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Pollak OH, Shin KE, Baroni A, Gerson RS, Bell KA, Tezanos KM, Fernandes SN, Robinaugh DJ, Schacter DL, Spirito A, Cha CB. An examination of episodic future thinking in the emergency department among youth experiencing suicidal thoughts and behaviors. Eur Child Adolesc Psychiatry 2024; 33:923-933. [PMID: 37162586 DOI: 10.1007/s00787-023-02219-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/22/2023] [Indexed: 05/11/2023]
Abstract
Youth experiencing suicidal thoughts and/or behaviors (STBs) frequently present to emergency departments for acute psychiatric care. These settings offer a transitory yet pivotal opportunity to assess, intervene on, and plan continued care for STBs. This study examined a clinically relevant, understudied aspect of psychological functioning among youth experiencing STBs in the emergency department: episodic future thinking, or the ability to imagine discrete autobiographical future events. A sample of 167 youths (10-17 years) presenting to a pediatric psychiatric emergency department for STBs completed a performance-based measure of episodic future thinking assessing richness in detail and subjective characteristics of imagined future events. STB recurrence was assessed 6 months later. Immediately following a suicide-related crisis, youth demonstrated mixed abilities to imagine their future: they generated some concrete future event details but did not subjectively perceive these events as being very detailed or likely to occur. Older adolescents (i.e., 15-17) generated more episodic details than pre-/younger adolescents (i.e., 10-14), particularly those pertaining to actions or sensory perceptions. There was no evidence linking less detailed episodic future thinking and greater likelihood of STBs following the emergency department visit; instead, hopelessness was a more robust risk factor. Findings underscore the importance and clinical utility of better understanding the psychological state of youth during or immediately following a suicide-related crisis. In particular, assessing youths' future thinking abilities in the emergency department may directly inform approaches to acute care delivery.
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Affiliation(s)
- Olivia H Pollak
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC, 27599, USA.
| | - Ki Eun Shin
- Department of Behavioral Sciences, Long Island University, Post Campus, Brookville, NY, USA
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Ruth S Gerson
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Kerri-Anne Bell
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Katherine M Tezanos
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | | | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Christine B Cha
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
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2
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Abstract
Over the past decade, there has been a surge of empirical research investigating mental disorders as complex systems. In this article, we investigate how to best make use of this growing body of empirical research and move the field toward its fundamental aims of explaining, predicting, and controlling psychopathology. We first review the contemporary philosophy of science literature on scientific theories and argue that fully achieving the aims of explanation, prediction, and control requires that we construct formal theories of mental disorders: theories expressed in the language of mathematics or a computational programming language. We then investigate three routes by which one can use empirical findings (i.e., data models) to construct formal theories: (a) using data models themselves as formal theories, (b) using data models to infer formal theories, and (c) comparing empirical data models to theory-implied data models in order to evaluate and refine an existing formal theory. We argue that the third approach is the most promising path forward. We conclude by introducing the abductive formal theory construction (AFTC) framework, informed by both our review of philosophy of science and our methodological investigation. We argue that this approach provides a clear and promising way forward for using empirical research to inform the generation, development, and testing of formal theories both in the domain of psychopathology and in the broader field of psychological science. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Oisín Ryan
- Department of Methodology and Statistics
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3
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Abstract
Over the past decade, there has been a surge of empirical research investigating mental disorders as complex systems. In this article, we investigate how to best make use of this growing body of empirical research and move the field toward its fundamental aims of explaining, predicting, and controlling psychopathology. We first review the contemporary philosophy of science literature on scientific theories and argue that fully achieving the aims of explanation, prediction, and control requires that we construct formal theories of mental disorders: theories expressed in the language of mathematics or a computational programming language. We then investigate three routes by which one can use empirical findings (i.e., data models) to construct formal theories: (a) using data models themselves as formal theories, (b) using data models to infer formal theories, and (c) comparing empirical data models to theory-implied data models in order to evaluate and refine an existing formal theory. We argue that the third approach is the most promising path forward. We conclude by introducing the abductive formal theory construction (AFTC) framework, informed by both our review of philosophy of science and our methodological investigation. We argue that this approach provides a clear and promising way forward for using empirical research to inform the generation, development, and testing of formal theories both in the domain of psychopathology and in the broader field of psychological science. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Oisín Ryan
- Department of Methodology and Statistics
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4
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Affiliation(s)
- Denny Borsboom
- Department of PsychologyUniversity of AmsterdamAmsterdamthe Netherlands
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5
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de Ron J, Robinaugh DJ, Fried EI, Pedrelli P, Jain FA, Mischoulon D, Epskamp S. Quantifying and addressing the impact of measurement error in network models. Behav Res Ther 2022; 157:104163. [PMID: 36030733 PMCID: PMC10786122 DOI: 10.1016/j.brat.2022.104163] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/30/2022] [Accepted: 07/12/2022] [Indexed: 11/02/2022]
Abstract
Network psychometric models are often estimated using a single indicator for each node in the network, thus failing to consider potential measurement error. In this study, we investigate the impact of measurement error on cross-sectional network models. First, we conduct a simulation study to evaluate the performance of models based on single indicators as well as models that utilize information from multiple indicators per node, including average scores, factor scores, and latent variables. Our results demonstrate that measurement error impairs the reliability and performance of network models, especially when using single indicators. The reliability and performance of network models improves substantially with increasing sample size and when using methods that combine information from multiple indicators per node. Second, we use empirical data from the STAR*D trial (n = 3,731) to further evaluate the impact of measurement error. In the STAR*D trial, depression symptoms were assessed via three questionnaires, providing multiple indicators per symptom. Consistent with our simulation results, we find that when using sub-samples of this dataset, the discrepancy between the three single-indicator networks (one network per questionnaire) diminishes with increasing sample size. Together, our simulated and empirical findings provide evidence that measurement error can hinder network estimation when working with smaller samples and offers guidance on methods to mitigate measurement error.
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Affiliation(s)
- Jill de Ron
- Department of Psychological Methods, University of Amsterdam, the Netherlands.
| | - Donald J Robinaugh
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, USA; Department of Applied Psychology, Northeastern University, USA
| | - Eiko I Fried
- Department of Clinical Psychology, Leiden University, the Netherlands
| | - Paola Pedrelli
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, USA
| | - Felipe A Jain
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, USA
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, USA
| | - Sacha Epskamp
- Department of Psychological Methods, University of Amsterdam, the Netherlands; Centre for Urban Mental Health, University of Amsterdam, the Netherlands
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6
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Cha CB, Robinaugh DJ, Schacter DL, Altheimer G, Marx BP, Keane TM, Kearns JC, Nock MK. Examining multiple features of episodic future thinking and episodic memory among suicidal adults. Suicide Life Threat Behav 2022; 52:356-372. [PMID: 34978101 PMCID: PMC9233069 DOI: 10.1111/sltb.12826] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/29/2021] [Accepted: 10/15/2021] [Indexed: 11/30/2022]
Abstract
BCKGROUND Theories of suicide suggest that suicidal ideation (SI) results in part from difficulty imagining the future, which itself relies on the ability to remember the past. The present study examines multiple components of episodic future thinking and memory including event richness, which is commonly measured within the cognitive literature but has not previously been assessed with suicidal individuals. METHODS Here, we tested the associations between SI and episodic future thinking and episodic memory across two studies (Study 1, n = 25; Study 2, n = 141): the first with a healthy comparison group and the second with a psychiatric comparison group. RESULTS Future event richness yielded large but statistically non-significant deficits in the SI group relative to healthy controls in Study 1 after controling the false discovery rate. The most robust effects for future thinking emerged in the case of perceived duration of future events, such that the SI group (vs. psychiatric comparison) imagined future events as longer-lasting in Study 2. Across both studies, episodic memory was unrelated to SI, and neither episodic future thinking nor memory predicted future SI. CONCLUSION Episodic future thinking may better distinguish individuals with SI history from psychiatric controls when compared with episodic memory, but that this effect is limited to select components of future thinking.
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Affiliation(s)
- Christine B. Cha
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University
| | | | | | | | - Brian P. Marx
- National Center for Posttraumatic Stress Disorder, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, and Boston University School of Medicine
| | - Terence M. Keane
- National Center for Posttraumatic Stress Disorder, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, and Boston University School of Medicine
| | - Jaclyn C. Kearns
- National Center for Posttraumatic Stress Disorder, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, and Boston University School of Medicine
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7
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Fried EI, Flake JK, Robinaugh DJ. Revisiting the theoretical and methodological foundations of depression measurement. Nat Rev Psychol 2022; 1:358-368. [PMID: 38107751 PMCID: PMC10723193 DOI: 10.1038/s44159-022-00050-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 12/19/2023]
Abstract
Depressive disorders are among the leading causes of global disease burden, but there has been limited progress in understanding the causes and treatments for these disorders. In this Perspective, we suggest that such progress crucially depends on our ability to measure depression. We review the many problems with depression measurement, including limited evidence of validity and reliability. These issues raise grave concerns about common uses of depression measures, such as diagnosis or tracking treatment progress. We argue that shortcomings arise because depression measurement rests on shaky methodological and theoretical foundations. Moving forward, we need to break with the field's tradition that has, for decades, divorced theories about depression from how we measure it. Instead, we suggest that epistemic iteration, an iterative exchange between theory and measurement, provides a crucial avenue for depression measurement to progress.
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Affiliation(s)
- Eiko I. Fried
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Jessica K. Flake
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Donald J. Robinaugh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, US
- Department of Applied Psychology, Northeastern University, Boston, Massachusetts, US
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8
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Abstract
The combination of network theory and network psychometric methods has opened up a variety of new ways to conceptualize and study psychological disorders. The idea of psychological disorders as dynamic systems has sparked interest in developing interventions based on results of network analytic tools. However, simply estimating a network model is not sufficient for determining which symptoms might be most effective to intervene upon, nor is it sufficient for determining the potential efficacy of any given intervention. In this paper, we attempt to remedy this gap by introducing fundamental concepts of control theory to both psychometricians and applied psychologists. We introduce two controllability statistics to the psychometric literature, average and modal controllability, to facilitate selecting the best set of intervention targets. Following this introduction, we show how intervention scientists can probe the effects of both theoretical and empirical interventions on networks derived from real data and demonstrate how simulations can account for intervention cost and the desire to reduce specific symptoms. Every step is based on rich clinical EMA data from a sample of subjects undergoing treatment for complicated grief, with a focus on the outcome suicidal ideation. All methods are implemented in an open-source R package netcontrol, and complete code for replicating the analyses in this manuscript are available online.
