Mapping the Relationship between Health-related Beliefs, Fear, Avoidance, and Depression: Lessons from the Pandemic and Beyond.

The COVID-19 pandemic brought a mental health crisis, with depression symptoms increasing nearly three-fold compared to pre-pandemic levels. To explain this surge and to outline related novel treatment targets for post-pandemic psychiatric interventions, the current study examined cognitive, emotional, and behavioral predictors of depression (in the context of the recent pandemic). Participants completed measures assessing perceived danger, perceived infectiousness, and fear of the coronavirus (COVID-19). Participants also reported symptoms of depression and behavioral tendencies: pandemic-related compulsive checking, cleaning, and avoidance (of activities, situations, places, and people). A multiple mediation model revealed that the relationship between perceived infectiousness of the virus and depression was atemporally mediated by fear of the virus and pandemic-related avoidance of activities, situations, places, and people. Furthermore, avoidance played a uniquely important role in the mediation model. First, it directly mediated the relationship between perceived infectiousness and depression, even when omitting fear from the model. Second, avoidance was a discriminant predictor of depression, as neither pandemic-related checking and reassurance-seeking nor cleaning behavior mediated the relationship between cognition and depressive symptoms. Clinical implications are discussed, including how addressing the relationship between anxiety about viral infections and depression can prospectively increase treatment success as we move beyond the pandemic.

Longitudinal and experimental investigations of implicit happiness and explicit fear of happiness.

ABSTRACTSome individuals devalue positivity previously associated with negativity (Winer & Salem, 2016). Positive emotions (e.g. happiness) may be seen as threatening and result in active avoidance of future situations involving positivity. Although some self-report measures can capture emotions of happiness-averse individuals, they are not always capable of capturing automatic processing. Thus, we examined the association between implicitly-assessed happiness and explicit (i.e. self-reported) fear of happiness in three studies. In Study 1, participants completed the Fear of Happiness Scale (FHS) and an implicit measure of emotions at four-time points over approximately one year. The implicit measure required participants to choose which emotion (i.e. anger, fear, happiness, sadness, or none) best corresponded to 20 individual Chinese characters. In Studies 2 and 3, we utilized an experimental design, implementing a mood induction to emphasise the relationship between explicit fear of happiness and implicitly-assessed happiness. Participants completed the FHS and chose which emotion they believed the artist tried to convey in 20 abstract images. Results indicated that greater self-reported fear of happiness was related to reduced implicit happiness. Findings from these studies provide compound evidence that individuals who hold negative views of positivity may process implicit happiness in a devaluative manner.

Is a diverse sample of college students motivated by compassionate, neutral, or fear-inducing language in COVID-19 crisis messages?

Objective: During public health emergencies such as the ongoing COVID-19 illness pandemic, it is essential to rapidly disseminate crisis messages which often contain embedded health directives. This study investigated which of three variants of the same messages (neutral tone, positive/compassionate tone, negative/fear-inducing tone) were most likely to motivate readers to engage in the health behavior proscribed in the message. Participants: Participants were 87 female and 41 male undergraduates at an urban university in the northeast U.S. Methods: A survey with three versions of eight different COVID messages containing health directives was administered. Results: Those who indicated stronger influence of positive/compassionate crisis messages (i.e., had higher Crisis Messages Survey scores) had higher adaptive health engagement scores, lower worry scores, and were likely to have had a past diagnosis of COVID-19. Moreover, a regression model including COVID-19 status and worry scores accounted for a significant proportion of variance in Crisis Messages Survey scores. Conclusions: Findings indicate that the use of neutral and compassionate language is optimal in motivating health behaviors embedded in university crisis messages.

Intolerance of uncertainty and information-seeking behavior: Experimental manipulation of threat relevance.

Prospective intolerance of uncertainty (IU) involves fear and anxiety in anticipation of future uncertainty and is especially related to worry and generalized anxiety disorder (GAD). Individuals high in IU appraise uncertain situations as threatening and thus may engage in excessive information-seeking behavior to decrease uncertainty. This study aimed to examine the links between prospective IU and information-seeking. Participants (N = 174) high and low in prospective IU completed an ostensible aptitude test (threat stimulus), which was supposedly either excellent (high relevance condition) or poor (low relevance condition) at predicting future outcomes. Thus, the test itself presented an immediate threat, and the awaited test results generated uncertainty. Following the relevance manipulation, participants were given the opportunity to engage in information-seeking behavior by asking questions about the ostensible test and by requesting feedback about the test results. Results indicated that in the high-relevance condition, individuals high and low in IU evidenced similar levels of information-seeking behavior. Conversely, in the low-relevance condition, individuals low in IU evidenced less information-seeking than did individuals high in IU. Furthermore, cognitive appraisals of ambiguous situations were associated with the extent of information-seeking behavior. The implications of these findings for the treatment of GAD are discussed.

