Moral Elevation Online Intervention for Veterans Experiencing Distress Related to Posttraumatic Stress Disorder and Moral Injury (MOVED): Pilot Trial of a 4-Week Positive Psychology Web-Based Intervention.

BACKGROUND: Veterans with posttraumatic stress disorder (PTSD) and moral injury can encounter several barriers to treatment, including limited access to care and low engagement with therapy. Furthermore, most treatment approaches focus on alleviating distress rather than cultivating positive experiences that could facilitate trauma recovery. A potential way to address these issues is through moral elevation: feeling uplifted and inspired by others' virtuous actions. OBJECTIVE: This study aimed to examine the feasibility and acceptability of a novel, web-based moral elevation intervention for veterans with PTSD symptoms and moral injury distress (Moral Elevation Online Intervention for Veterans Experiencing Distress Related to PTSD and Moral Injury [MOVED]). This mixed methods study also examined potential changes in PTSD symptoms, moral injury distress, quality of life, and prosocial behavior. METHODS: In this pilot trial, 48 participants were randomized to a MOVED or control condition (24 participants per condition). Both conditions included 8 sessions and lasted 1 month. The MOVED intervention and all survey components across both conditions were administered online. Participants completed self-report measures that assessed PTSD symptoms, moral injury distress, quality of life, and prosocial behavior at baseline and follow-up. Veterans in the MOVED condition also completed individual qualitative interviews at follow-up. We coded qualitative responses to interviews and identified emergent themes. RESULTS: Findings suggest the MOVED intervention was largely feasible, with evidence for moderate-to-high levels of participation, engagement, and retention in MOVED sessions. Both quantitative and qualitative results suggest veterans found MOVED to be acceptable and satisfactory at the overall treatment level. Furthermore, participants reported high scores for helpfulness and engagement at the session level. Veterans who completed MOVED reported large within-person decreases in PTSD symptoms (Cohen d=1.44), approximately twice that of veterans in the control condition (Cohen d=0.78). Those in MOVED also reported medium-sized increases in physical (Cohen d=0.71) and psychological domains of quality of life (Cohen d=0.74), compared with no meaningful changes in the control condition. Unexpectedly, MOVED veterans reported no decrease in moral injury distress, whereas veterans in the control condition endorsed a medium-sized decrease in the total score. There were no changes in prosociality for either condition. Qualitative feedback further supported high levels of perceived acceptability and satisfaction and positive treatment outcomes across a range of domains, including behaviors, cognitions, emotions, and social functioning. Veterans also recommended adaptations to enhance engagement and maximize the impact of intervention content. CONCLUSIONS: Overall, findings indicate that veterans with PTSD and moral injury distress were interested in an intervention based on exposure to and engagement with experiences of moral elevation. After further research and refinement guided by future trials, veterans may benefit from this novel approach, which may enhance treatment outcomes and increase treatment accessibility for those in need of additional trauma-focused care.

Interpersonal contrast avoidance as a mechanism for the maintenance of worry.

Despite consistent links between interpersonal problems and worry, mechanisms explaining this relationship remain unknown. The Contrast Avoidance Model (CAM; Newman & Llera, 2011) posits that individuals at risk for chronic worry and generalized anxiety disorder (GAD) fear sudden negative mood shifts, using worry to perpetuate negative moods and avoid these negative emotional contrasts. We propose interpersonal (IP) contrast avoidance (e.g., acting friendly to prevent others from causing mood shifts) as a novel explanation for interpersonal dysfunction in worriers. This study investigated IP contrast avoidance and worry in two samples. A nonclinical sample ranging in GAD symptoms (Study 1; N = 92) reported IP problems at baseline then IP contrast avoidance and worry over eight weeks (637 diaries). As expected, baseline IP problems prospectively predicted worry indirectly through chronic IP contrast avoidance. Affiliative, submissive, cold, and total IP contrast avoidance strategies predicted same-week and lagged next-week worry increases; affiliative, submissive, and total strategies also predicted maintenance of worry over eight weeks in growth models. Lastly, Study 2 showed the relevance of IP contrast avoidance strategies in a treatment-seeking clinical sample (N = 40), correlating with interpersonal problems and worry. Overall, results provide proof-of-concept for extending the CAM to the interpersonal domain.

Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts.

INTRODUCTION: Generalized anxiety disorder (GAD) is common and disabling. Different versions of cognitive behavioral therapy (CBT) have been tested, but no treatment works for everyone. Therefore, researchers have attempted approaches to enhance CBT. AREAS COVERED: The current narrative review examines meta-analyses and individual trials of CBT-based treatments for GAD. We focus on CBT and its cognitive and behavioral components as well as efforts to enhance CBT and its dissemination and generalizability. Enhancement efforts included interpersonal and emotional processing therapy, mindfulness-based CBT, emotion regulation therapy, intolerance of uncertainty therapy, the unified protocol, metacognitive therapy, motivational interviewing, and contrast avoidance targeted treatment. Emerging strategies to enhance dissemination have focused on technologically based treatments. Attempts at generalizability have included examination of efficacy within diverse racial and ethnic groups. EXPERT OPINION: We conclude that CBT is efficacious, and a number of enhancement efforts have shown some promise in improving upon CBT in single trials. However, more research is needed, particularly efforts to determine which enhancements work best for which individuals and what are the mechanisms of change. Furthermore, few technological interventions have been compared to active treatments. Finally, much more attention needs to be paid to ethnic and racial diversity in randomized controlled trials.

Character virtues prospectively predict responses to situational stressors in daily life in clinical and subclinical samples.

BACKGROUND: Character strengths and virtues may shape responses to stressors and risk for anxious and depressive distress. However, most studies have relied on cross-sectional designs, and it remains unclear whether virtues directly predict distress in daily life or buffer context-specific stressors. We tested whether higher-order intellectual (inquisitiveness), intrapersonal (self-control), and interpersonal virtues (caring) prospectively predicted coping responses and lower symptoms, and moderated effects of specific stressors on distress. METHODS: Treatment-seeking individuals diagnosed with anxiety/depression (N = 81; Study 1) and students (N = 112; Study 2) completed the VIA Inventory of Strengths survey at baseline, then experience-sampling of daily symptoms and situational responses (perceptions and/or coping strategies) over seven days (Study 1) or five weeks (Study 2). RESULTS: Multilevel models generally linked virtues to more adaptive daily responses during individuals' worst and best daily events (Study 1) and worst events (Study 2), but inquisitiveness unexpectedly predicted higher symptoms in both studies. Additionally, virtues buffered against the within-person effects of specific stressor perceptions on distress (Study 2). CONCLUSIONS: The relevance of character virtues for anxiety, stress, and coping may be complex, predicting higher or lower symptoms depending on both the virtue and the situational context.

Does depression in multiple sclerosis mediate effects of cognitive functioning on quality of life?

PURPOSE: Patients with multiple sclerosis (MS) are at significant risk for decreased quality of life (QoL), in part due to factors such as cognitive impairment and depression. However, objective versus subjective assessments of cognitive functioning may differentially predict QoL, and it remains unknown whether they each impact QoL through levels of depression. The aims of the present study included (1) testing the effects of cognitive impairment on MS-related QoL via depression symptoms and (2) examining whether perceived and objective cognitive functioning differentially predict QoL through depression. METHODS: Patients formally diagnosed with MS (N = 128) participated in cognitive assessment (Brief International Cognitive Assessment for Multiple Sclerosis) and completed self-report measures of perceived cognitive functioning (perceived deficits questionnaire), depression (Hospital Anxiety and Depression Scale), and MS-related QoL (functional assessment of multiple sclerosis). RESULTS: Mediational hypotheses were tested by regression and structural equation modeling. As hypothesized, both perceived and objective cognitive functioning independently predicted lower QoL controlling for the effects of depression (p < 0.001). Consistent with hypotheses, depression mediated effects of both perceived (95% CI [0.31, 0.68]) and objective cognitive functioning (95% CI [0.09, 6.96]) on QoL when tested in separate models. However, when both predictors were modeled simultaneously, depression only mediated the effects of perceived (not objective) cognitive functioning (95% CI for standardized effect [0.10, 0.61]). CONCLUSIONS: This study, thus, suggests the need to conceptualize different pathways by which objective and subjective cognitive impairment may shape QoL in the lives of individuals with MS.