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Affiliation(s)
- Teague R Henry
- Department of Psychology and School of Data Science, University of Virginia, Charlottesville, VA, USA.
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, USA.
| | - Donald J Robinaugh
- Department of Psychiatry, Harvard Medical School & Massachusetts General Hospital, Boston, USA
| | - Eiko I Fried
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
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9
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McNally RJ, Robinaugh DJ, Deckersbach T, Sylvia LG, Nierenberg AA. Estimating the symptom structure of bipolar disorder via network analysis: Energy dysregulation as a central symptom. J Psychopathol Clin Sci 2022; 131:86-97. [PMID: 34871024 PMCID: PMC9168523 DOI: 10.1037/abn0000715] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Using network analysis, we estimated the structure of relations among manic and depressive symptoms, respectively, in 486 patients (59% women; age: M = 37, SD = 12.1) with bipolar disorder prior to their entering a clinical trial. We computed three types of networks: (a) Gaussian graphical models (GGMs) depicting regularized partial correlations, (b) regression-based GGMs depicting nonregularized partial correlations, and (c) directed acyclic graphs (DAGs) via a Bayesian hill-climbing algorithm. Low energy and elevated energy were consistently identified as central nodes in the GGMs and as key parent nodes in the DAGs. Across analyses, pessimism about the future and depressed mood were the symptoms most strongly associated with suicidal thoughts and behavior. These exploratory analyses provide rich information about how bipolar disorder symptoms relate to one another, thereby furnishing a foundation for investigating how bipolar disorder symptoms may operate as a causal system. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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10
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Robinaugh DJ, Toner ER, Djelantik AAAMJ. The causal systems approach to prolonged grief: Recent developments and future directions. Curr Opin Psychol 2021; 44:24-30. [PMID: 34543876 DOI: 10.1016/j.copsyc.2021.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 11/03/2022]
Abstract
The network theory of prolonged grief posits that causal interactions among symptoms of prolonged grief play a significant role in their coherence and persistence as a syndrome. Drawing on recent developments in the broader network approach to psychopathology, we argue that advancing our understanding of the causal system that gives rise to prolonged grief will require that we (a) strengthen our assessment of each component of the grief syndrome, (b) investigate intra-individual relationships among grief components as they evolve over time within individuals, (c) incorporate biological and social components into network studies of grief, and (d) generate formal theories that posit precisely how these biological, psychological, and social components interact with one another to give rise to prolonged grief disorder.
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Affiliation(s)
- Donald J Robinaugh
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Emma R Toner
- University of Virginia, Department of Psychology, Charlottesville, VA, USA
| | - A A A Manik J Djelantik
- University Medical Centre Utrecht, Department of Psychiatry, Utrecht, the Netherlands; Altrecht GGZ, Department Youth KOOS, Utrecht, the Netherlands
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11
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Robinaugh DJ, Haslbeck JMB, Ryan O, Fried EI, Waldorp LJ. Invisible Hands and Fine Calipers: A Call to Use Formal Theory as a Toolkit for Theory Construction. Perspect Psychol Sci 2021; 16:725-743. [PMID: 33593176 PMCID: PMC8273080 DOI: 10.1177/1745691620974697] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In recent years, a growing chorus of researchers has argued that psychological theory is in a state of crisis: Theories are rarely developed in a way that indicates an accumulation of knowledge. Paul Meehl raised this very concern more than 40 years ago. Yet in the ensuing decades, little has improved. We aim to chart a better path forward for psychological theory by revisiting Meehl's criticisms, his proposed solution, and the reasons his solution failed to meaningfully change the status of psychological theory. We argue that Meehl identified serious shortcomings in our evaluation of psychological theories and that his proposed solution would substantially strengthen theory testing. However, we also argue that Meehl failed to provide researchers with the tools necessary to construct the kinds of rigorous theories his approach required. To advance psychological theory, we must equip researchers with tools that allow them to better generate, evaluate, and develop their theories. We argue that formal theories provide this much-needed set of tools, equipping researchers with tools for thinking, evaluating explanation, enhancing measurement, informing theory development, and promoting the collaborative construction of psychological theories.
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Affiliation(s)
| | | | - Oisín Ryan
- Department of Methodology and Statistics, Utrecht University
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12
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Dean KE, Ander I, Blanchard L, King F, Robinaugh DJ, Youn SJ. Understanding Cognitive-Behavioral Interventions for Social Anxiety Disorder. Psychiatr Ann 2021. [DOI: 10.3928/00485713-20210412-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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13
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Na PJ, Adhikari S, Szuhany KL, Chen AZ, Suzuki RR, Malgaroli M, Robinaugh DJ, Bui E, Mauro C, Skritskaya NA, Lebowitz BD, Zisook S, Reynolds CF, Shear MK, Simon NM. Posttraumatic Distress Symptoms and Their Response to Treatment in Adults With Prolonged Grief Disorder. J Clin Psychiatry 2021; 82. [PMID: 34000119 DOI: 10.4088/jcp.20m13576] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder and prolonged grief disorder (PGD) arise following major life stressors and may share some overlapping symptomatology. This study aimed to examine the presence and response to treatment of posttraumatic stress symptoms (PTSS) in bereaved adults with a primary diagnosis of PGD. METHODS A randomized controlled trial of 395 adults with PGD (defined as an Inventory of Complicated Grief score ≥ 30 plus confirmation on structured clinical interview) randomly assigned participants to either complicated grief treatment (CGT) with citalopram, CGT plus placebo, citalopram, or placebo between March 2010 and September 2014. This secondary analysis examined the presence of PTSS (per the Davidson Trauma Scale) at baseline and change in PTSS with treatment using longitudinal mixed-effects regression and examined the role of violent compared to nonviolent deaths (loss type). RESULTS High levels of PTSS were present at baseline, regardless of loss type, and were associated with increased functional impairment (P < .001). CGT with placebo demonstrated efficacy for PTSS compared to placebo in both threshold (OR = 2.71; 95% CI, 1.13-6.52; P = .026) and continuous (P < .001; effect size d = 0.47) analyses, and analyses were suggestive of a greater effect for CGT plus citalopram compared to citalopram alone (threshold analysis: OR = 2.84; 95% CI, 1.20-6.70; P = .017; continuous analysis: P = .053; d = 0.25). In contrast, citalopram did not differ from placebo, and CGT plus citalopram did not differ from CGT plus placebo. CONCLUSIONS Bereavement-related PTSS are common in bereaved adults with PGD in the context of both violent and nonviolent death and are associated with poorer functioning. CGT shows efficacy for PTSS, while the antidepressant citalopram does not. TRIAL REGISTRATION : ClinicalTrials.gov identifier: NCT01179568.
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Affiliation(s)
- Peter J Na
- Anxiety and Complicated Grief Program, Department of Psychiatry, New York University Grossman School of Medicine, New York, New York
| | - Samrachana Adhikari
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Kristin L Szuhany
- Anxiety and Complicated Grief Program, Department of Psychiatry, New York University Grossman School of Medicine, New York, New York
| | - Alan Z Chen
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Rebecca R Suzuki
- Anxiety and Complicated Grief Program, Department of Psychiatry, New York University Grossman School of Medicine, New York, New York
| | - Matteo Malgaroli
- Anxiety and Complicated Grief Program, Department of Psychiatry, New York University Grossman School of Medicine, New York, New York
| | - Donald J Robinaugh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Christine Mauro
- Department of Biostatistics, Columbia University Medical Center, New York, New York
| | | | - Barry D Lebowitz
- Department of Psychiatry, University of California at San Diego, San Diego, California
| | - Sidney Zisook
- Department of Psychiatry, University of California at San Diego, San Diego, California
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Naomi M Simon
- Anxiety and Complicated Grief Program, Department of Psychiatry, New York University Grossman School of Medicine, New York, New York.,Corresponding author: Naomi M. Simon, MD, MSc, NYU Langone Health, One Park Ave, 8th Floor, New York, NY 10016
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14
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Epskamp S, Fried EI, van Borkulo CD, Robinaugh DJ, Marsman M, Dalege J, Rhemtulla M, Cramer AOJ. Investigating the Utility of Fixed-margin Sampling in Network Psychometrics. Multivariate Behav Res 2021; 56:314-328. [PMID: 30463456 DOI: 10.1080/00273171.2018.1489771] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 06/09/2023]
Abstract
Steinley, Hoffman, Brusco, and Sher (2017) proposed a new method for evaluating the performance of psychological network models: fixed-margin sampling. The authors investigated LASSO regularized Ising models (eLasso) by generating random datasets with the same margins as the original binary dataset, and concluded that many estimated eLasso parameters are not distinguishable from those that would be expected if the data were generated by chance. We argue that fixed-margin sampling cannot be used for this purpose, as it generates data under a particular null-hypothesis: a unidimensional factor model with interchangeable indicators (i.e., the Rasch model). We show this by discussing relevant psychometric literature and by performing simulation studies. Results indicate that while eLasso correctly estimated network models and estimated almost no edges due to chance, fixed-margin sampling performed poorly in classifying true effects as "interesting" (Steinley et al. 2017, p. 1004). Further simulation studies indicate that fixed-margin sampling offers a powerful method for highlighting local misfit from the Rasch model, but performs only moderately in identifying global departures from the Rasch model. We conclude that fixed-margin sampling is not up to the task of assessing if results from estimated Ising models or other multivariate psychometric models are due to chance.
