Latent difference score approach to longitudinal trauma research

A New School, a Fresh Start? Change and Stability in Peer Relationships and Academic Performance in the Transition from Primary to Secondary School

Previous studies on peer relationships in school transitions neglected individual differences, or did not examine the relation with academic performance in secondary school. This study followed 649 students from their last year of primary school to their first year in secondary school (Mage at T1 = 11.6 (SD = 0.6); 53.6% girls). Results revealed that students became more attached to peers, less lonely, and were stable in victimization across the transition. Particularly students with more negative peer experiences in primary school enjoyed a "fresh start" in terms of peer experiences in secondary school. Students who had more co-transitioning peers experienced greater reductions in loneliness. Changes in peer experiences over the transition did not relate to academic performance in secondary school.

Protocol for a randomized controlled trial comparing phone-based prenatal mindfulness training to usual care for pregnant people at risk for hypertensive disorders of pregnancy

Hypertensive disorders of pregnancy (HDP) are the most common medical conditions in pregnancy and a leading cause of maternal morbidity and mortality in the United States. There are few interventions available to prevent HDP, and those currently available do not target underlying mechanisms of disease. Mindfulness training (MT) is effective at reducing blood pressure in non-pregnant patients with pre-hypertension and hypertension and has proven more effective at blood pressure reduction than other stress management interventions. MT thus holds great promise as a mind-body intervention to prevent HDP. This randomized trial will harness subjective and objective ecological momentary assessment methodology combined with wearable biosensor technology to capture psychological, physiological, and interpersonal processes through which MT may lead to improved maternal cardiovascular parameters. Pregnant women at risk for HDP will be randomized to an 8-week phone-delivered MT intervention or usual care. Through these methods, we will evaluate psychological, physiological, and interpersonal responses to daily experiences linking MT to cardiovascular parameters among women at risk for HDP.

Latent change scores models for applied research: A practical guide using Mplus

The present article provides a practical guide for modelling and interpreting several basic applications of the latent change scores (LCS) model, a useful and flexible approach for the analysis of change. The article is addressed to students, researchers and practitioners who are familiar with structural equation modelling but new to LCS. We first provided a gentle introduction to the LCS model using non-technical language and minimal mathematical formalism. We illustrated the basic ideas behind this approach, introducing LCS in its simplest form. We show how this model can be straightforwardly extended to more complex applications, including the dual change score (DCS) model and some of its variants (i.e., the proportional change and the constant change models). We illustrated how the univariate LCS model can be used to determine the growth trajectory of a variable across multiple waves of assessment. Next, we focused on the bivariate case, which allows for the modelling of the dynamic relations between two variables. For each model, we provided easy-to-follow examples of applications based on Schwartz's theory of basic personal values. The examples are accompanied by annotated syntax and output showing how they can be implemented with the Mplus software and how results can be interpreted.

An Exploration of Intervention Augmentation in a Single Case

Recent work has highlighted that process-outcome relationships are likely to vary depending on the client, yet much work remains to be done in the area of tailoring interventions to a given client. This naturalistic single-case analysis provides an example of augmenting a treatment protocol with "off protocol" relaxation methods, based on routinely collected outcome information to guide shared decision making. Intensive case study analyses were applied to one client with principal generalized anxiety disorder and comorbid major depressive disorder receiving transdiagnostic cognitive-behavioral therapy. The client completed two routine anxiety and depression symptom and functioning scales prior to each session of naturalistic treatment. Time series analyses were applied to the two symptom measures. Among the results, (a) significant linear decreases in anxiety and depression from baseline to posttreatment were observed; and (b) the introduction of relaxation methods had a significant impact on the course of anxiety symptom change. In conclusion, routine outcome assessment can be used to inform intervention augmentation with individual clients. Furthermore, regular assessment is needed to determine if a client may benefit from an alternative set of specific intervention strategies.

A systematic review of literature examining mediators and mechanisms of change in empirically supported treatments for posttraumatic stress disorder

Despite the availability of empirically supported treatments (ESTs) for posttraumatic stress disorder (PTSD), relatively little is known regarding these treatments' mechanisms of change. This systematic review moves beyond previous reviews by summarizing the findings and reviewing the methodological quality of literature that specifically examined mediators/mechanisms of change in ESTs for PTSD. Studies were included if they were written in English, empirical, peer-reviewed, claimed to study mediators/mechanisms of a recommended PTSD treatment, measured the mediator/mechanism during or before and after treatment, and included a posttreatment PTSD or global outcome (e.g., functioning). PsycINFO and PubMed were searched on October 7, 2022. Two coders screened and coded studies. Sixty-two eligible studies were identified. The most consistent mediator/mechanism was reduction in negative posttraumatic cognitions, followed by between-session extinction and decreased depression. Only 47% of studies measured the mediator/mechanism before the outcome and measured the mediator/mechanism and outcome at least three times, and 32% also used growth curve modeling to establish temporal precedence of change in the mediator/mechanism and outcome. Many of the mediators/mechanisms examined had weak or no empirical support. Results highlight the need for improved methodological rigor in treatment mediator and mechanism research. Implications for clinical care and research are discussed. PROSPERO ID: 248088.

