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Hoffman SN, Stein MB, Taylor CT. The relationship between expressive suppression, therapeutic bond, and treatment outcomes of a positive affect intervention for adults with anxiety and/or depression. Cogn Behav Ther 2024; 53:394-408. [PMID: 38483053 DOI: 10.1080/16506073.2024.2321891] [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: 09/25/2023] [Accepted: 02/15/2024] [Indexed: 03/23/2024]
Abstract
Expressive suppression (ES; reducing emotional expression) is linked with reduced social connectedness in individuals with anxiety or depression. One implication is that people who use ES may have difficulty establishing a bond with their therapist which may impede clinical improvement. We examined this hypothesis in 33 adults with clinically elevated anxiety or depression receiving treatment focused on enhancing positive thoughts, emotions, and behaviors. At baseline, participants rated ES for positive and negative emotions during a standardized conversation task designed to generate connectedness. They also rated measures of early (session 3) perceived therapeutic bond and treatment outcomes (i.e. positive affect and social connectedness). ES of positive (r = -.39, p = .018), but not negative (r = .06, p = .747), emotions was negatively associated with therapeutic bond. Therapeutic bond mediated the relationship between greater ES of positive emotions during affiliation and lower post-treatment positive affect, 95% bias-corrected bootstrap confidence interval [-0.021, -0.000], adjusted for pre-treatment positive affect, as well as lower post-treatment social connectedness [-0.397, -0.015]; however, the indirect effect was not significant when accounting for pre-treatment social connectedness (p > .05). ES of positive emotions may be an important factor in the development of therapeutic bond and therefore treatment outcomes for individuals with anxiety or depression.
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Affiliation(s)
- Samantha N Hoffman
- Joint Doctoral Program in Clinical Psychology SDSU Department of Psychology, San Diego State University/University of California San Diego (UCSD), San Diego, USA
- Department of Psychiatry, University of California San Diego, La Jolla, USA
| | - Murray B Stein
- Joint Doctoral Program in Clinical Psychology SDSU Department of Psychology, San Diego State University/University of California San Diego (UCSD), San Diego, USA
- Department of Psychiatry, University of California San Diego, La Jolla, USA
| | - Charles T Taylor
- Joint Doctoral Program in Clinical Psychology SDSU Department of Psychology, San Diego State University/University of California San Diego (UCSD), San Diego, USA
- Department of Psychiatry, University of California San Diego, La Jolla, USA
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2
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Rassaby M, Shakya HB, Fowler JH, Oveis C, Sieber WJ, Jain S, Stein MB, Taylor CT. Application of an egocentric social network approach to examine changes in social connections following treatment for anxiety and depression: A novel measurement tool for clinical trials research? Soc Sci Med 2024; 350:116914. [PMID: 38696938 DOI: 10.1016/j.socscimed.2024.116914] [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: 01/18/2024] [Revised: 04/02/2024] [Accepted: 04/23/2024] [Indexed: 05/04/2024]
Abstract
The epidemic of loneliness and social isolation has been recognized as a public health crisis warranting the same prioritization as other public health issues today, such as obesity, substance use disorders, and tobacco use. Social disconnection is particularly prevalent and disabling among individuals with anxiety and depression, yet it is inadequately evaluated and addressed in most clinical psychology treatment research. Studies generally employ global measures of perceived connectedness, loneliness, or relationship satisfaction, limiting understanding about elements of one's social network that may change with treatment. This study examined changes in the degree (number of people nominated) and quality of one's social network from pre-to post-treatment using an egocentric social network approach in 59 adults (mean age = 30.8 years, range = 18 to 54) with clinically elevated anxiety or depression who were randomized to a cognitive and behavioral positive valence treatment versus waitlist. Participants (egos) named people in their lives (alters) with whom they discussed important issues or spent free time. For each alter, participants rated how close they felt, how close they thought the alter felt to them, and how frequently they communicated. Linear regressions, which included treatment group as a predictor, revealed no group differences in changes in network degree, perceived alter feelings of closeness, or communication frequency, despite prior findings from this sample indicating larger increases in perceived global connectedness in the treatment group. Unexpectedly, the control group reported a greater increase in perceived closeness to alters. Post-hoc analyses revealed this was explained by the treatment group identifying more distal social ties (e.g., extended family, colleagues, roommates) as alters following treatment - an outcome positively associated with global improvements in connectedness. This proof-of-concept study suggests egocentric social network surveys may provide unique information on treatment-related changes in social functioning. Suggestions are provided for adaptations to facilitate application of social network surveys to mental health treatment research.