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Affiliation(s)
- Sacha Epskamp
- Department of Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands
| | - Eiko I Fried
- Department of Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands
| | - Claudia D van Borkulo
- Department of Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands
| | - Donald J Robinaugh
- Department of Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands
- Department of Psychiatry, Massachusetts General Hospital, Cambridge, MA, USA
| | - Maarten Marsman
- Department of Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands
| | - Jonas Dalege
- Department of Social Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Mijke Rhemtulla
- Department of Psychology, University of California, Davis, CA, USA
| | - Angélique O J Cramer
- Social and Behavioral Sciences, Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
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15
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Frumkin MR, Robinaugh DJ, LeBlanc NJ, Ahmad Z, Bui E, Nock MK, Simon NM, McNally RJ. The pain of grief: Exploring the concept of psychological pain and its relation to complicated grief, depression, and risk for suicide in bereaved adults. J Clin Psychol 2021; 77:254-267. [PMID: 32662088 PMCID: PMC7725983 DOI: 10.1002/jclp.23024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/15/2020] [Accepted: 06/24/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Emotional or psychological pain is a core symptom of complicated grief (CG), yet its correlates are largely unexamined among bereaved individuals. METHOD Bereaved adults (N = 135) completed self-reports regarding psychological pain, CG, depression, and suicidality. We assessed correlations among these variables and tested whether psychological pain was elevated among individuals with CG and individuals with current or past suicidal thoughts and behaviors. Using logistic regression, we also assessed psychological pain, depression, and CG symptom severity as predictors of suicide risk. RESULTS Psychological pain was strongly associated with both CG and depression severity and was elevated among subjects reporting current or past suicidality. CG and depression were not statistically significant predictors of suicidal ideation after accounting for the effects of psychological pain. CONCLUSIONS Psychological pain is strongly associated with bereavement-related psychopathology and warrants further investigation in studies examining the nature and treatment of CG.
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Affiliation(s)
- Madelyn R. Frumkin
- Department of Psychological and Brain Sciences, Washington University in St. Louis
| | - Donald J. Robinaugh
- Department of Psychiatry, Massachusetts General Hospital
- Department of Psychiatry, Harvard Medical School
| | - Nicole J. LeBlanc
- Department of Psychiatry, Massachusetts General Hospital
- Department of Psychiatry, Harvard Medical School
| | - Zeba Ahmad
- The Graduate Center and Hunter College, City University of New York
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital
- Department of Psychiatry, Harvard Medical School
| | | | - Naomi M. Simon
- Department of Psychiatry, NYU Langone Health, New York University School of Medicine
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16
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Abstract
BACKGROUND A significant increase in the number of individuals suffering from prolonged grief disorder is expected in the aftermath of the COVID-19 pandemic for two main reasons. First, the number of excess deaths has contributed to an immense number of bereaved individuals. Second, recent literature has shown that circumstances associated with COVID-19 deaths may be contributing to increased risk for the development of prolonged grief disorder. OBJECTIVE To best support those affected by loss during the COVID-19 pandemic, it is important to inform clinicians and researchers about the development, the nature and the treatment of prolonged grief disorder and employ sound research. METHOD In this editorial, we discuss important themes regarding prolonged grief disorder in the aftermath of the COVID-19 pandemic, to gather and present useful information for clinicians and researchers. RESULTS The following themes were addressed: 1. Harmonization in the diagnosis of prolonged grief disorder. 2. Screening tools and interventions. 3. Pharmacotherapy. 4. Special attention for the elderly. 5. Special attention for children and adolescents. 6. A causal system perspective for understanding grief and prolonged grief disorder. CONCLUSIONS If those involved in bereavement research and care manage to collaborate, the tragic consequences of COVID-19 might catalyse improvement of care for those most impaired following the loss of a loved one.
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Affiliation(s)
- A A A Manik J Djelantik
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, The Netherlands.,Department Youth - KOOS, Altrecht GGZ, Utrecht, The Netherlands
| | - Eric Bui
- Department Psychiatry, University of Caen Normandy, Caen, France
| | - Maja O'Connor
- Department of Psychology, Unit for Bereavement Research, Aarhus University/The Danish National Center for Grief, Aarhus, Denmark
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Donald J Robinaugh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Naomi M Simon
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Paul A Boelen
- ARQ National Psychotrauma Centre, Diemen, The Netherlands.,ARQ Centrum'45, Diemen, The Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, The Netherland
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17
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Millner AJ, Robinaugh DJ, Nock MK. Advancing the Understanding of Suicide: The Need for Formal Theory and Rigorous Descriptive Research. Trends Cogn Sci 2020; 24:704-716. [PMID: 32680678 PMCID: PMC7429350 DOI: 10.1016/j.tics.2020.06.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 01/05/2023]
Abstract
Suicide is a leading cause of death worldwide and perhaps the most puzzling and devastating of all human behaviors. Suicide research has primarily been guided by verbal theories containing vague constructs and poorly specified relationships. We propose two fundamental changes required to move toward a mechanistic understanding of suicide. First, we must formalize theories of suicide, expressing them as mathematical or computational models. Second, we must conduct rigorous descriptive research, prioritizing direct observation and precise measurement of suicidal thoughts and behaviors and of the factors posited to cause them. Together, theory formalization and rigorous descriptive research will facilitate abductive theory construction and strong theory testing, thereby improving the understanding and prevention of suicide and related behaviors.
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Affiliation(s)
- Alexander J Millner
- Harvard University, Cambridge, MA, USA; Franciscan Children's, Brighton, MA, USA.
| | - Donald J Robinaugh
- Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Matthew K Nock
- Harvard University, Cambridge, MA, USA; Franciscan Children's, Brighton, MA, USA; Massachusetts General Hospital, Boston, MA, USA
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18
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Abstract
In this editorial for the collection on complexity in mental health research, we introduce and summarize the inaugural contributions to this collection: a series of theoretical, methodological, and empirical papers that aim to chart a path forward for investigating mental health in all its complexity. A central theme emerges from these contributions: if we are to make genuine progress in explaining, predicting, and treating mental illness, we must study the systems from which psychopathology emerges. As the articles in this collection make clear, the systems that give rise to psychopathology encompass a host of components across biological, psychological, and social levels of analysis, intertwined in a web of complex interactions. The task of advancing our understanding of these systems will be a challenging one. Yet, this challenge presents a unique opportunity. From physics to ecology, there is a rapidly evolving body of interdisciplinary research dedicated to investigating complex systems. This work provides clear guidance for psychiatric research, opportunities for collaboration, and a set of tools and concepts from which we can draw in our efforts to understand mental health, helping us move toward our ultimate aim of improving the prevention and treatment of psychopathology.
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Affiliation(s)
- Eiko I. Fried
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Donald J. Robinaugh
- Department of Psychiatry, Harvard Medical School & Massachusetts General Hospital, Boston, MA USA
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19
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Bellet BW, LeBlanc NJ, Nizzi MC, Carter ML, van der Does FHS, Peters J, Robinaugh DJ, McNally RJ. "Identity confusion in complicated grief: A closer look": Correction. J Abnorm Psychol 2020; 129:543. [PMID: 32551740 DOI: 10.1037/abn0000631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Reports an error in "Identity confusion in complicated grief: A closer look" by Benjamin W. Bellet, Nicole J. LeBlanc, Marie-Christine Nizzi, Mikaela L. Carter, Florentine H. S. van der Does, Jacqueline Peters, Donald J. Robinaugh and Richard J. McNally (Journal of Abnormal Psychology, 2020[May], Vol 129[4], 397-407). In the original article, the following acknowledgment of funding was missing from the author note: "Donald J. Robinaugh's work on this article was supported by federal funding from the National Institute of Mental Health (Grant 1K23MH113805-01A1; principal investigator: Donald J. Robinaugh)." The online version of this article has been corrected. (The following abstract of the original article appeared in record 2020-23551-001). Complicated grief (CG) is characterized by a wide range of symptoms, including identity confusion or a sense that a part of oneself has died with the decedent. Although identity confusion is a commonly reported feature of CG, little is known about which specific aspects of self-concept are compromised. In the current study, we used qualitative coding methods to investigate which aspects of the sense of self differed between those with and without CG in a sample of 77 bereaved adults. Relative to individuals without CG, those with CG provided fewer descriptors of their self-concept overall (lower self-fluency), provided sets of descriptors that consisted of fewer categories (lower self-diversity), and had lower proportions of self-relevant preferences and activities. However, group differences were not observed for proportions of any other categories of self-concept descriptors, including references to the loss, the past, or distress-related self-statements. Directions for future research and clinical implications are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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20
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Burger J, van der Veen DC, Robinaugh DJ, Quax R, Riese H, Schoevers RA, Epskamp S. Bridging the gap between complexity science and clinical practice by formalizing idiographic theories: a computational model of functional analysis. BMC Med 2020. [PMID: 32264914 DOI: 10.31234/osf.io/gw2uc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND The past decades of research have seen an increase in statistical tools to explore the complex dynamics of mental health from patient data, yet the application of these tools in clinical practice remains uncommon. This is surprising, given that clinical reasoning, e.g., case conceptualizations, largely coincides with the dynamical system approach. We argue that the gap between statistical tools and clinical practice can partly be explained by the fact that current estimation techniques disregard theoretical and practical considerations relevant to psychotherapy. To address this issue, we propose that case conceptualizations should be formalized. We illustrate this approach by introducing a computational model of functional analysis, a framework commonly used by practitioners to formulate case conceptualizations and design patient-tailored treatment. METHODS We outline the general approach of formalizing idiographic theories, drawing on the example of a functional analysis for a patient suffering from panic disorder. We specified the system using a series of differential equations and simulated different scenarios; first, we simulated data without intervening in the system to examine the effects of avoidant coping on the development of panic symptomatic. Second, we formalized two interventions commonly used in cognitive behavioral therapy (CBT; exposure and cognitive reappraisal) and subsequently simulated their effects on the system. RESULTS The first simulation showed that the specified system could recover several aspects of the phenomenon (panic disorder), however, also showed some incongruency with the nature of panic attacks (e.g., rapid decreases were not observed). The second simulation study illustrated differential effects of CBT interventions for this patient. All tested interventions could decrease panic levels in the system. CONCLUSIONS Formalizing idiographic theories is promising in bridging the gap between complexity science and clinical practice and can help foster more rigorous scientific practices in psychotherapy, through enhancing theory development. More precise case conceptualizations could potentially improve intervention planning and treatment outcomes. We discuss applications in psychotherapy and future directions, amongst others barriers for systematic theory evaluation and extending the framework to incorporate interactions between individual systems, relevant for modeling social learning processes. With this report, we hope to stimulate future efforts in formalizing clinical frameworks.
