Performance-based attentional control, but not self-reported attentional control, predicts changes in depressive symptoms in short-term psychotherapy.

OBJECTIVE: Although impairments in attentional control are pervasive across psychopathology, there is substantial individual differences. In the current study, we examined whether individual differences in self-reported and performance-based measures of attentional control predict changes in depressive symptoms and well-being in a diagnostically diverse sample of patients attending a CBT-based partial hospital program. METHOD: Participants were 89 patients (56.2% men, 75.3% non-Hispanic White). At baseline, patients completed the self-reported Attentional Control Scale and the Rapid Serial Visual Presentation task (RSVP), a behavioral measure of attentional control. Depressive symptoms were assessed daily using the Patient Health Questionnaire and well-being was assessed using the Mental Health Continuum Short Form. RESULTS: On average, greater self-reported attentional control was significantly associated with lower depressive symptoms, ß = -0.49, t(52) = 4.84, p < .001, 95% CIs [-0.69, -0.29], and greater well-being, ß = 0.45, t(53) = 3.90, p < .001, 95% CIs [0.22, 0.67]. More accurate task-based performance was associated with a decline in depressive symptoms over time, ß = -0.02, t(32) = 2.50, p = .02, 95% CIs [-0.04, -0.01]. Neither self-reported nor performance-based measures of attentional control predicted changes in well-being. Finally, exploratory analyses suggest that depressive symptoms also improved over time for individuals who underestimated self-reported attentional control abilities relative to task-based performance, ß = -0.19, t(32) = 2.23, p = .03, 95% CIs [-0.36, -0.02]. CONCLUSIONS: Results suggest that performance-based attentional control may be an important target for assessment and intervention, as well as a potential mechanism underlying risk and recovery.

Measuring attentional blink magnitude: Reliability and validity of a novel single-target rapid serial visual presentation task index in a psychiatric sample.

Rapid serial visual presentation (RSVP) tasks have been frequently used to assess attentional control in psychiatric samples; however, it is unclear whether RSVP tasks exhibits the psychometric properties necessary to assess these individual differences. In the current study, we examined the reliability and validity of single-target computerized RSVP task outcomes in a sample of 63 participants with moderate to severe psychiatric illness. At the group level, we observed the classical attentional blink phenomenon. At the individual level, conventional indices of attentional blink magnitude exhibited poor internal consistency. We empirically evaluated a novel index for assessing attentional blink magnitude using a single-target RSVP task that involves collapsing across experimental trials in which the attentional blink phenomenon occurs and disregarding performance on control trials, which suffer from ceiling effects. We found that this new index resulted in much improved reliability estimates. Both novel and conventional indices provided evidence of convergent validity. Consequently, this novel index may be worth examining and adopting for researchers interested in assessing individual differences in attentional blink magnitude.

Investigating corroboration of self-perceived posttraumatic growth among Sri Lankan Tamil survivors of ethnopolitical warfare through trait, domain, and profile agreement approaches.

Though research on assessing posttraumatic growth has been severely critiqued, some evidence suggests close others can observe and report changes in individuals following traumatic life events and are sensitive to idiosyncratic ways in which changes manifest. We extended these findings by investigating corroboration of self-perceived posttraumatic growth (PTG) and depreciation (PTD) as measured by the Posttraumatic Growth Inventory-42 (PTGI-42) among Sri Lankan Tamil war survivors (n = 200). Informants slightly corroborated overall levels of PTG and PTD, while a more nuanced profile analysis procedure revealed overall-but not distinctive-profile agreement. This suggests self-other agreement is modest and may partly reflect shared narratives and collective cultural understandings about how people change after trauma. Results demonstrate further that informants were not sensitive to idiosyncratic ways in which target individuals had changed. Together, the lack of validity evidence suggests that the PTGI-42 may be inadequate in some cross-cultural contexts as a measure of nuanced posttraumatic change (i.e., as a measure of specific changes in the five theorized domains of growth and depreciation). Future work should emphasize culture- and context-sensitive measurement of posttraumatic change, particularly focusing on methods other than retrospective self-reports, such as prospective longitudinal designs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Personalized prescriptions of therapeutic skills from patient characteristics: An ecological momentary assessment approach.

