Perceived Burdensomeness and Thwarted Belongingness in Text Messages of Suicide Attempt Survivors.

OBJECTIVE: Perceived burdensomeness and thwarted belongingness are considered interpersonal risk factors for suicide. Examining these themes in personal text messages may help identify proximal suicide risk. METHOD: Twenty-six suicide attempt survivors provided personal text messages and reported dates for past periods characterized by positive mood, depressed mood, suicidal ideation (with no attempt), or the two-week period leading up to suicide attempt(s). Texts were then classified into the applicable period based on matching dates. Texts (N = 194,083; including n = 86,705 outgoing texts) were coded for perceived burdensomeness and thwarted belongingness by masked trained raters. Multilevel models were fit to examine whether the target themes (combined into one overall interpersonal risk variable due to low base rate) were more prevalent in texts sent during higher risk episodes (e.g., suicide attempt vs. depressed mood episodes). RESULTS: 0.57% of outgoing texts contained either target theme. As hypothesized, logistic models showed participants were more likely to send texts containing the target themes during suicide attempt episodes relative to suicidal ideation (with no attempt) episodes, depressed mood episodes, and positive mood episodes, and during suicidal ideation (with no attempt) episodes relative to positive mood episodes. All contrasts were robust to post-hoc correction except for suicide attempt episodes vs. ideation (with no attempt) episodes. No other significant pairwise differences for episode type emerged. CONCLUSIONS: Despite the small sample size and low base rate of target themes in the texts, perceived burdensomeness and thwarted belongingness were associated with intra-individual suicide risk severity in personal text messages.

Assessing Emotion Polyregulation in Daily Life: Who Uses It, When Is It Used, and How Effective Is It?

Most research on emotion regulation has focused on understanding individual emotion regulation strategies. Preliminary research, however, suggests that people often use several strategies to regulate their emotions in a given emotional scenario (polyregulation). The present research examined who uses polyregulation, when polyregulation is used, and how effective polyregulation is when it is used. College students (N = 128; 65.6% female; 54.7% White) completed an in-person lab visit followed by a 2-week ecological momentary assessment protocol with six randomly timed survey prompts per day for up 2 weeks. At baseline, participants completed measures assessing past-week depression symptoms, social anxiety-related traits, and trait emotion dysregulation. During each randomly timed prompt, participants reported up to eight strategies used to change their thoughts or feelings, negative and positive affect, motivation to change emotions, their social context, and how well they felt they were managing their emotions. In pre-registered analyses examining the 1,423 survey responses collected, polyregulation was more likely when participants were feeling more intensely negative and when their motivation to change their emotions was stronger. Neither sex, psychopathology-related symptoms and traits, social context, nor subjective effectiveness was associated with polyregulation, and state affect did not moderate these associations. This study helps address a key gap in the literature by assessing emotion polyregulation in daily life. Supplementary Information: The online version contains supplementary material available at 10.1007/s42761-022-00166-x.

Differential Associations between Guilt and Shame Proneness and Religious Coping Styles in a Diverse Sample of Young Adults.

Positive religious coping is linked with better mental health outcomes following physical and sexual abuse while negative religious coping is associated with poorer outcomes. Religious coping styles may be linked with dispositional tendencies to experience guilt or shame. This study compared the associations between guilt and shame proneness and religious coping styles and tested whether abuse history moderated these relationships. We conducted a cross-sectional study with 425 college students (n = 145 with physical and/or sexual abuse history, n = 280 with no abuse history). Participants completed questionnaires assessing positive and negative religious coping style, as well as two dimensions of guilt proneness and shame proneness. Structural equation models were fitted to examine associations between guilt proneness and shame proneness, and positive and negative religious coping, respectively, accounting for abuse history as a binary moderator. Across the full sample, positive religious coping was positively associated with guilt repair (i.e., the tendency to engage in reparative behaviors following one's wrongdoing), guilt negative behavior evaluation (i.e., the tendency to feel bad about how one acted in a given scenario), and shame withdrawal (i.e., the tendency to try and avoid unpleasant situations in which one has done something wrong), and negatively associated with shame negative self-evaluation (i.e., the tendency to make internal, negative self-attributions about one's wrongdoing). Negative religious coping was positively associated with shame withdrawal and, for participants with no abuse history, shame negative self-evaluation. Results suggest that positive religious coping is more closely related to guilt proneness, and negative religious coping to shame proneness. Additional research with longitudinal designs and more defined abuse history subgroups is needed.

Inferring sleep disturbance from text messages of suicide attempt survivors: A pilot study.

OBJECTIVE: Identifying digital markers of sleep disturbance-a known suicide risk factor-may aid in the detection of imminent suicide risk. This study examined sleep-related communication and texting patterns in personal text messages (N = 86,705) of suicide attempt survivors. METHOD: Twenty-six participants provided dates of past suicide attempts and 2-week periods of positive mood, depressed mood, or suicidal ideation. Linguistic Inquiry Word Count was used to identify sleep-related texts via a custom dictionary. Mixed effect models were fitted to test the association between suicide/mood episode type (e.g., attempt versus ideation) and three outcomes: likelihood of a text including sleep-related content, nightly count of texts sent from midnight to 5:00 AM, and sum of unique hour bins from midnight to 5:00 AM with outgoing texts. RESULTS: Analyses with a sleep dictionary that was manually revised to be more accurate (but not the original unedited dictionary) showed sleep-related communication was more likely during depressed mood episodes than positive mood episodes. Otherwise, there were no significant differences in sleep-related communication or objective texting patterns across episode type. CONCLUSIONS: Although we did not detect differences in sleep-related communication tied to suicidal thoughts or behaviors, sleep-related communication may differ as a function of within-person mood level.

