Detecting pathological exercise in college men: An investigation using latent profile analysis

OBJECTIVE

Pathological exercise is a dangerous behavior often observed in eating disorders. Data investigating associated characteristics of pathological exercise in men are lacking, despite college men and women being at equally elevated risk for developing eating disorders.

PARTICIPANTS

Two hundred and twenty-four college men who exercise regularly completed a series of self-report questionnaires.

METHODS

Latent profile analysis was used to identify empirically-derived homogenous subgroups of regular exercisers based on severity of other eating disorder attitudes and behaviors. Profiles were also compared on differences in exercise motivation and general psychopathology (i.e., depression, anxiety).

RESULTS

Fit indices indicated a three-profile solution. Profiles described an eating psychopathology group, a low psychopathology group, and a high exercise frequency group without eating disorder features.

CONCLUSIONS

Pathological exercise cannot be identified using exercise frequency alone. Other features like body dissatisfaction and exercise motivation style are relevant in identifying pathological exercise behavior in college men.

Measuring cognitions during exercise: Associations between thoughts and eating disorder behaviors over a 3-week ecological momentary assessment study

OBJECTIVE

Previous work has outlined cognitive beliefs about exercise in general, but very little is known about momentary cognitions while engaging in pathological exercise. The primary aim of this study was to explore thought content during exercise and to test whether these thoughts predicted later engagement in eating disorder behaviors. We also tested associations between thoughts and specific exercise activity.

METHOD

We monitored 31 women with clinically significant eating psychopathology for 3 weeks via ecological momentary assessment as they reported on their exercise and eating disorder behaviors, and thoughts about shape, weight, or calories during exercise. Thoughts were self-reported upon cessation of each exercise session.

RESULTS

Thinking about weight loss during exercise predicted later engagement in body-checking behaviors. Weight-bearing exercise was associated with a decreased likelihood of thinking about calories but an increased likelihood of thinking about shape during exercise.

DISCUSSION

These findings show that shape and weight thoughts are present during exercise and that their influence on eating disorder behaviors may exist on a much briefer time scale (i.e., within a day) than previous studies show. Clinically, future studies may seek to test interventions aimed at changing or restructuring cognitions during exercise to help shape adaptive exercise behavior during and after treatment.

PUBLIC SIGNIFICANCE

This is the first study measuring thoughts during pathological exercise in real-time among those with eating disorder psychopathology. The results show that thinking about weight loss during exercise might increase the likelihood of engaging in body-checking behaviors. Findings will inform the development of treatment approaches to help those in recovery from eating disorders re-engage with exercise.

The differential impact of COVID-19 across health service psychology students of color: An embedded mixed-methods study

OBJECTIVES

Communities of color in the United States systematically experience inequities in physical and mental health care compared to individuals who identify as non-Hispanic White. The coronavirus disease 2019 (COVID-19) pandemic exacerbated these structural drivers of inequity to disproportionate and devastating effects for persons of color. In addition to managing the direct effects of COVID-19 risk, persons of color were also navigating increased racial prejudice and discrimination. For mental health professionals and trainees of color, the effects of COVID-19 racial health disparities and the increase in acts of racism may have been compounded by their work responsibilities. The current study used an embedded mixed-methods approach to examine the differential impact of COVID-19 on health service psychology (HSP) students of color as compared to their non-Hispanic White peers.

METHOD

Using quantitative and qualitative data from the Epidemic-Pandemic Impacts Inventory, measures of perceived support and of discrimination, and open-ended questions about students' experiences with racism and microaggressions, we examined the extent to which different racial/ethnic HSP student groups experienced COVID-19-related discrimination, the impacts of COVID-19 felt by students of color, and how these experiences differed from those of their non-Hispanic White peers.

RESULTS

HSP students of color endorsed greater impacts of the pandemic on both self and others in the home, perceived themselves as less supported by others, and reported more experiences of racial discrimination than non-Hispanic White HSP students.

CONCLUSION

Throughout the graduate experience, HSP students of color and their experiences of discrimination need to be addressed. We provided recommendations to HSP training program directors and students both during and after the COVID-19 pandemic.

Aspects of positive identity buffer the longitudinal associations between discrimination and suicidal ideation among bi+ young adults

OBJECTIVE

Prior research has demonstrated that discrimination is associated with suicidal ideation among bi + individuals, but little is known about resilience factors (both general and bi + specific) that may buffer these associations. This prospective study examined the main and interactive effects of antibisexual discrimination and resilience factors, including general resilience and positive bi + identity factors (community, authenticity, and intimacy), in predicting suicidal ideation at 1- and 2-month follow-up.

METHOD

Participants were bi + young adults (N = 396; ages 18-29; 42.7% cisgender men, 42.2% cisgender women, 15.2% transgender/gender diverse individuals; 37.9% racial and ethnic minority individuals) who completed measures of antibisexual discrimination (Brief Antibisexual Experiences Scale), positive bi + identity (Lesbian, Gay, and Bisexual Positive Identity Measure), general resilience (Brief Resilience Scale), and suicidal ideation (Beck Scale for Suicide Ideation) at baseline, and suicidal ideation again at 1- and 2-month follow-up.

RESULTS

Greater antibisexual discrimination was significantly associated with increases in suicidal ideation at 1-month follow-up at low levels of community, authenticity, and intimacy, and increases in suicidal ideation at 2-month follow-up at low levels of authenticity. In addition, at high levels of authenticity, greater antibisexual discrimination was significantly associated with decreases in suicidal ideation at 1-month follow-up. In contrast, general resilience did not moderate the associations between antibisexual discrimination and suicidal ideation at 1- or 2-month follow-up.

CONCLUSIONS

Results suggest that promoting positive aspects of bi + identity (community, authenticity, and intimacy), but not general resilience, may help attenuate the effects of antibisexual discrimination on suicidal ideation over time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Testing the interpersonal theory of suicide in a sample of sexual minority young adults: Attention to within-group differences

INTRODUCTION

This study investigated demographic differences in interpersonal theory of suicide factors and their associations with suicide attempts among sexual minority young adults.

METHODS

784 sexual minority young adults ages 18-29 (42.7% cisgender men, 42.2% cisgender women, 15.1% transgender/gender diverse; 62.2% non-Hispanic White; 50.5% gay/lesbian, 49.5% bisexual+) completed an online survey assessing lifetime suicide attempts and interpersonal theory of suicide factors.

