Experiential avoidance as a moderator of the relationship between behavioral inhibition system sensitivity and posttraumatic stress symptoms

Experiential Avoidance, Post-Traumatic Stress Symptoms, and Academic Impairment

The ways in which Posttraumatic Stress Disorder (PTSD) symptoms lead to impairments in functioning, including academic performance, are not well understood. The present study sought to examine the role of a common maladaptive coping strategy, experiential avoidance, as a moderator of the relationship between posttraumatic stress symptoms (PTSS) and academic achievement. Participants (N = 326) were undergraduate students enrolled in introductory psychology courses at a large university in the Midwestern United States who reported at least one event potentially meeting Criterion A for PTSD. The prospective association of PTSS with current and subsequent semester GPAs, and with experiential avoidance as the moderator, were examined. The interaction between PTSS and experiential avoidance significantly predicted both current semester GPA and subsequent semester GPA, with stronger associations between PTSS and GPA being observed at higher levels of experiential avoidance. These results were not fully explained by control variables of high school performance, standardized test scores, and general negative affect. This study found that experiential avoidance significantly moderates the relationship between PTSS and academic performance. These results suggest that interventions that target PTSS and/or experiential avoidance may increase GPA. Limitations and future directions are discussed.

Psychological distress in a sample of predominately white female college students: the role of mindfulness and physical activity

Objective: Framed in Reinforcement Sensitivity Theory, this study examined the moderating effects of mindfulness and moderate-to-vigorous physical activity (MVPA) on the relationship between behavioral inhibition system (BIS) sensitivity and psychological distress in college students. Participants: Undergraduate students (n = 183) at a large public university in the United States were included in the study. Methods: Self-reported BIS sensitivity, mindfulness, MVPA, and psychological distress were examined in November 2021. Results: Findings revealed a positive relationship between BIS sensitivity and psychological distress, however, this relationship was conditional on levels of mindfulness and MVPA. Specifically, increased reports of mindfulness and MVPA related to lower psychological distress for participants with higher than average BIS sensitivity. Conclusions: Mindfulness and MVPA are buffers for university students prone to psychological distress. Identifying diverse strategies that effectively lower psychological vulnerabilities in college students can be used to develop targeted interventions that reduce psychopathology and promote mental health.

The relationship between sleep disturbance and obsessive- compulsive symptoms: the mediation of repetitive negative thinking and the moderation of experiential avoidance

Background

Studies have found that sleep disturbance is associated with obsessive-compulsive symptoms. This study aimed to elaborate on the mediating and moderating mechanisms between these two variables. We hypothesized that repetitive negative thinking plays a mediating role in the relationship between sleep disturbance and obsessive-compulsive symptoms, and experiential avoidance plays a moderating role.

Method

This study included 639 Chinese adults. A questionnaire survey was used to assess sleep quality, obsessive-compulsive symptoms, experiential avoidance, repetitive negative thinking, and depression symptoms. A moderated mediation model was established.

Results

After controlling for depressive symptoms, repetitive negative thinking partially mediated the positive correlation between sleep disturbance and obsessive-compulsive symptoms. This indirect relationship was significant in individuals with lower experiential avoidance levels. Particularly, the relationship between sleep disturbance and repetitive negative thinking was significant among individuals with lower experiential avoidance levels, but not among individuals with higher experiential avoidance levels.

Conclusion

This study demonstrated that repetitive negative thinking partially mediated the impact of sleep disturbance on obsessive-compulsive symptoms. The findings suggest that when providing support to individuals with sleep disturbance and obsessive-compulsive symptoms, assessing their level of experiential avoidance is necessary for performing targeted interventions. Individuals with low experiential avoidance may benefit from a clinical intervention targeting repetitive negative thinking to improve sleep quality and obsessive-compulsive symptoms.