Disgust uniquely predicts coping and interpersonal processes beyond anxiety and dysphoria in the context of naturalistic stressors.

BACKGROUND: Disgust is theorized to serve a unique function of motivating avoidance of noxious stimuli and setting interpersonal boundaries to prevent contamination. Research has established the relevance of disgust to OCD, posttraumatic stress, and phobias, suggesting transdiagnostic features. However, research has not always accounted for overlap of disgust with other negative emotions, obscuring unique contributions. Moreover, studies have not disentangled between-person (mean levels) and within-person (state) effects. The present study examined within- and between-person relationships of disgust, anxiety, and dysphoria with responses to daily social stressors. We expected disgust would uniquely predict cognitive avoidance and boundary-setting interpersonal behavior. METHOD: Individuals (N = 159) meeting ADIS-V anxiety/depressive disorder criteria (n = 55) and healthy controls (n = 104) completed online journals about naturalistic social stressors over five weeks (1,923 records), reporting disgust, anxiety, dysphoria, and responses to social stressors. RESULTS: As expected, disgust uniquely predicted lower acceptance, greater thought suppression, greater self-assertion, and less prosocial behavior, above and beyond anxiety and dysphoria. Several disgust effects were present at both between- and within-person levels, suggesting the relevance of both mean disgust and state fluctuations. CONCLUSIONS: Results demonstrate unique relevance of disgust for how individuals respond to social stressors.

Big five traits and interpersonal goals during stressors as predictors of hair cortisol.

Background: Hair cortisol concentrations (HCC) provide a biomarker for stress adaptation, which has downstream health consequences. Personality traits (e.g., neuroticism) and social processes (e.g., chronic interpersonal goals) may confer risk or buffer against dysregulated cortisol secretion. However, few studies have examined personality or interpersonal factors predicting hair cortisol, which estimates longer-term secretion and therefore provides a potential biomarker for studying trait-like psychological processes. The present study investigated effects of personality traits and daily interpersonal goals during stressors on HCC. Method: Participants (N = 90) reported Big Five traits at baseline, recorded interpersonal (self-image and compassionate) goals pursued during their worst psychosocial stressors for 4-5 weeks (1,949 entries), then provided a hair sample to estimate cortisol secretion over the past two months. Results: As hypothesized, neuroticism predicted higher HCC, beyond other Big Five traits (b = 7.45, SE = 3.36, p = .029). Moreover, this effect was greater for those chronically striving to promote/protect one's self-image during psychosocial stressors (b = 14.53, SE = 4.72, p = .003), and for those low in conscientiousness (b = 14.84, SE = 4.83, p = .003). Moderate extraversion was associated with higher HCC. Striving to support others (compassionate goals) exerted no direct or interactive effect on HCC, contrary to hypotheses. Conclusions: Results support the relevance of neuroticism and maladaptive interpersonal strivings to longer-term neuroendocrine responses, suggesting hair cortisol as a potential method for studying links of trait-like psychological and HPA processes.

Gratitude is positively associated with quality of life in multiple sclerosis.

PURPOSE/OBJECTIVE: Individuals diagnosed with multiple sclerosis (MS) often experience decreased quality of life (QoL), in part attributable to fatigue, depression (Benedict et al., 2005), and cognitive dysfunction (Cutajar et al., 2000). Beyond these well-established predictors, the positive trait of gratitude-attentiveness to positive features in one's life-has predicted QoL in the context of other chronic illnesses. However, relatively little research has examined the relevance of gratitude as a contributor to QoL in MS. The purpose of the present study was (a) to test whether trait gratitude would predict QoL in MS, above and beyond known predictors (e.g., perceived and objectively assessed cognitive dysfunction, fatigue, and depression symptoms), and (b) to test whether gratitude would buffer (i.e., moderate) the effects of these predictors on QoL. Research Method/Design: This study employed a cross-sectional, single time-point design. Participants formally diagnosed with MS (N = 128) completed a short battery to assess cognitive function and self-report measures of depression, fatigue, perceived cognitive functioning, gratitude, and QoL. RESULTS: Consistent with hypotheses, gratitude uniquely predicted higher QoL beyond other predictors. In addition, gratitude buffered the effect of objective cognitive performance on QoL as expected, but did not interact with other predictors. CONCLUSIONS/IMPLICATIONS: These results suggest the need for further research into gratitude as a potential source of resilience for individuals with MS. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Direct and Indirect Effects of Trait and State Gratitude on Health-Related Quality of Life in a Prospective Design.