RESULTS

Demographic differences included (1) greater perceived burdensomeness among transgender/gender diverse participants compared to other gender groups; (2) greater acquired capability for suicide and suicide attempts among cisgender men compared to cisgender women; (3) greater acquired capability for suicide among bisexual+ compared to gay/lesbian participants; and (4) a lower number of suicide attempts among Asian/Asian American sexual minority participants compared to most other sexual minority participants. All interpersonal theory of suicide factors were significantly associated with a higher number of suicide attempts, though only perceived burdensomeness and acquired capability for suicide remained significant when examining all three simultaneously. No two- or three-way interactions between interpersonal theory of suicide factors were significant.

CONCLUSION

The interpersonal theory of suicide may be useful for understanding suicide attempts in this population, with perceived burdensomeness and acquired capability being particularly relevant to consider.

Associations between the late positive potential and PTSD, anxiety, and depressive symptoms among trauma-exposed undergraduates

BACKGROUND

The late positive potential (LPP) is a neural marker of attention to emotional stimuli; dysregulations in those attentional processes might contribute to trauma-related psychopathology. Although higher LPP amplitudes to negative images have been found to be associated with anxiety symptoms, results have been mixed regarding depressive and PTSD symptoms, especially among trauma-exposed populations. Further, the relationships between the LPP to positive and neutral images and psychopathology symptoms have been underexamined. The purpose of the current study was to test the effects of image valence, and PTSD, anxiety, and depressive symptoms on LPP amplitude among trauma-exposed undergraduates.

METHOD

Seventy-three trauma-exposed undergraduates viewed a series of negative, positive, and neutral images while LPPs were recorded. Self-report measures were used to assess recent PTSD, anxiety, and depressive symptoms. Hierarchical linear modeling tested valence and symptom main effects, as well as Valence by Symptom interactions on LPP amplitude.

RESULTS

We found a main effect of valence such that individuals exhibited higher LPP amplitudes to negative images compared to neutral images. We also found a Valence by Depressive Symptoms interaction such that there was an inverse relationship between depressive symptoms and the LPP to neutral images but no associations between depressive symptoms and the LPP for positive or negative images. We found no main effects or interactions for anxiety and PTSD symptoms.

CONCLUSION

Depressive symptoms might be related to diminished attention to neutral stimuli among trauma-exposed undergraduates. Further investigation of the relationship between the LPP and psychopathology is needed.

Developmental and Momentary Dynamics in the Onset and Maintenance of Nonsuicidal Self-Injurious Behavior and Borderline Personality Disorder

PURPOSE OF REVIEW

Traditional conceptualizations of both nonsuicidal self-injury (NSSI) and borderline personality disorder (BPD) typically rely on static and unidirectional, linear associations between key biopsychosocial vulnerabilities. Instead, we argue that utilizing a complex dynamic systems view of NSSI and BPD will advance the field, as such conceptual models allow for analysis of bottom-up effects for key vulnerabilities on disorder and behavior emergence, as well as top-down effects of the emergent disorder on underlying vulnerabilities.

RECENT FINDINGS

Following the presentation of a novel framework highlighting momentary and developmental dynamics, we explore several advances in the field that exhibit key dynamic qualities or inform dynamic conceptualizations of NSSI and BPD. At the momentary dynamic level, several advances are being made with multimethod and repeated assessment approaches, as well as advanced bidirectional and complex modeling procedures. Additional progress is being made at the developmental dynamic level, although several questions have arisen regarding the problem of onset and subsequent trajectory, particularly with issues such as pain perception and the interplay between interpersonal, emotional, and behavioral symptoms before and after treatment. Self-injury and BPD both exhibit substantial momentary and developmental dynamics in underlying vulnerabilities, including potential variance in momentary dynamics as a function of psychopathological developmental stage (e.g., onset versus maintenance versus recovery). Recent work has highlighted the necessity of utilizing multimodal research to encapsulate a holistic view of the interplay of several vulnerability factors, the developmental importance of assessment timing, and the need to examine the dynamic interplay between affect, behavior, and interpersonal experiences in BPD and/or NSSI. Research also indicated substantial variation in key vulnerability factors at both between- and within-person levels, highlighting the utility of harnessing statistical models that allow for the simultaneous incorporation of numerous variables at both levels and across several time points. As such, by using a complex dynamic systems conceptualization, we can begin to better understand integrated connections between key vulnerabilities, how they collectively interact in the short term, and how changes in the dynamic interplay between vulnerabilities may arise over the long term and with successful treatment.

Application of minority stress and the interpersonal theory of suicide in bisexual+ versus gay/lesbian young adults

INTRODUCTION

Sexual minority young adults are at increased risk for suicidal ideation (SI) compared with heterosexual young adults. Though several frameworks exist to explain the development of suicide risk, including the Interpersonal Theory of Suicide (IPTS) and the Minority Stress Model, few studies have examined these frameworks simultaneously. This study examines these frameworks longitudinally among sexual minority young adults.

METHODS

A total of 792 sexual minority young adults (50% bisexual+, 50% gay/lesbian) completed an online survey at baseline, one-month follow-up, and two-month follow-up assessing constructs related to IPTS, the minority stress model, and SI.

RESULTS

Over half of our sample (52.9%) reported any SI at baseline. In the full sample, all types of minority stress at baseline were significantly associated with SI at two-month follow-up via perceived burdensomeness (PB) and thwarted belongingness (TB) at one-month follow-up. In the bisexual+ subsample, all bisexual-specific minority stressors at baseline were significantly associated with SI at two-month follow-up via PB at one-month follow-up; internalized binegativity was also associated with SI via TB. However, effects became non-significant when controlling for previous levels of the mediators and outcome variables.

CONCLUSION

Both minority stress and IPTS are relevant for understanding suicide risk among sexual minority young adults.

The Mental Health Impact of Daily News Exposure During the COVID-19 Pandemic: Ecological Momentary Assessment Study

BACKGROUND

Consumption of distressing news media, which substantially increased during the COVID-19 pandemic, has demonstrable negative effects on mental health.

OBJECTIVE

This study examines the proximal impact of daily exposure to news about COVID-19 on mental health in the first year of the pandemic.

METHODS

A sample of 546 college students completed daily ecological momentary assessments (EMAs) for 8 weeks, measuring exposure to news about COVID-19, worry and optimism specifically related to COVID-19, hopelessness, and general worry.