Measuring distinct emotional states implicitly: The role of response speed.

Affective science offers many self-report measures, but implicit measures of multiple distinct emotional states are lacking. Prior research (Bartoszek & Cervone, 2017) initiated the development of such an assessment method by examining whether ratings of the emotional content of abstract images reveal raters' emotional states. The current studies were designed to determine whether the speed of these ratings is key to the validity of an implicit emotion measure. To this end, Study 1 exploited naturally occurring variations in response times, whereas Study 2 used time pressure in responding to the implicit measure. Both studies featured a fear-induction and revealed that implicitly assessed fear correlated with psychophysiological (Study 1) and behavioral (Studies 1 and 2) responses even when controlling for self-reported fear. Importantly, results supported the construct, criterion, and incremental validity of the implicit measure only among participants who responded quickly. Study 3 employed a sadness-induction and an experimental manipulation of response times using fast- and slow-paced conditions. The emotion induction affected fast, but not slow, responses to the implicit measure. Overall, findings highlight the importance of response speed in implicit emotion assessment and suggest that the Implicit Measure of Distinct Emotional States can validly differentiate among emotions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Treatment choice among veterans with PTSD symptoms and substance-related problems: Examining the role of preparatory treatments in trauma-focused therapy.

Although common practice in Veterans Affairs (VA) PTSD clinics, it is unclear whether preparatory treatment improves trauma-focused treatment (TFT) completion and outcomes. Furthermore, little is known about whether treatment-seeking veterans in naturalistic settings would chose to prioritize preparatory treatment if given the option of a phase-based approach or direct access to TFT, and how substance-related problems (SRPs) influence this treatment choice. The first aim of this study was to explore how co-occurring SRPs (ranging from none to moderate/severe) influence PTSD treatment choices in a naturalistic setting where veterans were offered a choice between a phase-based approach (i.e., preparatory treatment) or direct access to TFT. The study also examined whether initial treatment choice and severity of co-occurring SRPs influenced TFT completion and outcomes. The second aim was to investigate whether preparatory treatment led to superior TFT completion or outcomes, irrespective of co-occurring SRPs. Analyses were conducted using archival data from 737 United States veterans referred for outpatient VA PTSD treatment. SRPs did not predict initial treatment choice or the length of preparatory group participation. Neither SRPs nor preparatory group participation predicted TFT completion or outcomes (measured as change in PTSD and depression symptoms from pre- to post-TFT). Preparatory group participation did not predict improved TFT completion or outcomes, irrespective of co-occurring SRPs. These findings suggest that veterans with PTSD symptoms and co-occurring SRPs may make similar treatment choices and benefit from either a phase-based approach or direct TFT initiation, and preparatory treatments may not increase patient readiness for veterans seeking TFT. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Individuals Intolerant of Uncertainty: The Maintenance of Worry and Distress Despite Reduced Uncertainty.

The intolerance of uncertainty model of worry posits that individuals worry as a means to cope with the discomfort they feel when outcomes are uncertain, but few experimental studies have investigated the causal relationships between intolerance of uncertainty, situational uncertainty, and state worry. Furthermore, existing studies have failed to control for the likelihood of future negative events occurring, introducing an important rival hypothesis to explain past findings. In the present study, we examined how individuals with high and low trait intolerance of uncertainty differ in their behavioral, cognitive, and emotional reactions to situational uncertainty about an upcoming negative event (watching emotionally upsetting film clips), holding constant the likelihood of that negative event taking place. We found that although individuals high in trait prospective intolerance of uncertainty reported a higher degree of belief that being provided with detailed information about the upcoming stressor would make them feel more at ease, they did not experience an actual decrease in distress or state worry upon being provided with more information, during anticipation of the film clips, or during the film clips themselves. Our results suggest that heightened distress regarding negative events may be more central than intolerance of uncertainty to the maintenance of worry.

Mapping the relationship between anxiety, anhedonia, and depression.