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Affiliation(s)
- Madeleine Rassaby
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, United States
| | | | | | | | | | - Sonia Jain
- University of California San Diego, United States
| | - Murray B Stein
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, United States; University of California San Diego, United States
| | - Charles T Taylor
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, United States; University of California San Diego, United States.
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3
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Taylor CT, Stein MB, Simmons AN, He F, Oveis C, Shakya HB, Sieber WJ, Fowler JH, Jain S. Amplification of Positivity Treatment for Anxiety and Depression: A Randomized Experimental Therapeutics Trial Targeting Social Reward Sensitivity to Enhance Social Connectedness. Biol Psychiatry 2024; 95:434-443. [PMID: 37607657 DOI: 10.1016/j.biopsych.2023.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/04/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Social disconnection is common and causes significant impairment in anxiety and depressive disorders, and it does not respond sufficiently to available treatments. The positive valence system supports social bond formation and maintenance but is often hyporesponsive in people with anxiety or depression. We conducted an experimental therapeutics trial to test the hypothesis that targeting positive valence processes through cognitive and behavioral strategies would enhance responsivity to social rewards, a core mechanism underlying social connectedness. METHODS Sixty-eight adults who endorsed clinically elevated anxiety and/or depression with social impairment were randomized 1:1:1 to 5 (n = 23) or 10 (n = 22) sessions of amplification of positivity (AMP) treatment or waitlist (n = 23). Pre- to posttreatment change in striatal activity (primary outcome) during social reward anticipation was measured using functional magnetic resonance imaging, and reactivity to a social affiliation task (secondary) and self-reported social connectedness (exploratory) were examined. Primary analyses compared AMP (doses combined) versus waitlist. A second aim was to compare the effects of different doses. RESULTS AMP engaged the hypothesized treatment target, leading to greater striatal activation during anticipation of social rewards versus waitlist (d = 1.01 [95% CI = 0.42-1.61]; largest striatal volume). AMP yielded larger improvements in positive affect and approach behavior during the affiliation task (but not other outcomes) and social connectedness. Larger striatal and social connectedness increases were observed for 5-session versus 10-session AMP (d range = 0.08-1.03). CONCLUSIONS Teaching people with anxiety or depression strategies to increase positive thoughts, behaviors, and emotions enhances activity in brain regions that govern social reward processing and promotes social connectedness. Social reward sensitivity may be a transdiagnostic target for remediating social disconnection.
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Affiliation(s)
- Charles T Taylor
- Department of Psychiatry, University of California San Diego, San Diego, California.
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, San Diego, California; VA San Diego Healthcare System, San Diego, California
| | - Alan N Simmons
- Department of Psychiatry, University of California San Diego, San Diego, California; VA San Diego Healthcare System, San Diego, California
| | - Feng He
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, San Diego, California
| | - Christopher Oveis
- Rady School of Management, University of California San Diego, San Diego, California
| | - Holly B Shakya
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, San Diego, California
| | - William J Sieber
- Department of Family Medicine, University of California San Diego, San Diego, California
| | - James H Fowler
- Department of Political Science, University of California San Diego, San Diego, California
| | - Sonia Jain
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, San Diego, California
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Zhou J, Fredrickson BL. Listen to resonate: Better listening as a gateway to interpersonal positivity resonance through enhanced sensory connection and perceived safety. Curr Opin Psychol 2023; 53:101669. [PMID: 37619451 DOI: 10.1016/j.copsyc.2023.101669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023]
Abstract
Although often experienced individually, emotions are at times co-experienced with others, collectively. One type of collective emotion, termed positivity resonance, refers to coexperienced positive affect accompanied by caring non-verbal behavioral synchrony and biological synchrony across persons. Growing evidence illustrates the contributions of positivity resonance to individual, relational, and community well-being. Two conditions theorized as conducive for the emergence of positivity resonance are real-time sensory connection and perceived safety. Here, we explore listening as an interpersonal process that can serve to enhance real-time sensory connection and perceived safety and thereby increase positivity resonance among conversation partners. Specifically, we present evidence that connects listening to direct gaze (i.e., real-time sensory connection) and psychological safety (i.e., perceived safety). We close by offering a framework to guide future research that can test whether and how conversational listening functions to create more moments of positivity resonance in interpersonal contexts.
