a retrospective chart review

BACKGROUND

Cognitive behavioural analysis system of psychotherapy (CBASP) is an effective individual treatment for persistent depressive disorder (PDD), but evidence on group treatment (Group-CBASP) is limited. Our aim was to review the effect of Group-CBASP on self-report depression severity in outpatients with PDD, overall and by age of depression-onset.

METHODS

A retrospective chart review study (November 2011-March 2017) in 54 patients with PDD (29 late-onset, 25 early-onset). Patients were previously treated by pharmacotherapy (92.6%), psychotherapy (98.1%) and/or electroconvulsive therapy (11.1%). Group-CBASP involved 24 weekly sessions during 6 months, followed by individual appointments over 6 months. The Inventory of Depressive Symptoms -self rating(IDS-SR) was used at baseline and after 3, 6, 9 and 12 months, computing mean differences and response rates.

RESULTS

The mean IDS-SR score decreased significantly from 39.83 at baseline to 33.78 at 6 months: a decrease from severe to moderate depression after 24 weeks of Group-CBASP, with a medium effect size (Cohen's d = .49). At 12 months, the mean IDS-SR score was 32.81, indicating moderate symptom levels remained. At 6 and 12 months, mean IDS-SR scores were similar among late- versus early-onset patients, but at 12 months response rates were higher among late-onset patients.

LIMITATIONS

Although results of our study provide valuable input for future prospective studies, limitations were the use of a retrospective design and the small group size.

CONCLUSION

Group-CBASP offered to an outpatient population with PDD was associated with clinically relevant decrease in self-reported symptom severity, and with sustained response particularly in patients with late onset of depression.

PRACTITIONER POINTS

Group-CBASP seems to be a good alternative for CBASP in individual setting. Patients with late age of depression-onset seem to benefit more from Group-CBASP. This study shows that clinical relevant effects of Group-CBASP, followed by individual contacts, remain at least for 6 months. Research on personalizing treatment strategies is needed to improve patient assignment for Group-CBASP.

Group Cognitive Behavioral Analysis System of Psychotherapy (CBASP): A Pilot Study for Bipolar Depression

OBJECTIVES

Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is an individually administered treatment model designed specifically for Persistent Depression however bipolar patients have traditionally been excluded from CBASP studies. There is a perception that bipolar depression will be harder to treat and requires a unique psychological approach. This pilot study reports on the feasibility of administering the same 20-week manualized group CBASP therapy with bipolar patients currently in a depressive episode.

METHODS

This non-randomized, single-arm prospective pilot study, reports on an a posteriori exploration of benefits to bipolar depressed patients (n=26) of the same 20-week group CBASP intervention administered to unipolar depressed patients (n=81). The clinical trial for the initial phase examining benefits of the manualized 20-week group CBASP intervention with unipolar patients was registered with the ISRCTN registry, study ID: ISRCTN95149444. Results reported here include mixed ANOVA analyses, across group treatment models and diagnostic categories. Changes over time in self-reported depressive symptoms (Inventory of Depressive Symptoms -IDS-SR), self-reported social functioning, interpersonal problems and interpersonal dispositions are documented for all patients. An exploratory longitudinal latent class analysis was used to examine patients' trajectories of improvement in depressive symptoms. Finally, the best predictors of change in reported depressive symptoms were explored with a logistic regression for all patients.

RESULTS

Improvements in depressive symptoms and in social functioning over time were significant for all patients with bipolar patients trending towards a greater improvement in depressive symptoms after controlling for baseline differences. An exploratory Latent Class Analysis identified two different treatment trajectories for the entire sample: 1) moderate to severely depressed patients who improved significantly (49%) and 2) severely depressed patients who did not improve (51%). The best predictors of non-response to group therapy include high baseline problems in social functioning and low rates of self-reported Perceived Improvements in overall health.

CONCLUSION

Bipolar patients in a depressive episode appear to benefit from the same 20-week group CBASP model designed originally for the treatment of Persistent Depressive Disorder. Bipolar patients seem more easily mobilized both during and outside of group therapy sessions and report more interpersonal confidence and more agency than unipolar depressed patients.

The latent structure of interpersonal problems: Validity of dimensional, categorical, and hybrid models

Interpersonal problems are key transdiagnostic constructs in psychopathology. In the past, investigators have neglected the importance of operationalizing interpersonal problems according to their latent structure by using divergent representations of the construct: (a) computing scores for severity, agency, and communion (“dimensional approach”), (b) classifying persons into subgroups with respect to their interpersonal profile (“categorical approach”). This hinders cumulative research on interpersonal problems, because findings cannot be integrated both from a conceptual and a statistical point of view. We provide a comprehensive evaluation of interpersonal problems by enlisting several large samples (Ns = 5,400, 491, 656, and 712) to estimate a set of latent variable candidate models, covering the spectrum of purely dimensional (i.e., confirmatory factor analysis using Gaussian and nonnormal latent t-distributions), hybrid (i.e., semiparametric factor analysis), and purely categorical approaches (latent class analysis). Statistical models were compared with regard to their structural validity, as evaluated by model fit (corrected Akaike’s information criterion and the Bayesian information criterion), and their concurrent validity, as defined by the models’ ability to predict relevant external variables. Across samples, the fully dimensional model performed best in terms of model fit, prediction, robustness, and parsimony. We found scant evidence that categorical and hybrid models provide incremental value for understanding interpersonal problems. Our results indicate that the latent structure of interpersonal problems is best represented by continuous dimensions, especially when one allows for nonnormal latent distributions.