Temperament, Life Satisfaction, and the Role of Psychological Flexibility

Abstract: Temperament is related to well-being. Establishing mediators of this relationship, especially mediators which can be influenced through psychological interventions, may contribute to tailoring these interventions to people’s needs determined by temperament. Psychological flexibility may be considered such a mediator. This study aims to examine the relationships between temperament traits and structures, satisfaction with life, and psychological flexibility, with the latter as a possible mediator of the relationship between temperament structures and life satisfaction. 538 participants (18–93 years old) took part in the study. They filled a set of self-reported questionnaires. Psychological flexibility explained a significant part of the variance in life satisfaction above and beyond temperament traits. People with harmonized temperament structures and higher stimulation processing capabilities (sanguine) exhibited higher psychological flexibility and satisfaction with life. Three temperament structures: phlegmatic, choleric, and melancholic in comparison to sanguine were found to be linked to lower satisfaction with life through lower psychological flexibility. The results suggest a meaningful role of stimulation processing capabilities in the development of both psychological flexibility and satisfaction with life.

Posttraumatic Stress Symptoms and its Association with Rumination, Thought Suppression and Experiential Avoidance: a Systematic Review and Meta-Analysis

Posttraumatic stress disorder (PTSD) is a severe mental disorder causing high individual and societal costs. The use of maladaptive emotion regulation (ER) strategies has been identified as a potential contributing factor. This meta-analysis aimed to quantify the associations between PTSD symptoms and rumination, thought suppression and experiential avoidance. The systematic literature search resulted in 5574 studies, 75 of which were included in the analysis. From those eligible studies 189 effect sizes were obtained. For symptoms of posttraumatic stress, large effects were found for associations with rumination (r = .52) and experiential avoidance (r = .48), whereas a medium effect size was found for thought suppression (r = .29). With respect to different PTSD symptom clusters, associations ranged between r = .35 and r = .41 for associations with intrusive re-experiencing, between r = .39 and r = .41 for associations with avoidance, between r = .50 and r = .53 for associations with alterations in cognitions and mood and between r = .41 and r = .45 for associations with alterations in arousal and activity. Few available studies provide some evidence that associations might be somewhat reduced but still substantial in longitudinal compared to cross-sectional studies. These findings provide valuable targets for future investigations with the long-term goal of improving targeted interventions for the prevention and treatment of PTSD symptoms.

Determinants of emotional distress in neonatal healthcare professionals: An exploratory analysis

Background

High levels of mental health problems have been consistently reported among neonatal healthcare professionals. While studies suggest that personality, coping strategies and safety culture might contribute to the psychological wellbeing of healthcare professionals, they have not been systematically investigated in low-risk (i.e., neonatal wards; NWs) and high-risk (i.e., neonatal intensive care units; NICUs) neonatal contexts. The current study investigated potential predictors of professionals' emotional distress and whether they differ according to the work setting (i.e., NICUs vs. NWs).

Methods

Healthcare professionals (N = 314) from 7 level-3 (i.e., NICUs) and 6 level-2 (i.e., NWs) neonatal units in Tuscany were included. Emotional distress (i.e., anxiety, depression, psychosomatic, post-traumatic stress symptoms and emotional exhaustion), Behavioral Inhibition System (BIS) and Behavioral Approach System (BAS) sensitivity, coping strategies and safety culture were assessed through well-validated, self-reported questionnaires.

Results

Greater BIS/BAS sensitivity, avoidance coping strategies and a sub-dimension of safety culture (i.e., stress recognition) were significantly associated with greater risk of emotional distress, whereas job satisfaction emerged as a protective factor. Three specific profiles of professionals in term of personality, coping and safety culture were identified and further predicted emotional distress. Neonatal wards and NICUs personnel presented different associations between personality, coping and safety culture.

Conclusion

These findings highlighted significant modifiable contributors of neonatal mental healthcare professionals' wellbeing. Institutional initiatives that target these factors and, particularly, job satisfaction may promote professionals' emotional wellbeing and thus improve caring processes.