OBJECTIVE: Rather than relying on a single psychotherapeutic orientation, most clinicians draw from a range of therapeutic approaches to treat their clients. To date, no data-driven approach exists for personalized predictions of which skill domain would be most therapeutically beneficial for a given patient. The present study combined ecological momentary assessment (EMA) and machine learning to test a data-driven approach for predicting patient-specific skill-outcome associations. METHOD: Fifty (Mage = 37 years old, 54% female, 84% White) adults received training in behavioral therapy (BT) and dialectical behavior therapy (DBT) skills within a behavioral health partial hospital program (PHP). Following discharge, patients received four EMA surveys per day for 2 weeks (total observations = 2,036) assessing the use of therapeutic skills and positive/negative affect (PA/NA). Clinical and demographic characteristics were submitted to elastic net regularization to predict, via cross-validation, patient-specific associations between the use of BT versus DBT skills and level of PA/NA. RESULTS: Cross-validated accuracy was 81% (sensitivity = 93% and specificity = 63%) in predicting whether a patient would exhibit a stronger association between the use of BT versus DBT skills and PA level. Predictors of positive DBT skills-PA associations included higher levels of nonsuicidal self-injury (NSSI) and sleep disturbance, whereas predictors of positive BT skills-PA relations included higher emotional lability and anxiety disorder comorbidity, and lower psychomotor retardation/agitation and worthlessness/guilt. Corresponding models with NA yielded no predictors. CONCLUSIONS: Findings from this initial proof-of-concept study highlight the potential of data-driven approaches to inform personalized prescriptions of which skill domains may be most therapeutically beneficial for a given patient. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Clarifying the Content of Intellectual Humility: A Systematic Review and Integrative Framework.

During the last decade, intellectual humility has gone from a topic of philosophical inquiry to one of serious scientific investigation. It has been variously described as a remedy for political polarization, a tool for advancing scientific credibility, and a disposition that promotes learning. However, less attention has been paid to how intellectual humility has been defined and measured or how well psychologists' definitions and measures align with one another or with philosophers' accounts. Through a systematic review of empirical intellectual humility research, we identified 18 separate definitions and 20 measures including16 unique questionnaires. We then synthesized this research to advance a new framework of intellectual humility. Implications of this framework for measurement and future research on intellectual humility are discussed.

Predictors of affect following discharge from partial hospitalization: a two-week ecological momentary assessment study.

BACKGROUND: Little is known about the everyday experiences of individuals transitioning from acute to outpatient psychiatric care, an important period of risk for mood symptom relapse. This study used ecological momentary assessment (EMA) to examine whether specific daily experiences were related to momentary affective states following discharge from a partial hospitalization program (PHP). METHODS: A sample of 114 adults (Mage = 36 years old, 52% female, 83% White) completed four brief EMA surveys every day for 2 weeks assessing intensity/type of stressful events and social contact, as well as positive/negative affect (PA/NA). Half of participants reported therapeutic skills use. RESULTS: Stress severity ratings prospectively predicted increased NA. NA predicted spending less time with close relationships. However, interacting with close relationships predicted increased positive affect (PA). Finally, PA predicted spending time with more people. The use of two skills (behavioral activation and interpersonal effectiveness) was concurrently, but not prospectively, associated with improved affect. CONCLUSIONS: Examining daily experiences of individuals discharging from partial hospitalization provides important information about factors that may influence affective states during the transition from acute to outpatient care. Findings from this study can be used to help prepare patients for discharge and develop interventions for the post-acute period.

Post-traumatic growth as positive personality change: Challenges, opportunities, and recommendations.