This study suggests that interpersonal problems are best characterized by continuous differences in severity and interpersonal style (i.e., agency and communion), and not by “types” of people.

Development and Validation of a Circumplex Measure of the Interpersonal Culture in Work Teams and Organizations

Interpersonal circumplex (IPC) inventories assess a range of dispositions but can condense and compare their findings within a circular model defined by two factors: agency and communion. Whereas other IPC inventories assess individuals, the current research introduces IPC inventories assessing the interpersonal culture (interaction and communication norms) characterizing an entire organization or team-namely, the Circumplex Culture Scan (CCS) and Circumplex Team Scan (CTS). Across an initial development sample (n = 1676), online validation sample (CCS, n = 808; CTS, n = 832), and onsite validation sample (CCS, n = 516 respondents from 21 organizations; CTS, n = 347 respondents from 38 teams), the eight 8-item CCS/CTS octant scales demonstrated good internal consistencies, circumplex properties, reliable within-group agreement and between-group variance (thus justifying aggregation across an organization/team), and convergent, discriminant, and incremental validity in relation to other measures. According to their members, the organizations/teams with the most satisfied members and customers/clients were organizations/teams with considerably stronger communal (e.g., being open and respectful) than uncommunal (e.g., being rude and guarded) norms and somewhat stronger agentic (e.g., being eager and assertive) than unagentic (e.g., being cautious and quiet) norms. The CCS/CTS complements existing IPC and organizational culture measures and helps bridge the IPC and organizational literatures.

Socioemotional Dynamics of Emotion Regulation and Depressive Symptoms: A Person-Specific Network Approach

Socioemotional processes engaged in daily life may afford and/or constrain individuals' emotion regulation in ways that affect psychological health. Recent findings from experience sampling studies suggest that persistence of negative emotions (emotion inertia), the strength of relations among an individual's negative emotions (density of the emotion network), and cycles of negative/aggressive interpersonal transactions are related to psychological health. Using multiple bursts of intensive experience sampling data obtained from 150 persons over one year, person-specific analysis, and impulse response analysis, this study quantifies the complex and interconnected socioemotional processes that surround individuals' daily social interactions and on-going regulation of negative emotion in terms of recovery time. We also examine how this measure of regulatory inefficiency is related to interindividual differences and intraindividual change in level of depressive symptoms. Individuals with longer recovery times had higher overall level of depressive symptoms. As well, during periods where recovery time of sadness was longer than usual, individuals' depressive symptoms were also higher than usual, particularly among individuals who experienced higher overall level of stressful life events. The findings and analysis highlight the utility of a person-specific network approach to study emotion regulation, how regulatory processes change over time, and potentially how planned changes in the configuration of individuals' systems may contribute to psychological health.

Interpersonal Self-Efficacy, Goals, and Problems of Persistently Depressed Outpatients: Prototypical Circumplex Profiles and Distinctive Subgroups

Severely and persistently depressed outpatients ( n = 138) completed interpersonal circumplex measures of self-efficacy, problems, and values/goals. Compared with normative samples, patients showed deficits in agency: They reported less self-efficacy, especially for being assertive, tough, and influential; stronger goals, especially to avoid conflict or humiliation; and more problems, especially with being too timid, inhibited, and accommodating. Circular and structural summary indices suggested greater variability among patients in goal profiles than in efficacy or problem profiles; nonetheless, latent profile analyses identified coherent subgroups of patients with distinct patterns of efficacy (e.g., lacking confidence for speaking up vs. setting boundaries) and problems (e.g., being overly inhibited vs. self-sacrificing) as well as goals (e.g., to be included vs. unobtrusive). Women and those with more severe symptoms were overrepresented in the least agentic groups. The results show how observing patients through multiple circumplex surfaces simultaneously can help clarify their interpersonal dispositions and inform interventions.

Therapeutic agency, in-session behavior, and patient-therapist interaction

OBJECTIVE

The aim of this study was to investigate associations between patients' subjective agency, their observable in-session behavior, and the patient-therapist interaction during the early phase of psychotherapy.

METHODS

The sample included 52 depressed patients in psychodynamic psychotherapy. After Session 5, the patients' agency and the quality of the therapeutic alliance were assessed. Based on session recordings, two independent observers rated the patients' involvement, their interpersonal behavior, and the therapists' directiveness.

RESULTS

Higher agency was associated with stronger therapeutic alliances. Patients who indicated higher agency in their therapy participated more actively in the session and showed less hostile impact messages. Patients' agency was not related to therapists' directiveness.

CONCLUSIONS

Patients' sense of agency in psychotherapy was associated with more active involvement and affiliative interaction. The findings support the idea that patients need to feel capable of acting within and having an influence on their therapy to benefit from it.