Psychological flexibility, temperament, and perceived stress

BACKGROUND

Psychological flexibility (PF) is an ability to engage in meaningful actions regardless of the presence of difficult internal experiences. Higher psychological flexibility was found to be related not only to a lower level of the symptoms of psychopathology, but also with better functioning, lower stress levels and higher well-being. As temperament impacts preferred styles of action, data on the relationships between temperament, psychological flexibility and other criteria can provide ideas on how to improve the process of PF development. The aim of this study was to examine the relationships between psychological flexibility, temperament traits and perceived stress.

PARTICIPANTS AND PROCEDURE

A total of 254 people, aged 18-93, recruited directly by 13 pollsters from a local community sample, took part in the study. Temperamental traits were operationalized according to the regulative theory of temperament. Participants completed self-report measures.

RESULTS

Psychological flexibility was predicted by emotional reactivity and perseveration and it was a significant predictor of stress beyond and above temperamental traits. While the relationship between stress and two temperamental traits - emotional reactivity and perseveration - was partially mediated by psychological flexibility, activity was related to stress directly.

CONCLUSIONS

Psychological flexibility is determined by temperamental traits to some extent. Further research on psychological flexibility and temperament needs to take an empirical design and test possible reciprocal effects.

Alpha frontal asymmetry underlies individual differences in reactivity to acute psychosocial stress in males

People vary in their responses to stress. The present study aimed to investigate whether and how alpha frontal asymmetry (AFA) measured in the resting state underlies the individual differences in psychological responses to acute psychosocial stress (e.g., increases in heart rate and cortisol) induced by the Trier social stress test. Forty-three healthy male adults were enrolled in this study. The results showed that the AFA score negatively predicted both heart rate and cortisol responses, that is relatively higher right-frontal activity during the resting state was related to a stronger physiological stress response. These results indicated that higher withdrawal motivation or effortful control is associated with a higher physiological stress response, which suggested that AFA in the resting state can serve as a biological predictor of acute stress responses in men.

Cognitive arousal mediates the relationship between perceived ostracism and sleep quality but it is not moderated by experiential avoidance

Previous research suggests that longer-term perceived ostracism is related to poor sleep quality. In this study, we investigated the mediating effect of cognitive arousal on the perceived ostracism-sleep quality relationship. We also investigated whether experiential avoidance was a moderator of the cognitive arousal-sleep quality relationship. Participants (N = 251) were recruited through online research portals to take part in an online survey. A path analysis was used to test a moderated mediation effect between variables. It was found that cognitive arousal mediated the perceived ostracism-sleep quality relationship; however, experiential avoidance was not a significant moderator. These findings suggest that further research needs to be conducted to elucidate the mechanism of experiential avoidance to account for when it may impact sleep quality. Moreover, treatment interventions targeted at reducing cognitive arousal (e.g., cognitive behavioural therapy) prior to sleep are likely to bear some fruit.

Direct and Indirect Effects of Behavioral Inhibition/Activation Systems on Depression and Current Suicidal Ideation Through Rumination and Self-Reflection

This study aimed to evaluate direct and indirect effects of the behavioral inhibition system (BIS) and the behavioral activation system (BAS) on depression and current suicidal ideation through rumination and self-reflection in a sample of suicide attempters. Three hundred suicide attempters completed the Rumination/Reflection Questionnaire (RRQ), the Carver and White BIS/BAS scales, the Beck Scale for Suicide Ideation (BSSI), and the Beck Depression Inventory-II (BDI-II). Results revealed that the BAS and BIS had direct effects on suicidal ideation but not depression. Low BAS had an indirect effect on depression through decreased self-reflection. High BIS had an indirect effect on depression via increased rumination. Low BAS and high BIS had indirect effects on suicidal ideation through decreased self-reflection. The findings suggest that low BAS and high BIS may be associated with depression and suicidal ideation in suicide attempters who have decreased self-reflection and increased rumination. Also, increasing self-reflection and reducing rumination as respectively adaptive and maladaptive self-focused attention strategies may prohibit depression and suicidal ideation.

