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Przeworski A, Newman MG. The Contrast Avoidance Model: Conclusion and synthesis of new research in the special issue. J Anxiety Disord 2024; 102:102830. [PMID: 38232491 PMCID: PMC10923164 DOI: 10.1016/j.janxdis.2024.102830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/06/2024] [Accepted: 01/07/2024] [Indexed: 01/19/2024]
Abstract
In this special series, new research on the Contrast Avoidance Model (CAM) was presented, including studies on the role of CAM in the maintenance of chronic worry, the incremental validity of CAM, CAM as a mediator of the association between generalized anxiety disorder (GAD) and other variables, CAM as transdiagnostic, and interpersonal behaviors as a means to avoid negative emotional contrasts (NECs). Furthermore, the role of perseverative thought in relation to positive emotional contrasts (PECs) was explored. Studies indicated that higher worry was positively and negatively reinforced, a factor that is likely to contribute to the maintenance of GAD. Further, research demonstrated that CAM contributed unique variance to understanding GAD above and beyond other variables associated with GAD, such as intolerance of uncertainty and negative problem orientation. Additional research revealed the transdiagnostic nature of contrast avoidance, as well as the association between contrast avoidance and problem-solving deficits. In addition, both worry and rumination increased the likelihood of PECs. Further, data suggested that anxious individuals may use interpersonal strategies to avoid NECs. Finally, savoring positive emotions was found to reduce contrast avoidance, providing a novel intervention strategy to address contrast avoidance in individuals with GAD.
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Strand ER, Hjemdal O, Anyan F, Nordahl H, Nordahl HM. Change in interpersonal problems and metacognitive beliefs as predictors of improvement in patients with generalized anxiety disorder. Clin Psychol Psychother 2023; 30:842-851. [PMID: 36797996 DOI: 10.1002/cpp.2841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Generalized anxiety disorder (GAD) is characterized by persistent worry and anxiety, often with a chronic course. We tested the role of two suggested underlying factors in GAD, interpersonal problems and negative metacognitive beliefs, as predictors of trait-worry and trait-anxiety. METHODS The sample consisted of 56 patients with a primary diagnosis of GAD from a randomized controlled trial. We first estimated the proportion of variance lying between the higher level of the data structure to account for potential therapists' effects. Two hierarchical regression analyses were conducted testing change in interpersonal problems and negative metacognitive beliefs as predictors of change in trait-worry and trait-anxiety following treatment. Change in depression and anxiety symptoms was controlled. RESULTS Change in negative metacognitive beliefs was the strongest predictor of improvement of both trait-worry and trait-anxiety. Change in interpersonal problems was not a unique predictor of change in trait-worry but did make a significant and unique contribution to trait-anxiety. CONCLUSIONS Negative metacognitive beliefs may be important targets to improve trait-worry and trait-anxiety in GAD. Interpersonal problems may be relevant for trait-anxiety but could also be a surface marker of higher order vulnerability factors. Implications for treatment are discussed.
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Affiliation(s)
- Eivind R Strand
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Nidaros DPS, St. Olavs Hospital, Trondheim, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Frederick Anyan
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Henrik Nordahl
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hans M Nordahl
- Østmarka, Division of Psychiatry, St. Olav's Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
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Constantino MJ, Castonguay LG, Coyne AE, Boswell JF, Newman MG. Baseline overly accommodating interpersonal problems in relation to parsed alliance-outcome associations in cognitive behavioral therapy for generalized anxiety disorder. Psychother Res 2023; 33:3-15. [PMID: 35696653 PMCID: PMC9744962 DOI: 10.1080/10503307.2022.2086836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Given its interpersonal underpinnings, relational factors may be salient in psychotherapy for generalized anxiety disorder (GAD). Supporting this point, research has indicated a positive total alliance-improvement correlation in cognitive behavioral therapy (CBT) for GAD. However, less research has disaggregated this correlation into within- and between-patient components, or examined theory-informed ways in which patient characteristics influence to these components. Thus, we first investigated parsed alliance-outcome associations in CBT for GAD. Second, consistent with theory that alliance may represent a direct interpersonal change correlate, we tested whether within-patient alliance improvements were especially therapeutic for patients with higher levels of an interpersonal problem prototypical of GAD-over accommodation. Also, consistent with theory that between-patient differences in overall alliance may be influenced by patients' preexisting relational characteristics, we tested whether more overly accommodating patients reported poorer average alliances that, in turn, related to worse outcomes. Sixty-nine patients received variants of CBT. Patients rated over accommodation at baseline, and alliance and outcome across treatment. As hypothesized, within-patient alliance improvements correlated with subsequent anxiety reduction, and this association was stronger for more overly accommodating patients. All between-patient associations were nonsignificant. Results help clarify the nuanced role of alliance in CBT for GAD.