RESULTS

Participants completed >80,000 surveys. Multilevel mediation models indicated that greater daily exposure to news about COVID-19 is associated with higher same-day and next-day worry about the pandemic. Elevations in worry specifically about COVID-19 were in turn associated with greater next-day hopelessness and general worry. Optimism about COVID-19 mediated the relationship between daily exposure to COVID-19 news and next-day general worry but was not related to hopelessness.

CONCLUSIONS

This study demonstrates the mental health impact of daily exposure to COVID-19 news and highlights how worry about the pandemic contributes over time to hopelessness and general worry.

Characterizing changes in mental health-related outcomes for health service psychology graduate students during the first year of the COVID-19 pandemic

OBJECTIVES

Health service psychology (HSP) graduate students experienced adverse mental health outcomes during COVID-19. However, little is known about how mental health outcomes changed in this population after the onset of COVID-19.

METHODS

N = 496 HSP graduate students reported onset or worsening of mental health outcomes, inability to access mental health care, worry about COVID-19, and stress at two different timepoints during the first year of the COVID-19 outbreak (timepoint 1: May 1 to June 25, 2020; timepoint 2: September 2 to October 17, 2020). This study tested whether mental health outcomes improved, worsened, or stayed stable during this timeframe. The study also examined whether rising COVID-19 case rates in the state where a participant lived moderated changes in mental health outcomes.

RESULTS

Overall, HSP graduate students endorsed adverse mental health outcomes at a higher rate during the first survey relative to the second survey. Even still, 62.68% of students reported worsened mental health symptoms, 49.84% reported worsened sleep, and 23.92% reported increased alcohol and substance use in the 2 months leading up to the second survey.

CONCLUSION

HSP programs should monitor graduate students' evolving mental health, provide wellness resources, and adopt flexible approaches to support graduate students navigating training during periods of immense disruption.

Trajectories and Processes of Symptom Change Over Time in Dialectical Behavior Therapy for Borderline Personality Disorder

Despite ample evidence for Dialectical Behavior Therapy (DBT) as an effective treatment for borderline personality disorder (BPD), close examination of the trajectory of change in BPD symptoms over the course of DBT is lacking. There also remain questions regarding the directionality of changes in different domains of BPD symptoms, such as improvements in dysfunctional behaviors and thoughts/feelings. In order to provide more fine-grained information about the treatment process in DBT, the current study aimed to (a) examine the trajectories of change of BPD-associated negative thoughts/feelings and behaviors, and positive behaviors, and (b) test the temporal relationship between changes in negative behaviors and thoughts/feelings. The study involved 55 adult clients attending a 6-month outpatient DBT program for BPD who completed assessments of BPD symptoms every four sessions. Growth curve models suggested that clients experienced a faster rate of decrease in negative behaviors during the initial phase of treatment, whereas steady rates of improvement were found for negative thoughts/feelings and positive behaviors, respectively, throughout treatment. Further, a random-intercept cross-lagged panel model found that the within-person fluctuations in negative behaviors preceded the within-person changes in negative thoughts/feelings at a subsequent time point during the later phase of treatment, whereas within-person fluctuations in thoughts/feelings were followed by changes in negative behaviors at the beginning and end of the treatment. These results highlighted the complexity of patterns and processes of change in BPD symptomatology during the course of DBT.

Greater Minority Stress is Associated with Lower Intentions to Disclose Suicidal Thoughts among LGBTQ + Youth

OBJECTIVE

The current study examined suicide-related disclosure intentions in LGBTQ + youth, and the associations between reporting of lifetime experiences of minority stress and intentions to disclose suicidal thoughts.

METHOD

A sample of 592 LGBTQ + youth ages 12-24 (22.3% cisgender men, 33.1% cisgender women, 44.6% gender diverse, 75.3% white) who contacted an LGBTQ-specific crisis service, completed a survey.

RESULTS

Youth reported highest intentions to disclose future suicidal ideation to LGBTQ-specific crisis services, a mental health professional, and someone they know who also identifies as LGBTQ. They reported lowest suicide-related disclosure intentions to family, spiritual counselors, and emergency room personnel. Greater lifetime minority stress was significantly associated with lower suicide-related disclosure intentions. When specific domains of minority stress were examined separately, five domains were significantly associated with lower suicide-related disclosure intentions: identity management, family rejection, homonegative communication, negative expectancies, and internalized homonegativity. However, only internalized homonegativity remained significant when they were examined simultaneously. In addition, greater lifetime minority stress was significantly associated with lower suicide-related disclosure intentions to some groups (e.g., family, friends), but not others (e.g., others who have thought about or attempted suicide, others who identify as LGBT).

CONCLUSIONS

Minority stress may play an important role in LGBTQ + youth's suicide-related disclosure intentions. As such, reducing minority stress and its effects may be an important target to promote disclosure of suicidal thoughts and access to treatment among LGBTQ + youth.HIGHLIGHTSMinority stress was associated with lower suicide-related disclosure intentions.Internalized homonegativity was uniquely associated with disclosure intentions.Reducing minority stress may promote disclosure of suicidal thoughts.

Behavioral reinforcement of pathological exercise in anorexia nervosa

Pathological exercise in anorexia nervosa (AN) is a harmful behavior associated with a chronic course and poor prognosis. To date, no comprehensive theoretical model exists to describe pathological exercise in the context of AN, and as such, few treatments are effective at promoting direct and sustained pathological exercise extinction. Using a framework put forth by Wise & Koob (2014), debating the relative importance of positive and negative reinforcement in substance use, we present three hypotheses of behavioral reinforcement of exercise, encompassing biological, psychological, and environmental influences. Specifically, we argue that exercise is positively reinforced through receipt of biological and behavioral rewards, negatively reinforced through avoidance of aversive emotions, and that these two systems work in tandem over time to engrain pathological exercise as a habit. We then present suggestions for testing each of these hypotheses as future directions for the field.

Multiply marginalized: Linking minority stress due to sexual orientation, gender, and weight to dysregulated eating among sexual minority women of higher body weight

OBJECTIVE

This study assessed whether baseline levels of distal and proximal minority stressors related to sexual orientation, gender, and weight were associated with prospective risk for dysregulated eating in daily life among sexual minority women with overweight/obesity.