Early childhood impulsivity and parenting predict children's development of externalizing psychopathology

Parenting and child impulsivity are consistent predictors of children's externalizing symptoms; however, the role of the range of parenting (i.e., variation in parenting across contexts), and its interactions with child impulsivity, are poorly understood. We examined whether characteristic parenting practices and parenting range predicted the course of externalizing symptoms in 409 children (M_age = 3.43 years at baseline, 208 girls) across ages 3, 5, 8, and 11. We assessed parent positive affectivity (PPA), hostility, and parenting structure at child age 3 using three behavioral tasks that varied in context, examining range by modeling a latent difference score for each parenting dimension. Greater PPA range, mean structure, and parenting structure range all predicted fewer symptoms at age 3 for children with higher impulsivity. Lower mean hostility predicted fewer symptoms at age 3 for children with lower impulsivity. Greater PPA, and smaller PPA range, predicted a decrease in symptoms for children higher in impulsivity. Lower hostility range predicted a decrease in symptoms for children with lower impulsivity but predicted maintaining symptoms for children with higher impulsivity. Results demonstrate the differential roles average parenting practices and parenting range play in the development of child externalizing psychopathology, especially in the context of child impulsivity.

Longitudinal associations between interpersonal relationship functioning and posttraumatic stress disorder (PTSD) in recently traumatized individuals: differential findings by assessment method

BACKGROUND

The role of interpersonal relationship functioning in trauma recovery is well-established. However, much of this research has been done with cross-sectional samples, often years after trauma exposure, using self-report methodology only, and is focused on intimate relationship adjustment.

METHODS

The current study investigated the longitudinal associations between interpersonal (intimate and non-intimate) relationship functioning and clinician- and self-reported posttraumatic stress disorder (PTSD) symptoms in 151 recently (within the past 6 months) traumatized individuals. Participants were assessed at four time points over 1 year.

RESULTS

Approximately 53% of the sample was diagnosed with PTSD at initial assessment, with declining rates of diagnostic status over time to 16%. Latent difference score (LDS) modeling revealed nonlinear declines in both clinician-assessed and self-reported PTSD symptom severity, with faster declines in earlier periods. Likewise, LDS models revealed nonlinear declines in negative (conflict) aspects of interpersonal relationship functioning, but linear declines in positive (support, depth) aspects. The relationship between PTSD and relationship functioning differed for clinician- and self-reported PTSD. Bivariate LDS modeling revealed significant cross-lagged effects from relationship conflict to clinician-assessed PTSD, and significant cross-lagged effects from self-reported PTSD to relationship conflict over time.

CONCLUSIONS

These results highlight that the variability in prior results may be related to the method of assessing PTSD symptomatology and different relational constructs. Implications for theory and early intervention are discussed.

Dynamics of risk: Recent changes in psychological inflexibility precede subsequent changes in returning US veterans' posttraumatic stress

OBJECTIVES

As a malleable risk-factor, psychological inflexibility is implicated in the development and maintenance of posttraumatic stress symptoms (PTS). Unfortunately, limited research has addressed whether changes in psychological inflexibility are antecedent to changes in PTS severity over time, or whether such changes are mutually dependent.

METHODS

Utilizing bivariate latent difference score modeling, this longitudinal study sequenced intraindividual changes in psychological inflexibility and PTS severity within a sample of 305 returning US veterans. Veterans' self-reported psychological inflexibility and PTS severity were assessed quarterly over 1 year.

RESULTS

Results indicated that early reductions in psychological inflexibility potentiated later declines in veterans' PTS severity, accounting for veterans' prior levels of psychological inflexibility and PTS severity.

CONCLUSIONS

These findings underscore the unique role of changes in psychological inflexibility as an important mechanism of change in PTS severity and provide empirical support for an antecedent model of the role of psychological inflexibility in PTS recovery.

Personality change during substance use disorder treatment is associated with improvements in abstinence self-efficacy post-treatment among U.S. military veterans

Prior research suggests that personality traits change during substance use disorder (SUD) treatment. However, the extent to which changes in traits during SUD treatment are associated with subsequent improvements in treatment outcomes remains untested. Among U.S. military veterans (n = 200) enrolled in SUD residential treatment, we examined whether changes in the personality factors of positive emotionality (PEM), negative emotionality (NEM), and constraint (CON) during treatment were associated with subsequent changes in abstinence self-efficacy and SUD symptoms. We analyzed data at treatment entry, discharge, and 12-months post-discharge via univariate and bivariate latent change score models. During treatment, PEM, CON, and abstinence self-efficacy increased, while NEM decreased, on average. Changes in NEM and CON were largely sustained, whereas PEM and abstinence self-efficacy significantly decreased post-treatment. SUD symptoms decreased from pre- to post-treatment. In bivariate models, higher levels of NEM at baseline were associated with less improvement in both abstinence self-efficacy during treatment and SUD symptoms pre- to post-treatment. Higher levels of CON at baseline were associated with greater improvement in SUD symptoms pre- to post-treatment, and increases in CON during treatment were associated with greater retention of treatment gains in abstinence self-efficacy post-treatment. Greater improvements in CON during treatment were also associated with greater improvements in SUD symptoms pre- to post-treatment in unadjusted (p = 0.041) but not adjusted models (p = 0.089). Our findings suggest that personality changes marked by improvements in impulse control over the course of SUD treatment may be linked to subsequent improvements in treatment outcomes and may have value as a proximal treatment target among SUD patients during residential care.