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Affiliation(s)
| | | | - Alice E Coyne
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst
| | - James F Boswell
- Department of Psychology, University at Albany, State University of New York
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Newman MG, Basterfield C, Erickson TM, Caulley E, Przeworski A, Llera SJ. Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts. Expert Rev Neurother 2022; 22:751-770. [PMID: 36107159 PMCID: PMC9754763 DOI: 10.1080/14737175.2022.2125800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/14/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Generalized anxiety disorder (GAD) is common and disabling. Different versions of cognitive behavioral therapy (CBT) have been tested, but no treatment works for everyone. Therefore, researchers have attempted approaches to enhance CBT. AREAS COVERED The current narrative review examines meta-analyses and individual trials of CBT-based treatments for GAD. We focus on CBT and its cognitive and behavioral components as well as efforts to enhance CBT and its dissemination and generalizability. Enhancement efforts included interpersonal and emotional processing therapy, mindfulness-based CBT, emotion regulation therapy, intolerance of uncertainty therapy, the unified protocol, metacognitive therapy, motivational interviewing, and contrast avoidance targeted treatment. Emerging strategies to enhance dissemination have focused on technologically based treatments. Attempts at generalizability have included examination of efficacy within diverse racial and ethnic groups. EXPERT OPINION We conclude that CBT is efficacious, and a number of enhancement efforts have shown some promise in improving upon CBT in single trials. However, more research is needed, particularly efforts to determine which enhancements work best for which individuals and what are the mechanisms of change. Furthermore, few technological interventions have been compared to active treatments. Finally, much more attention needs to be paid to ethnic and racial diversity in randomized controlled trials.
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Affiliation(s)
- Michelle G Newman
- Department of Psychology, The Pennsylvania State University, Park, PA, USA
| | | | - Thane M Erickson
- Department of Psychology, Seattle Pacific University, Seattle, Washington, USA
| | - Evan Caulley
- Department of Psychology, Seattle Pacific University, Seattle, Washington, USA
| | - Amy Przeworski
- Department of Psychology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sandra J Llera
- Department of Psychology, Towson University, Baltimore, Maryland, USA
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Nordahl H, Hjemdal O, Wells A. Metacognitive Beliefs Uniquely Contribute to Interpersonal Problems: A Test Controlling for Adult Attachment, Big-5 Personality Traits, Anxiety, and Depression. Front Psychol 2021; 12:694565. [PMID: 34539491 PMCID: PMC8440874 DOI: 10.3389/fpsyg.2021.694565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
Interpersonal difficulties are common across psychological disorders and are a legitimate target of treatment. Psychotherapeutic models differ in their understanding of interpersonal problems and how these problems are formulated and treated. It has been suggested that they are both the cause and effect of emotional distress symptoms, that they result from early attachment experiences, and that they are related to personality dimensions. However, the metacognitive model of psychopathology predicts that emotion disorder symptoms and interpersonal problems are linked to a common set of factors involving dysfunctional metacognition. In support of this view, metacognitive therapy has substantially reduced interpersonal problems in patients with anxiety and depression even though interpersonal problems are not directly targeted, indicating a role for metacognitive change. Nevertheless, the relationship between interpersonal problems and metacognitive beliefs remains underexplored, and the statistical control of emotion symptoms, personality, and attachment is important in substantiating any metacognition effects. The aim of the present study was therefore to test metacognitive beliefs as statistical predictors of interpersonal problems while controlling for anxiety/depression, adult attachment, and the Big-5 personality dimensions. In a cross-sectional study, 296 participants completed a battery of self-report questionnaires. We found that positive- and negative-metacognitive beliefs, cognitive confidence, and cognitive self-consciousness accounted for significant and unique variance in interpersonal problems together with avoidant attachment and conscientiousness when the overlap between all predictors was controlled. These findings support the notion that metacognitive beliefs are relevant to interpersonal problems with the potential implication that metacognitive therapy could have particularly broad effects on both emotion disorder symptoms and interpersonal problems.
