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Berg H, Akeman E, McDermott TJ, Cosgrove KT, Kirlic N, Clausen A, Cannon M, Yeh HW, White E, Thompson WK, Choquette EM, Sturycz-Taylor CA, Cochran G, Ramirez S, Martell CR, Wolitzky-Taylor KB, Craske MG, Abelson JL, Paulus MP, Aupperle RL. A randomized clinical trial of behavioral activation and exposure-based therapy for adults with generalized anxiety disorder. J Mood Anxiety Disord 2023; 1:100004. [PMID: 38384390 PMCID: PMC10881118 DOI: 10.1016/j.xjmad.2023.100004] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Objective Exposure-based therapy (EXP) and behavioral activation (BA) are empirically-supported behavioral intervention techniques that target avoidance and approach behavior to alleviate symptoms. Although EXP is an established treatment for generalized anxiety disorder (GAD), the effectiveness of BA for GAD has not been directly tested or compared with that of EXP. This study examined the efficacy of EXP and BA for adults with GAD. Method In a randomized clinical trial (clinicaltrials.gov: NCT02807480) with partial blinding in Tulsa, OK, 102 adults with GAD were allocated to manualized, 10-session EXP or BA between April 2016-April 2021. Primary analyses were intention-to-treat and included the 94 (46 EXP, 48 BA) participants who started treatment. The GAD-7 self-report scale was the primary outcome measure. Results Similar GAD-7 declines were observed at post-treatment for EXP (d=-0.97 [95% CI -1.40 to -0.53]) and BA (d=-1.14 [95% CI -1.57 to -0.70]), and were maintained through 6-month follow-up (EXP: d=-2.13, BA: d=-1.98). Compared to EXP, BA yielded more rapid declines in anxiety and depression scores during therapy (d=0.75-0.77), as well as lower anxiety and depression scores (d=0.13-0.14) and greater participant-rated improvement (d=0.64) at post-treatment. Bayesian analyses indicated 74-99% probability of greater change in BA than EXP at post-treatment. Conclusions BA and EXP are both effective in treating GAD, and BA may confer greater benefit during treatment. Future research is warranted to inform personalized treatment approaches.
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Affiliation(s)
- Hannah Berg
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Elisabeth Akeman
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Timothy J. McDermott
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
- Department of Psychology, University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Kelly T. Cosgrove
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
- Department of Psychology, University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Namik Kirlic
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Ashley Clausen
- St. Vincent Hospital, Billings, 1233 N 30th St, Billings, MT 59101, USA
| | - Mallory Cannon
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Hung-Wen Yeh
- Health Services & Outcomes Research, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO 64108, USA
| | - Evan White
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
- Department of Community Medicine, University of Tulsa, 1215 South Boulder Ave W, Tulsa, OK 74119, USA
| | - Wesley K. Thompson
- Family Medicine and Public Health, UC San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Emily M. Choquette
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | | | - Gabe Cochran
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Sam Ramirez
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
| | - Christopher R. Martell
- Department of Psychological and Brain Sciences, University of Massachusetts–Amherst, 135 Hicks Way, Amherst, MA 01003, USA
| | - Kate B. Wolitzky-Taylor
- Psychology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA 90077, USA
| | - Michelle G. Craske
- Psychology, Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA 90077, USA
| | - James L. Abelson
- Department of Psychiatry, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Martin P. Paulus
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
- Department of Community Medicine, University of Tulsa, 1215 South Boulder Ave W, Tulsa, OK 74119, USA
| | - Robin L. Aupperle
- Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, OK 74136, USA
- Department of Community Medicine, University of Tulsa, 1215 South Boulder Ave W, Tulsa, OK 74119, USA
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Yarrington JS, Vinograd M, Williams AL, Wolitzky-Taylor KB, Zinbarg RE, Mineka S, Waters AM, Craske MG. Fear-potentiated startle predicts longitudinal change in transdiagnostic symptom dimensions of anxiety and depression. J Affect Disord 2022; 311:399-406. [PMID: 35597470 DOI: 10.1016/j.jad.2022.05.080] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 05/04/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Elevated defensive responding, through startle reflex (SR) and skin conductance response (SCR), may contribute to onset and maintenance of depression and anxiety. Most work examining SR and SCR has predicted psychiatric diagnoses. There is a paucity of research examining links between SR or SCR and dimensional measures of psychopathology. METHODS We used latent growth curve modeling to predict longitudinal change in three symptom factors (i.e., General Distress, Fears, Anhedonia-Apprehension) from SR and SCR measured during a fear-potentiated startle paradigm among adolescents oversampled for neuroticism (N = 129). RESULTS Elevated SCR in danger phases before and after an unpleasant muscle contraction predicted increasing Fears over time. Elevated SR in safe phases post-contraction also predicted increasing Fears over time. Attenuated SR in safe phases post-contraction predicted elevated General Distress longitudinally. Attenuated SCR pre-contraction in danger phases predicted elevated Anhedonia-Apprehension over time. LIMITATIONS Our non-clinical sample may limit generalizability of results. Additionally, we did not assess change in SR and SCR over time. CONCLUSIONS The present study demonstrates that SR and SCR during a fear-potentiated startle paradigm predict longitudinal change in dimensional anxiety and depression symptom factors and relatedly, that SR and SCR may represent risk factors for the exacerbation of symptomatology.