COVID-19-Related News Consumption Linked with Stress and Worry, but Not Sleep Quality, Early in the Pandemic.

Beginning in early 2020, the novel coronavirus was the subject of frequent and sustained news coverage. Building on prior literature on the stress-inducing effects of consuming news during a large-scale crisis, we used network analysis to investigate the association between coronavirus disease 2019 (COVID-19) news consumption, COVID-19-related psychological stress, worries about oneself and one's loved ones getting COVID-19, and sleep quality. Data were collected in March 2020 from 586 adults (45.2% female; 72.9% White) recruited via Amazon Mechanical Turk in the U.S. Participants completed online surveys assessing attitudes and behaviors related to COVID-19 and a questionnaire assessing seven domains of sleep quality. Networks were constructed using partial regularized correlation matrices. As hypothesized, COVID-19 news consumption was positively associated with COVID-19-related psychological stress and concerns about one's loved ones getting COVID-19. However, there were very few associations between COVID-19 news consumption and sleep quality indices, and gender did not moderate any of the observed relationships. This study replicates and extends previous findings that COVID-19-news consumption is linked with psychological stress related to the pandemic, but even under such conditions, sleep quality can be spared due to the pandemic allowing for flexibility in morning work/school schedules.

Body Image After Mastectomy Scale: A New Measure of Body Image Behaviors and Beliefs in Women Following Mastectomy.

Background: Body image distress is frequently reported by women after mastectomy and is associated with negative health outcomes, such as reduced quality of life, elevated depression and anxiety symptoms, and impaired sexual functioning. To reduce body image distress after mastectomy, we must first understand the factors that contribute to its development and maintenance. We therefore developed a new measure, the Body Image after Mastectomy Scale (BIMS), to comprehensively assess maladaptive appearance-related beliefs and behaviors (e.g., avoidance and rituals) that may trigger and maintain body image distress after mastectomy. Materials and Methods: Forty-seven female patients undergoing mastectomy with breast reconstruction completed the BIMS and other measures 3 months after breast reconstruction. Results: Evaluation of the BIMS' initial psychometric properties showed that the overall scale has good internal consistency and strong construct validity. Domain-specific subscales ranged in reliability from good to poor. Conclusions: The BIMS can be used clinically to identify cognitive and behavioral psychotherapy targets to reduce body image distress resulting from mastectomy. It can also be used in research to identify factors that contribute to the development and maintenance of body image distress after mastectomy. ClinicalTrials.gov identifier: NCT03428399.

Cognitive-Behavioral Therapy in the Digital Age: Presidential Address.

Our field has come a long way in establishing cognitive-behavioral therapy as the empirically supported treatment of choice for a wide range of mental and behavioral health problems. Nevertheless, most individuals with mental disorders do not receive any care at all, and those who do often have difficulty accessing care that is consistently high in quality. Addressing these issues is complex and costly and thus progress has been slow. We are entering an exciting stage in which emerging technologies might offer novel solutions to the treatment gap. This paper discusses a number of technology-enabled solutions to our field's challenges, including Internet-based and smartphone-based cognitive-behavioral therapy. Nevertheless, we must remain attentive to potential pitfalls of these emerging technologies. The paper incorporates suggestions for how the field may approach these potential pitfalls and provides a vision for how we might develop powerful, scalable, precisely timed, personalized interventions to enhance global mental health.

Development and Pilot Testing of a Cognitive-Behavioral Therapy Digital Service for Body Dysmorphic Disorder.

Body dysmorphic disorder (BDD) has a severe presentation and chronic course when untreated. Although effective BDD treatments exist, most individuals do not have access to them. We therefore developed and pilot tested the first smartphone-delivered individual cognitive-behavioral therapy (CBT) treatment for adults with BDD. The digital service was developed via user-centered design, integrating input from engineering, design, and psychology experts, plus BDD patient consultants. We conducted a 12-week open pilot trial (N = 10) to describe preliminary results for feasibility, acceptability, and treatment outcome. Attrition rates (0%) and feedback on usability and satisfaction indicated that smartphone-based CBT for BDD may be feasible, acceptable, and satisfactory. Initial results suggest that smartphone-based CBT for BDD may hold promise for improving BDD symptom severity, BDD-related insight, functional impairment, and quality of life, as scores from baseline to posttreatment improved with large-to-very large effects; depression improved with a medium effect. Ninety percent of participants were responders at posttreatment and 3-month follow-up. Smartphone-based CBT for BDD may have strong potential as a standardized, low cost, and accessible treatment for this debilitating illness. A test of efficacy is merited as a next step, using a well-powered, randomized control trial design.

Pilot study of a personality-based approach to assessing eating disorder and Obsessive Compulsive Disorder symptom risk in college men and women.

Objective: To conduct a pilot test of the validity of using empirically derived personality types to characterize eating disorder (ED) risk in college students and resolve discrepancies regarding the role of perfectionism and obsessive-compulsive disorder (OCD) symptoms.Participants: Man and woman undergraduate students (N = 169) at a small, private university. Data were collected from February to May 2016 and 2018. Methods: Participants completed self-report measures of personality (perfectionism, impulsivity, and effortful control) and psychopathology (EDs, OCD). Results: Our analyses replicated three validated personality types: overcontrolled, undercontrolled, and resilient. Analysis of variances demonstrated perfectionism, ED, and OCD symptoms were significantly elevated in the overcontrolled subtype. There was no interaction by sex. Conclusions: These findings suggest that personality types may be useful for classifying ED risk and OCD symptoms in college students across sexes. Further study and relevance to prevention and intervention efforts to reduce the burden of EDs on college campuses will be discussed.