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Affiliation(s)
- Julian Burger
- University of Groningen, University Medical Center Groningen, University Center Psychiatry (UCP) Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- University of Amsterdam, Institute for Advanced Study, Amsterdam, The Netherlands.
| | - Date C van der Veen
- University of Groningen, University Medical Center Groningen, University Center Psychiatry (UCP) Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Donald J Robinaugh
- Harvard University, Department of Psychiatry, Massachusetts General Hospital, .Cambridge, MA, USA
| | - Rick Quax
- University of Amsterdam, Institute for Advanced Study, Amsterdam, The Netherlands
| | - Harriëtte Riese
- University of Groningen, University Medical Center Groningen, University Center Psychiatry (UCP) Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen, University Center Psychiatry (UCP) Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Sacha Epskamp
- University of Amsterdam, Institute for Advanced Study, Amsterdam, The Netherlands
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21
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Burger J, van der Veen DC, Robinaugh DJ, Quax R, Riese H, Schoevers RA, Epskamp S. Bridging the gap between complexity science and clinical practice by formalizing idiographic theories: a computational model of functional analysis. BMC Med 2020; 18:99. [PMID: 32264914 PMCID: PMC7333286 DOI: 10.1186/s12916-020-01558-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 03/16/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The past decades of research have seen an increase in statistical tools to explore the complex dynamics of mental health from patient data, yet the application of these tools in clinical practice remains uncommon. This is surprising, given that clinical reasoning, e.g., case conceptualizations, largely coincides with the dynamical system approach. We argue that the gap between statistical tools and clinical practice can partly be explained by the fact that current estimation techniques disregard theoretical and practical considerations relevant to psychotherapy. To address this issue, we propose that case conceptualizations should be formalized. We illustrate this approach by introducing a computational model of functional analysis, a framework commonly used by practitioners to formulate case conceptualizations and design patient-tailored treatment. METHODS We outline the general approach of formalizing idiographic theories, drawing on the example of a functional analysis for a patient suffering from panic disorder. We specified the system using a series of differential equations and simulated different scenarios; first, we simulated data without intervening in the system to examine the effects of avoidant coping on the development of panic symptomatic. Second, we formalized two interventions commonly used in cognitive behavioral therapy (CBT; exposure and cognitive reappraisal) and subsequently simulated their effects on the system. RESULTS The first simulation showed that the specified system could recover several aspects of the phenomenon (panic disorder), however, also showed some incongruency with the nature of panic attacks (e.g., rapid decreases were not observed). The second simulation study illustrated differential effects of CBT interventions for this patient. All tested interventions could decrease panic levels in the system. CONCLUSIONS Formalizing idiographic theories is promising in bridging the gap between complexity science and clinical practice and can help foster more rigorous scientific practices in psychotherapy, through enhancing theory development. More precise case conceptualizations could potentially improve intervention planning and treatment outcomes. We discuss applications in psychotherapy and future directions, amongst others barriers for systematic theory evaluation and extending the framework to incorporate interactions between individual systems, relevant for modeling social learning processes. With this report, we hope to stimulate future efforts in formalizing clinical frameworks.
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Affiliation(s)
- Julian Burger
- University of Groningen, University Medical Center Groningen, University Center Psychiatry (UCP) Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- University of Amsterdam, Institute for Advanced Study, Amsterdam, The Netherlands.
| | - Date C van der Veen
- University of Groningen, University Medical Center Groningen, University Center Psychiatry (UCP) Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Donald J Robinaugh
- Harvard University, Department of Psychiatry, Massachusetts General Hospital, .Cambridge, MA, USA
| | - Rick Quax
- University of Amsterdam, Institute for Advanced Study, Amsterdam, The Netherlands
| | - Harriëtte Riese
- University of Groningen, University Medical Center Groningen, University Center Psychiatry (UCP) Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen, University Center Psychiatry (UCP) Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Sacha Epskamp
- University of Amsterdam, Institute for Advanced Study, Amsterdam, The Netherlands
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22
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Bellet BW, LeBlanc NJ, Nizzi MC, Carter ML, van der Does FHS, Peters J, Robinaugh DJ, McNally RJ. Identity confusion in complicated grief: A closer look. J Abnorm Psychol 2020; 129:397-407. [PMID: 32250140 DOI: 10.1037/abn0000520] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Complicated grief (CG) is characterized by a wide range of symptoms, including identity confusion or a sense that a part of oneself has died with the decedent. Although identity confusion is a commonly reported feature of CG, little is known about which specific aspects of self-concept are compromised. In the current study, we used qualitative coding methods to investigate which aspects of the sense of self differed between those with and without CG in a sample of 77 bereaved adults. Relative to individuals without CG, those with CG provided fewer descriptors of their self-concept overall (lower self-fluency), provided sets of descriptors that consisted of fewer categories (lower self-diversity), and had lower proportions of self-relevant preferences and activities. However, group differences were not observed for proportions of any other categories of self-concept descriptors, including references to the loss, the past, or distress-related self-statements. Directions for future research and clinical implications are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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23
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LeBlanc NJ, Toner ER, O’Day EB, Moore CW, Marques L, Robinaugh DJ, McNally RJ. Shame, guilt, and pride after loss: Exploring the relationship between moral emotions and psychopathology in bereaved adults. J Affect Disord 2020; 263:405-412. [PMID: 31969271 PMCID: PMC7307182 DOI: 10.1016/j.jad.2019.11.164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/20/2019] [Accepted: 11/30/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Self-blame following bereavement has been implicated in the development of post-loss psychopathology. However, prior studies have not distinguished between the emotions of shame versus guilt. This study examined the cross-sectional associations among bereavement-related shame, bereavement-related guilt, and two mental disorders that commonly arise after bereavement: complicated grief and depression. In addition, exploratory analyses examined the associations between bereavement-related pride and post-loss psychopathology. METHODS Participants included 92 bereaved adults who experienced the death of a family member at least one year prior to the study. Participants completed self-report measures of complicated grief symptoms, depression symptoms, shame, guilt, and pride. RESULTS Shame and guilt were positively correlated with complicated grief and depression symptoms. When controlling for their shared variance, only shame remained a significant predictor of post-loss psychopathology. Follow-up analyses indicated that the effect of guilt on psychopathology depended on the level of shame, and vice versa. At low shame, guilt predicted psychopathology; however guilt did not predict psychopathology at moderate to high shame. At low to moderate guilt, shame predicted psychopathology; however shame did not predict psychopathology at high guilt. Pride negatively predicted depression symptoms, but not complicated grief symptoms, when we controlled for shame and guilt. LIMITATIONS Limitations include the cross-sectional design and modest sample size. CONCLUSIONS Our analyses identify shame as the more pathogenic moral emotion for bereaved adults. However, whereas guilt in the absence of shame is often considered adaptive, we found that guilt predicted greater psychological distress at low levels of shame in this sample.
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Affiliation(s)
- Nicole J. LeBlanc
- Department of Psychology, Harvard University,Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital
| | - Emma R. Toner
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital
| | | | - Cynthia W. Moore
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital,Department of Psychiatry, Harvard Medical School
| | - Luana Marques
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital,Department of Psychiatry, Harvard Medical School,Community Psychiatry Program for Research in Implementation and Dissemination of Evidence-Based Treatments, Massachusetts General Hospital
| | - Donald J. Robinaugh
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital,Department of Psychiatry, Harvard Medical School
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24
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Robinaugh DJ, Brown ML, Losiewicz OM, Jones PJ, Marques L, Baker AW. Towards a precision psychiatry approach to anxiety disorders with ecological momentary assessment: the example of panic disorder. Gen Psychiatr 2020; 33:e100161. [PMID: 32175524 PMCID: PMC7047468 DOI: 10.1136/gpsych-2019-100161] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/14/2019] [Accepted: 11/28/2019] [Indexed: 01/28/2023] Open
Abstract
Background Treatments for anxiety disorders are among the most effective in psychiatry. Yet, there is considerable room for improvement. Aim In this paper, we discuss the value of ecological momentary assessment as a research method and clinical tool. Methods We begin by describing ecological momentary assessment and its advantages, including the ability to collect ecologically valid information about mental disorders, in real time, in individual patients. We then illustrate the value of this approach for anxiety disorder treatment using two patients with panic disorder who completed ecological momentary assessments for 2 weeks before and after a cognitive-behavioural therapy intervention. We focus especially on two key pieces of information provided by ecological momentary assessment data: information about symptom dynamics and information about the relationships among symptoms as they unfold over time within individual patients. Perspective Although considerable work is needed to further develop this methodology in the context of anxiety disorder treatment, we believe that these pieces of information may ultimately inform our understanding of how anxiety disorder treatments have their effect and how those treatments can be tailored to individual patients.
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Affiliation(s)
- Donald J Robinaugh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Mackenzie L Brown
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Olivia M Losiewicz
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Payton J Jones
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Amanda W Baker
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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25
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Abstract
The network approach to psychopathology posits that mental disorders can be conceptualized and studied as causal systems of mutually reinforcing symptoms. This approach, first posited in 2008, has grown substantially over the past decade and is now a full-fledged area of psychiatric research. In this article, we provide an overview and critical analysis of 363 articles produced in the first decade of this research program, with a focus on key theoretical, methodological, and empirical contributions. In addition, we turn our attention to the next decade of the network approach and propose critical avenues for future research in each of these domains. We argue that this program of research will be best served by working toward two overarching aims: (a) the identification of robust empirical phenomena and (b) the development of formal theories that can explain those phenomena. We recommend specific steps forward within this broad framework and argue that these steps are necessary if the network approach is to develop into a progressive program of research capable of producing a cumulative body of knowledge about how specific mental disorders operate as causal systems.