METHODS

Fifty-five sexual minority women ages 18-60 (M = 25 ± 9) with BMI > 25kg/m2 (M = 32 ± 5) completed baseline assessments of distal and proximal minority stressors due to sexual orientation, gender, and weight. Participants then completed an Ecological Momentary Assessment (EMA) protocol. For five days, participants responded to five random prompts assessing engagement in dysregulated eating (i.e., overeating, binge eating). The cumulative number of EMA-measured overeating and binge eating episodes was summed per participant.

RESULTS

Several minority stressors related to sexual orientation, gender, and weight were associated with prospective risk for dysregulated eating behaviors during EMA. Women with higher (vs. lower) baseline levels of internalized homophobia reported more cumulative episodes of binge eating during the EMA period. Women reporting greater (vs. less) baseline sexual orientation concealment reported more episodes of overeating during the EMA period. Women with greater (vs. less) baseline weight bias experiences and internalization reported more overeating and binge eating episodes during the EMA period.

CONCLUSIONS

Findings from this pilot study identify internalized homophobia, sexual orientation concealment, and experienced and internalized weight bias as potential risk factors for dysregulated eating behaviors among sexual minority women of higher body weight.

A longitudinal examination of the interpersonal theory of suicide for predicting suicidal ideation among LGBTQ+ youth who utilize crisis services: The moderating effect of gender

INTRODUCTION

Despite high rates of suicide among LGBTQ+ youth, the interpersonal theory of suicide (IPTS) has rarely been examined in this population. The current study utilized a longitudinal design to examine whether perceived burdensomeness and thwarted belongingness independently and simultaneously predicted higher levels of suicidal ideation over time in a sample of LGBTQ+ youth who utilized crisis services. We also investigated whether gender identity moderated these associations.

METHODS

A total of 592 youth (12-24 years old) who had contacted a national crisis hotline for LGBTQ+ youth completed two assessments 1-month apart.

RESULTS

Perceived burdensomeness and thwarted belongingness independently predicted greater suicidal ideation 1 month later; however, only perceived burdensomeness remained prospectively associated with suicidal ideation when both factors were tested in the same model. Gender identity moderated the associations between IPTS factors and suicidal ideation, such that both perceived burdensomeness and thwarted belongingness were associated with greater suicidal ideation 1 month later for sexual minority cisgender young women and transgender/genderqueer individuals, but not for sexual minority cisgender young men.

CONCLUSION

The IPTS helps explain increases in suicidal ideation over time among LGBTQ+ youth and therefore can be used to inform suicide prevention and intervention approaches for this population.

Intrapersonal and Interpersonal Functions as Pathways to Future Self-Harm Repetition and Suicide Attempts

Background: Research has identified functions of non-suicidal self-harm/self-injury (NSSH) but whether functions change over time, from adolescence to early adulthood, or predict the continuation of the behavior prospectively remains unclear. This study aimed to prospectively explore whether intrapersonal and interpersonal NSSH functions in adolescence predict repetition of self-harm (regardless of suicidal intent) and incident suicide attempts in early adulthood.

Methods: Participants were 528 individuals with NSSH at age 16 years from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based birth cohort in the UK. Descriptive statistics were used to explore changes in functions over time from age 16 to 21, and logistic regression used to examine associations between NSSH functions and repeat self-harm and suicide attempts at age 21, 24, and 25 years.

Findings: The majority of 16-year-olds with NSSH endorsed intrapersonal (e.g., affect regulatory) functions only (73% at 16 years and 64% at 21 years). Just under half of adolescents (42%) and three quarters of 21 years olds reported more than one function simultaneously. A greater number of intrapersonal functions at 16 years independently predicted future repetition of self-harm at ages 21–25 years, over and above interpersonal functions (OR = 1.46, 95% CI 1.06–2.01). Interpersonal functions during adolescence did not predict repeat self-harm or suicide attempts in adulthood.

Discussion: Our findings suggest that intrapersonal but not interpersonal NSSH functions are a prospective risk factor for future self-harm and might also predict incident suicide attempts. The results highlight the central role of underlying affective difficulties and motivations in self-harm maintenance.

The roles of discrimination and social support in the associations between outness and mental health outcomes among sexual minorities

Compared to heterosexual individuals, sexual minorities exhibit elevated risk for depression and borderline personality disorder (BPD). One psychosocial factor relevant to sexual minority mental health is outness, or the degree to which an individual discloses or conceals their sexual orientation. Previous findings are mixed regarding whether outness is associated with better or worse mental health, likely because outness can have positive consequences (e.g., social support) and negative consequences (e.g., discrimination). Support exists for both mechanisms, but previous studies have not simultaneously considered how outness may be related to mental health outcomes in different ways through social support versus discrimination. The present study examined: (a) the association between outness and depressive symptoms, (b) the association between outness and BPD symptoms, and (c) the indirect effects of outness on depressive/BPD symptoms through social support and discrimination. A total of 256 sexual minority participants completed an online or in-person survey. Greater outness was associated with lower depressive symptoms and BPD symptoms. There was an indirect effect of outness on depressive symptoms through social support, with greater outness being associated with greater social support and, in turn, lower depressive symptoms. Outness had an indirect effect on BPD symptoms through both social support and discrimination. Greater outness was associated with both greater social support and discrimination, with greater social support being associated with lower BPD symptoms, and greater discrimination with greater BPD symptoms. Outness may contribute to mental health through multiple mechanisms, serving as either a risk or protective factor. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Student Self-Reported Positive Purpose Over Two Years in Urban Middle Schools

We used Developmental Systems Theory as a framework for understanding the role of contextual factors in the development of purpose in urban adolescents. The sample included primarily low-socioeconomic students of color attending urban middle schools (n = 2,629; 10-16 years of age). Longitudinal data were collected at four time points across two years. We used hierarchical linear modeling to model change in purpose. On average, purpose declined over time. We also identified several predictors of intercept and slope. For example, Black youth had a higher average purpose intercept, as well as a steeper average decline than other racial/ethnic groups. Females demonstrated a higher average purpose intercept than males, but this effect disappeared when academic achievement was added to the model.

Mapping features of pathological exercise using hierarchical-dimensional modeling

OBJECTIVE

Pathological exercise is common among those with eating disorders and has typically been characterized as excessive, compulsive, or compensatory in nature. Little is known about how pathological exercise is associated with other eating disorder behaviors or personality traits, or whether these associations differ between men and women.

METHOD

We used hierarchical dimensional modeling in three samples, including college women (N = 205), women with eating psychopathology (N = 268), and college men (N = 235), to examine latent associations between pathological exercise and eating disorder psychopathology, namely compulsivity, emotion regulation, and body dissatisfaction.