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Affiliation(s)
- Henrik Nordahl
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Adrian Wells
- School of Psychological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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Shu K. The effect of cognitive behavioral therapy on the release of interpersonal stress. Work 2021; 69:625-636. [PMID: 34120940 DOI: 10.3233/wor-213504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND interpersonal communication in workplace is a problem that is faced by every employee. It is common in all industries and increasingly lethal. When they are unable to bear such overload of psychological pressure, they tend to suffer from anxiety, irritability, depression, and other psychological disorders and even mental diseases. It is urgent to explore how to help employees relieve psychological stress. OBJECTIVE the study aimed to analyze the effects of cognitive behavioral therapy (CBT) on workplace interpersonal stress, and provide help for professionals, especially newcomers, to relieve social pressure. METHODS 125 employees of Internet enterprises were given multi-baseline designed CBT (with baseline phase, treatment phase, and post-baseline phase). 43 subjects who did not finish the therapist program were set as the control group and 82 subjects who finished the treatment program were set as the experimental group. First, the differences of interpersonal stress of subjects with different gender, age, educational background, and monthly salary were analyzed. Then, social avoidance, distress, anxiety, and depression scores in baseline, treatment, and post-baseline periods were compared. Finally, the effects of gender, age, educational background, and monthly salary on social avoidance, distress, anxiety, and depression scores of the experimental group were analyzed by multiple regression. and the influence paths of the workplace interpersonal pressure was constructed. RESULTS Social avoidance, distress, anxiety, and depression of employees earning 10000 or more per month were less than those earning 10000 or more per month. Social avoidance, distress, anxiety, and depression of employees aged 30-50 were higher than those aged < 30 and > 50 (P < 0.05). Social avoidance, social distress, and depression in males were lower than those in females (P < 0.05). Social distress, anxiety, and depression of employees with master's degree or above were less than those with bachelor's degree or junior college degree. There were significant differences between the two groups in the post baseline phase. The monthly salary had the greatest influence on the social avoidance and distress, anxiety, and depression scores of the employees after treatment, with the path coefficients of -0.183, -0.169, and -0.184, respectively. CONCLUSIONS CBT can effectively relieve social avoidance and distress of workplace employees and can improve the symptoms of anxiety and depression. Educational level, age, and monthly salary had a certain influence on the improvement of social avoidance, distress, anxiety and depression.
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Affiliation(s)
- Kunyao Shu
- School of Marxism, Wuhan University of Technology, Hubei, Wuhan, China.,Social Science Division, North China University of Water Resources and Electric Power, Zhengzhou, Henan, China. E-mail:
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Malivoire BL, Mutschler C, Monson CM. Interpersonal dysfunction and treatment outcome in GAD: A systematic review. J Anxiety Disord 2020; 76:102310. [PMID: 33002755 DOI: 10.1016/j.janxdis.2020.102310] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/01/2020] [Accepted: 09/08/2020] [Indexed: 01/06/2023]
Abstract
Interpersonal dysfunction is posited to maintain worry and generalized anxiety disorder (GAD). It has been suggested that the low remission rates in psychotherapy for GAD may be attributable, in part, to inadequately addressing interpersonal dysfunction. This paper systematically reviewed the literature examining the moderating role of interpersonal dysfunction on GAD psychotherapy outcomes and change in interpersonal dysfunction over the course of GAD treatment. Thirteen studies were identified, seven of which examined the relationship between interpersonal dysfunction or distress and treatment outcome and nine investigated change in interpersonal dysfunction over the course of psychotherapy. The majority of studies indicated that interpersonal dysfunction improves following psychotherapy. However, there is preliminary evidence that not all subscales of interpersonal dysfunction improve, including subscales relevant to GAD pathology such as overly-nurturant dysfunction. Further, greater interpersonal dysfunction predicted worse treatment outcomes. As such, interpersonal dysfunction may hinder treatment success and further research is needed to delineate for whom additional or integrated interpersonal interventions may be needed. Approaches to target interpersonal dysfunction in GAD are discussed.
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Affiliation(s)
- Bailee L Malivoire
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario, M5B 2K3, Canada.
| | - Christina Mutschler
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario, M5B 2K3, Canada
| | - Candice M Monson
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario, M5B 2K3, Canada
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Lord KA, Jacobson NC, Suvak MK, Newman MG. Social criticism moderates the relationship between anxiety and depression 10 years later. J Affect Disord 2020; 274:15-22. [PMID: 32469798 PMCID: PMC7365767 DOI: 10.1016/j.jad.2020.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 04/02/2020] [Accepted: 05/10/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Research has consistently documented anxiety and depression as bidirectional risk factors for one another. However, little research investigates the sequential comorbidity of anxiety and depression over lengthy durations, and the influence of contextual variables on this relationship have not been fully empirically investigated. METHOD The current study examined perceived social criticism as a moderator of the relationship between a history of anxiety and a past 12-month depressive episode at least 10 years later (and vice versa) utilizing the National Comorbidity Survey Baseline (N = 8,098) and Re-interview data (N = 5,001). History of anxiety and depressive diagnoses were assigned at Wave 1, past year diagnosis at Wave 2, and perceived social criticism was assessed at Wave 1. RESULTS Structural equation modeling indicated that when controlling for a Wave 1 latent depression factor, a positive relationship between Wave 1 latent anxiety and a Wave 2 latent depression emerged for those endorsing higher perceived social criticism from friends and relatives, respectively. Unexpectedly, when controlling for Wave 1 latent anxiety, a negative relationship between Wave 1 latent depression and Wave 2 latent anxiety emerged for those endorsing higher perceived social criticism from friends, but no relationship when moderated by perceived social criticism from relatives. LIMITATIONS Perceived social criticism was self-reported, which may introduce self-perception bias. CONCLUSIONS Results identified perceived social criticism as an important moderator in the sequential comorbidity of anxiety and depression over a long period of time.