Latent Change Score Models for the Study of Development and Dynamics in Organizational Research

The empirical study of change has proven to be one of the most vexing challenges in organizational science. Fortunately, contemporary methodologies originating from developmental psychology may provide a potential solution and are consequently working their way into the literature. In particular, organizational researchers are increasingly employing variations of latent change score (LCS) models to address questions regarding change, development, and dynamics. Although these models may indeed be used to reliably study change, development, and dynamics, many studies utilizing these models—and published in premier outlets—are characterized by questionable methodological choices, improper modeling procedures, and suboptimal research designs. Thus, the purpose of the present article is to (a) provide a critical review of LCS models, (b) outline appropriate modeling procedures (with corresponding Mplus and R syntax), (c) compare and contrast LCS modeling with other analytical techniques, and (d) delineate best practices. Ultimately, we endorse the use of LCS models by organizational researchers interested in studying longitudinal phenomena. However, we also heed researchers to do so judiciously because their misuse may lead to their unwarranted rejection by the field.

Longitudinal course and predictors of posttraumatic stress symptoms after spinal cord injury

OBJECTIVE

This study examined longitudinal changes in post-traumatic stress symptoms (PTSS) in individuals newly diagnosed with spinal cord injury (SCI) and tested various psychosocial and injury-related characteristics as predictors for interindividual differences in symptom courses.

DESIGN

Longitudinal data from the larger Swiss Spinal Cord Injury Cohort Study were used. The sample consisted of 269 patients (70.6% male; M_age = 53.21) admitted for inpatient rehabilitation to SCI rehabilitation centers.

MAIN OUTCOME MEASURE

PTSS were measured at one and six months after injury using the Impact of Event Scale-6.

RESULTS

Latent change score modelling revealed no average change in PTSS in the sample, but significant variability in the individual symptom courses. Reliable change index analyses suggest that among individuals with an initial PTSS severity of clinical concern (n = 65), only 27.7% showed clinically significant decreases over time. Predictors explained 34% of the variance in PTSS change. Loss appraisals (β = .30, p < .001) and cause of injury (β = .16, p = .018) emerged as unique predictors.

CONCLUSION

Clinically elevated PTSS one month after SCI typically remain across the following months highlighting the need for early screening and intervention. Low loss appraisals were related to decreases in symptom severity and might therefore be a suitable intervention target for reducing PTSS after SCI.

Maternal alcohol dependence and harsh caregiving across parenting contexts: The moderating role of child negative emotionality

Parental alcohol dependence is a significant risk factor for harsh caregiving behaviors; however, it is unknown whether and how harsh caregiving changes over time and across parenting contexts for alcohol-dependent mothers. Furthermore, to our knowledge, no studies have examined whether and how distinct dimensions of child characteristics, such as negative emotionality modulate harsh caregiving among alcohol-dependent mothers. Guided by parenting process models, the present study examined how two distinct domains of children's negative emotionality-fear and frustration-moderate the association between maternal alcohol dependence and maternal harshness across discipline and free-play contexts. A high-risk sample of 201 mothers and their two-year-old children were studied over a one-year period. Results from latent difference score analyses indicated that harsh parenting among alcohol-dependent mothers increased over time in the more stressful discipline context, but not in the parent-child play context. This effect was maintained even after controlling for other parenting risk factors, including other forms of maternal psychopathology. Furthermore, this increase in harsh parenting was specific to alcohol-dependent mothers whose children were displaying high levels of anger and frustration. Findings provide support for specificity in conceptualizations of child negative emotionality and parenting contexts as potential determinants of maladaptive caregiving among alcohol-dependent mothers.

Efficacy of the Unified Protocol for transdiagnostic treatment of comorbid psychopathology accompanying emotional disorders compared to treatments targeting single disorders

OBJECTIVE

This study aimed to examine whether the Unified Protocol (UP), a transdiagnostic cognitive-behavioral therapy for emotional disorders (i.e., anxiety, mood, and related disorders), is efficacious in the treatment of co-occurring emotional disorders compared to established single disorder protocols (SDPs) that target specific disorders (e.g., panic disorder).

METHOD

Participants included 179 adults seeking outpatient psychotherapy. Participant age ranged from 18 to 66 years, with an average of 30.66 years (SD = 10.77). The sample was 55% female and mostly Caucasian (83%). Diagnostic assessments were completed with the Anxiety Disorder Interview Schedule (ADIS), and disorder-specific, clinician-rated measures for the comorbid diagnoses of interest.

RESULTS

In both treatment conditions, participants' mean number of diagnoses dropped significantly from baseline to posttreatment, and baseline to 12-month follow-up. Additionally, large effects were observed for changes in comorbid generalized anxiety (ESSG: UP = -1.72; SDP = -1.98), social anxiety (ESSG: UP = -1.33, -0.86; SDP = -1.60, -1.54), and depression (ESSG: UP = -0.83; SDP = -0.84). Significant differences were not observed in between-group comparisons.