RESULTS

Using Goldberg's (2006) "bass-ackwards" method, we identified separate 10-factor solutions (women) or an 11-factor solution (men). A distinct muscle building factor arose in the three-factor solution for men, and it also notably arose in the six- and eight-factor solutions for community and college women, respectively, highlighting an important understudied motivation factor in both healthy and pathological exercise. Each solution accounted for 64.8% (college women), 51.9% (women with eating psychopathology), and 43.9% (college men) of the variance in excessive exercise, respectively.

DISCUSSION

Findings indicate that pathological exercise is associated with different psychological traits (e.g., poor emotion regulation, compulsivity) across populations, and such differences may necessitate unique treatment approaches tailored accordingly.

State versus trait weight, shape, and eating concerns: Disentangling influence on eating behaviors among sexual minority women

This study examined the relative influence of trait and state weight, shape, and eating concerns on dysregulated eating in the daily lives of sexual minority women with overweight and obesity. This study is a secondary analysis of data from an Ecological Momentary Assessment (EMA) study of 55 sexual minority women with overweight/obesity. Trait shape, weight, and eating concerns were assessed at baseline. For the following five days, participants used a smartphone to report state weight/shape concerns, overeating, and binge eating five times daily. Women who endorsed higher levels of trait weight, shape, and eating concerns at baseline reported more frequent state weight/shape concerns in daily life. Trait eating concerns were associated with higher odds of binge eating during EMA, but trait weight/shape concerns were unrelated to future dysregulated eating. In daily life, state weight/shape concerns was associated with greater risk for over/binge eating at the concurrent EMA prompt, the subsequent EMA prompt, and over the course of a full day, independent of trait concerns. State weight and shape concerns may play an important role in predicting dysregulated eating in daily life among sexual minority women of higher body weight.

Positive emotion and motivational dynamics in anorexia nervosa: A positive emotion amplification model (PE-AMP)

The role of positive emotion in anorexia nervosa (AN) has been underappreciated in both theory and treatment. Yet, people with AN demonstrate high motivation for and sustained effort toward weight loss, achieving success to an extreme beyond the capability of most people. Positive emotion dysregulation may facilitate and reinforce such efforts. The positive emotion amplification (PE-AMP) model of AN describes a dynamic interplay between biologically based enhanced reward responding and cognitive-behavioral factors that amplify positive emotion, resulting in positive feedback cycles that motivate and reinforce weight loss behavior during the AN onset phase. These experiences subvert the pursuit of happiness by providing artificial senses of autonomy, competency, and relatedness to others (self-determination theory; Ryan & Deci, 2000) that provide a stark contrast to an otherwise negative emotional environment, resulting in the emergence and persistence of AN psychopathology as a self-sustaining sense of purpose. Ultimately, negative emotion, PE dysregulation, and artificial self-determination threats continue to drive AN behavior during the AN maintenance phase, pushing patients toward a genuine self-determination breakdown that can lead to hospitalization, health crises, relational strife and diminished quality of life, or even manifest in suicidal behavior. Future research directions and novel methodological approaches inspired by the PE-AMP model are discussed, as are important treatment implications for addressing this highly treatment-resistant disorder. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Acute aerobic exercise increases respiratory sinus arrythmia reactivity and recovery to a sad film among individuals at risk for depression

Cardiac vagal control (CVC), as indexed by abnormalities in resting, reactivity, and recovery levels of respiratory sinus arrythmia (RSA), has been proposed as an index of impaired self-regulatory capacity in depression. Aerobic exercise has been shown to improve positive and negative affective responses and influence autonomic function; however, it is unknown whether exercise impacts RSA reactivity and subsequent recovery to emotional challenges among individuals at risk for depression. The present study aimed to determine the effects of moderate-intensity aerobic exercise on RSA reactivity and recovery to a sad film. Using a within-subjects design, 47 individuals with variable symptoms of depression completed a 30-min session of exercise and a sedentary control condition on separate days prior to viewing a sad film. On the control day, individuals with elevated depressive symptom severity displayed less vagal withdrawal to the sad film and exhibited impaired post-film RSA recovery. Following exercise, individuals with elevated depressive symptom severity demonstrated a higher degree of vagal withdrawal to the sad film and subsequent post-film recovery that matched individuals with lower depressive symptom severity. These findings suggest that a single session aerobic exercise may be an effective approach to increase emotional and self-regulatory capacity among individual at risk for, or currently experiencing, depression.

Characterizing Lifetime and Daily Experiences of Weight Stigma among Sexual Minority Women with Overweight and Obesity: A Descriptive Study

Sexual minority women are disproportionately impacted by obesity yet are underrepresented in weight stigma research. This Ecological Momentary Assessment (EMA) study is a secondary analysis that aimed to elucidate the frequency and contextual characteristics of perceived experiences of lifetime and momentary weight stigma among sexual minority women with overweight/obesity. Participants were 55 sexual minority women ages 18-60 with a body mass index ≥25 kg/m2. Perceived lifetime weight stigma events were assessed at baseline. For the subsequent five days, participants used a smartphone to complete five daily, random EMA prompts assessing the frequency/characteristics of perceived weight stigma events in daily life. All participants reported at least one lifetime weight stigma event. During the EMA period, participants reported 44 momentary weight stigma events (M = 0.80), with 24% of participants reporting at least one event. During most instances of weight stigma, women perceived the stigma's cause to be their weight and another minority identity (e.g., sexual orientation). Findings showing high rates of perceived lifetime weight stigma in this sample and frequent co-occurrence of perceived weight stigma with stigma due to other marginalized identities in daily life underscore the need for future, larger studies investigating weight stigma through an intersectional lens in sexual minority women with overweight/obesity.

Sexual Minority Status and Psychological Risk for Suicide Attempt: A Serial Multiple Mediation Model of Social Support and Emotion Regulation

The current study examined the relation between sexual minority status, social support, emotion dysregulation, and suicide attempt in a community sample. A total of 388 community and college adults completed a one-time survey examining self-injury and suicidality. Findings demonstrated that that social support and emotion regulation, independently and in sequence, mediated the relation between sexual minority status and suicide attempt. The reverse mediation model with emotion regulation as the first mediator and social support as the second mediator was also significant. Social support and emotion regulation may both be related and may explain the relation between sexual minority status and suicide attempt. If replicated longitudinally, these findings shed light on specific risk factors and their interrelations, which may have important implications for preventing suicide in sexual minorities.