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Affiliation(s)
| | - Nicholas C Jacobson
- Massachusetts General Hospital, Harvard Medical School, The Pennsylvania State University, United States
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McCloskey KD, Cox DW, Ogrodniczuk JS, Laverdière O, Joyce AS, Kealy D. Interpersonal problems and social dysfunction: Examining patients with avoidant and borderline personality disorder symptoms. J Clin Psychol 2020; 77:329-339. [DOI: 10.1002/jclp.23033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/13/2020] [Accepted: 07/03/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Katharine D. McCloskey
- Counselling Psychology Program University of British Columbia Vancouver British Columbia Canada
| | - Daniel W. Cox
- Counselling Psychology Program University of British Columbia Vancouver British Columbia Canada
| | - John S. Ogrodniczuk
- Département de Psychologie Université de Sherbrooke Sherbrooke Quebec Canada
| | | | - Anthony S. Joyce
- Department of Psychiatry University of British Columbia Vancouver British Columbia Canada
| | - David Kealy
- Department of Psychiatry University of British Columbia Vancouver British Columbia Canada
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Probst T, Schramm E, Heidenreich T, Klein J, Michalak J. Patients' interpersonal problems as moderators of depression outcomes in a randomized controlled trial comparing mindfulness-based cognitive therapy and a group version of the cognitive-behavioral analysis system of psychotherapy in chronic depression. J Clin Psychol 2020; 76:1241-1254. [PMID: 31997369 PMCID: PMC7318258 DOI: 10.1002/jclp.22931] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Interpersonal problems were examined as moderators of depression outcomes between mindfulness-based cognitive therapy (MBCT) and cognitive behavioral analysis system of psychotherapy (CBASP) in patients with chronic depression. METHODS Patients received treatment-as-usual and, in addition, were randomized to 8-weeks of MBCT (n = 34) or 8-weeks of CBASP (n = 34). MBCT and CBASP were given in a group format. The Hamilton depression rating scale (HAM-D) was the primary and the Beck Depression Inventory (BDI-II) the secondary outcome. The subscales of the Inventory of interpersonal problems (IIP-32) were moderators. Multilevel models were performed. RESULTS Higher scores on the "vindictive/self-centered" subscale were associated with a better outcome in MBCT than in CBASP (HAM-D: p < .01; BDI-II: p < .01). Higher scores on the "nonassertive" subscale were associated with a better outcome in CBASP than in MBCT (HAM-D: p < .01; BDI-II: p < .01). CONCLUSIONS If these results can be replicated in larger trials, MBCT should be preferred to CBASP in chronically depressed patients being vindictive/self-centered, whereas CBASP should be preferred to MBCT in chronically depressed patients being nonassertive.
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Affiliation(s)
- Thomas Probst
- Department for Psychotherapy and Biopsychosocial HealthDanube University KremsKrems an der DonauAustria
| | - Elisabeth Schramm
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of MedicineUniversity of FreiburgFreiburg im BreisgauGermany
| | - Thomas Heidenreich
- Faculty Social Work, Health, and NursingEsslingen University of Applied SciencesEsslingen am NeckarGermany
| | - Jan‐Philipp Klein
- Department of Psychiatry and PsychotherapyUniversity of LübeckLübeckGermany
| | - Johannes Michalak
- Department of Psychology and PsychotherapyWitten/Herdecke UniversityWittenGermany
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Frandsen FW, Simonsen S, Poulsen S, Sørensen P, Lau ME. Social anxiety disorder and avoidant personality disorder from an interpersonal perspective. Psychol Psychother 2020; 93:88-104. [PMID: 30656823 DOI: 10.1111/papt.12214] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 12/12/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The general objective of this article is to study the unclear and overlapping relationship between social anxiety disorder (SAD) and avoidant personality disorder (AvPD) from an interpersonal perspective. The first specific objective is to compare the disorders with regard to interpersonal problems and general symptom distress. The second specific objective is to examine interpersonal subgroups and pathoplasticity. DESIGN In a cross-sectional design, patients from an outpatient psychotherapy clinic diagnosed with social anxiety disorder (SAD, n = 299), avoidant personality disorder (AvPD, n = 180), or the comorbid condition of both disorders (AvPD + SAD, n = 29) were assessed before treatment. METHODS Patients filled out the Inventory of Interpersonal Problems (IIP-64) and the Symptom Checklist-Revised (SCL-R-90) before treatment. RESULTS AND CONCLUSIONS From an interpersonal perspective, the relationship between the diagnostic groups is well described by the severity continuum hypothesis, with similar interpersonal problems related to Nonassertiveness and lower levels of general interpersonal stress in the SAD group compared to the two AvPD groups. However, other differences in severity do not fit the severity continuum hypothesis, as there are no differences in severity on the global severity index, and, moreover, the SAD group has the most severe problems on the SCL-90 phobic anxiety scale. Interpersonal pathoplasticity is not found in the diagnostic groups or in the full sample. However, three interpersonal subgroups are identified in the full sample, designated as Nonassertive, Friendly-submissive, and Cold-submissive. Implications for treatment are discussed. PRACTITIONER POINTS SAD is characterized by a lower level of interpersonal distress compared to AvPD, but the two disorders are similar in having Nonassertiveness as their general interpersonal problem. Contrary to expectation, SAD and AvPD did not differ in general level of symptom severity, and patients with SAD reported more problems with phobic anxiety than AvPD patients did. When understanding SAD and AvPD as different conceptualizations of the same disorder and analysing all patients together, three distinct interpersonal subgroups emerge, which can be identified as Nonassertive, Friendly-submissive, and Cold-submissive.
