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Greene T, Contractor AA, Dicker-Oren SD, Fentem A, Sznitman SR. The Effects of the Processing of Positive Memories Technique on Posttrauma Affect and Cognitions Among Survivors of Trauma: Protocol for a Daily Diary Study. JMIR Res Protoc 2024; 13:e51838. [PMID: 38214953 PMCID: PMC10818235 DOI: 10.2196/51838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/14/2023] [Accepted: 12/17/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The Processing of Positive Memories Technique (PPMT) is a promising new treatment approach for posttraumatic stress disorder (PTSD), which involves detailed narration and processing of specific positive autobiographical memories. Indeed, preliminary case-series studies have found reductions in PTSD symptoms, negative affect, and negative cognitions among survivors of trauma who have received PPMT. However, PPMT's effects have not been investigated at the daily level. In this study, we describe the protocol for a study that will examine the daily-level impacts of PPMT in a trauma-exposed, nonclinical community sample. OBJECTIVE This study uses an innovative research protocol that combines case-series design and daily diary approaches to examine changes in daily affect, daily cognitions, and daily PTSD symptoms pre- and post-PPMT. We hypothesize that at the daily level, in comparison to their own pre-PPMT levels, following the PPMT intervention, participants will report (1) a lower count of endorsed daily PTSD symptoms, (2) increases in daily positive affect and decreases in daily negative affect, (3) increases in positive affect reactivity to daily positive events, and (4) decreases in daily posttrauma cognitions. METHODS We are currently recruiting participants (target n=70) from a metroplex in the southwest United States. Following a screening survey, eligible participants complete a preintervention baseline survey, followed by 21 daily surveys in their natural environments. Then, they receive 4 PPMT sessions on a weekly basis. After the conclusion of the PPMT intervention, participants complete a postintervention outcome survey and 21 daily surveys. To compare daily affect, daily cognitions, and daily PTSD symptoms before and after PPMT, we will use the daily diary report data and conduct multilevel random intercepts and slopes linear regression models. RESULTS Data collection was initiated in March 2022 and is expected to end by June 2024. As of November 28, 2023, a total of 515 participants had consented to the study in the screening phase. No analyses will be conducted until data collection has been completed. CONCLUSIONS Study findings could clarify whether deficits in positive autobiographical memory processes may also characterize PTSD alongside deficits in traumatic memory processes. Furthermore, PPMT could be an additional therapeutic tool for clinicians to help clients reduce posttraumatic distress in their everyday lives. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51838.
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Affiliation(s)
- Talya Greene
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Ateka A Contractor
- Department of Psychology, University of North Texas, Denton, TX, United States
| | | | - Andrea Fentem
- Department of Psychology, University of North Texas, Denton, TX, United States
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Wooldridge JS, Morse JL, Delgado J, Afari N. Daily Functioning of Veterans With Type 2 Diabetes: Protocol for an Ambulatory Assessment Study. JMIR Res Protoc 2023; 12:e53874. [PMID: 37983070 PMCID: PMC10696502 DOI: 10.2196/53874] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 10/27/2023] [Accepted: 10/29/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Diabetes impacts nearly 25% of veterans. Many veterans do not engage in recommended physical activity and other diabetes self-management behaviors. Type 2 diabetes is generally asymptomatic; as such, the long-term consequences of inadequate self-management and benefits of consistent self-management are not salient in the short term. Furthermore, self-management behaviors typically take place outside of medical visits; however, self-management-related factors are only assessed during medical visits, likely missing large amounts of variability. Thus, ambulatory assessment methods such as ecological momentary assessment (EMA), accelerometry, and continuous glucose monitoring are needed to understand the dynamics of daily self-management and identify potential intervention targets. OBJECTIVE The overarching goal of this study is to understand daily, time-varying factors (comorbid affective symptoms and social context) that influence physical activity, diabetes self-management, glycemic management, daily functioning, and quality of life in participants' natural environments. METHODS We are recruiting veterans with type 2 diabetes (target N=100). Participants are required to complete a battery of baseline assessments related to mental health, psychosocial factors, and self-management behaviors. Participants then receive 5 momentary EMA surveys and 1 daily EMA survey per day, in which veterans report comorbid affective symptoms (mood, stress, and pain), social support, social interactions, physical activity, and other self-management behaviors. Momentary surveys are delivered randomly during daily preprogrammed intervals over