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Affiliation(s)
- Jieni Zhou
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC, USA.
| | - Barbara L Fredrickson
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC, USA
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Carlton CN, Antezana L, Richey JA. Associations between resting-state neural connectivity and positive affect in social anxiety disorder. Brain Behav 2023; 13:e3006. [PMID: 37062915 PMCID: PMC10275543 DOI: 10.1002/brb3.3006] [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: 08/17/2022] [Revised: 03/10/2023] [Accepted: 03/20/2023] [Indexed: 04/18/2023] Open
Abstract
INTRODUCTION Social anxiety disorder (SAD) has been characterized by deficits in social motivation and lack of reactivity to pleasurable stimuli (i.e., positive affect; [PA]). Recent neuroimaging work has shifted toward examining positively valenced motivational systems in SAD focused on reward responses. However, little is known about the associations of reward connectivity and PA in individuals with SAD. As such, the purpose of the current study was to determine whether connectivity among key units of reward neurocircuitry meaningfully relate to PA and whether these key units are more heterogeneous in SAD as compared to controls. METHODS Thirty-one participants who met diagnostic criteria for SAD and 33 control participants were included (Mage = 24.8, SD = 6.9; 55% cisgender man). Seed-based timeseries correlations were conducted in NiTime to extract region of interest (ROI) coupling correlation strength values. ANOVAs were carried out to assess whether individuals with SAD differed in ROI-to-ROI connectivity strength as compared to controls. Correlations and variance analyses were also conducted to examine the relationship between ROI-to-ROI connectivity strength and PA, as well as heterogeneity in connectivity strength and PA expression. RESULTS Weaker connectivity between the left and right orbital frontal cortex was observed when comparing the SAD to the control group. Within the SAD group, PA was associated with several reward-related ROI couplings; however, these links were not observed among controls. Results further demonstrated that individuals with SAD had significantly more variability in reward connectivity strength as compared to controls. CONCLUSION Overall, these results provide emergent evidence for the association between reward regions and PA in individuals with SAD. Additionally, these findings show that individuals with SAD demonstrate greater heterogeneity in reward connectivity.
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Affiliation(s)
| | | | - John A. Richey
- Department of PsychologyVirginia TechBlacksburgVirginia
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvania
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Hoffman SN, Depp CA, Taylor CT. Examining affective reactivity as a link between suicidality and social disconnection. J Psychiatr Res 2023; 157:271-275. [PMID: 36527740 PMCID: PMC10846674 DOI: 10.1016/j.jpsychires.2022.12.008] [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: 07/13/2022] [Revised: 11/10/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022]
Abstract
The link between suicidality and social disconnection is well-established. We explored possible mechanisms that may account for this link using a positive and negative valence systems framework in a clinical sample with and without suicidality (i.e., suicidal ideation and/or behaviors in the past month). Participants (N = 228) interacted with a trained confederate during a controlled conversation task designed to generate social affiliation. Participant-rated positive affect (PA) and negative affect (NA) were collected during the task (baseline, anticipation, post). Participant-rated desire for future interaction was collected after the task. We tested if (1) groups with (n = 82) and without (n = 146) suicidality differed in affect during the task and (2) whether affect accounted for the link between suicidality and desire for future interaction. Results revealed that groups differed in PA, but not NA, throughout the task. Participants with suicidality reported no significant changes in PA over the task (ps > .05); and, experienced less PA at post-task compared to those without (p = .003, d = 0.38) whereas participants without suicidality reported increased PA at post-task compared to baseline and anticipation of the task, ps < .001. Mediation analysis suggested blunted post-task PA accounted for the relationship between suicidality and less desire for future interaction, 95%CI [-2.59,-0.51]. Diminished PA reactivity during social affiliation opportunities may help explain the link between suicidality and social disconnection. Preliminary findings highlight PA as a potential mechanistic target for improving social connection for individuals at risk for suicide, though prospective and experimental research is needed.