Temporal Bayesian Network modeling approach to evaluating the emotional cascade model of borderline personality disorder

Theoretical models of personality disorders can be complex and multifaceted, making it difficult to validate such models in a comprehensive, empirical fashion. One such model of borderline personality disorder (BPD) is the emotional cascade model (Selby & Joiner, 2009), which has garnered empirical support in piecemeal fashion but has not been examined in a gestalt fashion. One way to test comprehensive models of personality pathology is with Temporal Bayesian Network (TBN) modeling, in which the relations between multiple subcomponents of a model can be specified and examined over a dynamic time frame, allowing for the modeling of positive feedback processes in addition to comprehensive model utility. In this study, we applied TBN modeling to examine the emotional cascade model in a sample of adolescents and young adults who actively self-injure, including those with BPD. TBN modeling was applied to ecological momentary assessment data provided via participant smartphone assessments for a period of 2 weeks. TBN analysis suggested that the emotional cascade model has considerable predictive utility, demonstrating substantial accuracy in predicting BPD diagnosis (with accuracy estimates around 90%) and momentary prediction of rumination, negative emotion, and dysregulated behaviors (with accuracy estimates consistently above 70% and reaching up to 100%, depending on the level of momentary prediction specificity). These findings provide support and validity to the notion that BPD may emerge from a dynamic interplay between emotional cascades and dysregulated behaviors. Implications of TBN modeling of BPD and personality disorders, in general, are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Investigating the role of the intensity and duration of self-injury thoughts in self-injury with ecological momentary assessment

This study utilized ecological momentary assessment (EMA) to sharpen understanding of whether non-suicidal self-injury (NSSI) thought intensity and duration impacts NSSI behavior and potential alternative behaviors to NSSI. Self-injuring adolescents and young adults (N = 47) were randomly prompted using EMA to complete measures of NSSI thoughts (i.e., occurrence, intensity, duration) and behavior (i.e., engagement, frequency, duration, and methods) for two weeks. The most common NSSI thought duration was 1-30 min. Individuals with higher NSSI thought intensity were more likely to self-injure. NSSI thought intensity and duration interacted to predict NSSI frequency, duration, the number of NSSI methods, and the likelihood of cutting such that the positive relationship between NSSI thought intensity and these outcomes became stronger at longer NSSI thought durations. The most commonly endorsed non-NSSI behaviors following NSSI thoughts were pushing thoughts away, talking to others, and distraction (e.g., going out). Participants rarely endorsed using social media or online NSSI support groups in lieu of NSSI. Resisting intense NSSI thoughts over prolonged time periods may deplete the self-regulatory resources required to terminate NSSI episodes once they have begun, leading to greater NSSI frequency, longer NSSI duration, and more NSSI methods. Bolstering social support may help to reduce NSSI.

Suicide in DSM-5: Current Evidence for the Proposed Suicide Behavior Disorder and Other Possible Improvements

Suicide continues to be one of the greatest challenges faced by mental health clinicians and researchers, an issue made worse by increasing trends in the global suicide rate. Suicide behavior disorder (SBD) was introduced in DSM-5 as a disorder for further consideration and potential acceptance into the diagnostic system. There are numerous positive developments that would arise from the addition of a suicide-related diagnosis. Utilizing the 2009 guidelines established by Kendler and colleagues, the present review examines the evidence for SBD's validity and discusses the diagnosis' potential clinical benefits and limitations. Altogether, growing evidence indicates that SBD has preliminary validity and benefit. SBD presents with several significant limitations, however, and possible alternative additions to future DSMs are highlighted.

The posited effect of positive affect in anorexia nervosa: Advocating for a forgotten piece of a puzzling disease

Anorexia nervosa (AN) is a complex and life-threatening eating disorder. Current models of AN onset and maintenance have largely focused on the role of negative affect, while fewer models have described the role of positive affect (PA). Given that these theoretical models have informed current treatment approaches, and that treatment remains minimally effective for adults with AN, we advocate that targeting PA is one avenue for advancing maintenance models and by extension, treatment. We specifically propose that AN may arise and be chronically and pervasively maintained as a function of dysregulated PA in response to weight loss and weight loss behaviors (e.g., restriction, excessive exercise), to a degree that is not accounted for in existing models of AN. We present evidence from multiple domains, including biological, behavioral, and self-report, supporting the hypothesis that PA dysregulation in AN contributes to the maintenance of the disorder. We conclude with several specific avenues for treatment development research as well as a call for future work elucidating the biological correlates of PA.

Emotional experiences of clients with borderline personality disorder in dialectical behavior therapy: An empirical investigation of in-session affect

Borderline personality disorder (BPD) is a diagnosis characterized by intense and labile emotion; dialectical behavior therapy, a common treatment for BPD, aims to reduce the intensity and lability of clients' emotion through multiple methods, some of which occur in the therapy session, with the expectation that changes will generalize to the rest of clients' lives. However, little research has examined how BPD clients' affect presents and varies in session or whether affect in session reflects patients' patterns of affect outside of treatment. This study had 2 aims: (a) to explore changes in clients' positive and negative affect in therapy, and (b) to assess if the severity of client psychopathology relates to affect in treatment. Positive and negative affect ratings were collected from clients (N = 73) at the start and end of every individual therapy session (total sessions = 1,474). Hierarchical linear modeling and linear regression were used to examine patterns of affect and assess the relationship between affect and severity. Results indicated that positive affect increased while negative affect decreased between the start and end of sessions, with the same pattern of change in presession affect from week to week. In addition, increased BPD severity was associated with lower presession positive affect ratings and higher negative affect ratings. Further exploration is needed to assess which dialectical behavior therapy treatment processes contribute to changes in in-session affect and how in-session affect relates to treatment outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Using Multilevel Modeling to Examine Blunted Neural Responses to Reward in Major Depression

BACKGROUND

Major depressive disorder (MDD) is a pernicious disorder characterized by deficits in reward processing. A better understanding of these deficits may help to elucidate the underlying pathophysiology and guide treatment development.

METHODS

This study assessed reward positivity and feedback negativity event-related potentials and their difference scores elicited in response to monetary gains and losses among 100 young adults (52 with MDD). Multilevel modeling was used to assess individual- and trial-level change in neural responses over time.