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Affiliation(s)
- Julia S Yarrington
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Meghan Vinograd
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | | | - Kate B Wolitzky-Taylor
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Richard E Zinbarg
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Susan Mineka
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Allison M Waters
- School of Applied Psychology, Griffith University, Queensland, Australia
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.
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Abstract
BACKGROUND Prescription drug misuse (PDM) is a significant public health problem associated with mental health symptoms. OBJECTIVES This project investigates the connections between PDM motivations and mental health to inform intervention efforts. METHODS Using nationally representative adult data from the 2016-2018 National Survey on Drug Use and Health (N = 128,205; 53% female) this project investigated which motivations for misuse are related to past-year mental health problems including any mental illness, serious mental illness, major depressive episode, and suicidal thoughts. Complex samples logistic regression models of the main motivation of PDM for each mental health problem were conducted separately for each prescription drug class (i.e., opioids, tranquilizers, sedatives, and stimulants) while controlling for demographic characteristics. RESULTS Adults that reported PDM were more likely than those with no PDM to endorse past year mental health problems. Compared to those that reported PDM of other medications, those misusing prescription opioids and tranquilizers to help with emotions and misusing sedatives to "relax or relieve tension" were more likely to have all categories of mental health problems. Those that misused prescription stimulants to "help study" had lower odds of all mental health problems. CONCLUSIONS While there were differences based on prescription drug class, a range of motivations increased adults' likelihood to have mental health problems and common themes were found across drug classes. While causality is still undetermined, prevention and intervention efforts that are multifaceted and individualized, while broadly providing adults with other ways to cope with negative emotions are likely to help reduce PDM.
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Affiliation(s)
- Tess K Drazdowski
- UCLA Integrated Substance Abuse Programs, Los Angeles, California, USA.,Oregon Social Learning Center, Eugene, Oregon, USA
| | - Marya Schulte
- UCLA Integrated Substance Abuse Programs, Los Angeles, California, USA
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4
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Musa A, Valdez AJ, Aguilar JL, Pendi K, Wolitzky-Taylor KB, Lee D, Lee J, Safani D. The Prevalence of Intimate Partner Violence and Association With Depression in University Students: Results of a Cross-Sectional Study. J Nerv Ment Dis 2021; 209:71-75. [PMID: 33141781 PMCID: PMC8092032 DOI: 10.1097/nmd.0000000000001255] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this cross-sectional study was to determine the prevalence of intimate partner violence (IPV) among university students, investigate the potential predictors of IPV in this population, and study the link between IPV and depression. The survey included sociodemographic, relationship quality, and depression-related questions. From 498 respondents, the prevalence of IPV was 4.8%, depression was 30.9%, and suicidal ideation was 20.3%. After adjusting for covariates and confounders, relationship satisfaction (odds ratio [OR], 0.201; 95% confidence interval [CI], 0.101-0.401; p < 0.001) and jealousy (OR, 0.270; 95% CI, 0.094-0.776; p = 0.015) were significant predictors of IPV. Relationship satisfaction predicted depressive disorders (OR, 0.504; 95% CI, 0.365-0.698; p < 0.001). IPV trended toward predicting the presence of a depressive disorder (OR, 0.436; 95% CI, 0.170-1.113; p = 0.083). Relationship satisfaction and jealousy predicted IPV. Although IPV did not predict depression, poor relationship satisfaction increased the odds of depression, implicating the influence of relationship satisfaction on both IPV and depression.
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Affiliation(s)
- Arif Musa
- School of Medicine, Wayne State University, Detroit, MI 48201, USA
| | - Alfonso J Valdez
- Department of Sociology, University of California Irvine, Irvine, CA 92697, USA
| | - Jose L Aguilar
- Department of Psychiatry, University of California Riverside, Riverside, CA 92521, USA
| | - Kasim Pendi
- School of Professional Studies, Southern California University of Health Sciences, Whittier, CA 90604, USA
| | - Kate B Wolitzky-Taylor
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Danny Lee
- School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Joshua Lee
- School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - David Safani
- Department of Psychiatry and Human Behavior, University of California Irvine, Orange, CA 92868, USA
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Vinograd M, Williams A, Sun M, Bobova L, Wolitzky-Taylor KB, Vrshek-Schallhorn S, Mineka S, Zinbarg RE, Craske MG. Neuroticism and interpretive bias as risk factors for anxiety and depression. Clin Psychol Sci 2020; 8:641-656. [PMID: 32923175 PMCID: PMC7485931 DOI: 10.1177/2167702620906145] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Neuroticism has been associated with depression and anxiety both cross-sectionally and longitudinally. Interpretive bias has been associated with depression and anxiety, primarily in cross-sectional and bias induction studies. The purpose of the current study was to examine the role of interpretive bias as a prospective risk factor and a mediator of the relation between neuroticism and depressive and anxious symptoms in young adults assessed longitudinally. Neuroticism significantly predicted a broad general distress dimension, but not intermediate fears and anhedonia-apprehension dimensions, nor a narrow social fears dimension. Neuroticism also significantly predicted negative interpretive bias for social scenarios. Negative interpretive bias for social scenarios did not significantly predict dimension scores, nor did it mediate the relation between neuroticism and general distress or social fears. These results suggest that although neuroticism relates to negative interpretive bias, its risk for symptoms of depression and anxiety is at most weakly conferred through negative interpretive bias.
