Are We Measuring ADHD or Anxiety? Examining the Factor Structure and Discriminant Validity of the Adult ADHD Self-Report Scale in an Adult Anxiety Disorder Population.

Adults with clinical anxiety have significant symptom overlap and above average rates of attention-deficit/hyperactivity disorder (ADHD). Despite this, ADHD remains a vastly under-detected disorder among this population, indicating the need for a screener with well-understood symptom dimensions and good discriminant validity. The current study compared competing models of ADHD as well as discriminant properties of self-reported ADHD symptoms as measured by the Adult ADHD Self-Report Scale (ASRS-v1.1) in 618 adults with clinical anxiety. A three-factor correlated model of Inattention, Impulsivity, and Hyperactivity, with the movement of one item, talks excessively, to a factor of Impulsivity from Hyperactivity fit better than the one-factor, two-factor, and traditional three-factor models of ADHD. Discriminant properties of the screener were fair to good against measures of clinical anxiety and distress; however, some items within the Hyperactivity factor (e.g., difficulty relaxing; feeling driven by a motor) loaded more strongly onto factors of clinical anxiety than ADHD when measures were pooled together. These results suggest that clinicians making differential diagnoses between adult ADHD and anxiety or related disorders should look for evidence of ADHD beyond the overlapping symptoms, particularly for those within the Hyperactivity factor.

Preliminary Findings for Group Transdiagnostic Behavior Therapy for Affective Disorders Among Youths.

OBJECTIVE: The literature on transdiagnostic psychotherapy among youths is limited. Group transdiagnostic behavior therapy (TBT) has been shown to be effective for adults with affective disorders and may contain beneficial features for youths (e.g., behavioral focus, group format, ease of dissemination, and diversity of targeted diagnoses). This study aimed to investigate group TBT among youths in Canada to determine its feasibility and efficacy. METHODS: Twenty participants (ages 16-19) diagnosed as having a principal anxiety disorder completed 12 sessions of group TBT. Symptoms of anxiety, depression, and transdiagnostic impairment were assessed pre- and posttreatment. RESULTS: Participants demonstrated significant improvements on measures of anxiety (general, cognitive, and somatic) and stress, with moderate effect sizes. Findings for symptoms of depression and transdiagnostic impairment were unreliable, with small effect sizes. CONCLUSIONS: These findings provide preliminary support for the use of group TBT among youths with anxiety disorders. Future research should incorporate comparison groups and larger samples.

A Naturalistic Comparison of Group Transdiagnostic Behaviour Therapy (TBT) and Disorder-Specific Cognitive Behavioural Therapy Groups for the Affective Disorders.

BACKGROUND: Transdiagnostic psychotherapies are designed to apply the same underlying treatment principles across a set of psychiatric disorders, without significant tailoring to specific diagnoses. Several transdiagnostic psychotherapy protocols have been developed recently, each of which has its own strengths and weaknesses. One promising treatment is Transdiagnostic Behaviour Therapy (TBT), in that it is one of the few transdiagnostic treatments to date shown to be effective in patients with depressive and anxiety disorders. However, TBT has only been investigated via individual psychotherapy. AIMS: The present study investigated the effectiveness of a group protocol for TBT, compared with disorder-specific group psychotherapies, in a naturalistic setting. METHOD: 109 participants with various diagnoses of affective disorders completed either group TBT (n = 37) or a disorder-specific group psychotherapy (n = 72). Measures included assessments of psychiatric symptomatology and transdiagnostic impairment at baseline and post-treatment. RESULTS: Overall, participants in the TBT group demonstrated significant improvements across all measures. When compared with disorder-specific groups, no statistical differences were observed between groups across symptoms; however, participants in the TBT group demonstrated roughly twice the treatment effect sizes in transdiagnostic impairment compared with participants in the disorder-specific groups. In addition, when participants from the most well-represented diagnosis and disorder-specific treatment (social anxiety disorder) were investigated separately, participants in the TBT group demonstrated significantly larger improvements in comorbid depressive symptoms than participants in the disorder-specific treatment. CONCLUSIONS: Pending replication and additional comparison studies, group TBT may provide an effective group treatment option for patients with affective disorders.

Boredom, sustained attention and the default mode network.

Boredom is a ubiquitous human experience that can best be described as an inability to engage with one's environment despite the motivation to do so. Boredom is perceived as a negative experience and demonstrates strong associations with other negatively valenced states including depression and aggression. Although boredom has been shown to be elevated in neurological and psychiatric illnesses, little is known about the neural underpinnings of the state. We scanned the brains of healthy participants under four separate conditions: a resting state scan, a sustained attention task and two video-based mood inductions, one known to produce boredom and another we validated to produce a state of interest or engagement. Using independent components analyses, results showed common regions of correlated activation in posterior regions of the so-called default mode network (DMN) of the brain across all four conditions. The sustained attention and boredom induction scans were differentiated from the resting state scan by the presence of anticorrelated activity-i.e. when DMN regions were active, this region was deactivated-in the anterior insula cortex. This same region demonstrated correlated activity with both the DMN and the regions associated with attentional control during the interest mood induction. We interpret these findings to suggest that boredom represents a failure to engage executive control networks when faced with a monotonous task-in other words, when the task demands some level of engagement (watch the movie, search for infrequent targets), but is so mundane that attempts to do so fail.

Acceptability of the Fitbit in behavioural activation therapy for depression: a qualitative study.