RESULTS

Trial-level analyses indicated that a diagnosis of MDD and depressive symptom severity significantly moderated the trajectory of reward positivity, with individuals with higher symptoms of depression demonstrating less sensitivity to rewards over time.

CONCLUSIONS

These results provide further support for reward dysfunction in MDD and highlight important individual differences in the trajectory of neural responses to reward. Future studies are warranted to investigate reward sensitivity over time to elucidate important individual- and trial-level differences in reward processing.

An Ecological Investigation of the Emotional Context Surrounding Nonsuicidal Self-Injurious Thoughts and Behaviors in Adolescents and Young Adults

Ecological momentary assessment (EMA) methodology was used to examine the emotional context of nonsuicidal self-injury (NSSI). Forty-seven adolescents and young adults used a novel smartphone app to monitor their emotional experiences, NSSI thoughts, and NSSI behaviors for 2 weeks. Momentary changes in both negative and positive emotions predicted greater intensity of NSSI thoughts at the subsequent assessment, while only increases in negative emotion predicted NSSI behaviors. Immediately following NSSI behaviors participants reported reduced high-arousal negative emotions and increased low-arousal positive emotions, suggesting that NSSI may be an efficient and effective method of regulating emotion. Findings highlight the importance of addressing emotion regulation in NSSI interventions.

Putamen Volume Differences Among Older Adults: Depression Status, Melancholia, and Age

BACKGROUND

Individuals with major depressive disorder (MDD) may exhibit smaller striatal volumes reflecting deficits in the reward circuit. Deficits may change with age and be more pronounced among the melancholic subtype. Limited research has investigated striatal volume differences in older adults and by depression subtypes.

METHOD

We used baseline data from the Neurocognitive Outcomes of Depression in the Elderly study. We examined volumetric differences in the putamen and caudate nucleus among older adults (60 years and older), comparing healthy control participants (n = 134) to depressed participants (n = 226), and comparing nonmelancholic depressed participants (n = 93) to melancholic depressed participants (n = 133). Group-by-age interactions were examined.

RESULTS

There were no significant group differences for the caudate nucleus. For the left putamen, investigation of the significant group-by-age interaction revealed that volume size was greater for the healthy controls compared to the depressed participants but only at younger ages (60-65 years); group differences diminished with increasing age. Examining volume by depression subtype revealed that the melancholic depressed participants had a smaller left putamen compared to the nonmelancholic depressed participants. Anhedonia symptoms were related to both smaller left and right putamen.

CONCLUSION

Structural abnormalities in reward regions may underlie the anhedonic phenotype. Volume loss associated with MDD may attenuate in older age.

The role of stressful life events preceding death by suicide: Evidence from two samples of suicide decedents

Stressful life events (SLEs) are associated with increased risk for suicidal behavior. Less is known regarding the intensity of SLEs and how this may vary as a function of suicide attempt history. As a large percentage of suicide decedents do not have a history of suicidal behavior, SLEs precipitating suicide may help characterize suicidality in this understudied population. This paper examines the intensity, number, and accumulation of SLEs preceding death by suicide among decedents with varying suicide attempt histories. Suicide attempts, SLEs, and suicide methods were examined in two samples: 62 prison-based and 117 community-based suicide decedents. Regression was used to compare the level of stressor precipitating death by suicide in decedents who died on a first attempt versus multiple previous attempts. A non-significant trend was observed in the prison population which was supported by significant findings in the community-based sample. Decedents who died on a first attempt experienced a stressor of a lower magnitude when compared to decedents with multiple previous suicide attempts. We discuss the implications of these findings in relation to the stress-diathesis model for suicide.

Rising longitudinal trajectories in suicide rates: The role of firearm suicide rates and firearm legislation

Firearms account for approximately half of all US suicide deaths each year despite being utilized in only a small minority of suicide attempts. We examined the extent to which overall suicide rates fluctuated relative to firearm and non-firearm suicide rates across a period of 16years (1999-2015). We further tested the notion of means substitution by examining the association between firearm suicide rates and non-firearm suicide rates. Lastly, we examined the extent to which the presence of specific laws related to handgun ownership previously shown cross-sectionally to be associated with lower suicide rates (universal background checks, mandatory waiting periods) were associated with an attenuated trajectory in suicide rates across the study period. As anticipated, whereas decreases in firearm suicide rates were associated with decreases in overall suicide rates (b=0.46, SE=0.07, p<0.001), decreases in firearm suicides were not associated with off-setting increases in suicides by other methods (b=-0.04, SE=0.05, p=0.36). Furthermore, the absence of universal background check (b=0.12, SE=0.05, p=0.028) and mandatory waiting period (b=0.16, SE=0.06, p=0.008) laws was associated with a more steeply rising trajectory of statewide suicide rates. These results mitigate concerns regarding means substitution and speak to the potential high yield impact of systematically implemented means safety prevention efforts focused on firearms.

Daydreaming About Death

Anecdotal and empirical evidence suggests that suicidal individuals may daydream about suicide as a method of mood regulation (including increasing positive affect). These daydreams may center on future suicidal plans, previous suicide attempts, or on the ways that others will react to their death. Yet, even though violent daydreams may increase positive affect in the short term, in the long run they may actually increase both suicidality and the ability to engage in suicidal behavior. In this study, a sample of 83 college students was given the Beck Depression Inventory, Anger Rumination Scale, and the Beck Scale for Suicide Ideation. The authors hypothesized that a two-way interaction would exist between high levels of depression and high levels of violent daydreaming to predict increased levels of suicidality. Using linear regression, the results of this study supported the hypothesis. The clinical and theoretical implications of these findings are discussed.

Emotional dysregulation, internalizing symptoms, and self-injurious and suicidal behavior: Structural equation modeling analysis

This study used structural equation modeling to examine the relationships between emotion dysregulation, internalizing symptoms, nonsuicidal self-injury (NSSI), and suicide. One hundred forty-eight undergraduates completed a brief structured interview and self-report measures of emotion dysregulation, internalizing symptoms, and NSSI and suicidal behaviors. Results indicated a significant indirect effect of emotion dysregulation on NSSI via internalizing symptoms and on suicide attempts via NSSI. Findings provide a more nuanced understanding of the indirect association between emotion dysregulation and NSSI and suicidal behaviors. Implications for the potential utility of targeting internalizing symptoms as well as emotion dysregulation in interventions addressing NSSI and suicidal behaviors are discussed.