CONCLUSIONS

Results suggest that both the UP and SDPs are efficacious in reducing symptoms of comorbid emotional disorders. The clinical, practical, and cost-effective advantages of transdiagnostic CBT are discussed.

Latent Growth and Dynamic Structural Equation Models

Latent growth models make up a class of methods to study within-person change—how it progresses, how it differs across individuals, what are its determinants, and what are its consequences. Latent growth methods have been applied in many domains to examine average and differential responses to interventions and treatments. In this review, we introduce the growth modeling approach to studying change by presenting different models of change and interpretations of their model parameters. We then apply these methods to examining sex differences in the development of binge drinking behavior through adolescence and into adulthood. Advances in growth modeling methods are then discussed and include inherently nonlinear growth models, derivative specification of growth models, and latent change score models to study stochastic change processes. We conclude with relevant design issues of longitudinal studies and considerations for the analysis of longitudinal data.

Misspecification in Latent Change Score Models: Consequences for Parameter Estimation, Model Evaluation, and Predicting Change

Latent change score models (LCS) are conceptually powerful tools for analyzing longitudinal data (McArdle & Hamagami, 2001). However, applications of these models typically include constraints on key parameters over time. Although practically useful, strict invariance over time in these parameters is unlikely in real data. This study investigates the robustness of LCS when invariance over time is incorrectly imposed on key change-related parameters. Monte Carlo simulation methods were used to explore the impact of misspecification on parameter estimation, predicted trajectories of change, and model fit in the dual change score model, the foundational LCS. When constraints were incorrectly applied, several parameters, most notably the slope (i.e., constant change) factor mean and autoproportion coefficient, were severely and consistently biased, as were regression paths to the slope factor when external predictors of change were included. Standard fit indices indicated that the misspecified models fit well, partly because mean level trajectories over time were accurately captured. Loosening constraint improved the accuracy of parameter estimates, but estimates were more unstable, and models frequently failed to converge. Results suggest that potentially common sources of misspecification in LCS can produce distorted impressions of developmental processes, and that identifying and rectifying the situation is a challenge.

Oxytocin attenuates social and non-social avoidance: Re-thinking the social specificity of Oxytocin

Re-examining decades of the social construal of Oxytocin, the General Approach-Avoidance Hypothesis of Oxytocin (GAAO) predicts that Oxytocin will modulate responding to emotionally-evocative and personally-relevant social and non-social stimuli due to its action on the neural substrate of approach and avoidance motivation. We report the first critical experimental test of GAAO predictions by means of a double-blind intra-nasal administration of Oxytocin vs. placebo in 90 healthy adults (N=90, 50% women). As predicted, we found that among men and women for whom negative emotion (anxious arousal) is motivationally-relevant, intra-nasal administration of Oxytocin reduced behavioral avoidance of emotionally-evocative negatively-valenced social and non-social stimuli, but not closely matched emotionally-neutral stimuli. Findings cannot be explained by extant social theories of Oxytocin. We discuss the implications of the present findings for basic and translational clinical Oxytocin research.

Expectancies, working alliance, and outcome in transdiagnostic and single diagnosis treatment for anxiety disorders: An investigation of mediation

Patients' outcome expectancies and the working alliance are two psychotherapy process variables that researchers have found to be associated with treatment outcome, irrespective of treatment approach and problem area. Despite this, little is known about the mechanisms accounting for this association, and whether contextual factors (e.g., psychotherapy type) impact the strength of these relationships. The primary aim of this study was to examine whether patient-rated working alliance quality mediates the relationship between outcome expectancies and pre- to post-treatment change in anxiety symptoms using data from a recent randomized clinical trial comparing a transdiagnostic treatment (the Unified Protocol [UP]; Barlow et al., 2011a; Barlow, Sauer-Zavala, et al., in press) to single diagnosis protocols (SDPs) for patients with a principal heterogeneous anxiety disorder (n = 179). The second aim was to explore whether cognitive-behavioral treatment condition (UP versus SDP) moderated this indirect relationship. Results from mediation and moderated mediation models indicated that, when collapsing across the two treatment conditions, the relationship between expectancies and outcome was partially mediated by the working alliance (B = .037, SE = .05, 95% CI [.005, .096]). Interestingly, within-condition analyses showed that this conditional indirect effect was only present for SDP patients, whereas in the UP condition, working alliance did not account for the association between expectancies and outcome. These findings suggest that outcome expectancies and working alliance quality may interact to influence treatment outcomes, and that the nature and strength of the relationships among these constructs may differ as a function of the specific cognitive-behavioral treatment approach utilized.

The longitudinal relationship between post-traumatic stress disorder and perceived social support in survivors of traumatic injury

BACKGROUND

Although perceived social support is thought to be a strong predictor of psychological outcomes following trauma exposure, the temporal relationship between perceived positive and negative social support and post-traumatic stress disorder (PTSD) symptoms has not been empirically established. This study investigated the temporal sequencing of perceived positive social support, perceived negative social support, and PTSD symptoms in the 6 years following trauma exposure among survivors of traumatic injury.