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Affiliation(s)
- Donald J. Robinaugh
- Massachusetts General Hospital, Department of Psychiatry
- Harvard Medical School
| | | | - Emma R. Toner
- Massachusetts General Hospital, Department of Psychiatry
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26
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Greene T, Gelkopf M, Fried EI, Robinaugh DJ, Lapid Pickman L. Dynamic Network Analysis of Negative Emotions and DSM-5 Posttraumatic Stress Disorder Symptom Clusters During Conflict. J Trauma Stress 2020; 33:72-83. [PMID: 31433530 DOI: 10.1002/jts.22433] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 12/10/2018] [Accepted: 12/15/2018] [Indexed: 01/01/2023]
Abstract
Investigating dynamic associations between specific negative emotions and PTSD symptom clusters may provide novel insights into the ways in which PTSD symptoms interact with, emerge from, or are reinforced by negative emotions. The present study estimated the associations among negative emotions and the four DSM-5 PTSD symptom clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], and arousal) in a sample of Israeli civilians (n = 96) during the Israel-Gaza War of July-August 2014. Data were collected using experience sampling methodology, with participants queried via smartphone about PTSD symptoms and negative emotions twice a day for 30 days. We used a multilevel vector auto-regression model to estimate temporal and contemporaneous temporal networks. Contrary to our hypothesis, in the temporal network, PTSD symptom clusters were more predictive of negative emotions than vice versa, with arousal emerging as the strongest predictor that negative emotions would be reported at the next measurement point; fear and sadness were also strong predictors of PTSD symptom clusters. In the contemporaneous network, negative emotions exhibited the strongest associations with the NACM and arousal PTSD symptom clusters. The negative emotions of sadness, stress, fear, and loneliness had the strongest associations to the PTSD symptom clusters. Our findings suggest that arousal has strong associations to both PTSD symptoms and negative emotions during ongoing trauma and highlights the potentially relevant role of arousal for future investigations in primary or early interventions.
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Affiliation(s)
- Talya Greene
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Marc Gelkopf
- Department of Community Mental Health, University of Haifa, Haifa, Israel.,NATAL, Israel Trauma and Resiliency Center, Tel Aviv, Israel
| | - Eiko I Fried
- Department of Psychology, Leiden University, Leiden, the Netherlands.,Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Donald J Robinaugh
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Liron Lapid Pickman
- Department of Community Mental Health, University of Haifa, Haifa, Israel.,NATAL, Israel Trauma and Resiliency Center, Tel Aviv, Israel
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27
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Robinaugh DJ, Ward MJ, Toner ER, Brown ML, Losiewicz OM, Bui E, Orr SP. Assessing vulnerability to panic: a systematic review of psychological and physiological responses to biological challenges as prospective predictors of panic attacks and panic disorder. Gen Psychiatr 2020; 32:e100140. [PMID: 31922089 PMCID: PMC6936969 DOI: 10.1136/gpsych-2019-100140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/08/2019] [Accepted: 11/17/2019] [Indexed: 12/04/2022] Open
Abstract
Background Cognitive–behavioural theories of panic disorder posit that panic attacks arise from a positive feedback loop between arousal-related bodily sensations and perceived threat. In a recently developed computational model formalising these theories of panic attacks, it was observed that the response to a simulated perturbation to arousal provided a strong indicator of vulnerability to panic attacks and panic disorder. In this review, we evaluate whether this observation is borne out in the empirical literature that has examined responses to biological challenge (eg, CO2 inhalation) and their relation to subsequent panic attacks and panic disorder. Method We searched PubMed, Web of Science and PsycINFO using keywords denoting provocation agents (eg, sodium lactate) and procedures (eg, infusion) combined with keywords relevant to panic disorder (eg, panic). Articles were eligible if they used response to a biological challenge paradigm to prospectively predict panic attacks or panic disorder. Results We identified four eligible studies. Pooled effect sizes suggest that there is biological challenge response has a moderate prospective association with subsequent panic attacks, but no prospective relationship with panic disorder. Conclusions These findings provide support for the prediction derived from cognitive–behavioural theories and some preliminary evidence that response to a biological challenge may have clinical utility as a marker of vulnerability to panic attacks pending further research and development. Trial registration number 135908.
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Affiliation(s)
- Donald J Robinaugh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Meredith J Ward
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emma R Toner
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mackenzie L Brown
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Olivia M Losiewicz
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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28
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Simon NM, Shear K, Reynolds CF, Cozza SJ, Mauro C, Zisook S, Skritskaya N, Robinaugh DJ, Malgaroli M, Spandorfer J, Lebowitz B. Commentary on evidence in support of a grief-related condition as a DSM diagnosis. Depress Anxiety 2020; 37:9-16. [PMID: 31916663 PMCID: PMC7430251 DOI: 10.1002/da.22985] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/03/2019] [Accepted: 10/31/2019] [Indexed: 12/11/2022] Open
Abstract
The death of a loved one is one of life's greatest stressors. Most bereaved individuals experience a period of acute grief that diminishes in intensity as they adapt to the changes brought about by their loss. Over the past four decades, a growing body of research has focused on a form of prolonged grief that is painful and impairing. There is a substantial and growing evidence base that supports the validity and significance of a grief-related disorder, including the clinical value of being able to diagnose it and provide effective targeted treatment. ICD-11 will include a new diagnosis of prolonged grief disorder (PGD). DSM-5 called this condition persistent complex bereavement disorder (PCBD) and included it in Section III, signaling agreement that a diagnosis is warranted while further research is needed to determine the optimal criteria. Given the remaining uncertainties, reading this literature can be confusing. There is inconsistency in naming the condition (including complicated grief as well as PGD and PCBD) and lack of uniformity in identifying it, with respect to the optimal threshold and timeframe for distinguishing it from normal grief. As an introductory commentary for this Depression and Anxiety special edition on this form of grief, the authors discuss the history, commonalities, and key areas of variability in identifying this condition. We review the state of diagnostic criteria for DSM-5 and the current ICD-11 diagnostic guideline, highlighting the clinical relevance of making this diagnosis.
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Affiliation(s)
- Naomi M. Simon
- Department of Psychiatry, NYU Langone Health/NYU School of Medicine, New York, NY
| | | | | | - Stephen J. Cozza
- Center for the Study of Traumatic Stress, Uniformed Services University for the Health Sciences
| | - Christine Mauro
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Sidney Zisook
- University of California San Diego and San Diego Healthcare System, San Diego, CA
| | | | - Donald J. Robinaugh
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Matteo Malgaroli
- Department of Psychiatry, NYU Langone Health/NYU School of Medicine, New York, NY
| | - Julia Spandorfer
- Department of Psychiatry, NYU Langone Health/NYU School of Medicine, New York, NY
| | - Barry Lebowitz
- University of California San Diego and San Diego Healthcare System, San Diego, CA
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Djelantik AAAMJ, Robinaugh DJ, Kleber RJ, Smid GE, Boelen PA. Symptomatology following loss and trauma: Latent class and network analyses of prolonged grief disorder, posttraumatic stress disorder, and depression in a treatment-seeking trauma-exposed sample. Depress Anxiety 2020; 37:26-34. [PMID: 30724427 PMCID: PMC7004006 DOI: 10.1002/da.22880] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/14/2018] [Accepted: 01/02/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Although bereavement is likely a common stressor among patients referred to a psychotrauma clinic, no study has yet examined the co-occurrence and relationships between symptoms of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and major depressive disorder symptoms in this population. METHOD In a sample of patients seeking treatment following psychological trauma (n = 458), we used latent class analysis to identify classes of patients sharing the same profile of PGD, PTSD, and depression symptoms. We then used network analysis to investigate the relationships among these symptoms and with loss-related variables. RESULTS Most participants (65%) were members of a class that exhibited elevated endorsement of PGD symptoms. PGD, PTSD, and depression symptoms hung together as highly overlapping but distinguishable communities of symptoms. Symptoms related to social isolation and diminished sense of self bridged these communities. Violent loss was associated with more difficulty accepting the loss. The loss of close kin was most strongly associated with difficulty moving on in life. CONCLUSIONS PGD symptoms are common in trauma-exposed bereaved adults and closely associated with symptoms of PTSD and depression, illustrating the importance of assessing bereavement and PGD symptoms in those seeking treatment following trauma.
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Affiliation(s)
- A. A. A. Manik J. Djelantik
- Department of Clinical PsychologyUtrecht UniversityUtrechtThe Netherlands
- Arq Psychotrauma Expert GroupDiemenThe Netherlands
- Foundation Centrum ’45DiemenThe Netherlands
| | | | - Rolf J. Kleber
- Department of Clinical PsychologyUtrecht UniversityUtrechtThe Netherlands
- Arq Psychotrauma Expert GroupDiemenThe Netherlands
| | - Geert E. Smid
- Arq Psychotrauma Expert GroupDiemenThe Netherlands
- Foundation Centrum ’45DiemenThe Netherlands
| | - Paul A. Boelen
- Department of Clinical PsychologyUtrecht UniversityUtrechtThe Netherlands
- Arq Psychotrauma Expert GroupDiemenThe Netherlands
- Foundation Centrum ’45DiemenThe Netherlands
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30
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Simon NM, Hoeppner SS, Lubin RE, Robinaugh DJ, Malgaroli M, Norman SB, Acierno R, Goetter EM, Hellberg SN, Charney ME, Bui E, Baker AW, Smith E, Kim HM, Rauch SA. Understanding the impact of complicated grief on combat related posttraumatic stress disorder, guilt, suicide, and functional impairment in a clinical trial of post-9/11 service members and veterans. Depress Anxiety 2020; 37:63-72. [PMID: 31916660 PMCID: PMC7433022 DOI: 10.1002/da.22911] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/18/2019] [Accepted: 04/22/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Complicated grief (CG) is a bereavement-specific syndrome distinct from but commonly comorbid with posttraumatic stress disorder (PTSD). While bereavement is common among military personnel (Simon et al., 2018), there is little research on the impact of CG comorbidity on PTSD treatment outcomes. METHODS To evaluate the impact of comorbid CG on PTSD treatment outcomes we analyzed data from a randomized trial comparing prolonged exposure, sertraline, and their combination in veterans with a primary diagnosis of combat-related PTSD (n = 194). Assessment of PTSD, trauma-related guilt, functional impairment, and suicidal ideation and behavior occurred at baseline and weeks 6, 12, and 24 during the 24-week trial. RESULTS CG was associated with lower PTSD treatment response (odds ratio (OR) = 0.29, 95% confidence interval (CI) [0.12, 0.69], p = 0.005) and remission (OR = 0.28, 95% CI [0.11, 0.71], p = 0.007). Those with CG had greater severity of PTSD (p = 0.005) and trauma-related guilt (<0.001) at baseline and endpoint. In addition, those with CG were more likely to experience suicidal ideation during the study (CG: 35%, 14/40 vs. no CG 15%, 20/130; OR = 3.01, 95% CI [1.29, 7.02], p = 0.011). CONCLUSIONS Comorbid CG is associated with elevated PTSD severity and independently associated with poorer endpoint treatment outcomes in veterans with combat-related PTSD, suggesting that screening and additional intervention for CG may be needed.