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Affiliation(s)
| | | | | | | | | | | | | | - Richard E Zinbarg
- Northwestern University and The Family Institute at Northwestern University
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6
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Kemp JJ, Blakey SM, Wolitzky-Taylor KB, Sy JT, Deacon BJ. The effects of safety behavior availability versus utilization on inhibitory learning during exposure. Cogn Behav Ther 2019; 48:517-528. [PMID: 30760108 DOI: 10.1080/16506073.2019.1574312] [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] [Indexed: 10/27/2022]
Abstract
This study re-analyzes data from Sy and colleagues (2011; Behaviour Research and Therapy, 49, 305-314) comparing safety behavior availability (SBA) to safety behavior utilization (SBU) during exposure therapy for claustrophobic concerns. The present investigation assessed differential rates of inhibitory learning (i.e. change in danger expectancy and coping self-efficacy) between SBA and SBU before, during, and after a single-session treatment. Thirty-nine participants with marked claustrophobic fear completed six consecutive 5-minute exposure trials in a claustrophobia chamber. Participants in the SBA condition exhibited more interference with inhibitory learning relative to the SBU condition. Danger expectancy was significantly higher in the SBA group and decreased at a markedly slower rate across exposure trials relative to SBU. Coping self-efficacy was also significantly lower among participants in the SBA condition, although groups demonstrated similar rates of change across trials. Limitations, clinical implications, and future directions are discussed.
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Affiliation(s)
- Joshua J Kemp
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University , Providence , RI , USA
| | - Shannon M Blakey
- Department of Psychology and Neuroscience (CB 3270), University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Kate B Wolitzky-Taylor
- Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Southern California , Los Angeles , CA , USA
| | | | - Brett J Deacon
- Department of Psychology, University of New South Wales , Sydney , Australia
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7
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Nielsen SKK, Hageman I, Petersen A, Daniel SIF, Lau M, Winding C, Wolitzky-Taylor KB, Steele H, Vangkilde S. Do emotion regulation, attentional control, and attachment style predict response to cognitive behavioral therapy for anxiety disorders? – an investigation in clinical settings. Psychother Res 2018; 29:999-1009. [DOI: 10.1080/10503307.2018.1425933] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
| | - Ida Hageman
- Copenhagen University Hospital, Copenhagen, Denmark
| | - Anders Petersen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | | | - Marianne Lau
- Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Clas Winding
- Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Kate B Wolitzky-Taylor
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California-Los Angeles, Los Angeles, CA, USA
| | - Howard Steele
- Psychology Department, New School of Social Research, New York, NY, USA
| | - Signe Vangkilde
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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8
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Nielsen SKK, Lønfeldt N, Wolitzky-Taylor KB, Hageman I, Vangkilde S, Daniel SIF. Adult attachment style and anxiety - The mediating role of emotion regulation. J Affect Disord 2017; 218:253-259. [PMID: 28477504 DOI: 10.1016/j.jad.2017.04.047] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [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: 08/16/2016] [Revised: 03/19/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although there is substantial evidence for the role of emotion regulation in the etiology and maintenance of anxiety disorders, knowledge about what contributes to emotion dysregulation is sparse. Attachment style is related to emotion regulation and anxiety symptoms, but these variables have rarely been examined together. Examining emotion dysregulation within the context of anxiety disorders through an attachment theory framework will lead to a better understanding of the etiology and maintenance of anxiety disorders. In the present study we combined theoretically and empirically derived knowledge to examine the mediating role of emotion regulation between attachment dimensions (avoidance and anxiety) and anxiety symptoms. METHODS A total of 147 individuals were assessed with Beck Anxiety Inventory (BAI), Experiences in Close Relationships-Revised (ECR-R) and Difficulties in Emotion Regulation Scale (DERS), and statistical mediation analyses were conducted. RESULTS Our results indicate that the significant association between anxiety and attachment anxiety was mediated by emotion dysregulation, whereas attachment avoidance was not significantly related to anxiety when covarying for attachment anxiety. The primary limitation of our study is that data is cross-sectional and so causation cannot be inferred. Secondly, all measures used in this study were derived from self-reported questionnaires, which may be more susceptible to bias. CONCLUSIONS Our results suggest that it is not insecure attachment in general that is important in anxiety disorders, but that attachment anxiety is specifically relevant. Thus, clinical interventions for anxiety disorders may improve by targeting attachment related difficulties.
