Psychometric properties of the Distress Tolerance Scale in a clinical sample.

The factor structure, reliability, and concurrent validity of the Distress Tolerance Scale were evaluated in a large outpatient sample (N = 775). Prior research demonstrates mixed findings regarding the most appropriate factor structure, finding evidence for the presence of four subfactors as well as a potential second-order (hierarchical) General Distress Tolerance factor. Competing factor structures were compared using confirmatory factor analyses. A second-order hierarchical model with correlated residuals fit the data well, though results suggested poor factor discrimination. A bifactor hierarchical model also demonstrated acceptable fit. However, all subfactors except for Regulation demonstrated small or nonsignificant loadings and/or variances. The model was respecified with all items loading onto a General Distress Tolerance factor and three items loading onto the Regulation factor, which also demonstrated acceptable fit. In support of its concurrent validity, General Distress Tolerance was more strongly associated with neuroticism and a measure of difficulties with emotion regulation than with symptoms of anxiety and depression. The present study extends the literature by demonstrating support for a hierarchical bifactor structure and the favorable psychometric properties of the Distress Tolerance Scale in a large clinical sample. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Direct and Interactive Effects of Personality and Experiencing Changes in Relationships on Symptoms of Internalizing Psychopathology During the COVID-19 Pandemic.

Purpose: The present study examined the prospective direct and interactive effects of personality (neuroticism, extraversion) and experiencing changes in friendships during the pandemic on symptoms of stress, anxiety, and depression. Methods: A sample of patients (N = 77) at an outpatient treatment clinic who had received a diagnostic assessment in the 6 months prior to the COVID-19 lockdown was re-contacted during the pandemic (May-June 2020) and completed a survey assessing stressors and symptoms of internalizing psychopathology. Results: Neuroticism had main effects on anxiety, whereas experiencing changes in friendships had main effects on stress and depression. Extraversion did not have main effects on stress, depression, or anxiety. The relationship between experiencing changes in friendships and stress and anxiety was moderated by extraversion, such that the strength of the relationship between changes in friendships and stress and anxiety waned as the level of extraversion increased. Neuroticism was not a moderator of the association between changes in friendships and emotional disorder symptoms. Conclusion: These results suggest that higher levels of extraversion may protect against symptoms of stress reactivity and anxiety that are associated with COVID-related changes in friendships, while neuroticism may have limited prospective associations with symptoms during the pandemic. Supplementary Information: The online version of this article contains supplementary material available 10.1007/s10608-023-10364-x.

Developing Transdiagnostic Internalizing Disorder Prognostic Indices for Outpatient Cognitive Behavioral Therapy.

A growing literature is devoted to understanding and predicting heterogeneity in response to cognitive behavioral therapy (CBT), including using supervised machine learning to develop prognostic models that could be used to inform treatment planning. The current study developed CBT prognostic models using data from a broad dimensionally oriented pretreatment assessment (324 predictors) of 1,210 outpatients with internalizing psychopathology. Super learning was implemented to develop prognostic indices for three outcomes assessed at 12-month follow-up: principal diagnosis improvement (attained by 65.8% of patients), principal diagnosis remission (56.8%), and transdiagnostic full remission (14.3%). The models for principal diagnosis remission and transdiagnostic remission performed best (AUROCs = 0.71-0.73). Calibration was modest for all three models. Three-quarters (77.3%) of patients in the top tertile of the predicted probability distribution achieved principal diagnosis remission, compared to 35.0% in the bottom tertile. One-third (35.3%) of patients in the top two deciles of predicted probabilities for transdiagnostic complete remission achieved this outcome, compared to 2.7% in the bottom tertile. Key predictors included principal diagnosis severity, social anxiety diagnosis/severity, hopelessness, temperament, and global impairment. While additional work is needed to improve performance, integration of CBT prognostic models ultimately could lead to more effective and efficient treatment of patients with internalizing psychopathology.

A Randomized Clinical Trial of Oxytocin or Galantamine in Schizophrenia: Assessing the Impact on Behavioral, Lexical, and Self-Report Indicators of Social Affiliation.

Prior studies examining the impact of oxytocin on negative symptoms in schizophrenia have yielded mixed results. The current study explored whether oxytocin can improve more proximal indicators of social affiliation as indicated by changes in behavior, language and subjective indices of social affiliation among individuals with schizophrenia spectrum disorders during a role-play designed to elicit affiliative responses. We tested the hypothesis that daily intranasal oxytocin administered for 6 weeks would improve social affiliation as manifested by increased social skill ratings, use of positive, affiliative, and social words, and subjective responses from a previously published randomized controlled trial. Forty outpatients with schizophrenia or schizoaffective disorder were randomized to the oxytocin, galantamine, or placebo group and completed affiliative role-plays and self-report questionnaires of affect, reactions to the affiliative confederate, and willingness to interact at baseline and post-treatment. Results demonstrated that oxytocin was not effective at improving behavioral or subjective indicators of social affiliation. This study adds to a growing literature that the prosocial effects of oxytocin in schizophrenia are limited or null.