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Affiliation(s)
| | - Sebastian Simonsen
- Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark, Gentofte, Denmark
| | | | - Per Sørensen
- Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark, Gentofte, Denmark
| | - Marianne Engelbrecht Lau
- Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark, Gentofte, Denmark
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Quinlan E, Deane FP, Crowe T. Types and severity of interpersonal problems in Australian mental health carers. COUNSELLING PSYCHOLOGY QUARTERLY 2020. [DOI: 10.1080/09515070.2020.1722611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Elly Quinlan
- Illawarra Institute for Mental Health, University of Wollongong, Wollongong, Australia
| | - Frank P. Deane
- Illawarra Institute for Mental Health, University of Wollongong, Wollongong, Australia
| | - Trevor Crowe
- Illawarra Institute for Mental Health, University of Wollongong, Wollongong, Australia
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Wendt LP, Wright AGC, Pilkonis PA, Nolte T, Fonagy P, Montague PR, Benecke C, Krieger T, Zimmermann J. The latent structure of interpersonal problems: Validity of dimensional, categorical, and hybrid models. JOURNAL OF ABNORMAL PSYCHOLOGY 2019; 128:823-839. [PMID: 31556632 PMCID: PMC6816327 DOI: 10.1037/abn0000460] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
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.
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Affiliation(s)
| | | | - Paul A Pilkonis
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Tobias Nolte
- Anna Freud National Centre for Children and Families
| | - Peter Fonagy
- Anna Freud National Centre for Children and Families
| | - P Read Montague
- Research Department of Clinical, Educational, and Health Psychology, University College London
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Shin KE, Newman MG. Self- and other-perceptions of interpersonal problems: Effects of generalized anxiety, social anxiety, and depression. J Anxiety Disord 2019; 65:1-10. [PMID: 31054457 PMCID: PMC6658327 DOI: 10.1016/j.janxdis.2019.04.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 04/09/2019] [Accepted: 04/21/2019] [Indexed: 11/28/2022]
Abstract
Despite attention on overlap and distinction between generalized anxiety disorder (GAD), social anxiety disorder (SAD), and major depressive disorder (MDD), interpersonal specificity (distinct, prototypical interpersonal features) between the disorders has been understudied. There is emerging evidence for such specificity (e.g., Erickson et al., 2016), but most studies relied on self-report, and not all studies controlled for shared variance between the disorders, complicating interpretation of findings. The present study extended the literature by examining unique interpersonal correlates of GAD, SAD, and MDD symptoms on self- and informant-report, and how self-informant agreement (both mean-level and correlation) in perception of interpersonal affiliation, dominance, and distress varied as a function of the symptoms. 369 college-aged participants (43% with clinical-level symptoms for at least one of the disorders (GAD, SAD, MDD), 57% non-disordered) and up to three of their significant others rated participants' interpersonal problems (interpersonal behaviors that were difficult to engage in or engaged in excessively). We found evidence for exploitable tendencies in GAD, socially avoidant and nonassertive tendencies in SAD, and coldness in MDD based on self-report, but not on informant-report. Although self-other correlation was positive across outcomes, participants endorsed higher affiliation and interpersonal distress and lower dominance relative to informants. GAD, SAD, and MDD symptoms showed distinct moderating effects on these self-informant discrepancies. GAD symptoms predicted over-endorsing affiliation, SAD predicted under-endorsing dominance and affiliation, and MDD predicted no discrepancies in affiliation and dominance. The results speak to potential differentiation of the disorders based on distinct patterns of self-other discrepancy in interpersonal perceptions.