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Affiliation(s)
- Samantha N Hoffman
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, USA
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7
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The impact of particular safety behaviours on perceived likeability and authenticity during interpersonal interactions in social anxiety disorder. Behav Cogn Psychother 2023; 51:46-60. [PMID: 36377520 DOI: 10.1017/s1352465822000492] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Safety behaviours are hypothesized to play a vital role in maintaining social anxiety disorder (SAD), in part by orienting socially anxious individuals to adopt an avoidance-based mindset focused on self-protection and self-concealment. Evidence suggests an association between safety behaviour use and negative social outcomes for individuals with SAD. However, research has largely focused on the broad group of safety behaviours, whereas specific subtypes have received less attention. AIM The present study aimed to further our understanding of the negative interpersonal consequences of specific types of safety behaviours for individuals with SAD by examining whether active, inhibiting/restricting, or physical symptom management safety behaviour use affects perceived likeability and authenticity during a conversation with a stranger. METHOD Individuals with SAD (n = 29; mean age 35.5 years) and healthy control (non-SAD) participants (n = 40; mean age 18.6 years) engaged in a semi-structured social interaction with trained confederates. RESULTS Participants with SAD were perceived as significantly less likeable and authentic by the confederates, and rated themselves as significantly less authentic compared with those without SAD. The association between group status and likeability was mediated by the use of inhibiting/restricting safety behaviours and the association between group status and participant-rated authenticity was mediated by the use of both inhibiting/restricting and active safety behaviours, but not physical symptom management strategies. CONCLUSIONS These results contribute to a growing literature suggesting that some, but not all, safety behaviours may play an important role in creating the negative social outcomes that individuals with SAD experience.
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8
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Now I Always have to Perform Well! Effects of CBT for Social Anxiety Disorder on Negative Interpretations of Positive Social Events. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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9
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Casey K, King R, Banner J, Fuller-Tyszkiewicz M. Romantic relationship quality and functioning for individuals with clinical and sub-clinical social anxiety: a scoping review. J Ment Health 2022; 32:670-698. [PMID: 35786177 DOI: 10.1080/09638237.2022.2091755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Social Anxiety Disorder (SAD) is associated with pervasive functional impairments and chronicity. Romantic relationship functioning and quality for individuals with SAD has been previously explored but existing studies have not been synthesised. AIMS This scoping review charted existing literature regarding the quality and functioning of romantic relationships for people with SAD and high sub-clinical social anxiety (SA). METHODS The review used a scoping approach to explore the current evidence base relating to SA, romantic relationship quality and functioning. Articles published in English after 1980 that reported either clinical or high sub-clinical SA were eligible. Double screening, data extraction, quality assessment, and thematic analysis of studies was conducted. RESULTS 50 studies from 46 articles were identified, involving a range of community, college, adolescent, and clinical samples. Thematic analysis identified four themes; Relationship Quality, Satisfaction and Commitment; Communication and Self-Disclosure; Conflict, Social Support and Trust; Intimacy, Closeness and Sexual Satisfaction. CONCLUSIONS The review highlights that evidence relating to romantic relationship functioning for individuals with SAD and high sub-clinical SA is heterogeneous, with relationship initiation in particular relatively under-explored. Further research is required to elucidate key constructs and interpersonal processes related to relationship functioning, and to inform treatment approaches with this group.