Gratitude has been consistently linked to well-being, but its influence on health-related functioning is not well understood. Furthermore, research suggests the need to differentiate between-person and within-person effects of personality characteristics, and research on gratitude and health has not typically done so. This prospective study aimed to (1) differentiate the unique effects of trait and state gratitude on health-related quality of life (HRQoL) and (2) test state gratitude as a mediator between baseline trait gratitude and subsequent HRQoL. Undergraduate participants (N = 141) completed a trait gratitude measure at baseline and then repeated measures of weekly state gratitude and HRQoL over eight weeks. Multilevel models examined baseline trait gratitude, state gratitude averaged across the study (person aggregate) as between-person individual differences, and within-person variability in state gratitude (person-centered) as predictors of HRQoL, as well as the indirect effect of trait gratitude on HRQoL via state gratitude. Greater aggregate and person-centered state gratitude each predicted higher HRQoL. Baseline trait gratitude did not have a significant direct effect but prospectively predicted higher HRQoL via higher weekly state gratitude. Results suggest that understanding effects of gratitude on health-related perceptions requires accounting for both between-person individual differences and within-person fluctuation in state gratitude.

Compassionate and self-image goals as interpersonal maintenance factors in clinical depression and anxiety.

OBJECTIVE: Interpersonal models of depression and anxiety have not examined the role of interpersonal goals in shaping relationships and symptoms. Striving to promote/protect desired self-images (self-image goals) may undermine relationships and increase symptoms, whereas striving to support others (compassionate goals) may be protective, but clinical relevance is unknown. METHOD: We tested effects of compassionate versus self-image goals on interpersonal functioning and symptoms in clinically depressed and/or anxious participants (N = 47) during 10 days of experience sampling, over a 6-week follow-up, and in a dyadic relationship. RESULTS: Participants reported higher conflict and symptoms on days that they most pursued self-image goals, but noted higher perceived support and lower symptoms when pursuing compassionate goals. Goals prospectively predicted symptom changes 6 weeks later. Lastly, informant-rated interpersonal goals predicted relationship satisfaction of both patients and significant others. CONCLUSION: Results suggest the relevance of self-image and compassionate goals for the interpersonal maintenance of depression and anxiety.

Mediators of compassionate goal intervention effects on human neuroendocrine responses to the Trier Social Stress Test.

OBJECTIVES: The hypothalamic-pituitary-adrenal (HPA) axis is thought to mediate the effects of stress on illness. Research has identified a limited number of psychological variables that modulate human HPA responses to stressors (e.g. perceived control and social support). Prosocial goals can reduce subjective stress, but have not been carefully examined in experimental settings where pathways of impact on biological stress markers may be traced. Recent work demonstrated that coaching individuals to strive to help others reduced HPA responses to the Trier Social Stress Test (TSST) relative to other cognitive interventions. However, identification of mediational pathways, which were not examined in the original study, is necessary to determine whether the HPA buffering effects were due to helping motivations (compassionate goals; CGs) rather than via previously identified variables such as control or support. METHODS: In this new analysis, we combined the original cortisol data with novel observer ratings of interpersonal behavior and psychological variables during the stress task, and conducted new, theory-driven analyses to determine psychological mediators for the intervention's effect on cortisol responses (N = 54; 21 females, 33 males; 486 cortisol samples). RESULTS: Control, support, and task ego-threat failed to account for the effects of the intervention. As hypothesized, self and observer-rated CGs, as well as observer-rated perceptions of participants' interpersonal behavior as morally desirable (but not as dominant or affiliative) were significant mediators of neuroendocrine responses. CONCLUSIONS: The findings suggest that stress-reduction interventions based on prosocial behavior should target particular motivational and interpersonal features.