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Affiliation(s)
| | | | - Kate B Wolitzky-Taylor
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California-Los Angeles, CA, USA
| | | | - Signe Vangkilde
- Department of Psychology, University of Copenhagen, 2A Oester Farimagsgade, 1353 Copenhagen C, Denmark
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Niles AN, Wolitzky-Taylor KB, Arch JJ, Craske MG. Applying a novel statistical method to advance the personalized treatment of anxiety disorders: A composite moderator of comparative drop-out from CBT and ACT. Behav Res Ther 2017; 91:13-23. [DOI: 10.1016/j.brat.2017.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 11/13/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
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10
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Nielsen SKK, Vangkilde S, Wolitzky-Taylor KB, Daniel SIF, Hageman I. An investigation of general predictors for cognitive-behavioural therapy outcome for anxiety disorders in a routine clinical setting. BMJ Open 2016; 6:e010898. [PMID: 27016248 PMCID: PMC4809100 DOI: 10.1136/bmjopen-2015-010898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Cognitive-behavioural therapy (CBT) is effective for treating anxiety disorders and is offered in most mental health services around the world. However, a relatively large number of patients with anxiety disorders do not benefit from CBT, experience relapses or drop out. Reliable predictors of treatment effects are lacking. The aim of this study is to investigate the predictive value of emotion regulation and attentional control for CBT outcome in a routine setting. METHODS AND ANALYSIS In this prospective and practice-based study, 112 patients with anxiety disorders referred for manual-based group CBT at two psychiatric outpatient clinics will be recruited. Emotion regulation, severity of anxiety and attentional control will be assessed with self-report measures and with an experimental computer-based attentional control task at baseline, post-treatment and at a 6-month follow-up. Emotion regulation will be measured with Difficulties in Emotion Regulation Questionnaire, severity of anxiety will be assessed with Beck Anxiety Inventory and attentional control will be measured with the self-report questionnaire, Attention Control Scale, and with an experimental computer-based attentional control task based on theory of visual attention. Data will be analysed using multilevel mixed-effects modelling. ETHICS AND DISSEMINATION The study is approved by the Danish National Ethical Board, the Department of Psychology Ethical Board, University of Copenhagen and by the Danish Data Protection Agency. Study findings will be disseminated through peer-reviewed journal publications and conference presentations. The Danish Committee System on Health Research Ethics has been notified about the project. TRIAL REGISTRATION NUMBER NCT02638363.
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Affiliation(s)
| | - Signe Vangkilde
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Kate B Wolitzky-Taylor
- Department of Psychiatry and Biobehavioral Sciences Semel Institute, University of California, California, USA
| | | | - Ida Hageman
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
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11
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Schneider RL, Arch JJ, Wolitzky-Taylor KB. The state of personalized treatment for anxiety disorders: A systematic review of treatment moderators. Clin Psychol Rev 2015; 38:39-54. [DOI: 10.1016/j.cpr.2015.02.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 02/11/2015] [Accepted: 02/13/2015] [Indexed: 11/26/2022]
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12
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Craske MG, Niles AN, Burklund LJ, Wolitzky-Taylor KB, Vilardaga JCP, Arch JJ, Saxbe DE, Lieberman MD. Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: outcomes and moderators. J Consult Clin Psychol 2014; 82:1034-48. [PMID: 24999670 DOI: 10.1037/a0037212] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cognitive behavioral therapy (CBT) is an empirically supported treatment for social phobia. However, not all individuals respond to treatment and many who show improvement do not maintain their gains over the long-term. Thus, alternative treatments are needed. METHOD The current study (N = 87) was a 3-arm randomized clinical trial comparing CBT, acceptance and commitment therapy (ACT), and a wait-list control group (WL) in participants with a diagnosis of social phobia based on criteria of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). Participants completed 12 sessions of CBT or ACT or a 12-week waiting period. All participants completed assessments at baseline and posttreatment, and participants assigned to CBT and ACT also completed assessments 6 and 12 months following baseline. Assessments consisted of self-report measures, a public-speaking task, and clinician ratings. RESULTS Multilevel modeling was used to examine between-group differences on outcomes measures. Both treatment groups outperformed WL, with no differences observed between CBT and ACT on self-report, independent clinician, or public-speaking outcomes. Lower self-reported psychological flexibility at baseline was associated with greater improvement by the 12-month follow-up in CBT compared with ACT. Self-reported fear of negative evaluation significantly moderated outcomes as well, with trends for both extremes to be associated with superior outcomes from CBT and inferior outcomes from ACT. Across treatment groups, higher perceived control and extraversion were associated with greater improvement, whereas comorbid depression was associated with poorer outcomes. CONCLUSIONS Implications for clinical practice and future research are discussed.
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Affiliation(s)
| | | | | | | | | | - Joanna J Arch
- Department of Psychology, University of Colorado at Boulder
| | - Darby E Saxbe
- Department of Psychology, University of Southern California
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13
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Olatunji BO, Naragon-Gainey K, Wolitzky-Taylor KB. Specificity of Rumination in Anxiety and Depression: A Multimodal Meta-Analysis. Clin Psychol Sci Pract 2013. [DOI: 10.1111/cpsp.12037] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Olatunji BO, Naragon-Gainey K, Wolitzky-Taylor KB. Specificity of rumination in anxiety and depression: A multimodal meta‐analysis. Clinical Psychology: Science and Practice 2013. [DOI: 10.1037/h0101719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Zbozinek TD, Rose RD, Wolitzky-Taylor KB, Sherbourne C, Sullivan G, Stein MB, Roy-Byrne PP, Craske MG. Diagnostic overlap of generalized anxiety disorder and major depressive disorder in a primary care sample. Depress Anxiety 2012; 29. [PMID: 23184657 PMCID: PMC3629816 DOI: 10.1002/da.22026] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [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] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Generalized anxiety disorder (GAD) and major depressive disorder (MDD) are highly comorbid. A possible explanation is that they share four symptoms according to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision (DSM-IV-TR). The present study addressed the symptom overlap of people meeting DSM-IV-TR diagnostic criteria for GAD, MDD, or both to investigate whether comorbidity might be explained by overlapping diagnostic criteria. METHODS Participants (N = 1,218) were enrolled in the Coordinated Anxiety Learning and Management study (a randomized effectiveness clinical trial in primary care). Hypotheses were (1) the comorbid GAD/MDD group endorses the overlapping symptoms more than the nonoverlapping symptoms, and (2) the comorbid GAD/MDD group endorses the overlapping symptoms more than GAD only or MDD only groups, whereas differences would not occur for nonoverlapping symptoms. RESULTS The overlapping GAD/MDD symptoms were endorsed more by the comorbid group than the MDD group but not the GAD group when covarying for total symptom endorsement. Similarly, the comorbid group endorsed the overlapping symptoms more than the nonoverlapping symptoms and did not endorse the nonoverlapping symptoms more than the GAD or MDD groups when covarying for total symptom endorsement. CONCLUSIONS The results suggest that comorbidity of GAD and MDD is strongly influenced by diagnostic overlap. Results are discussed in terms of errors of diagnostic criteria, as well as models of shared psychopathology that account for diagnostic criteria overlap.