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Affiliation(s)
- Kit Casey
- Faculty of Health, School of Psychology, Deakin University, Burwood, VIC, Australia
| | - Ross King
- Faculty of Health, School of Psychology, Deakin University, Burwood, VIC, Australia
| | - Jennifer Banner
- Faculty of Health, School of Psychology, Deakin University, Burwood, VIC, Australia
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10
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Davidson EJ, Taylor CT, Ayers CR, Quach NE, Tu XM, Lee EE. The Relationship Between Loneliness and Positive Affect in Older Adults. Am J Geriatr Psychiatry 2022; 30:678-685. [PMID: 34887211 PMCID: PMC9095765 DOI: 10.1016/j.jagp.2021.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To establish whether positive affect (PA) is uniquely associated with loneliness and other social functioning variables beyond negative affect (NA) among older adults. METHODS Four hundred and twenty-eight participants (aged 60+ years old, 82% White, and 48% female) were recruited using random digit-dialing and completed scales for loneliness (UCLA Loneliness Scale), companionship (PROMIS scale), satisfaction with discretionary social activities (PROMIS scale), PA (Center for Epidemiologic Studies [CES] Happiness Scale), and NA (CES-Depression scale and Brief Symptom Inventory-Anxiety Subscale). RESULTS Multiple linear regression models found PA to be a significant predictor of lower loneliness where the effect of PA on loneliness is dependent on the level of NA; a large effect size at the mean level of NA, which becomes attenuated when NA increases. Although the direction of effect of PA on loneliness will change for NA > 5.10, which is 5 standard deviations away from 0, based on the model estimates, the percent of subjects with this large NA levels is practically 0. Thus, higher PA is associated with lower loneliness, however this effect is attenuated for larger NA. Similarly, multiple linear regression models found that companionship was associated with PA and NA where the effect of PA is dependent on the level of NA; a medium effect size at the mean level of NA, which becomes attenuated when NA increases. As in the case of loneliness, the direction of effect of PA on companionship will change for NA > 3.52, which is 3.5 standard deviation away from 0, based on the model estimates, but the percent of subjects with this large NA levels is practically 0. Thus, higher PA is associated with increased companionship, aand this effect is attenuated with greater NA. Satisfaction with social activities was associated with PA only (medium effect size). CONCLUSION Results suggest PA appears to be uniquely associated with social functioning among older adults. These findings support the potential for treatments that target PA to decrease loneliness among older adults, or vice versa.
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Affiliation(s)
- Eliza J. Davidson
- Research Service, VA San Diego Healthcare System,San Diego State University/ University of California, San Diego Joint Doctoral Program in Clinical Psychology
| | - Charles T. Taylor
- San Diego State University/ University of California, San Diego Joint Doctoral Program in Clinical Psychology,Department of Psychiatry, University of California, San Diego School of Medicine
| | - Catherine R. Ayers
- Mental Healthcare Line, VA San Diego Healthcare System,Department of Psychiatry, University of California, San Diego School of Medicine
| | - Natalie E. Quach
- Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego
| | - Xin M. Tu
- Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego
| | - Ellen E. Lee
- Mental Healthcare Line, VA San Diego Healthcare System,Department of Psychiatry, University of California, San Diego School of Medicine,Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego, CA
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11
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Fadhli T, Situmorang DDB. The implementation of Solution-Focused Brief Therapy (SFBT) as a solution for handling psychological anxiety in facing the COVID-19 outbreak. EUROPEAN JOURNAL OF PSYCHOTHERAPY & COUNSELLING 2022. [DOI: 10.1080/13642537.2022.2064533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Teuku Fadhli
- Department of Guidance and Counseling, Jabal Ghafur University, Sigli, Aceh, Indonesia
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12
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Weilenmann S, von Luckner A, Peyk P, Huber C, Schnyder U, Pfaltz MC. Experimental Induction of Emotional and Sexual Intimacy: Exploring the Validity of the German Fast Friends Procedure in Individuals with and without Childhood Maltreatment. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1703-1719. [PMID: 34761346 DOI: 10.1007/s10508-021-02081-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/26/2021] [Accepted: 06/10/2021] [Indexed: 06/13/2023]
Abstract
The Fast Friends Procedure (FFP) is a widely used experimental paradigm to induce emotional intimacy. Besides exploring the validity of a German translation of the paradigm (n = 46), we developed an extension of the FFP that induces sexual intimacy and assessed heart rate, high-frequency heart rate variability, and electrodermal activity responses to the FFP and its extension. Furthermore, we examined its applicability to individuals with childhood maltreatment (n = 56), who frequently suffer from intimacy-related difficulties. Intimacy, positive affect, liking, and attraction increased during the FFP and partly during the sexual intimacy extension in both study groups. Moreover, both groups showed physiological responses consistent with positive social interactions. The use of the German FFP and its sexual intimacy extension can thus be recommended for research in the general population and in individuals with childhood maltreatment, although more studies are needed to further validate the paradigms.