METHOD

Participants were 1132 trauma survivors initially assessed upon admission to one of four Level 1 trauma hospitals in Australia after experiencing a traumatic injury. Participants were followed up at 3 months, 12 months, 24 months, and 6 years after the traumatic event.

RESULTS

Latent difference score analyses revealed that greater severity of PTSD symptoms predicted subsequent increases in perceived negative social support at each time-point. Greater severity of PTSD symptoms predicted subsequent decreases in perceived positive social support between 3 and 12 months. High levels of perceived positive or negative social support did not predict subsequent changes in PTSD symptoms at any time-point.

CONCLUSIONS

Results highlight the impact of PTSD symptoms on subsequent perceived social support, regardless of the type of support provided. The finding that perceived social support does not influence subsequent PTSD symptoms is novel, and indicates that the relationship between PTSD and perceived social support may be unidirectional.

OpenMx 2.0: Extended Structural Equation and Statistical Modeling

The new software package OpenMx 2.0 for structural equation and other statistical modeling is introduced and its features are described. OpenMx is evolving in a modular direction and now allows a mix-and-match computational approach that separates model expectations from fit functions and optimizers. Major backend architectural improvements include a move to swappable open-source optimizers such as the newly written CSOLNP. Entire new methodologies such as item factor analysis and state space modeling have been implemented. New model expectation functions including support for the expression of models in LISREL syntax and a simplified multigroup expectation function are available. Ease-of-use improvements include helper functions to standardize model parameters and compute their Jacobian-based standard errors, access to model components through standard R $ mechanisms, and improved tab completion from within the R Graphical User Interface.

Changes in positive affect and mindfulness predict changes in cortisol response and psychiatric symptoms: a latent change score modelling approach

OBJECTIVE

This study examined whether and how changes in positive affect and mindfulness predicted changes in cortisol secretion and psychological distress in adaptation to examination stress.

DESIGN

A sample of 105 college students completed a questionnaire set and provided salivary samples before (T1), during (T2) and after (T3) an examination period.

RESULTS

Latent change score modelling revealed that T1-T2 and T2-T3 increases in mindfulness were associated with larger T2-T3 decrease in area-under-the-curve ground of cortisol awakening response (CARg), whereas T2-T3 increases in both positive affect and mindfulness were associated with larger T2-T3 decrease in anxiety symptoms (comparative fit index = .96; Tucker-Lewis index = .93-.95; root-mean-square error of approximation = .04-.08; standardised root-mean-square residual = .08-.10). T1-T2 and T2-T3 increases in positive affect were not associated T2-T3 decrease in CARg, whereas T1-T2 increases in positive affect and mindfulness were not associated with T2-T3 decrease in anxiety symptoms.

CONCLUSION

The levels of post-stress recovery from anxiety symptoms could depend on concurrent increases in positive affect and mindfulness, whereas the levels of post-stress decline in cortisol secretion could depend on increases in mindfulness both during and after stress. Directions for translating the present findings into stress management programmes in college settings are discussed.

Predictors of decline in overall mental health, PTSD and alcohol use in OEF/OIF veterans

This study identified predictors of worsening mental health (including PTSD and alcohol use) over a 6-month period following return from deployment to Iraq (OIF) or Afghanistan (OIF). Using a national sample of 512 OEF/OIF veterans surveyed within 12 months of return from deployment (T1), and 6 months later (T2), we obtained demographic and deployment characteristics, risk and resilience factors, mental health status, PTSD and alcohol abuse. We performed logistic regression analyses to identify predictors of worse mental health, PTSD or alcohol use between T1 and T2, controlling for initial levels. Of the sample, 14-25% showed clinically worse mental health, PTSD or alcohol use. Each outcome was associated with some shared and some unique predictors. For example, younger age and recent medical care were both associated with worse alcohol use. Lack of adequate deployment training was uniquely associated with worse PTSD symptoms.

Bidirectional relationships between trauma exposure and posttraumatic stress: a longitudinal study of Detroit residents

Previous research has documented bidirectional relationships between trauma exposure and posttraumatic stress (PTS), such that individuals who are exposed to more traumatic events are at increased risk of developing PTS, and more severe PTS is associated with more subsequent trauma exposure. However, the empirical literature is limited by a lack of longitudinal studies that include continuous measures of PTS, differentiate between assaultive (e.g., sexual assault, being held up or mugged) and nonassaultive (e.g., serious illness, natural disaster) trauma, and focus on urban contexts. The purpose of this study was to fill these gaps through testing 3-wave cross-lagged panel models of exposure to assaultive and nonassaultive traumatic events and PTS among a large sample of urban-dwelling adults (N = 1,360; 84.4% non-Hispanic Black). In the model including assaultive trauma, more Wave 2 assaultive events were associated with significantly higher Wave 3 PTS. In contrast, in the model including nonassaultive trauma, higher Wave 1 and Wave 2 PTS were associated with more nonassaultive events at Waves 2 and 3, respectively. Taken together, the findings suggest a cycle of adversity wherein urban residents who have experienced assaultive trauma are at risk of more severe PTS, which in turn increases risk for exposure to nonassaultive trauma. This cycle could be tested directly in future studies through models including both types of events. Additional research on the mechanisms that underlie the pathways between PTS and traumatic events could also have implications for policy and practice.