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Affiliation(s)
| | - Raphael D. Rose
- University of California, Los Angeles, Department of Psychology
| | | | | | | | - Murray B. Stein
- University of California, San Diego, Department of Psychiatry and Department of Family & Preventive Medicine
| | | | - Michelle G. Craske
- University of California, Los Angeles, Department of Psychology,University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences
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Arch JJ, Wolitzky-Taylor KB, Eifert GH, Craske MG. Longitudinal treatment mediation of traditional cognitive behavioral therapy and acceptance and commitment therapy for anxiety disorders. Behav Res Ther 2012; 50:469-78. [DOI: 10.1016/j.brat.2012.04.007] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 04/20/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022]
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Meuret AE, Wolitzky-Taylor KB, Twohig MP, Craske MG. Coping skills and exposure therapy in panic disorder and agoraphobia: latest advances and future directions. Behav Ther 2012; 43:271-84. [PMID: 22440065 PMCID: PMC3327306 DOI: 10.1016/j.beth.2011.08.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [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: 02/02/2011] [Revised: 08/20/2011] [Accepted: 08/21/2011] [Indexed: 10/17/2022]
Abstract
Although cognitive-behavioral treatments for panic disorder have demonstrated efficacy, a considerable number of patients terminate treatment prematurely or remain symtpomatic. Cognitive and biobehavioral coping skills are taught to improve exposure therapy outcomes but evidence for an additive effect is largely lacking. Current methodologies used to study the augmenting effects of coping skills test the degree to which the delivery of coping skills enhances outcomes. However, they do not assess the degree to which acquisition of coping skills and their application during exposure therapy augment outcomes. We examine the extant evidence on the role of traditional coping skills in augmenting exposure for panic disorder, discuss the limitations of existing research, and offer recommendations for methodological advances.
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Wolitzky-Taylor KB, Arch JJ, Rosenfield D, Craske MG. Moderators and non-specific predictors of treatment outcome for anxiety disorders: A comparison of cognitive behavioral therapy to acceptance and commitment therapy. J Consult Clin Psychol 2012; 80:786-99. [DOI: 10.1037/a0029418] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Craske MG, Wolitzky-Taylor KB, Mineka S, Zinbarg R, Waters AM, Vrshek-Schallhorn S, Epstein A, Naliboff B, Ornitz E. Elevated responding to safe conditions as a specific risk factor for anxiety versus depressive disorders: evidence from a longitudinal investigation. J Abnorm Psychol 2011; 121:315-24. [PMID: 21988452 DOI: 10.1037/a0025738] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [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
The current study evaluated the degree to which startle reflexes (SRs) in safe conditions versus danger conditions were predictive of the onset of anxiety disorders. Specificity of these effects to anxiety disorders was evaluated in comparison to unipolar depressive disorders and with consideration of level of neuroticism. A startle paradigm was administered at baseline to 132 nondisordered adolescents as part of a longitudinal study examining risk factors for emotional disorders. Participants underwent a repetition of eight safe-danger sequences and were told that delivery of an aversive stimulus leading to a muscle contraction of the arm would occur only in the late part of danger conditions. One aversive stimulus occurred midway in the safe-danger sequences. Participants were assessed for the onset of anxiety and unipolar depressive disorders annually over the next 3 to 4 years. Larger SR magnitude during safe conditions following delivery of the aversive stimulus predicted the subsequent first onset of anxiety disorders. Moreover, prediction of the onset of anxiety disorders remained significant above and beyond the effects of comorbid unipolar depression, neuroticism, and subjective ratings of intensity of the aversive stimulus. In sum, elevated responding to safe conditions following an aversive stimulus appears to be a specific, prospective risk factor for the first onset of anxiety disorders.
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Affiliation(s)
- Michelle G Craske
- Department of Psychology, University of California-Los Angeles, Los Angeles, CA 90095-1563, USA.