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Affiliation(s)
- Sonja Weilenmann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, 8091, Zürich, Switzerland.
- Medical Faculty, University of Zurich, Zurich, Switzerland.
| | - Alexander von Luckner
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, 8091, Zürich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Peter Peyk
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, 8091, Zürich, Switzerland
| | - Charlotte Huber
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, 8091, Zürich, Switzerland
| | | | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, 8091, Zürich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
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13
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McNeil GD, Repetti RL. Increases in positive emotions as precursors to therapeutic change. Clin Psychol Psychother 2021; 29:1113-1124. [PMID: 34862687 DOI: 10.1002/cpp.2698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/08/2022]
Abstract
Increases in positive emotions may not only be indicators of progress in therapy but also precursors to that improvement. Conducted in a psychology training clinic, this naturalistic, repeated-measures study tracked changes over the course of therapy in 34 clients' emotional experience and two of the primary targets of clinical interventions, symptom distress and relationship functioning. During treatment, positive emotions increased, negative emotions decreased, and improvements were seen in therapeutic outcomes. Positive and negative emotions were correlated, as were changes in positive and negative emotions. However, despite this association, increases in positive emotions were a significant predictor of concurrent improvements in symptom distress and relationship functioning, even when decreases in negative emotions were included in the same model. Additionally, positive emotions not only predicted change in these treatment outcomes over the same time period, but they also predicted future change. This study contributes to research on the critical role positive emotions play in psychotherapy and may encourage the development of interventions focusing on increasing positive emotions. These findings highlight the distinct functioning of positive emotions separate from negative and the value of attending to positive emotions during therapy.
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Affiliation(s)
- Galen D McNeil
- University of California, Los Angeles, California, USA.,UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA
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14
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Psychometric Evaluation of a Controlled Social Affiliation Paradigm: Findings From Anxiety, Depressive Disorder, and Healthy Samples. Behav Ther 2021; 52:1464-1476. [PMID: 34656199 PMCID: PMC8812488 DOI: 10.1016/j.beth.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
Social impairments are common across many psychiatric conditions. Standardized dyadic assessments intended to elicit social affiliation between unacquainted partners are used to elucidate mechanisms that disrupt relationship formation and inform possible treatment targets; however, the psychometric properties of such paradigms remain poorly understood. This study evaluated the psychometric properties of a controlled social affiliation paradigm intended to induce connectedness between a target participant and trained confederate. Individuals with an anxiety or depressive disorder diagnosis (clinical group; n = 132) and those without (control group; n = 35) interacted face-to-face with a trained confederate; partners took turns answering a series of increasingly intimate questions about themselves. Social connectedness, affect, and affiliative behavior measures were collected during the interaction. Participant symptom and social functioning measures were collected to examine validity. The paradigm elicited escalating social connectedness throughout the task for both participants and confederates. Parallel forms (i.e., different question sets) elicited similar affiliation outcomes. Self-reported (but not behavioral) affiliation differed across some demographic variables (e.g., participant gender, Hispanic ethnicity). Within-task affiliation measures were associated with one another and with global social connectedness and social anxiety symptom measures, but not with somatic anxiety measures. Clinical participants reported lower social affiliation and positive affect reactivity and higher negative affect reactivity than healthy participants. These findings provide initial psychometric support for a standardized and controlled dyadic affiliation paradigm that could be used to reliably probe social disconnection mechanisms across psychopathology.