Understanding Dysregulated Behaviors and Compulsions: An Extension of the Emotional Cascade Model and the Mediating Role of Intrusive Thoughts

Objective: The Emotional Cascade Model (ECM) by Selby et al. (2008) proposes that people often engage in dysregulated behaviors to end extreme, aversive emotional states triggered by a self-perpetuating vicious cycle of (excessive) rumination, negative affect, and attempts to suppress negative thoughts.

Method: Besides replicating the ECM, we introduced intrusions as a mediator between rumination and behavioral dysregulation and tested this extended ECM for compulsions as part of obsessive–compulsive disorders. A structural equation modeling approach was used to test this in a sample of N = 414, randomly recruited from the general population.

Results: Intrusions were found to fully mediate the effect of rumination on a broad array of dysregulated behaviors and compulsions. This mediation endured when controlling for symptoms of depression.

Conclusion: These findings support the idea that rumination fuels intrusions, which in turn foster dysregulated behaviors. Therefore, addressing rumination as well as intrusions may improve psychotherapeutic interventions for mental disorders characterized by dysregulated behaviors and/or extreme aversive emotional states.

Predicting Persistence of Nonsuicidal Self-Injury in Suicidal Adolescents

Prospective predictors of persistent nonsuicidal self-injury (NSSI) were examined in adolescents admitted to an inpatient psychiatric unit for suicidal behaviors and followed naturalistically for 6 months. Seventy-one (77%) participants reported NSSI at baseline, and 40 (56%) persisted at the 6 month follow-up. Those who endorsed automatic positive reinforcement (APR) as the predominant reason for NSSI were more likely to persist in NSSI. Depression over follow-up, but not at baseline, also predicted persistence. These results suggest that helping high-risk adolescents to identify alternative ways of generating emotion(s) to counter the effects of APR that may accompany NSSI should be a high priority treatment target.

Integrating affective and cognitive correlates of heart rate variability: A structural equation modeling approach

High frequency heart rate variability (HRV) is a measure of neurocardiac communication thought to reflect predominantly parasympathetic cardiac regulation. Low HRV has been associated empirically with clinical and subclinical levels of anxiety and depression and, more recently, high levels of HRV have been associated with better performance on some measures of executive functioning (EF). These findings have offered support for theories proposing HRV as an index measure of a broad, self-regulatory capacity underlying aspects of emotion regulation and executive control. This study sought to test that proposition by using a structural equation modeling approach to examine the relationships of HRV to negative affect (NA) and EF in a large sample of U.S. adults ages 30s-80s. HRV was modeled as a predictor of an NA factor (self-reported trait anxiety and depression symptoms) and an EF factor (performance on three neuropsychological tests tapping facets of executive abilities). Alternative models also were tested to determine the utility of HRV for predicting NA and EF, with and without statistical control of demographic and health-related covariates. In the initial structural model, HRV showed a significant positive relationship to EF and a nonsignificant relationship to NA. In a covariate-adjusted model, HRV's associations with both constructs were nonsignificant. Age emerged as the only significant predictor of NA and EF in the final model, showing inverse relationships to both. Findings may reflect population and methodological differences from prior research; they also suggest refinements to the interpretations of earlier findings and theoretical claims regarding HRV.

A perfect storm: examining the synergistic effects of negative and positive emotional instability on promoting weight loss activities in anorexia nervosa

Growing evidence indicates that both positive and negative emotion potentially influence the development and maintenance of anorexia nervosa, through both positive and negative reinforcement of weight loss activities. Such reactive emotional experience may be characterized by frequent and intense fluctuations in emotion, a construct known as "emotional instability." The purpose of this study was to investigate the association between positive emotional instability and weight loss activities in anorexia nervosa, and to investigate the synergistic effects of positive and negative emotional instability on promoting weight loss activities. Using ecological momentary assessment methods, 118 participants with anorexia nervosa reported their emotional experiences and behaviors at least six times daily over 2 weeks using a portable digital device. Using generalized linear modeling, results indicated that high levels of both positive and negative emotional instability, and the interaction between the two, were associated with more frequent weight-loss activities, beyond anorexia subtype and mean levels of emotional intensity. These findings indicate that when women with anorexia exhibit both high levels of both positive and negative emotional instability they are more prone to a variety of weight loss activities. The importance of addressing the role of both positive and negative emotion in anorexia treatment is discussed.

Rumination in major depressive disorder is associated with impaired neural activation during conflict monitoring

Individuals with major depressive disorder (MDD) often ruminate about past experiences, especially those with negative content. These repetitive thoughts may interfere with cognitive processes related to attention and conflict monitoring. However, the temporal nature of these processes as reflected in event-related potentials (ERPs) has not been well-described. We examined behavioral and ERP indices of conflict monitoring during a modified flanker task and the allocation of attention during an attentional blink (AB) task in 33 individuals with MDD and 36 healthy controls, and whether their behavioral performance and ERPs varied with level of rumination. N2 amplitude elicited by the flanker task was significantly reduced in participants with MDD compared to healthy controls. Level of self-reported rumination was also correlated with N2 amplitude. In contrast, P3 amplitude during the AB task was not significantly different between groups, nor was it correlated with rumination. No significant differences were found in behavioral task performance measures between groups or by rumination levels. These findings suggest that rumination in MDD is associated with select deficits in cognitive control, particularly related to conflict monitoring.

Perceived burdensomeness and thwarted belongingness predict excessive reassurance seeking among clinical outpatients

OBJECTIVE

The current study aimed to investigate whether perceived burdensomeness and thwarted belongingness (i.e., suicide risk factors) were associated with excessive reassurance seeking (a behavior linked to rejection). It was predicted that perceived burdensomeness and thwarted belongingness would predict higher levels of excessive reassurance seeking, controlling for depressive symptoms and global functioning.

METHOD

A cross-sectional sample of 415 clinical outpatients (62% female; mean age = 28) was examined.

RESULTS

Perceived burdensomeness and thwarted belongingness significantly predicted excessive reassurance seeking, controlling for depressive symptoms and global functioning.

CONCLUSIONS

Perceived burdensomeness and thwarted belongingness predicted excessive reassurance seeking, suggesting that it would be beneficial for clinicians to assess for and target excessive reassurance seeking among individuals experiencing perceived burdensomeness and thwarted belongingness so that excessive reassurance seeking does not elicit interpersonal rejection.