Treatment of co-occurring PTSD-AUD: effects of exposure-based and non-trauma focused psychotherapy on alcohol and trauma cue-reactivity

Laboratory studies have shown that exposure to trauma memories increases both craving and salivation responses to alcohol cues among individual with co-occurring posttraumatic stress disorder (PTSD) and alcohol dependence (AD). The purpose of the present study was to examine 1) whether this cue reactivity is dampened following exposure-based treatment for PTSD and 2) how changes in reactivity to trauma cues correspond to changes in alcohol cue-reactivity. Adults with current PTSD and AD (N = 120) were randomly assigned to 9-12 sessions of either Trauma-focused Exposure Therapy (EXP) for PTSD or Health & Lifestyles (HLS, a non-trauma focused comparison treatment), concurrent with 6-week residential AD treatment-as-usual. Participants completed trauma and alcohol cue-reactivity laboratory sessions before and after treatment. Compared to HLS, individuals receiving EXP showed significantly greater reductions in negative affect elicited by trauma cues following treatment. Both treatments demonstrated similar, moderate to large reductions in craving and salivary reactivity over time. Interestingly, latent change in trauma cue-elicited distress over the course of treatment predicted latent change in both trauma cue-elicited alcohol craving and salivation. Overall, findings highlight the utility of integrating trauma-focused therapies like EXP into substance use treatment in the interests of reducing PTSD symptoms and distress associated with trauma cues.

Flexible models of change: using structural equations to match statistical and theoretical models of multiple change processes

OBJECTIVE

To introduce and illustrate recent advances in statistical approaches to simultaneous modeling of multiple change processes.

METHODS

Provide a general overview of how to use structural equations to simultaneously model multiple change processes and illustrate the use of a theoretical model of change to guide selection of an appropriate specification from competing alternatives. The selected latent change score model is then fit to data collected during an adolescent weight-control treatment trial.

RESULTS

A latent change score model is built starting with the foundation of repeated-measures analysis of variance and illustrated using graphical notation.

CONCLUSIONS

The assumptions behind using structural equations to model change are discussed as well as limitations of the approach. Practical guidance is provided on matching the statistical model to the theory underlying the observed change processes and the research question(s) being answered by the analyses.

Mechanisms of change in cognitive behavioral therapy for panic disorder: the unique effects of self-efficacy and anxiety sensitivity

The present study examined temporal dependencies of change of panic symptoms and two promising mechanisms of change (self-efficacy and anxiety sensitivity) during an 11-session course of cognitive-behavior therapy (CBT) for Panic Disorder (PD). 361 individuals with a principal diagnosis of PD completed measures of self-efficacy, anxiety sensitivity, and PD symptoms at each session during treatment. Effect size analyses indicated that the greatest changes in anxiety sensitivity occurred early in treatment, whereas the greatest changes in self-efficacy occurred later in treatment. Results of parallel process latent growth curve models indicated that changes in self-efficacy and anxiety sensitivity across treatment uniquely predicted changes in PD symptoms. Bivariate and multivariate latent difference score models indicated, as expected, that changes in anxiety sensitivity and self-efficacy temporally preceded changes in panic symptoms, and that intraindividual changes in anxiety sensitivity and self-efficacy independently predicted subsequent intraindividual changes in panic symptoms. These results provide strong evidence that changes in self-efficacy and anxiety sensitivity during CBT influence subsequent changes in panic symptoms, and that self-efficacy and anxiety sensitivity may therefore be two distinct mechanisms of change of CBT for PD that have their greatest impact at different stages of treatment.

Cognitive change predicts symptom reduction with cognitive therapy for posttraumatic stress disorder

OBJECTIVE

There is a growing body of evidence for the effectiveness of trauma-focused cognitive behavior therapy (TF-CBT) for posttraumatic stress disorder (PTSD), but few studies to date have investigated the mechanisms by which TF-CBT leads to therapeutic change. Models of PTSD suggest that a core treatment mechanism is the change in dysfunctional appraisals of the trauma and its aftermath. If this is the case, then changes in appraisals should predict a change in symptoms. The present study investigated whether cognitive change precedes symptom change in Cognitive Therapy for PTSD, a version of TF-CBT.

METHOD

The study analyzed weekly cognitive and symptom measures from 268 PTSD patients who received a course of Cognitive Therapy for PTSD, using bivariate latent growth modeling.

RESULTS

Results showed that (a) dysfunctional trauma-related appraisals and PTSD symptoms both decreased significantly over the course of treatment, (b) changes in appraisals and symptoms were correlated, and (c) weekly change in appraisals significantly predicted subsequent reduction in symptom scores (both corrected for the general decrease over the course of therapy). Changes in PTSD symptom severity did not predict subsequent changes in appraisals.

CONCLUSIONS

The study provided preliminary evidence for the temporal precedence of a reduction in negative trauma-related appraisals in symptom reduction during trauma-focused CBT for PTSD. This supports the role of change in appraisals as an active therapeutic mechanism.