OBJECTIVE: Post-traumatic growth typically refers to enduring positive psychological change experienced as a result of adversity, trauma, or highly challenging life circumstances. Critics have challenged insights from much of the prior research on this topic, pinpointing its significant methodological limitations. In response to these critiques, we propose that post-traumatic growth can be more accurately captured in terms of personality change-an approach that affords a more rigorous examination of the phenomenon. METHOD: We outline a set of conceptual and methodological questions and considerations for future work on the topic of post-traumatic growth. RESULTS: We provide a series of recommendations for researchers from across the disciplines of clinical/counseling, developmental, health, personality, and social psychology and beyond, who are interested in improving the quality of research examining resilience and growth in the context of adversity. CONCLUSION: We are hopeful that these recommendations will pave the way for a more accurate understanding of the ubiquity, durability, and causal processes underlying post-traumatic growth.

Factor structure and concurrent validity of the Cognitive Fusion Questionnaire (CFQ) in a sample of Somali immigrants living in North America.

The process of resettlement in a new country and culture is commonly one of intense stress. Somali immigrants and refugees living in North America represent a large ethnocultural group navigating the complexities of forced displacement and resettlement. Despite the immense resilience exhibited by Somali communities in resettlement, the behavioral health needs of these communities require effective and culturally appropriate psychological assessment tools that can be used across service and research sectors. Given this need, we sought to examine the psychometric properties and concurrent validity of the Cognitive Fusion Questionnaire (CFQ), a transdiagnostic measure of cognitive fusion, in a sample of 233 (M age = 25.35; female = 45%) Somali young adults living in North America. Results using confirmatory factor analysis demonstrated that the one-factor structure of the CFQ previously found in other diverse populations held in the present sample. The structure and related item loadings were invariant across three key variables: gender, age, and location of resettlement in North America. Importantly, cognitive fusion was meaningfully associated with aspects of clinical and psychosocial functioning thought to be highly relevant to this population, including posttraumatic stress, anxiety, and depression symptoms, thwarted belongingness and perceived burdensomeness, and experiences of discrimination. Building upon the growing body of evidence supporting the CFQ's strong psychometric properties across cultural groups, researchers, and clinicians should have an added degree of confidence and enthusiasm in utilizing this measure to support immigrant and refugee communities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Personalized prognostic prediction of treatment outcome for depressed patients in a naturalistic psychiatric hospital setting: A comparison of machine learning approaches.

OBJECTIVE: Research on predictors of treatment outcome in depression has largely derived from randomized clinical trials involving strict standardization of treatments, stringent patient exclusion criteria, and careful selection and supervision of study clinicians. The extent to which findings from such studies generalize to naturalistic psychiatric settings is unclear. This study sought to predict depression outcomes for patients seeking treatment within an intensive psychiatric hospital setting and while comparing the performance of a range of machine learning approaches. METHOD: Depressed patients (N = 484; ages 18-72; 89% White) receiving treatment within a psychiatric partial hospital program delivering pharmacotherapy and cognitive behavioral therapy were split into a training sample and holdout sample. First, within the training sample, 51 pretreatment variables were submitted to 13 machine learning algorithms to predict, via cross-validation, posttreatment Patient Health Questionnaire-9 depression scores. Second, the best performing modeling approach (lowest mean squared error; MSE) from the training sample was selected to predict outcome in the holdout sample. RESULTS: The best performing model in the training sample was elastic net regularization (ENR; MSE = 20.49, R2 = .28), which had comparable performance in the holdout sample (MSE = 11.26; R2 = .38). There were 14 pretreatment variables that predicted outcome. To demonstrate the translation of an ENR model to personalized prediction of treatment outcome, a patient-specific prognosis calculator is presented. CONCLUSIONS: Informed by pretreatment patient characteristics, such predictive models could be used to communicate prognosis to clinicians and to guide treatment planning. Identified predictors of poor prognosis may suggest important targets for intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Smartphone, Social Media, and Mental Health App Use in an Acute Transdiagnostic Psychiatric Sample.