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Affiliation(s)
- Ki Eun Shin
- Department of Psychology, Pennsylvania State University, Moore Building, University Park, PA, 16802, United States.
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Newman MG, Shin KE, Lanza ST. Time-varying moderation of treatment outcomes by illness duration and comorbid depression in generalized anxiety disorder. J Consult Clin Psychol 2019; 87:282-293. [PMID: 30714750 PMCID: PMC6632089 DOI: 10.1037/ccp0000385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To extend the sparse literature on moderators, we used time-varying effect modeling (TVEM; Tan, Shiyko, Li, Li, & Dierker, 2012) to examine how depressive symptoms and duration of generalized anxiety disorder (GAD) moderated effects of 3 treatments for GAD (applied relaxation [AR], cognitive-behavioral therapy [CBT], and nondirective therapy [ND]) over time using intensive repeated measures. METHOD In a secondary analysis of Borkovec and Costello (1993), 66 GAD clients were randomly assigned to AR (n = 23), CBT (n = 23), or ND (n = 20). Clients received 12 therapy sessions over 6 weeks, and after 2 weeks of posttreatment assessment, had 2 additional weekly fading sessions. They completed thrice daily anxiety ratings during this 10-week period. GAD duration (Anxiety Disorders Interview Schedule-Revised) and depressive symptoms (Hamilton Depression Rating Scale) were assessed at baseline. RESULTS Longer GAD duration predicted less anxiety reduction in CBT and ND relative to AR. These effects were pronounced in the later phase of treatment, suggesting benefits of focused relaxation practice for clients with longer duration. Higher depression predicted better response to CBT than AR and ND. The moderation effects were also more noticeable in the later phase. In multilevel analyses, a similar moderation pattern held at 1-year follow-up on clinician-rated measures. CONCLUSION GAD clients with long-standing symptoms may benefit more from repeatedly practicing fewer skills than learning multiple skills. On the other hand, clients with comorbid depression may respond better to CBT than AR, perhaps because CBT includes cognitive interventions that can generalize to depression. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Ki Eun Shin
- Department of Psychology, Pennsylvania State University
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16
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Hayden MC, Müllauer PK, Gaugeler R, Senft B, Andreas S. Mentalization as Mediator between Adult Attachment and Interpersonal Distress. Psychopathology 2019; 52:10-17. [PMID: 30904904 DOI: 10.1159/000496499] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 12/24/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to investigate the mediating role of mentalization in the association between adult attachment and interpersonal problems. METHODS The sample consisted of 89 patients with different types of mental disorders who were at the beginning of treatment in one of two medical centers. Both mediational analysis and path analysis were used to test the model. RESULTS The proposed model revealed a good model fit. The data indicate that mentalization fully mediates the effect of attachment on interpersonal distress. Symptom severity proved to be a strong confounding variable that influenced all other variables and reduced existing effects. CONCLUSION We conclude that both mentalization and symptom distress are key components in the association of adult attachment and interpersonal problems. Therefore, we recommend research on integrative psychotherapy concepts rather than unilateral approaches.
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Affiliation(s)
| | | | | | - Birgit Senft
- Reha-Klinik für Seelische Gesundheit und Prävention, Klagenfurt, Austria
| | - Sylke Andreas
- Alpen-Adria-Universität Klagenfurt, Klagenfurt, Austria.,Universität Witten/Herdecke, Witten, Germany
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17
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Jacobson NC, Roche MJ. Current evolutionary adaptiveness of anxiety: Extreme phenotypes of anxiety predict increased fertility across multiple generations. J Psychiatr Res 2018; 106:82-90. [PMID: 30296705 PMCID: PMC6219631 DOI: 10.1016/j.jpsychires.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 09/12/2018] [Accepted: 10/01/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Although recent research has begun to examine the impact of elevated anxiety on evolutionary fitness, no prior research has examined anxiety across a continuum. Such research is important as the effect of traits across a continuum on fertility hold important implications for the levels and distribution of the traits in later generations. METHOD In a three-generational sample (N = 2657) the linear and quadratic relationship between anxiety and the number of children, grandchildren, and great-grandchildren 15 years later was examined. RESULTS The findings suggested that anxiety had a positive quadratic relationship with the number of children, grandchildren, and great-grandchildren 15 years later. These relationships were not significantly moderated by sex. Moreover, most of the variance between anxiety and the number of great-grandchildren was explained by anxiety's influence on the number of children and grandchildren, as opposed to anxiety having an independent direct impact on the number of great-grandchildren. CONCLUSION These findings suggest that extreme values from the mean anxiety are associated with increased evolutionary fitness within the modern environment.