Individual and group sensitivity to remedial reading program design: Examining reading gains across three middle school reading projects

The purpose of this project was to examine group- and individual-level responses by struggling adolescents readers (6^th - 8^th grades; N = 155) to three different modalities of the same reading program, Reading Achievement Multi-Component Program (RAMP-UP). The three modalities differ in the combination of reading components (phonological decoding, spelling, fluency, comprehension) that are taught and their organization. Latent change scores were used to examine changes in phonological decoding, fluency, and comprehension for each modality at the group level. In addition, individual students were classified as gainers versus non-gainers (a reading level increase of a year or more vs. less than one year) so that characteristics of gainers and differential sensitivity to instructional modality could be investigated. Findings from both group and individual analyses indicated that reading outcomes were related to modalities of reading instruction. Furthermore, differences in reading gains were seen between students who began treatment with higher reading scores than those with lower reading scores; dependent on modality of treatment. Results, examining group and individual analyses similarities and differences, and the effect the different modalities have on reading outcomes for older struggling readers will be discussed.

Developmental trajectories of acculturation in Hispanic adolescents: associations with family functioning and adolescent risk behavior

This study examined longitudinal acculturation patterns, and their associations with family functioning and adolescent risk behaviors, in Hispanic immigrant families. A sample of 266 Hispanic adolescents (Mage  = 13.4) and their primary parents completed measures of acculturation, family functioning, and adolescent conduct problems, substance use, and sexual behavior at five timepoints. Mixture models yielded three trajectory classes apiece for adolescent and parent acculturation. Assimilated adolescents reported the poorest family functioning, but adolescent assimilation negatively predicted adolescent cigarette smoking, sexual activity, and unprotected sex indirectly through family functioning. Follow-up analyses indicated that discrepancies between adolescent and parent family functioning reports predicted these adolescent outcomes. Results are discussed regarding acculturation trajectories, adolescent risk behavior, and the mediating role of family functioning.

The role of negative affectivity and negative reactivity to emotions in predicting outcomes in the unified protocol for the transdiagnostic treatment of emotional disorders

The present study aimed to understand the contributions of both the trait tendency to experience negative emotions and how one relates to such experience in predicting symptom change during participation in the Unified Protocol (UP), a transdiagnostic treatment for emotional disorders. Data were derived from a randomized controlled trial comparing the UP to a waitlist control/delayed-treatment condition. First, effect sizes of pre- to post-treatment change for frequency of negative emotions and several variables measuring reactivity to emotional experience (emotional awareness and acceptance, fear of emotions, and anxiety sensitivity) were examined. Second, the relative contributions of change in negative emotions and emotional reactivity in predicting symptom (clinician-rated anxiety, depression, and severity of principal diagnosis) reductions were investigated. Results suggested that decreases in the frequency of negative emotions and reactivity to emotions following participation in the UP were both large in magnitude. Further, two emotional reactivity variables (fear of emotions and anxiety sensitivity) remained significantly related to symptom outcomes when controlling for negative emotions, and accounted for significant incremental variance in their prediction. These findings lend support to the notion that psychological health depends less on the frequency of negative emotions and more on how one relates to these emotions when they occur.

Teacher's Corner: Latent Curve Models and Latent Change Score Models Estimated in R

In recent years the use of the Latent Curve Model (LCM) among researchers in social sciences has increased noticeably, probably thanks to contemporary software developments and to the availability of specialized literature. Extensions of the LCM, like the the Latent Change Score Model (LCSM), have also increased in popularity. At the same time, the R statistical language and environment, which is open source and runs on several operating systems, is becoming a leading software for applied statistics. We show how to estimate both the LCM and LCSM with the sem, lavaan, and OpenMx packages of the R software. We also illustrate how to read in, summarize, and plot data prior to analyses. Examples are provided on data previously illustrated by Ferrer, Hamagami, & McArdle, 2004. The data and all scripts used here are available on the first author's website.

Mechanisms of Change in Cognitive Processing Therapy and Prolonged Exposure Therapy for PTSD: Preliminary Evidence for the Differential Effects of Hopelessness and Habituation

The present study examined two potential mechanisms of change, hopelessness cognitions and habituation, in a randomized controlled trial of cognitive processing therapy (CPT) and prolonged exposure therapy (PE) for posttraumatic stress disorder (PTSD). Participants were 171 adult women with a current primary diagnosis of sexual assault related PTSD. The potential mechanisms were examined by evaluating the intraindividual change in hopelessness within the course of both treatments and subjective units distress (SUDS) ratings (a proxy for habituation) within the course of PE. The effects of intraindividual change in the proposed mechanisms were then examined on within-treatment changes in PTSD symptoms. Findings indicated that the participants assigned to the CPT treatment had significantly greater pre-post reductions in hopelessness than those assigned to PE and that the changes in hopelessness predicted changes in PTSD symptoms (R² = .24). Intraindividual changes in SUDS ratings for participants in the PE treatment condition also predicted changes in PTSD symptoms and did so independently of the effect of changes in hopelessness. Future research should examine these mechanisms using more intensive methods of data collection that would permit the demonstration of temporality of change.