Reinforcement sensitivity, depression and anxiety: A meta-analysis and meta-analytic structural equation model

Reinforcement Sensitivity Theory (RST) posits that individual differences in reward and punishment processing predict differences in cognition, behavior, and psychopathology. We performed a quantitative review of the relationships between reinforcement sensitivity, depression and anxiety, in two separate sets of analyses. First, we reviewed 204 studies that reported either correlations between reinforcement sensitivity and self-reported symptom severity or differences in reinforcement sensitivity between diagnosed and healthy participants, yielding 483 effect sizes. Both depression (Hedges' g = .99) and anxiety (g = 1.21) were found to be high on punishment sensitivity. Reward sensitivity negatively predicted only depressive disorders (g = -.21). More severe clinical states (e.g., acute vs remission) predicted larger effect sizes for depression but not anxiety. Next, we reviewed an additional 39 studies that reported correlations between reinforcement sensitivity and both depression and anxiety, yielding 156 effect sizes. We then performed meta-analytic structural equation modeling to simultaneously estimate all covariances and control for comorbidity. Again we found punishment sensitivity to predict depression (β = .37) and anxiety (β = .35), with reward sensitivity only predicting depression (β = -.07). The transdiagnostic role of punishment sensitivity and the discriminatory role of reward sensitivity support a hierarchical approach to RST and psychopathology.

Experiential avoidance moderates the association between motivational sensitivity and prolonged grief but not posttraumatic stress symptoms

Within the current theoretical frameworks used in grief and bereavement research, it remains unclear which individual factors confer risk for specific bereavement-related mental health problems, such as posttraumatic stress disorder (PTSD) and prolonged grief disorder. The present study investigated individual differences in motivational sensitivity and self-regulatory processes in a sample of 326 bereaved individuals who experienced sudden and/or unexpected death losses. We (1) examined associations between behavioral activation system (i.e., orientation to rewarding stimuli) and behavioral inhibition system (i.e., orientation to aversive stimuli) sensitivity and bereavement-related mental health problems (i.e., PTSD and prolonged grief symptoms), and (2) explored whether experiential avoidance (i.e., effortful avoidance of internal stimuli) would moderate such associations. Results revealed PTSD was more strongly associated with behavioral inhibition system sensitivity, while prolonged grief symptoms more strongly associated with behavioral activation system sensitivity. In particular, drive sensitivity - a dimension of the behavioral activation system - appeared uniquely associated with prolonged grief symptoms, especially in those who endorsed high experiential avoidance. Findings support a theoretical reconceptualization of prolonged grief as a reward system disorder. This reconceptualization may aid in further understanding mechanisms of bereavement-related mental health problems and related risk factors.

The behavioural inhibition system, behavioural activation system and experiential avoidance as explanatory variables of comorbid chronic pain and posttraumatic stress symptoms

Background: The variables that underlie comorbid chronic pain and posttraumatic stress symptoms (PTSS) are not yet clearly established. Objective: The aim of the present study was to analyse the role of the behavioural inhibition system (BIS), behavioural approach system (BAS) and experiential avoidance (EA) in pain adjustment (i.e. pain intensity, daily functioning and pain-related impairment) in patients with chronic pain and PTSS. Methods: A battery of instruments was administered to 388 chronic pain patients. The sample was divided into those with PTSS (n = 194) and those without PTSS (n =194). Results: Significant differences were found between groups in the BIS, EA, impairment and daily functioning. No differences were found between groups in the BAS. Structural equation modelling showed that the BIS and EA were associated with worse adjustment in the 194 patients with both chronic pain and PTSS. The BAS was associated with a lower level of pain and greater daily functioning. Conclusion: The findings provide evidence that BIS and BAS activation and EA play a role in adjustment to chronic pain in patients with concurrent PTSS. These results may help guide the development of psychological treatments for patients with both conditions.