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Affiliation(s)
- Naomi M. Simon
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, New York University School of Medicine, New York, NY
| | - Susanne S. Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Rebecca E. Lubin
- Department of Psychiatry, New York University School of Medicine, New York, NY
| | - Donald J. Robinaugh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Matteo Malgaroli
- Department of Psychiatry, New York University School of Medicine, New York, NY
| | - Sonya B. Norman
- National Center for PTSD, White River Junction, VT,Mental Health Service Line, Veterans Affairs San Diego Healthcare System, San Diego, CA,School of Medicine, University of California, San Diego, La Jolla,Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, CA
| | - Ron Acierno
- Mental Health Service Line, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC,College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Elizabeth M. Goetter
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | | | - Meredith E. Charney
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Amanda W. Baker
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Erin Smith
- VA Ann Arbor Healthcare System, Ann Arbor, MI,Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - H. Myra Kim
- VA Ann Arbor Healthcare System, Ann Arbor, MI,Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor, MI
| | - Sheila A.M. Rauch
- Mental Health Service Line, Veterans Affairs Atlanta Healthcare System, Decatur, GA,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
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31
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Kuczynski AM, Kanter JW, Robinaugh DJ. Differential associations between interpersonal variables and quality-of-life in a sample of college students. Qual Life Res 2019; 29:127-139. [PMID: 31535262 DOI: 10.1007/s11136-019-02298-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Humans are fundamentally social beings, and the relationships we form with others are crucial for our well-being. Research across a variety of domains has established the association between a variety of interpersonal factors and health outcomes, including quality-of-life. However, there is a need for a more integrative, holistic analysis of these variables and how they relate to one another. METHODS Undergraduate students (n = 1456) from four universities across the United States completed self-report measures of their quality-of-life and a variety of interpersonal factors identified as important predictors across the literature. We examined zero-order correlations between these measures and quality-of-life, estimated a path model to look at unique variance accounted for by each, and finally used network analysis to examine the network of direct and indirect associations among these variables and quality-of-life. RESULTS Loneliness had the strongest association with quality-of-life across all analyses. When examining the unique association between quality-of-life and each interpersonal variable, six remained statistically significant: loneliness, social support, social connectedness, emotional intelligence, intimacy with one's romantic partner, and empathic concern. These results were supported by the network model, which found direct associations between quality-of-life and these six variables as well as indirect associations with all other interpersonal variables in the model. CONCLUSIONS Results from this research suggest that interpersonal factors in general, and loneliness in particular, are strongly associated with quality-of-life. Future research is needed to establish the direction of these effects and examine for whom these findings are generalizable.
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Affiliation(s)
- Adam M Kuczynski
- University of Washington, 119a Guthrie Hall, Box 351525, Seattle, WA, 98195, USA.
| | - Jonathan W Kanter
- University of Washington, 119a Guthrie Hall, Box 351525, Seattle, WA, 98195, USA
| | - Donald J Robinaugh
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 1 Bowdoin Square, Room 656, Boston, MA, 02114, USA
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32
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Rodgers RF, DuBois R, Frumkin MR, Robinaugh DJ. A network approach to eating disorder symptomatology: Do desire for thinness and fear of gaining weight play unique roles in the network? Body Image 2018; 27:1-9. [PMID: 30086480 DOI: 10.1016/j.bodyim.2018.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 07/26/2018] [Accepted: 07/26/2018] [Indexed: 01/08/2023]
Abstract
This study used network analyses to test the hypotheses that desire for thinness and fear of gaining weight are related but distinct constructs that play a central role in disordered eating. Data from a sample of 251 college women were used. Sparse undirected eating disorder symptom networks were calculated. Bootstrapped difference tests for edge weights and centrality indices were used to compare the position of desire for thinness and fear of gaining weight. Desire for thinness and fear of gaining weight exhibited unique patterns of associations within the network. Desire for thinness was highly connected to body dissatisfaction, thoughts about dieting, and thoughts about binge eating. Fear of gaining weight was not. Desire for thinness emerged as the most central symptom. Our findings support the distinction between fear of gaining weight and desire for thinness and their different roles within the eating disorder symptom network.
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Affiliation(s)
- Rachel F Rodgers
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, United States; Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, France.
| | - Russell DuBois
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, United States
| | - Madelyn R Frumkin
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, United States
| | - Donald J Robinaugh
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, United States
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33
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Affiliation(s)
- Denny Borsboom
- Department of PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
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34
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Simon NM, O'Day EB, Hellberg SN, Hoeppner SS, Charney ME, Robinaugh DJ, Bui E, Goetter EM, Baker AW, Rogers AH, Nadal-Vicens M, Venners MR, Kim HM, Rauch SAM. The loss of a fellow service member: Complicated grief in post-9/11 service members and veterans with combat-related posttraumatic stress disorder. J Neurosci Res 2017; 96:5-15. [PMID: 28609578 DOI: 10.1002/jnr.24094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/01/2017] [Accepted: 05/09/2017] [Indexed: 11/10/2022]
Abstract
Bereavement is a potent and highly prevalent stressor among service members and veterans. However, the psychological consequences of bereavement, including complicated grief (CG), have been minimally examined. Loss was assessed in 204 post-9/11, when service members and veterans with combat-related posttraumatic stress disorder (PTSD) took part in a multicenter treatment study. Those who reported the loss of an important person completed the inventory of complicated grief (ICG; n = 160). Over three quarters (79.41%) of the sample reported an important lifetime loss, with close to half (47.06%) reporting the loss of a fellow service member (FSM). The prevalence of CG was 24.75% overall, and nearly one third (31.25%) among the bereaved. CG was more prevalent among veterans who lost a fellow service member (FSM) (41.05%, n = 39) compared to those bereaved who did not (16.92%, n = 11; OR = 3.41, 95% CI: 1.59, 7.36). CG was associated with significantly greater PTSD severity, functional impairment, trauma-related guilt, and lifetime suicide attempts. Complicated grief was prevalent and associated with adverse psychosocial outcomes in veterans and service members with combat-related PTSD. Clinicians working with this population should inquire about bereavement, including loss of a FSM, and screen for CG. Additional research examining CG in this population is needed.
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Affiliation(s)
- Naomi M Simon
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Emily B O'Day
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Samantha N Hellberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Susanne S Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Meredith E Charney
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Donald J Robinaugh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Elizabeth M Goetter
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Amanda W Baker
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Andrew H Rogers
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Mireya Nadal-Vicens
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Margaret R Venners
- VA Ann Arbor Healthcare System, 2215 Fuller Road 116c, Ann Arbor, MI, 48105, USA.,University of Michigan, Department of Psychiatry, 4250 Plymouth Rd., Ann Arbor, MI, 48109
| | - Hyungjin M Kim
- VA Ann Arbor Healthcare System, 2215 Fuller Road 116c, Ann Arbor, MI, 48105, USA
| | - Sheila A M Rauch
- VA Ann Arbor Healthcare System, 2215 Fuller Road 116c, Ann Arbor, MI, 48105, USA.,University of Michigan, Department of Psychiatry, 4250 Plymouth Rd., Ann Arbor, MI, 48109.,Emory University, School of Medicine, 12 Executive Park, 3rd Floor, Atlanta, GA, 30329, USA.,Atlanta VA Medical Center, 1670 Clairmont Road 116c, Atlanta, GA, 30033, USA
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35
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Affiliation(s)
- Christina Haag
- Department of Experimental Psychopathology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | | | - Anke Ehlers
- Department of Experimental Psychology, Oxford University, Oxford, England
| | - Birgit Kleim
- Department of Experimental Psychopathology and Psychotherapy, University of Zurich, Zurich, Switzerland
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36
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McNally RJ, Heeren A, Robinaugh DJ. A Bayesian network analysis of posttraumatic stress disorder symptoms in adults reporting childhood sexual abuse. Eur J Psychotraumatol 2017; 8:1341276. [PMID: 29038690 PMCID: PMC5632780 DOI: 10.1080/20008198.2017.1341276] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 06/06/2017] [Indexed: 12/20/2022] Open
Abstract
Background: The network approach to mental disorders offers a novel framework for conceptualizing posttraumatic stress disorder (PTSD) as a causal system of interacting symptoms. Objective: In this study, we extended this work by estimating the structure of relations among PTSD symptoms in adults reporting personal histories of childhood sexual abuse (CSA; N = 179). Method: We employed two complementary methods. First, using the graphical LASSO, we computed a sparse, regularized partial correlation network revealing associations (edges) between pairs of PTSD symptoms (nodes). Next, using a Bayesian approach, we computed a directed acyclic graph (DAG) to estimate a directed, potentially causal model of the relations among symptoms. Results: For the first network, we found that physiological reactivity to reminders of trauma, dreams about the trauma, and lost of interest in previously enjoyed activities were highly central nodes. However, stability analyses suggest that these findings were unstable across subsets of our sample. The DAG suggests that becoming physiologically reactive and upset in response to reminders of the trauma may be key drivers of other symptoms in adult survivors of CSA. Conclusions: Our study illustrates the strengths and limitations of these network analytic approaches to PTSD.