a 14-day sampling period. Accelerometry and continuous glucose monitoring are also used to assess physical activity and blood glucose, respectively. The first 6 participants also completed interviews assessing their experience in the study and barriers to participation. These test participants informed modifications to the protocol for the remaining participants. RESULTS The project received funding in April of 2023. Enrollment began in March of 2023 and is planned to be completed in April 2025. Among the 6 test participants, the overall EMA response rate was 87% (range 74%-95%). The response rate for the EMA survey including daily items (67%, range 21%-93%) was lower than the earlier shorter EMA surveys (89%, range 81%-96%). The mean rate of valid accelerometer wear of at least 20 hours per day was 93% (SD 11%), and continuous glucose monitoring data were available for 91% (SD 17%) of days on average. Participants reported few barriers to completing EMA surveys but noted the random timing of questions made it difficult to plan around, and the end-of-day survey was long. Two participants reported survey items reminded or motivated them to engage in diabetes self-management behaviors. CONCLUSIONS Assessment tools developed from this study can inform clinical decision-making by considering barriers to self-management that occur in daily life. Clinical applications include tailored, adaptive technology-supported interventions to improve self-management that provide the right type and amount of support at the right time by adapting to an individual's changing internal and contextual state. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53874.
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Affiliation(s)
- Jennalee S Wooldridge
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Jessica L Morse
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Jorge Delgado
- VA San Diego Healthcare System, San Diego, CA, United States
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
- VA Center of Excellence for Stress and Mental Health, San Diego, CA, United States
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Rapisarda F, Bergeron N, Dufour MM, Guay S, Geoffrion S. Longitudinal assessment and determinants of short-term and longer-term psychological distress in a sample of healthcare workers during the COVID-19 pandemic in Quebec, Canada. Front Psychiatry 2023; 14:1112184. [PMID: 37275978 PMCID: PMC10232907 DOI: 10.3389/fpsyt.2023.1112184] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/27/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Previous research has demonstrated the negative impact of the COVID-19 pandemic emergency on the wellbeing of healthcare workers. However, few research contributions reported a longitudinal evaluation of psychological distress and examined determinants of its duration and course over time. The present study aims to explore the impact of the pandemic emergency on HCWs mental health by adopting a longitudinal design and assessing mental health as combination of overlapping clinical symptoms (post-traumatic stress disorder, depression and anxiety). Methods Data were collected weekly through a mobile application during and after the first wave of COVID-19 in the province of Quebec, Canada, in 2020. Analysis was conducted on a final sample of 382 participants. Participants were grouped into "resilient" (RES) if they did not manifest clinical-level psychological distress during monitoring, "short-term distress" (STD) if distress exceeded the clinical threshold for 1-3 weeks, and longer-term distress (LTD) if it occurred for four or more weeks, even if not consecutively. Descriptive statistics for all variables were computed for each subgroup (RES, STD and LTD), and pairwise comparisons between each group for every descriptive variable were made using chi square statistics for categorical variables and t-test for continuous variables. Predictors of distress groups (STD and LTD vs RES) were assessed running multinomial hierarchical logistic regression models. Results In our sample, almost two third (59.4%) HCWs did not manifest moderate or severe distress during the monitoring time. Short-term distress, mostly post-traumatic symptoms that lasted for less than 4 weeks, were the most common distress response, affecting almost one third of participants. Longer psychological distress occurred only in a smaller percentage (12.6%) of cases, as a combination of severe posttraumatic, depressive and anxiety symptoms. Perceived occupational stress was the most significant risk factor; moreover individual, peritraumatic work and family risk and protective factors, were likely to significantly affect the stress response. Discussion Results tend to provide a more complex and resiliency-oriented representation of psychological distress compared to previous cross-sectional studies, but are in line with stress response studies. Findings allow us to better describe the profiles of distress response in STD and LTD groups. Participants that manifest short term distress experience acute stress reaction in which the interplay between personal, family and professional life events is associated with the stress response. Conversely, longer term distress response in HCWs presents a more complex mental health condition with an higher level of impairment and support needs compared to participants with short-term distress.