Anhedonia and emotional numbing in treatment-seeking veterans: behavioural and electrophysiological responses to reward

Background: Anhedonia is a common symptom following exposure to traumatic stress and a feature of the PTSD diagnosis. In depression research, anhedonia has been linked to deficits in reward functioning, reflected in behavioural and neural responses. Such deficits following exposure to trauma, however, are not well understood. Objective: The current study aims to estimate the associations between anhedonia, PTSD symptom-clusters and behavioural and electrophysiological responses to reward. Methods: Participants (N = 61) were recruited among Danish treatment-seeking veterans at the Department of Military Psychology in the Danish Defence. Before entering treatment, participants were screened with symptom measurement instruments and participated in a joint behavioural-electrophysiological experiment. The experimental paradigm consisted of a signal-detection task aimed at assessing reward-driven learning. Simultaneous electrophysiological-recordings were analysed to evaluate neural responses upon receiving reward, as indicated by the Feedback-Related Negativity (FRN) component. Result: Anhedonia as conceptualized in depression correlated with behavioural learning (r = -0.28, p = .032). Neither anhedonia nor behavioural learning correlated with FRN. However, the anhedonia symptom cluster of PTSD did correlate with FRN (r = 0.29, p = .023). Extending upon this in an exploratory analysis, the specific PTSD-symptom emotional numbing was found to correlate moderately with FRN (r = 0.38, p = .003). Conclusion: The present data suggest that anhedonia in trauma-exposed individuals is related to the anticipatory aspect of reward, whereas the neural consummatory reward response seems unlinked. Interestingly, emotional numbing in the same population is related to the consummatory phase of reward, correlating with the FRN response. This suggests that anhedonia and emotional numbing in response to trauma might pertain to different phases of reward processing.

Behavioral Inhibition and Activation Systems, and Emotional Regulation in Individuals With Chronic Musculoskeletal Pain

Gray's Reinforcement Sensitivity Theory postulates two distinct neurophysiological systems that underlie thoughts, emotions, and behavior: the Behavioral Inhibition System (BIS) and the Behavioral Approach System (BAS). Preliminary research suggests that both systems may play relevant roles in the adjustment of individuals with chronic pain. However, there is a lack of research on the extent to which emotional regulation (i.e., cognitive reappraisal and expressive suppression) mediates the associations between BIS and BAS activation and emotional responses in individuals with chronic pain. The aim of this study was to test a model of the associations between the BIS and BAS, cognitive reappraisal and expressive suppression, and positive and negative affect in individuals with chronic musculoskeletal pain. In total, 516 participants were interviewed. Structural Equation Modeling was used to estimate the associations between variables. The empirical model showed a good fit to the data (χ²/df = 1.95; RMSEA = 0.04; GFI = 0.99; AGFI = 0.98; CFI = 0.99). The hypothesized model received partial support. The BIS was associated with cognitive reappraisal and expressive suppression; cognitive reappraisal was associated with negative and positive affect; expressive suppression was positively associated with affect; and the BAS was not associated with the emotional regulation strategies assessed. However, the BIS and BAS were both directly associated with negative and positive affect. The results suggest that individuals with chronic pain with higher BIS activation appear to use greater expressive suppression. Cognitive reappraisal strongly mediated the BIS-negative affect association. The results also suggest that BAS activation may have a weak or inconsistent association with emotional regulation approaches in individuals with chronic pain. These data provide new and relevant information on the potential role of the BIS and BAS as predictors of psychological functioning in individuals with chronic pain. They suggest that the BIS-BAS model of chronic pain may need to be modified to take into account the potential negative effects of BAS activation. The findings suggest that treatments for emotional regulation could potentially reduce the negative impact of chronic pain via BIS.

Coping with psychosomatic symptoms: The buffering role of psychological flexibility and impact on quality of life

Individual differences in avoidant coping were hypothesized to exacerbate quality of life impairment associated with somatization and illness anxiety symptoms; psychological flexibility was expected to moderate this impairment. Individuals from a random community sample ( N = 298; 182 females), who met screening criteria for somatization and illness anxiety, reported lower quality of life and psychological flexibility and greater avoidant coping compared to controls. Psychological flexibility significantly moderated the impact of somatization and illness anxiety on quality of life domains. Findings suggest that decreasing avoidant coping through therapy may be promising in mitigating the negative impact of these symptom categories.