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Affiliation(s)
- Nicholas C Jacobson
- Massachusetts General Hospital, Harvard Medical School, The Pennsylvania State University, United States.
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18
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Brugnera A, Lo Coco G, Salerno L, Sutton R, Gullo S, Compare A, Tasca GA. Patients with Binge Eating Disorder and Obesity have qualitatively different interpersonal characteristics: Results from an Interpersonal Circumplex study. Compr Psychiatry 2018; 85:36-41. [PMID: 29960139 DOI: 10.1016/j.comppsych.2018.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/14/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Patients with Binge Eating Disorder (BED) and obesity experience distressing relationships, which could trigger negative affect and over-eating. To date no studies compared the interpersonal profiles and prototypicality of both groups using the Interpersonal Circumplex. METHOD A sample of 177 patients with BED (mean age: 41.0 ± 12.5 years; 11.3% males), 321 obese non-BED adults (mean age: 44.5 ± 13.4 years; 28% males), and 108 normal weight adults (mean age: 37.3 ± 9.6 years; 52.77% males) completed the Inventory of Interpersonal Problems (IIP-32), and scales of binge eating and psychological distress at one time-point. RESULTS Compared to normal weight and obese participants, those with BED reported higher levels of interpersonal problems on all circumplex dimensions, except for Vindictive, with small to medium effects. All groups had highly prototypical profiles. Both obese and normal weight adults had very similar interpersonal profiles characterized by predominant friendly-dominant themes. On the contrary, those with BED had predominant friendly-submissive themes. Patients with BED reported significantly higher levels of psychological distress and binge eating severity, compared to the other two groups. Greater Domineering, Cold, Socially Inhibited and Non-Assertive scale scores, and lower Vindictive scale scores significantly predicted higher binge eating and psychological distress, regardless of group membership. DISCUSSION Findings lend support to an interpersonal model of binge eating and to the presence of qualitative differences between patients with obesity and BED. Finally, results suggest some strategies for the clinical management of BED focused on non-assertion and problems with experiences and expression of anger.
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Affiliation(s)
- Agostino Brugnera
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy.
| | - Gianluca Lo Coco
- Department of Psychology and Educational Sciences, University of Palermo, Palermo, Italy
| | - Laura Salerno
- Department of Psychology and Educational Sciences, University of Palermo, Palermo, Italy
| | - Rachel Sutton
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - Salvatore Gullo
- Department of Psychology, University "N. Cusano", Rome, Italy
| | - Angelo Compare
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
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Hayden MC, Müllauer PK, Gaugeler R, Senft B, Andreas S. Improvements in mentalization predict improvements in interpersonal distress in patients with mental disorders. J Clin Psychol 2018; 74:2276-2286. [PMID: 29998458 PMCID: PMC6282818 DOI: 10.1002/jclp.22673] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/30/2018] [Accepted: 06/19/2018] [Indexed: 11/09/2022]
Abstract
Objectives Associations between interpersonal problems and mentalization have rarely been investigated. In this study, we explored patterns of interpersonal problems, mentalization, symptom severity, and attachment during inpatient treatment and at follow‐up. Additionally, we investigated whether mentalization predicts a decrease in interpersonal distress. Method We analyzed time‐series data from patients with mental disorders. Data were collected at the beginning and at the end of inpatient treatment, and approximately 6 months after discharge from hospital. Results Patterns of correlations were stable from admission to the hospital until follow‐up. Treatment significantly increased the levels of mentalization and decreased the levels of interpersonal problems and symptom severity, whereas attachment was only partially targeted. Improvements in mentalization significantly predicted reduction in interpersonal distress at each point in time. Conclusion Results revealed characteristic patterns of interpersonal problems, mentalization, symptom severity, and attachment. Mentalization was found to play a key role in the reduction of interpersonal distress.