Prospective Investigation of the Contrast Avoidance Model of Generalized Anxiety and Worry.

The factors that maintain generalized anxiety disorder (GAD) symptoms and worry over time are not entirely clear. The Contrast Avoidance Model (CAM) postulates that individuals at risk for pathological worry and GAD symptoms uniquely fear emotional shifts from neutral or positive emotions into negative emotional states, and consequently use worry to maintain negative emotion in order to avoid shifts or blunt the effect of negative contrasts. This model has received support in laboratory experiments, but has not been investigated prospectively in the naturalistic context of daily life. The present study tested the CAM in a longitudinal experience sampling study with a subclinical sample. Participants selected to represent a broad range of symptoms (N = 92) completed baseline measures of GAD and depression symptoms, and eight weekly assessments of worry, experiences of negative emotional contrasts during their worst event of the week, and situation-specific negative emotion. Consistent with the CAM, GAD symptoms prospectively predicted higher endorsement of negative contrast experiences as worst events, independent of depression symptoms. Unsurprisingly, higher negative contrasts predicted higher negative emotion. However, both higher baseline GAD symptoms and weekly worry uniquely moderated (reduced) this relationship, providing consistent support for the idea that worry may blunt the emotional effects of contrasts. Depression symptoms did not have the same moderating effect. These findings support the CAM in an ecologically valid context.

Interpersonal Problems Predict Differential Response to Cognitive Versus Behavioral Treatment in a Randomized Controlled Trial.

OBJECTIVE: We examined dimensional interpersonal problems as moderators of cognitive behavioral therapy (CBT) versus its components (cognitive therapy [CT] and behavioral therapy [BT]). We predicted that people with generalized anxiety disorder (GAD) whose interpersonal problems reflected more dominance and intrusiveness would respond best to a relaxation-based BT compared to CT or CBT, based on studies showing that people with personality features associated with a need for autonomy respond best to treatments that are more experiential, concrete, and self-directed compared to therapies involving abstract analysis of one's problems (e.g., containing CT). METHOD: This was a secondary analysis of Borkovec, Newman, Pincus, and Lytle (2002). Forty-seven participants with principal diagnoses of GAD were assigned randomly to combined CBT (n = 16), CT (n = 15), or BT (n = 16). RESULTS: As predicted, compared to participants with less intrusiveness, those with dimensionally more intrusiveness responded with greater GAD symptom reduction to BT than to CBT at posttreatment and greater change to BT than to CT or CBT across all follow-up points. Similarly, those with more dominance responded better to BT compared to CT and CBT at all follow-up points. Additionally, being overly nurturant at baseline was associated with GAD symptoms at baseline, post, and all follow-up time-points regardless of therapy condition. CONCLUSIONS: Generally anxious individuals with domineering and intrusive problems associated with higher need for control may respond better to experiential behavioral interventions than to cognitive interventions, which may be perceived as a direct challenge of their perceptions.

Somatic Symptoms Mediate the Relationship Between Health Anxiety and Health-Related Quality of Life over Eight Weeks.

Previous research has indicated that at clinical levels, health anxiety is cross-sectionally correlated with both somatic symptoms and health-related quality of life (HRQOL). However, research has not tested mediational models of how health anxiety may lead to diminished HRQOL prospectively, and more broadly outside of clinical contexts. In the context of an eight-week prospective diary study of 118 subclinical adults, we examined whether somatic symptoms mediate the relationship between health anxiety and both same-week HRQOL and week-to-week change in HRQOL. Multilevel modelling indicated that somatic symptoms fully mediated the relationship between HA and HRQOL concurrently and over time. Even after accounting for depressive symptoms, individuals who were predisposed to experience illness preoccupation and oversensitivity to bodily sensations were at risk for higher somatic symptoms and thereby poorer levels of perceived health. Thus, both health anxiety and somatic symptoms may be an important target for interventions seeking to improve HRQOL in subclinical populations. Copyright © 2016 John Wiley & Sons, Ltd.

Shifts in Attitudes, Knowledge, and Social Goals in Nursing Students Following Structured Contact With Community-Dwelling Older Adults.