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Affiliation(s)
| | - Alexandre Heeren
- Department of Psychology, Harvard University, Cambridge, MA, USA.,Institute of Psychological Science, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Donald J Robinaugh
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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37
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Abstract
The network approach to psychopathology conceptualizes mental disorders as networks of mutually reinforcing nodes (i.e., symptoms). Researchers adopting this approach have suggested that network topology can be used to identify influential nodes, with nodes central to the network having the greatest influence on the development and maintenance of the disorder. However, because commonly used centrality indices do not distinguish between positive and negative edges, they may not adequately assess the nature and strength of a node's influence within the network. To address this limitation, we developed 2 indices of a node's expected influence (EI) that account for the presence of negative edges. To evaluate centrality and EI indices, we simulated single-node interventions on randomly generated networks. In networks with exclusively positive edges, centrality and EI were both strongly associated with observed node influence. In networks with negative edges, EI was more strongly associated with observed influence than was centrality. We then used data from a longitudinal study of bereavement to examine the association between (a) a node's centrality and EI in the complicated grief (CG) network and (b) the strength of association between change in that node and change in the remainder of the CG network from 6- to 18-months postloss. Centrality and EI were both correlated with the strength of the association between node change and network change. Together, these findings suggest high-EI nodes, such as emotional pain and feelings of emptiness, may be especially important to the etiology and treatment of CG. (PsycINFO Database Record
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38
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LeBlanc NJ, Dixon L, Robinaugh DJ, Valentine SE, Bosley HG, Gerber MW, Marques L. PTSD and Romantic Relationship Satisfaction: Cluster- and Symptom-Level Analyses. J Trauma Stress 2016; 29:259-67. [PMID: 27163435 PMCID: PMC5352989 DOI: 10.1002/jts.22100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Previous studies have demonstrated bidirectional associations between posttraumatric stress disorder (PTSD) and romantic relationship dissatisfaction. Most of these studies were focused at the level of the disorder, examining the association between relationship dissatisfaction and having a diagnosis of PTSD or the total of PTSD symptoms endorsed. This disorder-level approach is problematic for trauma theorists who posit symptom-level mechanisms for these effects. In the present study, we examined the prospective, bidirectional associations between PTSD symptom clusters (e.g., reexperiencing) and relationship satisfaction using the data from 101 previously studied individuals who had had a recent motor vehicle accident. We also conducted exploratory analyses examining the prospective, bidirectional associations between individual PTSD symptoms and relationship satisfaction. Participants had completed the PTSD Checklist-Civilian Version and the Relationship Assessment Scale at 4, 10, and 16 weeks after the MVA. We performed time-lagged mixed-effects regressions to examine the effect of lagged relationship satisfaction on PTSD clusters and symptoms, and vice versa. No cluster effects were significant after controlling for a false discovery rate. Relationship satisfaction predicted prospective decreases in reliving the trauma (d = 0.42), emotional numbness (d = 0.46), and irritability (d = 0.49). These findings were consistent with the position that relationship satisfaction affects PTSD through symptom-level mechanisms.
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Affiliation(s)
- Nicole J. LeBlanc
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - Louise Dixon
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Donald J. Robinaugh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah E. Valentine
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Hannah G. Bosley
- Department of Psychology, University of California, Berkeley, Berkeley, California, USA
| | - Monica W. Gerber
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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39
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Robinaugh DJ, Mauro C, Bui E, Stone L, Shah R, Wang Y, Skritskaya NA, Reynolds CF, Zisook S, O’Connor MF, Shear K, Simon NM. Yearning and Its Measurement in Complicated Grief. Journal of Loss and Trauma 2015. [DOI: 10.1080/15325024.2015.1110447] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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40
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Asnaani A, Aderka IM, Marques L, Simon N, Robinaugh DJ, Hofmann SG. The structure of feared social situations among race-ethnic minorities and Whites with social anxiety disorder in the United States. Transcult Psychiatry 2015; 52:791-807. [PMID: 25795220 PMCID: PMC5319844 DOI: 10.1177/1363461515576823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We investigated feared social situations in individuals with social anxiety disorder from different racial and ethnic groups in the United States. The sample included 247 African Americans, 158 Latinos, and 533 non-Latino Whites diagnosed with social anxiety disorder within the past 12 months from the integrated Collaborative Psychiatric Epidemiology Studies data set. After randomly splitting the full sample, we conducted an exploratory factor analysis with half of the sample to determine the structure of feared social situations in a more diverse sample than has been used in previous studies. We found evidence for a model consisting of three feared social domains: performance/public speaking, social interaction, and observational. We then conducted a confirmatory factor analysis on the remaining half of the sample to examine whether this factor structure varied significantly between the race-ethnic groups. Analyses revealed an adequate fit of this model across all three race-ethnic groups, suggesting invariance of the factor structure between the study groups. Broader cultural contexts within which these findings are relevant are discussed, along with important implications for comprehensive, culturally sensitive assessment of social anxiety.
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Affiliation(s)
| | | | - Luana Marques
- Massachusetts General HospitalHarvard Medical School
| | - Naomi Simon
- Massachusetts General HospitalHarvard Medical School
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41
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Bui E, Mauro C, Robinaugh DJ, Skritskaya NA, Wang Y, Gribbin C, Ghesquiere A, Horenstein A, Duan N, Reynolds C, Zisook S, Simon NM, Shear MK. THE STRUCTURED CLINICAL INTERVIEW FOR COMPLICATED GRIEF: RELIABILITY, VALIDITY, AND EXPLORATORY FACTOR ANALYSIS. Depress Anxiety 2015; 32:485-92. [PMID: 26061724 PMCID: PMC4565180 DOI: 10.1002/da.22385] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/21/2015] [Accepted: 05/07/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Complicated grief (CG) has been recently included in the DSM-5, under the term "persistent complex bereavement disorder," as a condition requiring further study. To our knowledge, no psychometric data on any structured clinical interview for CG (SCI-CG) is available to date. In this manuscript, we introduce the SCI-CG, a 31-item "SCID-like" clinician-administered instrument to assess the presence of CG symptoms. METHODS Participants were 281 treatment-seeking adults with CG (77.9% [n = 219] women, mean age = 52.4, standard deviation [SD] = 17.8) who were assessed with the SCI-CG and measures of depression, posttraumatic stress, anxiety, functional impairment. RESULTS The SCI-CG exhibited satisfactory internal consistency (α = .78), good test-retest reliability (interclass correlation [ICC] 0.68, 95% CI [0.60-0.75]), and excellent interrater reliability (ICC = 0.95, 95% CI [0.89-0.98]). Exploratory factor analyses revealed that a five-factor structure, explaining 50.3% of the total variance, was the best fit for the data. CONCLUSIONS The clinician-rated SCI-CG demonstrates good internal consistency, reliability, and convergent validity in treatment-seeking individuals with CG and therefore can be a useful tool to assess CG. Although diagnostic criteria for CG have yet to be adequately validated, the SCI-CG may facilitate this process. The SCI-CG can now be used as a validated instrument in research and clinical practice.
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Affiliation(s)
- Eric Bui
- Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | | | | | | | | | | | | | | | | | | | | | - Naomi M. Simon
- Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
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42
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Robinaugh DJ, Crane ME, Enock PM, McNally RJ. Training the removal of negative information from working memory: A preliminary investigation of a working memory bias modification task. Cogn Emot 2015; 30:570-81. [DOI: 10.1080/02699931.2015.1014312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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43
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Hoge EA, Bui E, Goetter E, Robinaugh DJ, Ojserkis RA, Fresco DM, Simon NM. Change in Decentering Mediates Improvement in Anxiety in Mindfulness-Based Stress Reduction for Generalized Anxiety Disorder. Cognit Ther Res 2014; 39:228-235. [PMID: 28316355 DOI: 10.1007/s10608-014-9646-4] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to examine psychological mechanisms of treatment outcomes of a mindfulness meditation intervention for Generalized Anxiety Disorder (GAD). METHODS We examined mindfulness and decentering as two potential therapeutic mechanisms of action of generalized anxiety disorder (GAD) symptom reduction in patients randomized to receive either mindfulness-based stress reduction (MBSR) or an attention control class (N=38). Multiple mediation analyses were conducted using a non-parametric cross product of the coefficients approach that employs bootstrapping. RESULTS Analyses revealed that change in decentering and change in mindfulness significantly mediated the effect of MBSR on anxiety. When both mediators were included in the model, the multiple mediation analysis revealed a significant indirect effect through increases in decentering, but not mindfulness. Furthermore, the direct effect of MBSR on decrease in anxiety was not significant, suggesting that decentering fully mediated the relationship. Results also suggested that MBSR reduces worry through an increase in mindfulness, specifically by increases in awareness and nonreactivity. CONCLUSIONS Improvements in GAD symptoms resulting from MBSR are in part explained by increased levels of decentering.
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Affiliation(s)
- Elizabeth A Hoge
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Elizabeth Goetter
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | | | | | - David M Fresco
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Naomi M Simon
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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Robinaugh DJ, McNally RJ, LeBlanc NJ, Pentel KZ, Schwarz NR, Shah RM, Nadal-Vicens MF, Moore CW, Marques L, Bui E, Simon NM. Anxiety sensitivity in bereaved adults with and without complicated grief. J Nerv Ment Dis 2014; 202:620-2. [PMID: 25075646 PMCID: PMC4118557 DOI: 10.1097/nmd.0000000000000171] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Complicated grief (CG) is a bereavement-specific syndrome chiefly characterized by symptoms of persistent separation distress. Physiological reactivity to reminders of the loss and repeated acute pangs or waves of severe anxiety and psychological pain are prominent features of CG. Fear of this grief-related physiological arousal may contribute to CG by increasing the distress associated with grief reactions and increasing the likelihood of maladaptive coping strategies and grief-related avoidance. Here, we examined anxiety sensitivity (AS; i.e., the fear of anxiety-related sensations) in two studies of bereaved adults with and without CG. In both studies, bereaved adults with CG exhibited elevated AS relative to those without CG. In study 2, AS was positively associated with CG symptom severity among those with CG. These findings are consistent with the possibility that AS contributes to the development or maintenance of CG symptoms.