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15
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Bomyea J, Choi SH, Sweet A, Stein M, Paulus M, Taylor C. Neural Changes in Reward Processing Following Approach Avoidance Training for Depression. Soc Cogn Affect Neurosci 2021; 17:nsab107. [PMID: 34643736 PMCID: PMC8881638 DOI: 10.1093/scan/nsab107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/17/2021] [Accepted: 09/14/2021] [Indexed: 11/14/2022] Open
Abstract
Altered approach motivation is hypothesized to be critical for the maintenance of depression. Computer-administered approach-avoidance training programs to increase approach action tendencies toward positive stimuli produce beneficial outcomes. However, there have been few studies examining neural changes following approach-avoidance training. Participants with Major Depressive Disorder were randomized to an Approach Avoidance Training (AAT) manipulation intended to increase approach tendencies for positive social cues (n=13) or a control procedure (n=15). We examined changes in neural activation (primary outcome) and connectivity patterns using Group Iterative Multiple Model Estimation during a social reward anticipation task (exploratory). A laboratory-based social affiliation task was also administered following the manipulation to measure affect during anticipation of real-world social activity. Individuals in the AAT group demonstrated increased activation in reward processing regions during social reward anticipation relative to the control group from pre to post-training. Following training, connectivity patterns across reward regions were observed in the full sample and connectivity between the medial PFC and caudate was associated with anticipatory positive affect before the social interaction; preliminary evidence of differential connectivity patterns between the two groups also emerged. Results support models whereby modifying approach-oriented behavioral tendencies with computerized training leads to alterations in reward circuitry. (NCT02330744).
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Affiliation(s)
- Jessica Bomyea
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, San Diego, CA 92037, USA
| | - Soo-Hee Choi
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine and Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea
| | - Alison Sweet
- Department of Psychiatry, University of California, San Diego, San Diego, CA 92037, USA
| | - Murray Stein
- Department of Psychiatry, University of California, San Diego, San Diego, CA 92037, USA
- School of Public Health, University of California, San Diego, San Diego, CA, USA
- Psychiatry Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Martin Paulus
- Laureate Institute for Brain Research, Tulsa, OK 74136, USA
| | - Charles Taylor
- Department of Psychiatry, University of California, San Diego, San Diego, CA 92037, USA
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Carlton CN, Dike JE, Brown MFD, Stanton K, Richey JA. Motivationally-relevant domains of positive affectivity are differentially related to social anxiety symptoms. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02165-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hassan R, Rowa K, McCabe RE, Lahat A, Schmidt LA. Shyness and anxiety: Protective role of extraversion. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021. [DOI: 10.1016/j.paid.2021.110859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Taylor CT, Tsai TC, Smith TR. Examining the link between positive affectivity and anxiety reactivity to social stress in individuals with and without social anxiety disorder. J Anxiety Disord 2020; 74:102264. [PMID: 32623281 PMCID: PMC9246012 DOI: 10.1016/j.janxdis.2020.102264] [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: 10/01/2019] [Revised: 06/02/2020] [Accepted: 06/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Positive affect (PA) attenuates negative reactivity to stress; however, this adaptive function of PA is seldom studied in psychiatric conditions characterized by more extreme forms of affective responding. We tested distinct associations of PA and negative affect (NA) with anxiety reactivity in participants with social anxiety disorder (SAD)-a condition characterized by heightened NA and diminished PA-and non-SAD control subjects. METHOD Adults with a principal diagnosis of SAD (n = 71) and those without a psychiatric history (n = 36) rated their PA and NA during the past week, and were exposed to a laboratory stressor wherein they delivered a video-recorded speech on a controversial topic. Anxiety reactivity was assessed in terms of anticipatory anxiety prior to the speech, and observer-rated anxiety-related behavior during the speech. RESULTS Across all participants, higher PA significantly predicted lower anticipatory anxiety and less anxiety-related behavior, beyond level of NA; lower NA significantly predicted attenuated anticipatory anxiety, but not anxiety-related behavior, beyond level of PA. The association between PA and stress reactivity was diminished for individuals with especially elevated NA, as well as for individuals with SAD compared to those without. CONCLUSIONS PA may be protective against negative reactivity to social stress; however, theoretical models and clinical applications should consider possible interactive effects of PA and NA in modulating stress reactivity.