BACKGROUND: Traditional nursing pedagogies have not systematically addressed the ageist perspectives students bring into training that threaten competent care for older adults. The current study evaluated nursing students' shifts in attitudes, knowledge about aging, and social goals during a program of repeated and structured social interactions with community-dwelling older adults. METHOD: Beginning nursing students in pairs met with high-functioning older adults four times over 8 months to provide brief health promotion activities. Students' knowledge and attitudes on aging were assessed at baseline and prior to each visit; social goals were assessed after each visit. RESULTS: Multilevel growth curves revealed increases in students' knowledge about aging and positive views on caring for older adults. Motivation to help older adults (i.e., compassionate goals) did not change, but students' motivation to defend their competence (i.e., self-image goals) declined. CONCLUSION: A relational contact-based program may shift knowledge, attitudes, and social goals in nursing students, complementing traditional classroom nursing education. [J Nurs Educ. 2016;55(10):569-573.].

Does Worrying Mean Caring Too Much? Interpersonal Prototypicality of Dimensional Worry Controlling for Social Anxiety and Depressive Symptoms.

Worry, social anxiety, and depressive symptoms are dimensions that have each been linked to heterogeneous problems in interpersonal functioning. However, the relationships between these symptoms and interpersonal difficulties remain unclear given that most studies have examined diagnostic categories, not accounted for symptoms' shared variability due to general distress, and investigated only interpersonal problems (neglecting interpersonal traits, interpersonal goals, social behavior in daily life, and reports of significant others). To address these issues, students (Study 1; N=282) endorsed symptoms and interpersonal circumplex measures of traits and problems, as well as event-contingent social behaviors during one week of naturalistic daily interactions (N=184; 7,036 records). Additionally, depressed and anxious patients (N=47) reported symptoms and interpersonal goals in a dyadic relationship, and significant others rated patients' interpersonal goals and impact (Study 2). We derived hypotheses about prototypical interpersonal features from theories about the functions of particular symptoms and social behaviors. As expected, worry was uniquely associated with prototypically affiliative tendencies across all self-report measures in both samples, but predicted impacting significant others in unaffiliative ways. As also hypothesized, social anxiety was uniquely and prototypically associated with low dominance across measures, and general distress was associated with cold-submissive tendencies. Findings for depressive symptoms provided less consistent evidence for unique prototypical interpersonal features. Overall, results suggest the importance of multimethod assessment and accounting for general distress in interpersonal models of worry, social anxiety, and depressive symptoms.

Ambivalence About Interpersonal Problems and Traits Predicts Cross-Situational Variability of Social Behavior.

Multiple theoretical perspectives suggest that maladjusted personality is characterized by not only distress, but also opposing or "ambivalent" self-perceptions and behavioral lability across social interactions. However, the degree to which ambivalence about oneself predicts cross-situational variability in social behavior has not been examined empirically. Using the interpersonal circumplex (IPC) as a nomological framework, the present study investigated the extent to which endorsing opposing or "ambivalent" tendencies on IPC measures predicted variability in social behavior across a range of hypothetical interpersonal scenarios (Part 1; N = 288) and naturalistic social interactions (Part 2; N = 192). Ambivalent responding for interpersonal problems and traits was associated with measures of distress, maladaptive interpersonal tendencies, and greater variability of social behavior across both hypothetical and daily social interactions, though more consistently for interpersonal problems. More conservative tests suggested that ambivalence predicted some indexes of behavioral variability even when accounting for mean levels and squared means of social behaviors, vector length, gender, and depressive symptoms. Results suggest that processes theorized as typifying personality disorder may apply more broadly to personality maladjustment occurring outside of clinical samples.

Brief cognitive intervention can modulate neuroendocrine stress responses to the Trier Social Stress Test: buffering effects of a compassionate goal orientation.