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Affiliation(s)
| | | | | | - Birgit Senft
- Reha-Klinik für Seelische Gesundheit und Prävention, Klagenfurt, Austria
| | - Sylke Andreas
- Alpen-Adria-Universität Klagenfurt, Klagenfurt, Austria.,Universität Witten/Herdecke, Witten, Germany
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20
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Cooper D, Anderson T. Interpersonal Subtypes Within Social Anxiety: The Identification of Distinct Social Features. J Pers Assess 2017; 101:64-72. [PMID: 28980830 DOI: 10.1080/00223891.2017.1373116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Although social anxiety disorder is defined by anxiety-related symptoms, little research has focused on the interpersonal features of social anxiety. Prior studies (Cain, Pincus, & Grosse Holtforth, 2010; Kachin, Newman, & Pincus, 2001) identified distinct subgroups of socially anxious individuals' interpersonal circumplex problems that were blends of agency and communion, and yet inconsistencies remain. We predicted 2 distinct interpersonal subtypes would exist for individuals with high social anxiety, and that these social anxiety subtypes would differ on empathetic concern, paranoia, received peer victimization, perspective taking, and emotional suppression. From a sample of 175 undergraduate participants, 51 participants with high social anxiety were selected as above a clinical cutoff on the social phobia scale. Cluster analyses identified 2 interpersonal subtypes of socially anxious individuals: low hostility-high submissiveness (Cluster 1) and high hostility-high submissiveness (Cluster 2). Cluster 1 reported higher levels of empathetic concern, lower paranoia, less peer victimization, and lower emotional suppression compared to Cluster 2. There were no differences between subtypes on perspective taking or cognitive reappraisal. Findings are consistent with an interpersonal conceptualization of social anxiety, and provide evidence of distinct social features between these subtypes. Findings have implications for the etiology, classification, and treatment of social anxiety.
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21
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Nielsen SKK, Lønfeldt N, Wolitzky-Taylor KB, Hageman I, Vangkilde S, Daniel SIF. Adult attachment style and anxiety - The mediating role of emotion regulation. J Affect Disord 2017; 218:253-259. [PMID: 28477504 DOI: 10.1016/j.jad.2017.04.047] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 03/19/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although there is substantial evidence for the role of emotion regulation in the etiology and maintenance of anxiety disorders, knowledge about what contributes to emotion dysregulation is sparse. Attachment style is related to emotion regulation and anxiety symptoms, but these variables have rarely been examined together. Examining emotion dysregulation within the context of anxiety disorders through an attachment theory framework will lead to a better understanding of the etiology and maintenance of anxiety disorders. In the present study we combined theoretically and empirically derived knowledge to examine the mediating role of emotion regulation between attachment dimensions (avoidance and anxiety) and anxiety symptoms. METHODS A total of 147 individuals were assessed with Beck Anxiety Inventory (BAI), Experiences in Close Relationships-Revised (ECR-R) and Difficulties in Emotion Regulation Scale (DERS), and statistical mediation analyses were conducted. RESULTS Our results indicate that the significant association between anxiety and attachment anxiety was mediated by emotion dysregulation, whereas attachment avoidance was not significantly related to anxiety when covarying for attachment anxiety. The primary limitation of our study is that data is cross-sectional and so causation cannot be inferred. Secondly, all measures used in this study were derived from self-reported questionnaires, which may be more susceptible to bias. CONCLUSIONS Our results suggest that it is not insecure attachment in general that is important in anxiety disorders, but that attachment anxiety is specifically relevant. Thus, clinical interventions for anxiety disorders may improve by targeting attachment related difficulties.
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Affiliation(s)
| | | | - Kate B Wolitzky-Taylor
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California-Los Angeles, CA, USA
| | | | - Signe Vangkilde
- Department of Psychology, University of Copenhagen, 2A Oester Farimagsgade, 1353 Copenhagen C, Denmark
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Harrison AJ, Timko C, Blonigen DM. Interpersonal styles, peer relationships, and outcomes in residential substance use treatment. J Subst Abuse Treat 2017; 81:17-24. [PMID: 28847451 DOI: 10.1016/j.jsat.2017.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 10/19/2022]
Abstract
Interpersonal relationships play a key role in recovery from substance use disorders (SUDs). We examined the associations between problematic interpersonal styles, peer relationships, and treatment outcomes in a sample of U.S. military veterans in residential SUD treatment. Participants were 189 veterans enrolled in a residential SUD treatment program at a Department of Veterans Affairs medical center. Participants were interviewed at the time of treatment entry (baseline), one month into treatment, and 12months following discharge from treatment. More problematic interpersonal styles at treatment entry, measured by the Inventory of Interpersonal Problems-Circumplex (IIP-C), predicted more SUD symptoms 12months post-discharge (r=0.29, P<0.01). Results of a principal components analysis of the IIP-C subscales revealed three main factors of interpersonal styles: Passive, Cruel/Aloof, and Controlling. With the exception of the Passive factor, the relationship between these interpersonal styles and SUD symptoms 12months after discharge was mediated by relationship quality with peers one month in treatment: i.e., more problematic interpersonal styles at baseline predicted poorer relationship quality with peers at 1month, which in turn predicted more SUD symptoms at 12months. Results demonstrate the importance of assessing interpersonal styles among patients in residential SUD treatment, as well as potentially augmenting existing evidence-based psychosocial treatments with a focus on interpersonal styles.
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Affiliation(s)
- Anna J Harrison
- Department of Psychiatry, University of California San Francisco, United States.
| | - Christine Timko
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, United States; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States
| | - Daniel M Blonigen
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, United States; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States; Palo Alto University, United States
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