Effects of the behavioral inhibition system (BIS), behavioral activation system (BAS), and emotion regulation on depression: A one-year follow-up study in Chinese adolescents

Depression is a worldwide mental health problem among adolescents. The current study aimed to examine the roles of the behavioral inhibition system (BIS), behavioral activation system (BAS), and emotion regulation on adolescent depression. A total of 330 Chinese adolescents were recruited to complete initial assessments of BIS/BAS, emotion regulation, and depression, with a follow-up after one year. Depression on these two occasions was positively correlated with gender, age, initial scores of BIS/BAS activity, and with Cognitive Emotion Regulation Questionnaire scores for self-blame, rumination, putting into perspective, catastrophizing, and blaming others, and negatively correlated with initial positive reappraisal scores. Structural equation modeling demonstrated that higher BIS activity, catastrophizing, rumination, and lower positive reappraisal predicted depression after one year. However, after controlling for initial depression, these variables were indirectly related to subsequent depression. Implications are discussed for assessments of depression and interventions targeted at the BIS, BAS, and emotion regulation.

The Comparison of Experiential Avoidance, [corrected] Mindfulness and Rumination in Trauma-Exposed Individuals With and Without Posttraumatic Stress Disorder (PTSD) in an Iranian Sample

The aim of this study was to compare experimental avoidance, mindfulness and rumination in trauma-exposed individuals with and without PTSD in an Iranian sample. The method of the study was retrospective. The statistical population of the study composed of all people under the auspices of Committee on Relief or Martyr Foundation because of exposure to at least one traumatic event in Gilan-Gharb city (Iran) (N=1708). One hundred people, selected randomly by stratified sampling method, responded to Mississippi PTSD scale and the questionnaires of experimental avoidance, mindfulness and rumination individually. Subjects were divided into two groups of with and without PTSD based on Mississippi PTSD scale and structured clinical interview. Multivariate analysis of variance (MANOVA) test was used for analyzing data. Results showed that although the mean scores of the group with PTSD were significantly higher than the group without PTSD in variables of experimental avoidance (P<0/001, F=63/8) and rumination (P<0/001, F=21/34), the mean scores of the group with PTSD were significantly lower than the group without PTSD in the overall score of mindfulness (P<0/05, F=6/64) and variables of observing (P<0/05, F=8/27) and action description (P<0/05, F=9/19). These results show that the experimental avoidance and rumination are as the risk factors and mindfulness as the protective factor PTSD in people faced with trauma.

Further Investigation of the Association between Anxiety Sensitivity and Posttraumatic Stress Disorder: Examining the Influence of Emotional Avoidance

Anxiety sensitivity (AS) and the tendency to avoid emotions have both been identified as vulnerability factors for the development and maintenance of posttraumatic stress disorder (PTSD). Furthermore, both cross-sectional and prospective research have provided evidence that emotional avoidance and AS interact to predict anxiety symptoms, such that AS may only be associated with anxiety-related pathology among those who exhibit a tendency to avoid their emotions. The purpose of the present study was to determine if this moderator model extends to PTSD within a sample of substance dependent patients. Specifically, this study examined if AS is associated with PTSD only among individuals with high (vs. low) levels of negative emotional avoidance. As predicted, results of a logistic regression analysis revealed a significant interaction between negative emotional avoidance and AS in predicting PTSD status. Follow-up analyses revealed a significant positive association between AS and PTSD status for participants high in negative emotional avoidance; however, AS was not associated with PTSD for those low in negative emotional avoidance. This finding remained even when relevant covariates were included in the model. Results confirm hypotheses and are consistent with the extant anxiety-risk literature.