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Cisler JM, Wolitzky-Taylor KB, Adams TG, Babson KA, Badour CL, Willems JL. The emotional Stroop task and posttraumatic stress disorder: a meta-analysis. Clin Psychol Rev 2011; 31:817-28. [PMID: 21545780 PMCID: PMC3132173 DOI: 10.1016/j.cpr.2011.03.007] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [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: 06/12/2010] [Revised: 03/18/2011] [Accepted: 03/19/2011] [Indexed: 12/20/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with significant impairment and lowered quality of life. The emotional Stroop task (EST) has been one means of elucidating some of the core deficits in PTSD, but this literature has remained inconsistent. We conducted a meta-analysis of EST studies in PTSD populations in order to synthesize this body of research. Twenty-six studies were included with 538 PTSD participants, 254 non-trauma exposed control participants (NTC), and 276 trauma exposed control participants (TC). PTSD-relevant words impaired EST performance more among PTSD groups and TC groups compared to NTC groups. PTSD groups and TC groups did not differ. When examining within-subject effect sizes, PTSD-relevant words and generally threatening words impaired EST performance relative to neutral words among PTSD groups, and only PTSD-relevant words impaired performance among the TC groups. These patterns were not found among the NTC groups. Moderator analyses suggested that these effects were significantly greater in blocked designs compared to randomized designs, toward unmasked compared to masked stimuli, and among samples exposed to assaultive traumas compared to samples exposed to non-assaultive traumas. Theoretical and clinical implications are discussed.
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Affiliation(s)
- Josh M Cisler
- University of Arkansas for Medical Sciences, Brain Imaging Research Center, United States
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Craske MG, Wolitzky-Taylor KB, Labus J, Wu S, Frese M, Mayer EA, Naliboff BD. A cognitive-behavioral treatment for irritable bowel syndrome using interoceptive exposure to visceral sensations. Behav Res Ther 2011; 49:413-21. [PMID: 21565328 PMCID: PMC3100429 DOI: 10.1016/j.brat.2011.04.001] [Citation(s) in RCA: 172] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 04/01/2011] [Accepted: 04/08/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a chronic and debilitating medical condition with few efficacious pharmacological or psychosocial treatment options available. Evidence suggests that visceral anxiety may be implicated in IBS onset and severity. Thus, cognitive-behavioral treatment (CBT) that targets visceral anxiety may alleviate IBS symptoms. METHODS The current study examined the efficacy of a CBT protocol for the treatment of IBS which directly targeted visceral sensations. Participants (N = 110) were randomized to receive 10 sessions of either: (a) CBT with interoceptive exposure (IE) to visceral sensations; (b) stress management (SM); or (c) an attention control (AC), and were assessed at baseline, mid-treatment, post-treatment, and follow-up sessions. RESULTS Consistent with hypotheses, the IE group outperformed AC on several indices of outcome, and outperformed SM in some domains. No differences were observed between SM and AC. The results suggest that IE may be a particularly efficacious treatment for IBS. CONCLUSIONS Implications for research and clinical practice are discussed.
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Craske MG, Wolitzky-Taylor KB, Labus J, Wu S, Frese M, Mayer EA, Naliboff BD. A cognitive-behavioral treatment for irritable bowel syndrome using interoceptive exposure to visceral sensations. Behav Res Ther 2011. [PMID: 21565328 DOI: 10.1016/jbrat.2011.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a chronic and debilitating medical condition with few efficacious pharmacological or psychosocial treatment options available. Evidence suggests that visceral anxiety may be implicated in IBS onset and severity. Thus, cognitive-behavioral treatment (CBT) that targets visceral anxiety may alleviate IBS symptoms. METHODS The current study examined the efficacy of a CBT protocol for the treatment of IBS which directly targeted visceral sensations. Participants (N = 110) were randomized to receive 10 sessions of either: (a) CBT with interoceptive exposure (IE) to visceral sensations; (b) stress management (SM); or (c) an attention control (AC), and were assessed at baseline, mid-treatment, post-treatment, and follow-up sessions. RESULTS Consistent with hypotheses, the IE group outperformed AC on several indices of outcome, and outperformed SM in some domains. No differences were observed between SM and AC. The results suggest that IE may be a particularly efficacious treatment for IBS. CONCLUSIONS Implications for research and clinical practice are discussed.
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Wolitzky-Taylor KB, Resnick HS, McCauley JL, Amstadter AB, Kilpatrick DG, Ruggiero KJ. Is reporting of rape on the rise? A comparison of women with reported versus unreported rape experiences in the National Women's Study-Replication. J Interpers Violence 2011; 26:807-832. [PMID: 20522886 DOI: 10.1177/0886260510365869] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Rape affects one in seven women nationwide. Historically, most rape victims do not report rape to law enforcement. Research is needed to identify barriers to reporting and correlates of reporting to guide policy recommendations that address such barriers. We investigated the prevalence of reporting rape among a national sample of women (N = 3,001) interviewed in 2006. The study also examined predictors of reporting as well as barriers to reporting, concerns about reporting, and women's experiences with the reporting process. Results demonstrated that the overall prevalence of reporting (15.8%) has not significantly increased since the 1990s. Differences were found between rape types, with rapes involving drug or alcohol incapacitation or facilitation being less likely to be reported than forcible rapes. Several predictors of reporting emerged in multivariable analyses. Implications for public health and public policy are discussed.