BACKGROUND: Despite high rates of smartphone ownership in psychiatric populations, there are very little data available characterizing smartphone use in individuals with mental illness. In particular, few studies have examined the interest and use of smartphones to support mental health. OBJECTIVE: This study aimed to (1) characterize general smartphone app and social media usage in an acute transdiagnostic psychiatric sample with high smartphone ownership, (2) characterize current engagement and interest in the use of smartphone apps to support mental health, and (3) test demographic and clinical predictors of smartphone use. METHODS: The survey was completed by all patients attending an adult partial hospital program, with no exclusion criteria. The primary outcomes were frequency of use of general and mental health smartphone apps (smartphone use survey) and the frequency of social media use and phone-checking behavior (mobile technology engagement scale). RESULTS: Overall, 322 patients (aged mean 33.49, SD 13.87 years; 57% female) reported that their most frequently used app functions were texting, email, and social media. Younger individuals reported more frequent use across most types of apps. Baseline depression and anxiety symptoms were not associated with the frequency of app use. Participants reported health care, calendar, and texting apps as most supportive of their mental health and social media apps as most negatively affecting their mental health. Most patients reported an interest in (73.9% [238/322]) and willingness to use (81.3% [262/322]) a smartphone app to monitor their mental health condition. Less than half (44%) of the patients currently had a mental health app downloaded on their smartphone, with mindfulness and meditation apps being the most common type. CONCLUSIONS: The high interest in and willingness to use mental health apps, paired with the only moderate current reported usage, indicate a potential unmet treatment opportunity in psychiatric populations. There is potential to optimize non-mental health-specific apps to better support the needs of those with mental illness and to design a new wave of mental health apps that match the needs of these populations as well as the way they use smartphones in daily life.

Examining differential relationships among self-reported attentional control, depression, and anxiety in a transdiagnostic clinical sample.

BACKGROUND: Poor attentional control, defined as difficulty focusing attention on a task or shifting attention flexibly between tasks, is a transdiagnostic construct theorized to confer risk for, and maintain, depression and anxiety. Research to date in non-clinical samples has suggested a dissociable relationship between the two factors of self-reported attentional control and psychopathology, with depression being associated with difficulties shifting and anxiety being associated with focusing. However, to our knowledge no study has tested this differential set of relationships in a clinical sample. METHODS: Adults (N = 493) presenting for psychiatric treatment completed measures of depressive and anxiety symptom severity and self-reported attentional control. Hierarchical linear regression and Zou's (2007) confidence interval method were used to examine the relationship between clinical symptoms and attentional control. RESULTS: Both shifting and focusing were significantly correlated with anxiety and depressive symptoms in this sample. However, focusing was more strongly associated with clinical symptomatology than shifting, which showed a weak correlation. LIMITATIONS: All constructs were measured cross-sectionally by self-report questionnaires. CONCLUSIONS: In contrast to studies conducted in non-clinical samples, attentional focusing appears to be more relevant than attentional shifting in a clinical sample for both depression and anxiety symptoms. These findings lend support to efforts to develop neurocognitive interventions that improve focusing. Replication of these findings, particularly in longitudinal studies, is warranted.

Changes in daily manifestations of Openness to Experience during intensive cognitive-behavioral treatment.

OBJECTIVE: Research examining relationships between trait Openness to Experience, psychopathology, and well-being has produced contradictory findings. Examining temporary manifestations of Openness may provide further insight into the interplay between Openness and symptoms in clinical populations. METHOD: The present study validated a brief new measure to assess daily Openness in 271 adults (Mage = 34 years, 52% women, 83% White) taking part in 7 days of intensive treatment for acute psychopathology. Participants also completed a daily measure of depressive symptoms. RESULTS: Participants overall experienced a significant but small increase in daily Openness during treatment. Two latent classes best characterized initial levels and trajectories of Openness in this sample: medium/increase (86% of sample) and low/decrease (14%). Daily Openness negatively related to depressive symptoms over the entire course of treatment and at the daily level. Daily Openness, however, did not predict depressive symptoms from one day to the next (or vice versa). CONCLUSIONS: Results of this study contribute to the scientific understanding of positive personality change during challenging life circumstances. Future research could examine whether targeting Openness as part of treatment holds clinical value. Findings are limited by this study's short time frame and the lack of ethnoracial diversity in this sample.