Reward functioning in PTSD: a systematic review exploring the mechanisms underlying anhedonia

Post-traumatic stress disorder (PTSD) is a debilitating psychiatric disorder. An important diagnostic feature of PTSD is anhedonia, which may result from deficits in reward functioning. This has however never been studied systematically in PTSD. To determine if PTSD is associated with reward impairments, we conducted a systematic review of studies in which reward functioning was compared between PTSD patients and healthy control participants, or investigated in relation to PTSD symptom severity. A total of 29 studies were included, covering reward anticipation and approach ('wanting'), and hedonic responses to reward ('liking'). Overall, results were mixed, although decreased reward anticipation and approach and reduced hedonic responses were repeatedly observed in PTSD patients compared to healthy controls. Decreased reward functioning was seen more often in female than in male PTSD samples and most often in response to social positive stimuli. Though more research is needed, these findings are a first step in understanding the possible mechanisms underlying anhedonia in PTSD.

Direct and indirect predictors of social anxiety: The role of anxiety sensitivity, behavioral inhibition, experiential avoidance and self-consciousness

Using mediated and moderated regression, this study examined the hypothesis that anxiety sensitivity, the tendency to be concerned about anxiety symptoms, and behavioral inhibition, the tendency to withdraw from novel and potentially dangerous stimuli, predict social anxiety indirectly through experiential avoidance as measured by the Acceptance and Action Questionnaire-II and self-consciousness, as measured by the Self-Consciousness Scale. Behavioral inhibition and anxiety sensitivity are operationalized as temperamental traits, while experiential avoidance and self-consciousness are seen as learned emotion regulation strategies. Study 1 included college student groups from Cyprus scoring high and low on social anxiety (N=64 and N=63) as measured by the Social Phobia and Anxiety Inventory. Study 2 examined a random community sample aged 18-65 (N=324) treating variables as continuous and using the Psychiatric Disorders Screening Questionnaire to screen for social anxiety. Results suggest that experiential avoidance, but not self-consciousness mediates the effects of anxiety sensitivity on predicting social anxiety status, but that behavioral inhibition predicts social anxiety directly and not through the proposed mediators. Moderation effects were not supported. Overall, the study finds that social anxiety symptomatology is predicted not only by behavioral inhibition, but also anxiety sensitivity, when individuals take actions to avoid anxious experiences. Modifying such avoidant coping approaches may be more beneficial for psychological treatments than attempts to change long-standing, temperamental personality traits.

Acceptance and commitment therapy for anxiety and OCD spectrum disorders: an empirical review

A fair amount of research exists on acceptance and commitment therapy (ACT) as a model and a treatment for anxiety disorders and OCD spectrum disorders; this paper offers a quantitative account of this research. A meta-analysis is presented examining the relationship between psychological flexibility, measured by versions of the Acceptance and Action Questionnaire (AAQ and AAQ-II) and measures of anxiety. Meta-analytic results showed positive and significant relationships between the AAQ and general measures of anxiety as well as disorder specific measures. Additionally, all outcome data to date on ACT for anxiety and OCD spectrum disorders are reviewed, as are data on mediation and moderation within ACT. Preliminary meta-analytic results show that ACT is equally effective as manualized treatments such as cognitive behavioral therapy. Future directions and limitations of the research are discussed.

A model of BIS/BAS sensitivity, emotion regulation difficulties, and depression, anxiety, and stress symptoms in relation to sleep quality

Recent research has indicated that interactions between behavioral inhibition system (BIS)/behavioral activation system (BAS) sensitivity and emotion regulation (ER) difficulties increases risk for psychopathology. Considering sleep quality (SQ) has been linked to emotion regulation difficulties (ERD) and psychopathology, further investigation of a possible mechanism is needed. The current study examined associations between BIS/BAS sensitivity, ERD, and SQ to depression, anxiety, and stress symptoms in an undergraduate sample (n=459). Positive relationships between BIS sensitivity and both ERD and stress symptoms, and negative relationships between BAS-reward sensitivity and both ERD and depression symptoms were observed. Furthermore, ERD were positively related to depression, anxiety, and stress symptoms. Succeeding analyses revealed differential relationships between ERD and depression, anxiety, and stress symptoms among good quality and poor quality sleepers. The findings are discussed within the context of personality dimensions and self-regulatory mechanisms, along with implications for the treatment of depression, anxiety and sleep difficulties.