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Deacon BJ, Fawzy TI, Lickel JJ, Wolitzky-Taylor KB. Cognitive Defusion Versus Cognitive Restructuring in the Treatment of Negative Self-Referential Thoughts: An Investigation of Process and Outcome. J Cogn Psychother 2011. [DOI: 10.1891/0889-8391.25.3.218] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Within traditional cognitive therapy, cognitive restructuring is often used to challenge the veracity of dysfunctional thoughts. In contrast, acceptance and commitment therapy (ACT) uses “cognitive defusion” techniques to change the function of negative thoughts rather than modify their content. Previous research has shown that a cognitive defusion technique known as the “milk exercise” (rapidly repeating a self-referential, one-word thought such as “fat”) reduces the discomfort and believability associated with negative thoughts. This study sought to replicate and extend these findings by comparing the impact of cognitive defusion with that of cognitive restructuring in a sample of participants distressed by negative thoughts about their body shape. Participants received a detailed rationale and training followed by instructions to practice the assigned technique as homework for 1 week. Results indicated that both cognitive techniques produced substantial improvements that generalized well beyond the specific thoughts targeted for treatment. Clear differences in treatment process and the course of improvement were evident. Findings are discussed in the context of theoretical and practical similarities and differences between these two approaches.
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Abstract
BACKGROUND Studies indicate that a small percentage of rapes are reported to law enforcement officials. Research also suggests that rapes perpetrated by a stranger are more likely to be reported and that rapes involving drugs and/or alcohol are less likely to be reported. College women represent a unique and understudied population with regard to reporting rape. METHODS In the current study, the authors interviewed a national sample of 2,000 college women about rape experiences in 2006. RESULTS Only 11.5% of college women in the sample reported their most recent/only rape experience to authorities, with only 2.7% of rapes involving drugs and/or alcohol reported. Minority status (ie, nonwhite race) was associated with lower likelihood of reporting, whereas sustaining injuries during the rape was associated with increased likelihood of reporting. DISCUSSION Reporting, particularly for rapes involving drugs and alcohol, is low among college women. Implications for policy are discussed.
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Affiliation(s)
- Kate B Wolitzky-Taylor
- UCLA Anxiety Disorders Research Center, Department of Psychology, University of California-Los Angeles, Los Angeles, California 90095-1563, USA.
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Olatunji BO, Moretz MW, Wolitzky-Taylor KB, McKay D, McGrath PB, Ciesielski BG. Disgust vulnerability and symptoms of contamination-based OCD: descriptive tests of incremental specificity. Behav Ther 2010; 41:475-90. [PMID: 21035612 DOI: 10.1016/j.beth.2009.11.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [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] [Received: 05/11/2009] [Revised: 11/13/2009] [Accepted: 11/14/2009] [Indexed: 10/19/2022]
Abstract
The present investigation examines the incremental association between disgust propensity and sensitivity and contamination-based obsessive-compulsive disorder (OCD) symptoms. Structural equation modeling in Study 1 indicated that general disgust was related to contamination fear even when controlling for negative affect in a nonclinical sample. Evidence was also found for a model in which the effect of negative affect on contamination fear is mediated by general disgust. Study 1 also showed that both disgust sensitivity and disgust propensity uniquely predicted contamination fear when controlling for negative affect. Growth curve analyses in Study 2 indicated that higher baseline contamination fear is associated with less reduction in contamination fear over a 6-week period as disgust sensitivity increases even when controlling for negative affect. Lastly, disgust propensity was associated with concurrent levels of excessive washing symptoms among patients with OCD in Study 3 when controlling for depression. Implications of these findings from nonclinical, analogue, and clinical samples for future research on the specificity of disgust-related vulnerabilities in the etiology of contamination concerns in OCD are discussed.
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Affiliation(s)
- Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, 111 21st Avenue South, Nashville, TN 37203, USA.
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Wolitzky-Taylor KB, Ruggiero KJ, McCart MR, Smith DW, Hanson RF, Resnick HS, de Arellano MA, Saunders BE, Kilpatrick DG. Has adolescent suicidality decreased in the United States? Data from two national samples of adolescents interviewed in 1995 and 2005. J Clin Child Adolesc Psychol 2010; 39:64-76. [PMID: 20390799 DOI: 10.1080/15374410903401146] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We compared the prevalence and correlates of adolescent suicidal ideation and attempts in two nationally representative probability samples of adolescents interviewed in 1995 (National Survey of Adolescents; N = 4,023) and 2005 (National Survey of Adolescents-Replication; N = 3,614). Participants in both samples completed a telephone survey that assessed major depressive episode (MDE), post-traumatic stress disorder, suicidal ideation and attempts, violence exposure, and substance use. Results demonstrated that the lifetime prevalence of suicidal ideation among adolescents was lower in 2005 than 1995, whereas the prevalence of suicide attempts remained stable. MDE was the strongest predictor of suicidality in both samples. In addition, several demographic, substance use, and violence exposure variables were significantly associated with increased risk of suicidal ideation and attempts in both samples, with female gender, nonexperimental drug use, and direct violence exposure being consistent risk factors in both samples.
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Affiliation(s)
- Kate B Wolitzky-Taylor
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, 67 President Street, MSC861, Charleston, SC 29425, USA.