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Affiliation(s)
- Charles T. Taylor
- University of California, San Diego,Corresponding author: Charles T. Taylor, PhD, Department of Psychiatry, University of California, San Diego, La Jolla, CA 92037, Phone: 858.534.9446, FAX: 858.534.9450,
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Taylor CT, Pearlstein SL, Kakaria S, Lyubomirsky S, Stein MB. Enhancing Social Connectedness in Anxiety and Depression Through Amplification of Positivity: Preliminary Treatment Outcomes and Process of Change. COGNITIVE THERAPY AND RESEARCH 2020; 44:788-800. [PMID: 32661447 DOI: 10.1007/s10608-020-10102-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Anxiety and depressive disorders are often characterized by perceived social disconnection, yet evidence-based treatments produce only modest improvements in this domain. The well-established link between positive affect (PA) and social connectedness suggests that directly targeting PA in treatment may be valuable. Method A secondary analysis of a waitlist-controlled trial (N=29) was conducted to evaluate treatment response and process of change in social connectedness within a 10-session positive activity intervention protocol-Amplification of Positivity (AMP)-designed to increase PA in individuals seeking treatment for anxiety or depression (ClinicalTrials.gov Identifier: NCT02330627). Perceived social connectedness and PA/negative affect (NA) were assessed throughout treatment. Time-lagged multilevel mediation models examined the process of change in affect and connectedness throughout treatment. Results The AMP group displayed significantly larger improvements in social connectedness from pre- to post-treatment compared to waitlist; improvements were maintained through 6-month follow-up. Within the AMP group, increases in PA and decreases in NA both uniquely predicted subsequent increases in connectedness throughout treatment. However, experiencing heightened NA throughout treatment attenuated the effect of changes in PA on connectedness. Improvements in connectedness predicted subsequent increases in PA, but not changes in NA. Conclusions These preliminary findings suggest that positive activity interventions may be valuable for enhancing social connectedness in individuals with clinically impairing anxiety or depression, possibly through both increasing positive emotions and decreasing negative emotions.
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A tale of two systems: Testing a positive and negative valence systems framework to understand social disconnection across anxiety and depressive disorders. J Affect Disord 2020; 266:207-214. [PMID: 32056878 PMCID: PMC7351468 DOI: 10.1016/j.jad.2020.01.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 11/26/2019] [Accepted: 01/12/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Social disconnection is a common and pernicious feature of anxiety and depressive disorders, yet is insufficiently addressed by our best available treatments. To better understand why people with anxiety and depression feel socially disconnected, we tested a positive and negative valence systems framework informed by research on how normative social connections develop and flourish. METHOD Individuals seeking treatment for anxiety or depression (N = 150) completed measures of perceived social connectedness, positive and negative valence temperament, social goals, affect, symptoms, and life satisfaction. RESULTS Feeling less socially connected was associated with diminished life satisfaction, beyond clinical symptom severity. Regression analyses revealed that both diminished positive valence and heightened negative valence temperament, and their corresponding motivational and affective outputs, were significantly and uniquely (with no significant interaction between them) associated with lower perceived connectedness. LIMITATIONS Data was cross-sectional and based on self-report-limiting conclusions about causality and social disconnection processes at different units of analysis. CONCLUSIONS Understanding social disconnection through the lens of a positive and negative valence systems framework may inform transdiagnostic models and treatment approaches.
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Pearlstein SL, Taylor CT, Stein MB. Facial Affect and Interpersonal Affiliation: Displays of Emotion During Relationship Formation in Social Anxiety Disorder. Clin Psychol Sci 2019; 7:826-839. [PMID: 31565542 DOI: 10.1177/2167702619825857] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Social anxiety disorder (SAD) often involves difficulty developing relationships. Facial expressions are important in relationship formation, but data are limited regarding facial display production among persons with SAD during social interaction. The current study compared facial displays of individuals diagnosed with SAD (n=41) to control participants (n=24) as they interacted with a confederate; confederates and observers then rated their desire for future interaction with participants. Automated software used the Facial Action Coding System (FACS; Ekman & Friesen, 1978) to classify displays. During portions of the interaction that involved listening to partners, the SAD group smiled less frequently and less intensely than controls, and lower smiling was associated with others' lower desire for future interaction with participants. Diminished positive facial affect in response to interaction partners may disrupt relationship formation in SAD and may serve as an effective treatment target.
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Affiliation(s)
- Sarah L Pearlstein
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology
| | - Charles T Taylor
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology.,University of California, San Diego
| | - Murray B Stein
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology.,University of California, San Diego
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