INTRODUCTION: Major depressive disorder is characterised by low mood and poor motivation. Literature suggests that increased physical activity has positive effects on alleviating depression. Fitness-tracking devices may complement behavioural activation (BA) therapy to improve physical activity and mental health in patients with depression. OBJECTIVES: To understand patients' perceived benefit from the Fitbit and explore themes associated with patient experiences. To compare perceived benefit, patient factors, Fitbit usage and Beck's Depression Inventory (BDI) scores. METHODS: Semistructured interviews were conducted with patients (n=36) who completed a 28-week BA group programme in a mood disorders outpatient clinic. All patients were asked to carry a Fitbit One device. We conducted thematic analyses on the interviews and exploratory quantitative analyses on patient characteristics, Fitbit usage, steps recorded, perceived benefit and BDI scores. FINDINGS: Twenty-three patients found the Fitbit helpful for their physical activity. Themes of positive experiences included self-awareness, peer motivation and goal-setting opportunities. Negative themes included inconvenience, inaccuracies and disinterest. Age, baseline and change in BDI scores, prior physical activity goals and familiarity with technology were not associated with perceived benefit from the Fitbit or usage. Perceived benefit was significantly (p<0.01) associated with usage. CONCLUSIONS: Overall, the Fitbit is an acceptable tool to complement BA therapy for patients with depression. Many positive themes were concordant with current literature; however, patients also reported negative aspects that may affect use. CLINICAL IMPLICATIONS: Clinicians and researchers should consider both strengths and limitations of activity trackers when implementing them to motivate patients with depression. TRIAL REGISTRATION NUMBER: NCT02045771; Pre-results.

Characterizing the psychophysiological signature of boredom.

Research on the experience and expression of boredom is underdeveloped. The purpose of the present study was to explore the psychophysiological signature of the subjective experience of boredom. Healthy undergraduates (n = 72) viewed previously validated and standardized video clips to induce boredom, sadness, and a neutral affective state, while their heart rate (HR), skin conductance levels (SCL), and cortisol levels were measured. Boredom yielded dynamic psychophysiological responses that differed from the other emotional states. Of particular interest, the physiological signature of boredom relative to sadness was characterized by rising HR, decreased SCL, and increased cortisol levels. This pattern of results suggests that boredom may be associated with both increased arousal and difficulties with sustained attention. These findings may help to resolve divergent conceptualizations of boredom in the extant literature and, ultimately, to enhance our understanding and treatment of clinical syndromes in which self-reported boredom is a prominent symptom.

Self-portrayal concerns mediate the relationship between recalled teasing and social anxiety symptoms in adults with anxiety disorders.

Previous research on individuals with anxiety disorders has demonstrated that both childhood peer maltreatment and concerns about negative self-portrayal are related to elevated symptoms of social anxiety (SA). In the present study, we examined whether concerns about negative self-portrayal might either moderate or mediate the relation between recalled childhood teasing history and current symptoms of SA in a non-treatment-seeking clinical sample of 238 individuals with anxiety disorders. Participants completed the Teasing Questionnaire-Revised (TQ-R), the Negative Self-Portrayal Scale (NSPS), and the Social Phobia Inventory (SPIN). Analyses using structural equation modeling (SEM) indicated that self-portrayal concerns mediated, but did not moderate, the relationship between recalled teasing and current SA, accounting for 51% of the total effect. Clinical implications and directions for future research are discussed.

Exploring the relationship between boredom and sustained attention.

Boredom is a common experience, prevalent in neurological and psychiatric populations, yet its cognitive characteristics remain poorly understood. We explored the relationship between boredom proneness, sustained attention and adult symptoms of attention deficit hyperactivity disorder (ADHD). The results showed that high boredom-prone individuals (HBP) performed poorly on measures of sustained attention and showed increased symptoms of ADHD and depression. The results also showed that HBP individuals can be characterised as either apathetic-in which the individual is unconcerned with his/her environment, or as agitated-in which the individual is motivated to engage in meaningful activities, although attempts to do so fail to satisfy. Apathetic boredom proneness was associated with attention lapses, whereas agitated boredom proneness was associated with decreased sensitivity to errors of sustained attention, and increased symptoms of adult ADHD. Our results suggest there is a complex relationship between attention and boredom proneness.

Retrieval properties of negative vs. positive mental images and autobiographical memories in social anxiety: outcomes with a new measure.

High (n=41) and low (n=39) socially anxious (SA) participants completed the Waterloo Images and Memories Interview (WIMI), a new assessment tool that measures the accessibility and properties of mental images and associated autobiographical memories that individuals may experience across both anxiety-provoking (negative) and non-anxiety-provoking (positive) social situations. Results indicated that both high and low SA individuals experience negative images and associated autobiographical memories in anxiety-provoking social situations, but the rates of endorsement of such images and memories among high SA participants were substantially lower than those reported in recent studies. Moreover, whereas low SA individuals were capable of accessing a relatively balanced array of both negative and positive self-representations that were rich in episodic detail, high SA individuals retrieved a higher, more unbalanced ratio of negative-to-positive images and memories, as well as impoverished positive images that were significantly degraded in episodic detail. Finally, negative images influenced the two groups differently, with high SA individuals experiencing more negative emotional and cognitive consequences associated with bringing such images to mind. These results are discussed in relation to theoretical models of learning and memory within the context of contemporary cognitive behavioral models of social anxiety.

Multimodal temporal perception deficits in a patient with left spatial neglect.

We examined multisecond time estimation (up to 60 s) for visual and auditory events in a patient with left spatial neglect (RR), who grossly underestimated all durations in all tasks. In contrast, healthy controls and a patient with left hemisphere damage (HW) demonstrated accurate estimates of the same durations. These findings add to a growing body of literature suggesting that neglect cannot be understood simply in terms of a bias in orienting attention to one side of space. In addition, these data suggest that the right hemisphere parietal cortex may be important for the perception of time across multiple modalities.