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Olatunji BO, Wolitzky-Taylor KB, Sawchuk CN, Ciesielski BG. Worry and the anxiety disorders: A meta-analytic synthesis of specificity to GAD. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.appsy.2011.03.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
This review aims to address issues unique to older adults with anxiety disorders in order to inform potential changes in the DSM-V. Prevalence and symptom expression of anxiety disorders in late life, as well as risk factors, comorbidity, cognitive decline, age of onset, and treatment efficacy for older adults are reviewed. Overall, the current literature suggests: (a) anxiety disorders are common among older age individuals, but less common than in younger adults; (b) overlap exists between anxiety symptoms of younger and older adults, although there are some differences as well as limitations to the assessment of symptoms among older adults; (c) anxiety disorders are highly comorbid with depression in older adults; (d) anxiety disorders are highly comorbid with a number of medical illnesses; (e) associations between cognitive decline and anxiety have been observed; (f) late age of onset is infrequent; and (g) both pharmacotherapy and CBT have demonstrated efficacy for older adults with anxiety. The implications of these findings are discussed and recommendations for the DSM-V are provided, including extending the text section on age-specific features of anxiety disorders in late life and providing information about the complexities of diagnosing anxiety disorders in older adults.
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Olatunji BO, Wolitzky-Taylor KB, Babson KA, Feldner MT. Anxiety sensitivity and CO2 challenge anxiety during recovery: differential correspondence of arousal and perceived control. J Anxiety Disord 2009; 23:420-8. [PMID: 18835694 DOI: 10.1016/j.janxdis.2008.08.006] [Citation(s) in RCA: 8] [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: 06/05/2008] [Revised: 08/15/2008] [Accepted: 08/20/2008] [Indexed: 11/24/2022]
Abstract
The relations between changes in arousal and perceived control with changes in anxiety-related distress during a 10-min recovery period after exposure to 10% CO(2)-enriched air was examined among community participants (N=47) high (n=23) and low (n=24) in anxiety sensitivity (AS). Rate of decline in arousal was significantly positively associated with rate of decline in anxiety among high and low AS participants when controlling for valence. Rate of increase in perceived control was significantly negatively related to rate of decline in anxiety in the high AS group but not in the low AS group when controlling for valence. These findings suggest that associations between arousal, perceived control, and anxiety-related recovery from a panic-relevant episode of abrupt increases in bodily arousal differ as a function of pre-existing fears of anxiety-related symptoms (i.e., AS). Implications of these findings for disorders associated with elevated AS are discussed.
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Affiliation(s)
- Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN 37203, USA.
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Affiliation(s)
- Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN 37203, USA.
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Olatunji BO, Wolitzky-Taylor KB, Willems J, Lohr JM, Armstrong T. Differential habituation of fear and disgust during repeated exposure to threat-relevant stimuli in contamination-based OCD: an analogue study. J Anxiety Disord 2009; 23:118-23. [PMID: 18541403 DOI: 10.1016/j.janxdis.2008.04.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [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: 12/04/2007] [Revised: 04/25/2008] [Accepted: 04/25/2008] [Indexed: 10/22/2022]
Abstract
In the present study, participants (N=20) displaying marked contamination concerns were provided 30 min of repeated in vivo exposure to threat-relevant stimuli (cleaning a 'dirty' bed pan), during which time their fear and disgust levels were repeatedly assessed. Results indicated that repeated exposure led to a significant decline in fear but not disgust. The observed decline in fear remained significant after accounting for changes in disgust and vice versa. Although initial disgust was higher than initial fear ratings, differences between the two slopes were not statistically significant. Baseline trait anxiety and global disgust sensitivity levels prior to exposure did not moderate the level of fear or disgust activation during exposure. However, sensitivity specifically related to core and contamination disgust was marginally associated with fear and disgust parameters during outcome. There was also evidence that less fear decline during repeated exposure was associated with higher disgust ratings after the exposure was completed. Theoretical and clinical implications of the present findings for the treatment of contamination concerns in obsessive-compulsive disorder are discussed.
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Affiliation(s)
- Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, Nashville, TN 37203, United States.
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Cougle JR, Wolitzky-Taylor KB, Lee HJ, Telch MJ. Mechanisms of change in ERP treatment of compulsive hand washing: does primary threat make a difference? Behav Res Ther 2007; 45:1449-59. [PMID: 17240352 DOI: 10.1016/j.brat.2006.12.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2006] [Revised: 12/02/2006] [Accepted: 12/05/2006] [Indexed: 10/23/2022]
Abstract
The present study sought to examine patterns of habituation in exposure and response prevention (ERP) treatment of compulsive hand washing. Sub-clinical compulsive washers (n=27) with illness or non-illness primary threats were compared in order to detect potential differences in response to a single session of ERP. Changes in anxiety, disgust, and urge to wash were analyzed, and significant reductions in both anxiety and disgust were noted. Urge to wash significantly declined among washers primarily concerned with illness; among those concerned with non-illness threats, urge to wash did not significantly decline. Moreover, anxiety was found to decline when controlling for disgust and vice versa. Lastly, when both anxiety and disgust were entered into a model predicting changes in urge to wash, anxiety but not disgust predicted urge to wash for those with illness-related threats; for washers with non-illness threats, the findings were the reverse. Several clinical and theoretical implications are discussed.
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Affiliation(s)
- Jesse R Cougle
- Laboratory for the Study of Anxiety Disorders, Department of Psychology, University of Texas, Austin, TX 78712 0187, USA
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