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Affiliation(s)
- Donald J. Robinaugh
- Department of Psychology, Harvard University, Cambridge, Massachusetts, United States of America
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Richard J. McNally
- Department of Psychology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Nicole J. LeBlanc
- Department of Psychology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Kimberly Z. Pentel
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Noah R. Schwarz
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Riva M. Shah
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Mireya F. Nadal-Vicens
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Cynthia W. Moore
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Luana Marques
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Eric Bui
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Naomi M. Simon
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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Robinaugh DJ, LeBlanc NJ, Vuletich HA, McNally RJ. Network analysis of persistent complex bereavement disorder in conjugally bereaved adults. J Abnorm Psychol 2014; 123:510-22. [PMID: 24933281 PMCID: PMC4170793 DOI: 10.1037/abn0000002] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Persistent complex bereavement disorder (PCBD) is a bereavement-specific syndrome characterized by prolonged and impairing grief. Most research on this syndrome rests on the traditional latent variable model, whereby symptoms reflect an underlying entity. The network (or causal system) approach offers an alternative framework for understanding PCBD that does not suffer from limitations inherent in the latent entity approach. The network approach to psychopathology conceptualizes the relation between symptoms and disorder as mereological, not reflective. That is, symptoms do not reflect an inferred, unobservable category or dimension, but rather are themselves constitutive of the disorder. Accordingly, we propose that PCBD constitutes a causal system of mutually reinforcing symptoms that arise following the death of a loved one and settle into a pathological equilibrium. In this study, we used data from the Changing Lives of Older Couples database to identify symptoms central to PCBD, to distinguish the PCBD network from an overlapping but distinct network of depression symptoms, and to examine how previously identified risk factors may contribute to the maintenance or development of PCBD. Together, these findings provide an important first step toward understanding the nature and etiology of the PCBD network.
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Friedberg JP, Robinaugh DJ, Wang B, Allegrante JP, Lipsitz SR, Natarajan S. Who Is Being Reached for a Telephone-Delivered Intervention for Patients with Uncontrolled Hypertension? Telemed J E Health 2014; 20:229-34. [DOI: 10.1089/tmj.2013.0071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Jennifer P. Friedberg
- VA New York Harbor Healthcare System, New York, New York
- New York University School of Medicine, New York, New York
| | | | - Binhuan Wang
- New York University School of Medicine, New York, New York
| | - John P. Allegrante
- Teachers College and the Mailman School of Public Health, Columbia University, New York, New York
| | - Stuart R. Lipsitz
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sundar Natarajan
- VA New York Harbor Healthcare System, New York, New York
- New York University School of Medicine, New York, New York
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Hoge EA, Bui E, Marques L, Metcalf CA, Morris LK, Robinaugh DJ, Worthington JJ, Pollack MH, Simon NM. Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: effects on anxiety and stress reactivity. J Clin Psychiatry 2013; 74:786-92. [PMID: 23541163 PMCID: PMC3772979 DOI: 10.4088/jcp.12m08083] [Citation(s) in RCA: 230] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 02/11/2013] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Mindfulness meditation has met increasing interest as a therapeutic strategy for anxiety disorders, but prior studies have been limited by methodological concerns, including a lack of an active comparison group. This is the first randomized, controlled trial comparing the manualized Mindfulness-Based Stress Reduction (MBSR) program with an active control for generalized anxiety disorder (GAD), a disorder characterized by chronic worry and physiologic hyperarousal symptoms. METHOD Ninety-three individuals with DSM-IV-diagnosed GAD were randomly assigned to an 8-week group intervention with MBSR or to an attention control, Stress Management Education (SME), between 2009 and 2011. Anxiety symptoms were measured with the Hamilton Anxiety Rating Scale (HAMA; primary outcome measure), the Clinical Global Impressions-Severity of Illness and -Improvement scales (CGI-S and CGI-I), and the Beck Anxiety Inventory (BAI). Stress reactivity was assessed by comparing anxiety and distress during pretreatment and posttreatment administration of the Trier Social Stress Test (TSST). RESULTS A modified intent-to-treat analysis including participants who completed at least 1 session of MBSR (n = 48) or SME (n = 41) showed that both interventions led to significant (P < .0001) reductions in HAMA scores at endpoint, but did not significantly differ. MBSR, however, was associated with a significantly greater reduction in anxiety as measured by the CGI-S, the CGI-I, and the BAI (all P values < .05). MBSR was also associated with greater reductions than SME in anxiety and distress ratings in response to the TSST stress challenge (P < .05) and a greater increase in positive self-statements (P = .004). CONCLUSIONS These results suggest that MBSR may have a beneficial effect on anxiety symptoms in GAD and may also improve stress reactivity and coping as measured in a laboratory stress challenge. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01033851.
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Affiliation(s)
- Elizabeth A. Hoge
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | | | - Laura K. Morris
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | | | | | | | - Naomi M. Simon
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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Robinaugh DJ, Lubin RE, Babic L, McNally RJ. Are habitual overgeneral recollection and prospection maladaptive? J Behav Ther Exp Psychiatry 2013; 44:227-30. [PMID: 23238224 DOI: 10.1016/j.jbtep.2012.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 11/12/2012] [Accepted: 11/15/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Individuals with depression exhibit difficulty retrieving specific memories and imagining specific future events when instructed to do so relative to non-clinical comparison groups. Instead of specific events, depressed individuals frequently retrieve or imagine "overgeneral" memories that span a long period of time or that denote a category of similar events. Recently, Raes, Hermans, Williams, and Eelen (2007) developed a sentence completion procedure (SCEPT) to assess the tendency to recall overgeneral autobiographical memories. They found that specificity on this measure was associated with depression and rumination. We aimed to replicate these findings and to examine the tendency to imagine overgeneral future events. METHODS We had 170 subjects complete past (SCEPT) and future-oriented (SCEFT) sentence completion tasks and measures of depression severity, PTSD severity, hopelessness, and repetitive negative thought. RESULTS Although specificities of past and future events were correlated, neither SCEPT nor SCEFT specificity was negatively associated with depression severity, posttraumatic stress symptoms, repetitive negative thought (RNT), or hopelessness. LIMITATIONS Our data are cross-sectional, preventing any determination of causality and limiting our assessment of whether specificity is associated with psychological distress following a stressful life event. In addition, we observed poor internal consistency for both the SCEPT and SCEFT. CONCLUSIONS These findings fail to support the hypothesis that overgeneral memory and prospection on these tasks are associated with psychological distress.
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Affiliation(s)
- Donald J Robinaugh
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA.
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Bui E, Simon NM, Robinaugh DJ, LeBlanc NJ, Wang Y, Skritskaya NA, Mauro C, Shear MK. Periloss dissociation, symptom severity, and treatment response in complicated grief. Depress Anxiety 2013; 30:123-8. [PMID: 23212730 PMCID: PMC3967786 DOI: 10.1002/da.22029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 10/22/2012] [Accepted: 11/02/2012] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Complicated grief (CG) is a bereavement-specific syndrome characterized by traumatic and separation distress lasting over 6 months. Little is known about the role of dissociation experienced during or immediately after the loss of a loved one (i.e., periloss dissociation [PLD]) in CG. The present study aimed to examine the psychometric properties of the PLD-adapted Peritraumatic Dissociative Experiences Questionnaire and its association with symptom severity, treatment response, and drop-out rate. METHODS PLD data collected as part of a randomized controlled trial of two loss-focused psychotherapy approaches for CG were examined. Treatment-seeking individuals with primary CG (n = 193) were assessed for PLD at the initial visit, 95 of whom were randomized and completed at least one treatment session. RESULTS The PLD-adapted Peritraumatic Dissociative Experiences Questionnaire was found to be internally consistent (α = 0.91) with good convergent and divergent validity. After controlling for age, gender, time since loss, and current comorbid psychiatric diagnosis, self-reported PLD was associated with greater CG symptom severity (P < .01). However, contrary to our hypotheses, after controlling for age, baseline symptoms severity, psychiatric comorbidity, and treatment arm, PLD was predictive of better treatment response (P < .05) and lower study discontinuation (P < .01). CONCLUSIONS PLD may be useful in identifying individuals at risk for CG and those who might respond to psychotherapy. Additional research should investigate the relationship of PLD with treatment outcome for different treatment approaches, and whether PLD prospectively predicts the development of CG.
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Affiliation(s)
- Eric Bui
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
| | - Naomi M. Simon
- Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
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Sung SC, Porter E, Robinaugh DJ, Marks EH, Marques LM, Otto MW, Pollack MH, Simon NM. Mood regulation and quality of life in social anxiety disorder: an examination of generalized expectancies for negative mood regulation. J Anxiety Disord 2012; 26:435-41. [PMID: 22343166 PMCID: PMC4090049 DOI: 10.1016/j.janxdis.2012.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Revised: 10/11/2011] [Accepted: 01/09/2012] [Indexed: 10/14/2022]
Abstract
The present study examined negative mood regulation expectancies, anxiety symptom severity, and quality of life in a sample of 167 patients with social anxiety disorder (SAD) and 165 healthy controls with no DSM-IV Axis I disorders. Participants completed the Generalized Expectancies for Negative Mood Regulation Scale (NMR), the Beck Anxiety Inventory, and the Quality of Life Enjoyment and Satisfaction Questionnaire. SAD symptom severity was assessed using the Liebowitz Social Anxiety Scale. Individuals with SAD scored significantly lower than controls on the NMR. Among SAD participants, NMR scores were negatively correlated with anxiety symptoms and SAD severity, and positively correlated with quality of life. NMR expectancies positively predicted quality of life even after controlling for demographic variables, comorbid diagnoses, anxiety symptoms, and SAD severity. Individuals with SAD may be less likely to engage in emotion regulating strategies due to negative beliefs regarding their effectiveness, thereby contributing to poorer quality of life.
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Affiliation(s)
- Sharon C. Sung
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 1 Bowdoin Square, 6th Floor, Boston, MA 02114, United States,Corresponding author. Present address: Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore 169857, Singapore. Tel.: +65 6601 1648; fax: +65 6222 7453. , (S.C. Sung)
| | - Eliora Porter
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 1 Bowdoin Square, 6th Floor, Boston, MA 02114, United States
| | - Donald J. Robinaugh
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 1 Bowdoin Square, 6th Floor, Boston, MA 02114, United States
| | - Elizabeth H. Marks
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 1 Bowdoin Square, 6th Floor, Boston, MA 02114, United States
| | - Luana M. Marques
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 1 Bowdoin Square, 6th Floor, Boston, MA 02114, United States
| | - Michael W. Otto
- Translational Research Program, Center for Anxiety and Related Disorders, Boston University, 648 Beacon Street, 5th Floor, Boston, MA 02215, United States
| | - Mark H. Pollack
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 1 Bowdoin Square, 6th Floor, Boston, MA 02114, United States
| | - Naomi M. Simon
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 1 Bowdoin Square, 6th Floor, Boston, MA 02114, United States
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