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Affiliation(s)
- Filippo Rapisarda
- Research Centre, Institut universitaire en sant9́ mentale de Montréal (IUSMM), Montreal, QC, Canada
| | - Nicolas Bergeron
- Département de psychiatrie et d'addictologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Research Centre, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Marie-Michèle Dufour
- École de psychoéducation, Faculté des arts et des sciences, Université de Montréal, Montreal, QC, Canada
| | - Stéphane Guay
- Research Centre, Institut universitaire en sant9́ mentale de Montréal (IUSMM), Montreal, QC, Canada
- Département de psychiatrie et d'addictologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- École de criminologie, Faculté des arts et des sciences, Université de Montréal, Montreal, QC, Canada
| | - Steve Geoffrion
- Research Centre, Institut universitaire en sant9́ mentale de Montréal (IUSMM), Montreal, QC, Canada
- École de psychoéducation, Faculté des arts et des sciences, Université de Montréal, Montreal, QC, Canada
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Alexander JD, Freis SM, Zellers SM, Corley R, Ledbetter A, Schneider RK, Phelan C, Subramonyam H, Frieser M, Rea-Sandin G, Stocker ME, Vernier H, Jiang M, Luo Y, Zhao Q, Rhea SA, Hewitt J, Luciana M, McGue M, Wilson S, Resnick P, Friedman NP, Vrieze SI. Evaluating longitudinal relationships between parental monitoring and substance use in a multi-year, intensive longitudinal study of 670 adolescent twins. Front Psychiatry 2023; 14:1149079. [PMID: 37252134 PMCID: PMC10213319 DOI: 10.3389/fpsyt.2023.1149079] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/04/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Parental monitoring is a key intervention target for adolescent substance use, however this practice is largely supported by causally uninformative cross-sectional or sparse-longitudinal observational research designs. Methods We therefore evaluated relationships between adolescent substance use (assessed weekly) and parental monitoring (assessed every two months) in 670 adolescent twins for two years. This allowed us to assess how individual-level parental monitoring and substance use trajectories were related and, via the twin design, to quantify genetic and environmental contributions to these relationships. Furthermore, we attempted to devise additional measures of parental monitoring by collecting quasi-continuous GPS locations and calculating a) time spent at home between midnight and 5am and b) time spent at school between 8am-3pm. Results ACE-decomposed latent growth models found alcohol and cannabis use increased with age while parental monitoring, time at home, and time at school decreased. Baseline alcohol and cannabis use were correlated (r = .65) and associated with baseline parental monitoring (r = -.24 to -.29) but not with baseline GPS measures (r = -.06 to -.16). Longitudinally, changes in substance use and parental monitoring were not significantly correlated. Geospatial measures were largely unrelated to parental monitoring, though changes in cannabis use and time at home were highly correlated (r = -.53 to -.90), with genetic correlations suggesting their relationship was substantially genetically mediated. Due to power constraints, ACE estimates and biometric correlations were imprecisely estimated. Most of the substance use and parental monitoring phenotypes were substantially heritable, but genetic correlations between them were not significantly different from 0. Discussion Overall, we found developmental changes in each phenotype, baseline correlations between substance use and parental monitoring, co-occurring changes and mutual genetic influences for time at home and cannabis use, and substantial genetic influences on many substance use and parental monitoring phenotypes. However, our geospatial variables were mostly unrelated to parental monitoring, suggesting they poorly measured this construct. Furthermore, though we did not detect evidence of genetic confounding, changes in parental monitoring and substance use were not significantly correlated, suggesting that, at least in community samples of mid-to-late adolescents, the two may not be causally related.