Change trajectories during home-based services with chronic child welfare cases

This study examines how risk factor change patterns vary with case chronicity, and whether risk factor improvement still predicts lower recidivism risk among chronic cases. 2,175 parents in home based child welfare services were surveyed for risk factors at pre-treatment, post-treatment and 6-month follow-up. Mixture modeling of latent difference scores identified change trajectory classes related retrospectively to chronicity and prospectively to recidivism. Five change trajectories were identified: stable low problem, stable high problem, sustained improvement, relapsing, and paradoxical. Chronicity was associated with a decreasing probability of membership in the stable low problem trajectory and increasing probability of membership in the stable high problem and sustained improvement trajectories. Cases with more favorable trajectories recidivated less across levels of chronicity. Findings suggest that chronic cases may improve little, but still retain a stable or increasing chance of sustained improvement associated with lower risk. A cumulative service benefit might be one possible explanation for this observation, and might suggest that repeated intervention efforts are not always wasted on chronic cases. The current episodic and reactive service delivery model in child welfare may be a mismatch with chronic cases where progress is absent or tends to occur cumulatively across service episodes.

Longitudinal Modeling of Developmental Changes in Psychological Research

In this article we provide a review of recent advances in longitudinal models for multivariate change. We first claim the need for dynamic modeling approaches as a way to evaluate psychological theories. We then describe one such approach, latent change score (LCS) models, and illustrate their utility with a summary of research findings in various areas of psychological science. We then highlight the most prominent features of LCS models. We conclude the article with suggestions for future research on multivariate models of change that can enhance our understanding of psychological science.

PTSD symptom increases in Iraq-deployed soldiers: comparison with nondeployed soldiers and associations with baseline symptoms, deployment experiences, and postdeployment stress

This prospective study examined: (a) the effects of Iraq War deployment versus non-deployment on pre- to postdeployment change in PTSD symptoms and (b) among deployed soldiers, associations of deployment/postdeployment stress exposures and baseline PTSD symptoms with PTSD symptom change. Seven hundred seventy-four U.S. Army soldiers completed self-report measures of stress exposure and PTSD symptom severity before and after Iraq deployment and were compared with 309 soldiers who did not deploy. Deployed soldiers, compared with non-deployed soldiers, reported increased PTSD symptom severity from Time 1 to Time 2. After controlling for baseline symptoms, deployment-related stressors contributed to longitudinal increases in PTSD symptoms. Combat severity was more strongly associated with symptom increases among active duty soldiers with higher baseline PTSD symptoms.

Sequential Temporal Dependencies in Associations Between Symptoms of Depression and Posttraumatic Stress Disorder: An Application of Bivariate Latent Difference Score Structural Equation Modeling

Depression and posttraumatic stress disorder (PTSD) are highly comorbid conditions that may arise following exposure to psychological trauma. This study examined their temporal sequencing and mutual influence using bivariate latent difference score structural equation modeling. Longitudinal data from 182 emergency room patients revealed level of depression symptom severity to be positively associated with changes in PTSD intrusion, avoidance, and hyperarousal over 3 time intervals, beginning shortly after the traumatic event. Higher scores on depression anticipated increases (or worsening) in PTSD symptom severity. The pattern of influence from PTSD symptom severity to change in depression symptom severity simply followed the general trend toward health and well-being. Results are discussed in terms of the dynamic interplay and associated mechanisms of posttrauma depression and PTSD symptom severity.

The course of posttraumatic stress in children: examination of recovery trajectories following traumatic injury

OBJECTIVE

Group-based trajectory modeling was used to identify patterns of posttraumatic stress symptom (PTSS) in children 6-16 years following accidental injury. The aims were to: (a) identify probable groups of children following distinct trajectories, and (b) identify risk factors affecting the probability of group membership.

METHOD

Children's Impact of Events Scale (n = 190) was used to assess PTSS up to 2 years post injury. Age, gender, type of injury, and preinjury behavior were assessed as risk factors.

RESULTS

Three distinct trajectory groups were identified: resilient (57%), elevated stress symptoms which recovered quickly (33%), and chronic (10%). Younger children were more likely to be in the recovery group. Those with serious injuries were more likely to be in the chronic group. Preinjury child behavior problems were predictive of recovery and high chronic symptoms.

CONCLUSION

Identification of distinct PTSS trajectory groups has implications for understanding the course and treatment of PTSS in children.

Effects of family violence on psychopathology symptoms in children previously exposed to maltreatment

Although many studies suggest that family violence is associated with child psychopathology, multiple features of the home environment might account for this association, such as poverty and caregiver psychopathology. Studies are needed examining how change in psychopathology symptoms is affected by home violence, controlling for children's own developmental symptom histories and other predictors of psychopathology. This study used latent difference score structural equation modeling to test if witnessing home violence and/or experiencing harsh physical discipline predicted changes in psychopathology symptoms among 2,925 youth aged 5-16 years previously exposed to violence. Results demonstrated that harsh physical discipline predicted child-specific changes in externalizing symptoms, whereas witnessing violence predicted child-specific changes in internalizing symptoms across time. Implications for research and policy are discussed.