Effectiveness of a brief adjunctive yoga intervention for short-term mood and psychiatric symptom change during partial hospitalization.

OBJECTIVE: Evidence concerning the effectiveness of yoga in partial hospital programs is limited. Yet, partial hospitals provide treatment at a critical juncture by bridging inpatient and outpatient care. The present study tested the effectiveness of a single-session group yoga intervention for short-term mood and psychiatric symptom change in participants attending a 1- to 2-week partial hospital program. METHOD: Participants included 104 partial hospital patients who participated in the single-session yoga intervention and completed a measure of positive/negative affect before and after the group. Participants, as well as partial hospital patients who did not attend the yoga intervention (n = 438), completed measures of depression and anxiety symptoms at admission and discharge from the program. At discharge, they also rated their perceived improvement and the overall quality of the care they received. RESULTS: Participants who attended the yoga intervention experienced significant improvements in positive and negative affect during the group. They did not show greater improvements in symptoms of anxiety or depression over the course of treatment compared to individuals who did not attend the group. Yoga intervention participants nonetheless gave higher ratings to the quality of the care they received. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings demonstrated that attending a single yoga session during partial hospitalization was associated with short-term mood benefits, and with enhanced overall perceptions of treatment. Further research is needed to determine the conditions under which participation in yoga during partial hospitalization could contribute to symptom change in this context. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Turning the UPPS down: Urgency predicts treatment outcome in a partial hospitalization program.

BACKGROUND: Impulsivity in response to negative mood (negative urgency) and positive mood (positive urgency) is common in psychiatric disorders. The aims of this study were to test if urgency predicts treatment response during partial hospitalization in a transdiagnostic sample, and if urgency is malleable over the course of brief treatment. METHOD: Participants (N = 348, 55% female, M age = 32.9) were patients presenting to a CBT-based partial hospitalization program. Urgency and a range of symptoms were assessed with self-report measures during treatment. RESULTS: Higher negative urgency scores predicted worse outcome for depression and anxiety symptoms. Negative urgency (p < .001, Cohen's dz = 0.61) and positive urgency (p < .001, Cohen's dz = 0.39) significantly decreased during treatment. DISCUSSION: Findings suggest that participants report decreases in urgency during brief partial hospitalization treatment. Higher negative urgency predicted poorer treatment response for symptoms of depression and anxiety, demonstrating the need for novel treatments for urgency.

Randomized controlled trial of SecondStory, an intervention targeting posttraumatic growth, with bereaved adults.

OBJECTIVE: People often report positive psychological changes after adversity, a phenomenon known as posttraumatic growth (PTG). Few PTG-focused interventions have been rigorously tested, and measurement strategies have had significant limitations. This study evaluated the effects of a new group-format psychosocial intervention, SecondStory, aimed at facilitating PTG by helping participants make meaning of the past and plan a purposeful future. METHOD: In a randomized controlled trial, adults (N = 112, 64% women) bereaved within 5 years were randomly assigned to SecondStory or an active control, expressive writing. The primary outcome, PTG, was measured using two contrasting methods: the Posttraumatic Growth Inventory, which asks participants retrospectively how much they believe they have changed due to struggling with adversity, and the Current-Standing Posttraumatic Growth Inventory, which tracks quantifiable change in participants' standing in PTG domains over time. Secondary outcomes included depression symptoms, posttraumatic stress symptoms, and life satisfaction. Outcomes were measured at 2-week intervals: pretest, posttest, and three follow-up occasions. Hierarchical linear modeling was used to assess whether SecondStory participants experienced greater gains in primary and/or secondary outcomes over the 8-week trial. RESULTS: Results indicated that SecondStory participants did not show significantly greater improvements than control participants on measures of PTG, posttraumatic stress, or life satisfaction, but they did show greater decreases in depression symptoms by the first follow-up. CONCLUSIONS: These findings suggest that SecondStory may not facilitate PTG more effectively than existing interventions but may be promising for addressing depression. Positive interventions may productively be refined to support people experiencing trauma and loss. (PsycINFO Database Record

Positive beliefs about mental illness: Associations with sex, age, diagnosis, and clinical outcomes.