INTRODUCTION: Anxiety and depression are often comorbid conditions, but there is uncertainty as to how this comorbidity develops. Thus, in three studies, we attempted to discern whether anhedonia may be a key linking factor between anxiety and depression. METHODS: Three studies asked participants about their symptoms of anxiety and depression: in Study 1, 109 participants completed measures of anxiety, depression, activity avoidance, and perceived enjoyability and importance of avoided activities; in Study 2, 747 participants completed measures of anhedonia, anxiety, depression, and defensiveness; in Study 3, 216 participants completed measures assessing the same constructs as in Study 2 at four time-points (ranging 11 months in span). RESULTS: In Study 1, symptoms of anxiety and depression were positively related only in individuals who relinquished potential enjoyment due to their anxiety-related avoidance; in Study 2, the indirect effect of anhedonia helped explained how anxiety symptoms imparted risk onto depressive symptoms; and in Study 3, anxiety led to anhedonia and then depression over time and anhedonia led to anxiety and then depression at both 5 and 11 months. LIMITATIONS: The manuscript is limited by the use of a student sample in study 2, cross-sectional methods in studies 1 and 2, and reliance on self-ratings. CONCLUSIONS: Anxiety may devolve into depression through anhedonia, such that anxious individuals begin to lose pleasure in anxiety-provoking activities, which results in the development of other depressive symptoms.

Trauma-Related Pain, Reexperiencing Symptoms, and Treatment of Posttraumatic Stress Disorder: A Longitudinal Study of Veterans.

Research has demonstrated a strong positive association between posttraumatic stress disorder (PTSD) symptoms and physical pain. However, few studies have explored the impact of pain problems on the symptoms and treatment of PTSD, and results remain inconsistent. This longitudinal study examined whether trauma-related and trauma-unrelated pain differentially and uniquely predicted reexperiencing symptoms. We also examined whether levels of reexperiencing symptoms mediated the relationship between pain intensity and posttreatment symptoms of avoidance, numbing, and hyperarousal (ANH). Analyses were conducted using archival data from 99 treatment-seeking veterans who reported the etiology and intensity of their pain and severity of PTSD symptoms pre- and posttreatment. Among veterans with trauma-related pain, pain intensity (a) uniquely corresponded to greater posttreatment reexperiencing symptoms (b = 1.09), and (b) was indirectly predictive of ANH symptoms via the reexperiencing symptoms (b = 1.93). However, veterans with trauma-unrelated pain evidenced no associations between pain intensity and reexperiencing (b = 0.04) or ANH symptoms (b = 0.06). We thus found that trauma-related pain was indirectly related to poor PTSD treatment outcomes via reexperiencing symptoms. These findings offer additional insight into factors that may influence PTSD treatment outcomes for pain-suffering trauma survivors.

Toward an implicit measure of emotions: ratings of abstract images reveal distinct emotional states.

Although implicit tests of positive and negative affect exist, implicit measures of distinct emotional states are scarce. Three experiments examined whether a novel implicit emotion-assessment task, the rating of emotion expressed in abstract images, would reveal distinct emotional states. In Experiment 1, participants exposed to a sadness-inducing story inferred more sadness, and less happiness, in abstract images. In Experiment 2, an anger-provoking interaction increased anger ratings. In Experiment 3, compared to neutral images, spider images increased fear ratings in spider-fearful participants but not in controls. In each experiment, the implicit task indicated elevated levels of the target emotion and did not indicate elevated levels of non-target negative emotions; the task thus differentiated among emotional states of the same valence. Correlations also supported the convergent and discriminant validity of the implicit task. Supporting the possibility that heuristic processes underlie the ratings, group differences were stronger among those who responded relatively quickly.

Spider-fearful individuals hesitantly approach threat, whereas depressed individuals do not persistently approach reward.

BACKGROUND AND OBJECTIVES: Much research documents that anxiety is related to the avoidance of threatening information. Research is also beginning to suggest that depression is related to a lack of approach toward positive information. However, many questions remain regarding the specificity and robustness of these effects. The goal of the present study was to examine specific motivational patterns differentiating between anxiety and depression. METHODS: The current study used the approach-avoidance task (AAT) to further investigate these phenomena. Spider-fearful, depressed, and non-fearful/non-depressed (control) participants pulled or pushed a joystick lever in response to positive, neutral, and negative (spider and spider-unrelated) pictures. Unlike in previous AAT studies, duration times (DTs) of joystick movements were examined in addition to reaction times (RTs). RESULTS: As hypothesized, in contrast to depressed and control groups, spider-fearful participants exhibited avoidance tendencies by evidencing slower RTs when pulling the joystick in response to spider versus neutral pictures. As further hypothesized, depressed participants exhibited diminished approach motivation as evidenced by their pulling positive pictures for a shorter duration than neutral pictures, in comparison to the control group. LIMITATIONS: Participants in our study were from a non-clinical student sample and further research is required for generalization to spider phobia and major depressive disorder. CONCLUSION: These findings inform theoretical understanding of the specific motivational tendencies of anxiety and depression, and introduce a modification of the AAT that, if incorporated in clinical settings, would increase the specificity and success of cognitive bias modifications.