BACKGROUND: The hypothalamic-pituitary-adrenal (HPA) axis is a critical mediator linking stress to health. Understanding how to modulate its reactivity could potentially help reduce the detrimental health effects of HPA axis activation. Social evaluative threat is a potent activator of this system. Access to control and coping responses can reduce its reactivity to pharmacological activation. Compassionate or affiliative behaviors may also moderate stress reactivity. Impact of these moderators on social evaluative threat is unknown. Here, we tested the hypotheses that interventions to increase control, coping, or compassionate (versus competitive) goals could reduce HPA-axis response to social evaluative threat. METHODS: Healthy participants (n=54) were exposed to social evaluative threat using the Trier Social Stress Test (TSST). They were randomly assigned to receive one of four different instructions prior to the stressor: Standard TSST instructions (SI), standard instructions with access to "control" (SI Control), or one of two cognitive interventions (CI) that (1) increased familiarity and helped participants prepare coping strategies (CI Coping), or (2) shifted goal orientation from self-promotion to helping others (CI Compassionate Goals). ACTH and cortisol were obtained before and after stress exposure via intravenous catheter. RESULTS: Control alone had no effect. CI Compassionate Goals significantly reduced ACTH and cortisol responses to the TSST; CI Coping raised baseline levels. Compassionate Goals reduced hormonal responses without reducing subjective anxiety, stress or fear, while increasing expression of pro-social intentions and focus on helping others. CONCLUSIONS: Brief intervention to shift focus from competitive self-promotion to a goal orientation of helping-others can reduce HPA-axis activation to a potent psychosocial stressor. This supports the potential for developing brief interventions as inoculation tools to reduce the impact of predictable stressors and lends support to growing evidence that compassion and altruistic goals can moderate the effects of stress.

A pilot study of group mindfulness-based cognitive therapy (MBCT) for combat veterans with posttraumatic stress disorder (PTSD).

BACKGROUND: "Mindfulness-based" interventions show promise for stress reduction in general medical conditions, and initial evidence suggests that they are accepted in trauma-exposed individuals. Mindfulness-based cognitive therapy (MBCT) shows substantial efficacy for prevention of depression relapse, but it has been less studied in anxiety disorders. This study investigated the feasibility, acceptability, and clinical outcomes of an MBCT group intervention adapted for combat posttraumatic stress disorder (PTSD). METHODS: Consecutive patients seeking treatment for chronic PTSD at a VA outpatient clinic were enrolled in 8-week MBCT groups, modified for PTSD (four groups, n = 20) or brief treatment-as-usual (TAU) comparison group interventions (three groups, n = 17). Pre and posttherapy psychological assessments with clinician administered PTSD scale (CAPS) were performed with all patients, and self-report measures (PTSD diagnostic scale, PDS, and posttraumatic cognitions inventory, PTCI) were administered in the MBCT group. RESULTS: Intent to treat analyses showed significant improvement in PTSD (CAPS (t(19) = 4.8, P < .001)) in the MBCT condition but not the TAU conditions, and a significant Condition × Time interaction (F[1,35] = 16.4, P < .005). MBCT completers (n = 15, 75%) showed good compliance with assigned homework exercises, and significant and clinically meaningful improvement in PTSD symptom severity on posttreatment assessment in CAPS and PDS (particularly in avoidance/numbing symptoms), and reduced PTSD-relevant cognitions in PTCI (self blame). CONCLUSIONS: These data suggest group MBCT as an acceptable brief intervention/adjunctive therapy for combat PTSD, with potential for reducing avoidance symptom cluster and PTSD cognitions. Further studies are needed to examine efficacy in a randomized controlled design and to identify factors influencing acceptability and efficacy.

Worry and generalized anxiety disorder: a review and theoretical synthesis of evidence on nature, etiology, mechanisms, and treatment.

Generalized anxiety disorder (GAD) is associated with substantial personal and societal cost yet is the least successfully treated of the anxiety disorders. In this review, research on clinical features, boundary issues, and naturalistic course, as well as risk factors and maintaining mechanisms (cognitive, biological, neural, interpersonal, and developmental), are presented. A synthesis of these data points to a central role of emotional hyperreactivity, sensitivity to contrasting emotions, and dysfunctional attempts to cope with strong emotional shifts via worry. Consistent with the Contrast Avoidance model, evidence shows that worry evokes and sustains negative affect, thereby precluding sharp increases in negative emotion. We also review current treatment paradigms and suggest how the Contrast Avoidance model may help to target key fears and avoidance tendencies that serve to maintain pathology in GAD.