BACKGROUND: Beliefs about mental illness affect how individuals cope with their symptoms. Positive beliefs about mental illness (PBMI) refer to perceptions of positive attributes individuals may identify in their illness, such as beneficial consequences, enhanced creativity or cognition, or growth through adversity. METHODS: The present study developed and tested a brief measure of PBMI in 332 adults presenting for partial hospitalization with a variety of acute psychiatric conditions. RESULTS: Results indicated that older individuals and women had lower levels of PBMI than others, while individuals with bipolar disorder had higher levels of PBMI than others. PBMI significantly increased over the course of brief standard treatment. Baseline levels of PBMI, as well as changes in PBMI over the course of treatment, were associated with clinical outcomes including, but not limited to, depression and well-being. A diagnosis of bipolar disorder moderated the relationship between PBMI and only one clinical outcome, emotional lability. Increases in PBMI during treatment were associated with reduced emotional lability only in participants without bipolar disorder. LIMITATIONS: Our findings are limited by the naturalistic study design. In addition, the lack of ethnoracial diversity in our sample limits the generalization of results. CONCLUSIONS: Our results suggest that PBMI are a distinct set of beliefs that meaningfully relate to demographic characteristics, diagnostic characteristics, and clinical outcomes. Future research should examine the mechanisms through which PBMI and outcomes are related, as well as determine whether interventions designed to address PBMI (and perhaps tailored for different diagnostic groups) have clinical utility.

The protective function of personal growth initiative among a genocide-affected population in Rwanda.

The aim of the current study was to investigate the extent to which individual differences in personal growth initiative (PGI) were associated with lower reports of functional impairment of daily activities among a genocide-affected population in Rwanda. PGI measures an individual's motivation to develop as a person and the extent to which he or she is active in setting goals that work toward achieving self-improvement. We found that PGI was negatively associated with functional impairment when controlling for depression, posttraumatic stress disorder, and other demographic factors. Our results suggest that PGI may constitute an important mindset for facilitating adaptive functioning in the aftermath of adversity and in the midst of psychological distress, and as such they might have practical applications for the development of intervention programs.

Personality science, resilience, and posttraumatic growth.

PASTOR represents an innovative development in the study of resilience. This commentary highlights how PASTOR can help both clarify critical questions in and benefit from engaging with new research in personality science on behavioral flexibility across situations in addition to stability over time, and also clarify the relationship between resilience and posttraumatic growth.

The factor structure of the CES-D in a sample of Rwandan genocide survivors.

BACKGROUND: Past research suggests that culture shapes the way psychopathology is experienced and expressed. Standard psychiatric assessment instruments may therefore not capture the same underlying constructs in different contexts. The present study investigated the factor structure of a standard depression scale in a sample of Rwandan genocide survivors. METHODS: One hundred ninety six Rwandan adults provided socio-demographic information and completed the Center for Epidemiological Studies-Depression scale (CES-D), one of the most widely used self-report instruments assessing depressive symptoms, as part of a larger study on well-being and mental health in Rwanda. RESULTS: A two-factor solution provided the best fit for these CES-D data. The first factor corresponded to general depressive symptoms (including depressed affect, somatic symptoms, and interpersonal concerns) and explained 37.20% of the variance. The second factor included items assessing positive affect and explained 8.68% of the variance. CONCLUSIONS: The two-factor solution found in the present study deviates from the commonly reported four-factor structure, but is consistent with studies showing that depressed affect and somatic symptoms may not be experienced as distinct in certain non-Western and minority cultural groups.