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Affiliation(s)
- Jordan D. Alexander
- Psychology Department, University of Minnesota, Minneapolis, MN, United States
| | - Samantha M. Freis
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, United States
| | - Stephanie M. Zellers
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Robin Corley
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, United States
| | - Amy Ledbetter
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, United States
| | - Rachel K. Schneider
- Psychology Department, University of Minnesota, Minneapolis, MN, United States
| | - Chanda Phelan
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | | | - Maia Frieser
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, United States
| | - Gianna Rea-Sandin
- Psychology Department, University of Minnesota, Minneapolis, MN, United States
| | - Michelle E. Stocker
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, United States
| | - Helen Vernier
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, United States
| | - Ming Jiang
- Department of Computer Science, University of Minnesota, Minneapolis, MN, United States
| | - Yan Luo
- Department of Computer Science, University of Minnesota, Minneapolis, MN, United States
| | - Qi Zhao
- Department of Computer Science, University of Minnesota, Minneapolis, MN, United States
| | - Sally Ann Rhea
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, United States
| | - John Hewitt
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, United States
| | - Monica Luciana
- Psychology Department, University of Minnesota, Minneapolis, MN, United States
| | - Matt McGue
- Psychology Department, University of Minnesota, Minneapolis, MN, United States
| | - Sylia Wilson
- Institute of Child Development, University of Minnesota, Minneapolis, MN, United States
| | - Paul Resnick
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Naomi P. Friedman
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, United States
| | - Scott I. Vrieze
- Psychology Department, University of Minnesota, Minneapolis, MN, United States
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Abstract
Mental health care is built around patient recall and report of clinical symptoms. However, memories of events and experiences rely on cognitive heuristics that influence our recall. The peak-end bias, which refers to the tendency for the most intense and proximate aspects of an experience to disproportionately influence our memory, has been understudied in the context of mental health symptoms and may unduly influence self-reported symptoms, even in the context of standardized assessments. To determine whether the peak-end bias applies to the report of depressive symptoms on the standardized Patient Health Questionnaire-9 (PHQ-9) assessment, we compared two scores from daily mood assessments collected over a 2-week period from 4,322 medical interns (56% women; 60% non-Hispanic White). The peak-end-mood score, which averaged the single lowest and most recent mood scores over 2 weeks had a significantly stronger correlation with the PHQ-9 than the mean-mood score, which averaged all mood scores during the 2 weeks. Likelihood ratio tests and fit statistics provided further support that the peak-end-mood score was a significantly better predictor of depression than the mean-mood score. Results were consistent when limiting the sample to those with mild-to-severe depressive symptoms, and when only examining the two primary mood items as the dependent variable. These findings provide evidence for a modest peak-end recall bias for mood and depressive symptoms. There may be benefits to implementing intermittent assessment strategies to support clinical decision-making. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Adam G. Horwitz
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Zhuo Zhao
- Michigan Neuroscience Institute, The University of Michigan Medical School, Ann Arbor, Michigan
| | - Srijan Sen
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
- Michigan Neuroscience Institute, The University of Michigan Medical School, Ann Arbor, Michigan
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Kiekens G, Hasking P, Nock MK, Boyes M, Kirtley O, Bruffaerts R, Myin-Germeys I, Claes L. Fluctuations in Affective States and Self-Efficacy to Resist Non-Suicidal Self-Injury as Real-Time Predictors of Non-Suicidal Self-Injurious Thoughts and Behaviors. Front Psychiatry 2020; 11:214. [PMID: 32265760 PMCID: PMC7099647 DOI: 10.3389/fpsyt.2020.00214] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 03/03/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Although research over the past decade has resulted in significantly increased knowledge about distal risk factors for non-suicidal self-injury (NSSI), little is known about short-term (proximal) factors that predict NSSI thoughts and behaviors. Drawing on contemporaneous theories of NSSI, as well as the concept of ideation-to-action, the present study clarifies (a) real-time factors that predict NSSI thoughts and (b) the extent to which theoretically important momentary factors (i.e., negative affect, positive affect, and self-efficacy to resist NSSI) predict NSSI behavior in daily life, beyond NSSI thoughts. METHODS Using experience sampling methodology, intensive longitudinal data was obtained from 30 young adults with frequent NSSI episodes in the last year. Participants completed assessments up to eight times per day for 12 consecutive days (signal-contingent sampling). This resulted in the collection of 2,222 assessments (median compliance = 79.2%) during which 591 NSSI thoughts and 270 NSSI behaviors were recorded. Using the dynamic structural equation modeling framework, multilevel vector autoregressive models were constructed. RESULTS Within the same assessment, negative affect was positively associated with NSSI thoughts, whereas positive affect and self-efficacy to resist NSSI were each negatively associated with NSSI thoughts. Across assessments, higher-than-usual negative affect and self-efficacy to resist NSSI were predictive of short-term change in NSSI thoughts. While fluctuations in both negative affect and positive affect prospectively predicted NSSI behavior, these factors became non-significant in models that controlled for the predictive effect of NSSI thoughts. In contrast, self-efficacy to resist NSSI incrementally predicted a lower probability of engaging in NSSI, above and beyond NSSI thoughts. DISCUSSION This study provides preliminary evidence that affective fluctuations may uniquely predict NSSI thoughts but not NSSI behaviors, and point to the role of personal belief in the ability to resist NSSI in preventing NSSI behavior. These findings illustrate the need to differentiate between the development of NSSI thoughts and the progression from NSSI thoughts to behavior, as these are likely distinct processes, with different predictors.
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Affiliation(s)
- Glenn Kiekens
- School of Psychology, Curtin University, Perth, WA, Australia.,Department of Neurosciences, Center for Public Health Psychiatry, Leuven, Belgium
| | | | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Mark Boyes
- School of Psychology, Curtin University, Perth, WA, Australia
| | - Olivia Kirtley
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Ronny Bruffaerts
- Department of Neurosciences, Center for Public Health Psychiatry, Leuven, Belgium.,Institute for Social Research, Population Studies Center, University of Michigan, Ann Arbor, MI, United States
| | - Inez Myin-Germeys
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
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Abstract
BACKGROUND Conceptualizing posttraumatic stress disorder (PTSD) symptoms as a dynamic system of causal elements could provide valuable insights into the way that PTSD develops and is maintained in traumatized individuals. We present the first study to apply a multilevel network model to produce an exploratory empirical conceptualization of dynamic networks of PTSD symptoms, using data collected during a period of conflict. METHODS Intensive longitudinal assessment data were collected during the Israel-Gaza War in July-August 2014. The final sample (n = 96) comprised a general population sample of Israeli adult civilians exposed to rocket fire. Participants completed twice-daily reports of PTSD symptoms via smartphone for 30 days. We used a multilevel vector auto-regression model to produce contemporaneous and temporal networks, and a partial correlation network model to obtain a between-subjects network. RESULTS Multilevel network analysis found strong positive contemporaneous associations between hypervigilance and startle response, avoidance of thoughts and avoidance of reminders, and between flashbacks and emotional reactivity. The temporal network indicated the central role of startle response as a predictor of future PTSD symptomatology, together with restricted affect, blame, negative emotions, and avoidance of thoughts. There were some notable differences between the temporal and contemporaneous networks, including the presence of a number of negative associations, particularly from blame. The between-person network indicated flashbacks and emotional reactivity to be the most central symptoms. CONCLUSIONS This study suggests various symptoms that could potentially be driving the development of PTSD. We discuss clinical implications such as identifying particular symptoms as targets for interventions.
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Affiliation(s)
- Talya Greene
- Department of Community Mental Health,University of Haifa,Haifa,Israel
| | - Marc Gelkopf
- Department of Community Mental Health,University of Haifa,Haifa,Israel
| | - Sacha Epskamp
- Department of Psychology,University of Amsterdam,Amsterdam,The Netherlands
| | - Eiko Fried
- Department of Psychology,University of Amsterdam,Amsterdam,The Netherlands
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