PTSD's underlying symptom dimensions and relations with behavioral inhibition and activation

Reinforcement sensitivity theory (RST) stipulates that individuals have a behavioral activation system (BAS) guiding approach (rewarding) behaviors (Gray, 1971, 1981), and behavioral inhibition system (BIS) guiding conflict resolution between approach and avoidance (punishment) behaviors (Gray & McNaughton, 2000). Posttraumatic stress disorder (PTSD) severity overall relates to both BIS (e.g., Myers, VanMeenen, & Servatius, 2012; Pickett, Bardeen, & Orcutt, 2011) and BAS (Pickett et al., 2011). Using a more refined approach, we assessed specific relations between PTSD's latent factors (Simms, Watson, & Doebbeling, 2002) and observed variables measuring BIS and BAS using 308 adult, trauma-exposed primary care patients. Confirmatory factor analysis and Wald chi-square tests demonstrated a significantly greater association with BIS severity compared to BAS severity for PTSD's dysphoria, avoidance, and re-experiencing factors. Further, PTSD's avoidance factor significantly mediated relations between BIS/BAS severity and PTSD's dysphoria factor.

Trauma-related reactivity and regulation of emotion: associations with posttraumatic stress symptoms

BACKGROUND AND OBJECTIVES

Both emotional reactivity to traumatic event cues and difficulties regulating emotion have been linked to posttraumatic stress symptom severity. The current study uniquely extended these two lines of research by examining the degree to which these two factors alone, and in combination, account for variability in posttraumatic stress symptom severity.

METHOD

Self-reported emotion regulation difficulties, and both subjective and physiological reactivity in response to a script-driven imagery procedure, were assessed among a community sample of 21 adult women with a history of interpersonal assault. Relationships with an interview-based measure of posttraumatic stress symptom severity were examined.

RESULTS

Results were consistent with hypotheses. Both traumatic event-related emotional reactivity and emotion regulation difficulties independently predicted posttraumatic stress symptom severity. A significant interaction also emerged such that traumatic event-related emotional reactivity and posttraumatic stress symptom severity were only significantly associated at relatively elevated levels of emotion regulation difficulties.

LIMITATIONS

Limitations included the use of a self-report questionnaire to assess emotion regulation difficulties, relatively small sample size, and lack of evidence regarding generalizability across gender or other traumatic event types.

CONCLUSIONS

These results highlight that the interaction of heightened emotional reactivity and difficulties regulating emotion may be particularly influential in posttraumatic stress symptom severity.

A psychophysiological investigation of threat and reward sensitivity in individuals with panic disorder and/or major depressive disorder

Heightened sensitivity to threat and reduced sensitivity to reward are potential mechanisms of dysfunction in anxiety and depressive disorders, respectively. However, few studies have simultaneously examined whether these mechanisms are unique or common to these disorders. In this study, sensitivity to predictable and unpredictable threat (measured by startle response during threat anticipation) and sensitivity to reward (measured by frontal electroencephalographic [EEG] asymmetry during reward anticipation) were assessed in 4 groups (N = 191): those with (1) panic disorder (PD) without a lifetime history of depression, (2) major depression (MDD) without a lifetime history of an anxiety disorder, (3) comorbid PD and MDD, and (4) controls. General distress/negative temperament (NT) was also assessed via self-report. Results indicated that PD (with or without comorbid MDD) was uniquely associated with heightened startle to predictable and unpredictable threat, and MDD (with or without comorbid PD) was uniquely associated with reduced frontal EEG asymmetry. Both psychophysiological measures of threat and reward sensitivity were stable on retest approximately 9 days later in a subsample of participants. Whereas the comorbid group did not respond differently on the tasks relative to the PD-only and MDD-only groups, they did report greater NT than these 2 groups (which did not differ from each other). Results suggest that heightened sensitivity to threat and reduced sensitivity to reward may be specific components of PD and MDD, respectively. In addition, relative to noncomorbid depression and PD, comorbid MDD and PD may be characterized by heightened NT, but not abnormal levels of these "specific" components.