Caveat emptor: Mental health specialty certifications and the public's preferences for clinical care.

Appropriate training and continuing education for mental health professionals are designed to ensure that clinicians provide effective and ethical care. Mental health consumers may depend upon these credentials to judge the level of a professional's competence, but whether these activities and credentials provide a valid indicator of knowledge and skills is subject to debate. The present study was designed to examine preferences for mental health clinicians among potential consumers and factors that may inform these preferences, specifically comparing preferences for doctoral-level mental health clinicians and masters-level clinicians with and without specialty certification for treating anxiety symptoms. Cross-sectional assessment with self-report surveys (clinician preferences, prior mental health diagnosis and treatment, demographic characteristics, generalized anxiety symptoms, mental health literacy, and mental health stigma) was administered in two samples: a college student sample (N = 224; 71.9% female; Mage = 19.1, SD = 1.5) and a sample of adults with chronic pain (N = 116; 74.1% female; Mage = 43.8, SD = 13.8). The present study found that across both samples, therapists with a specialty certification were preferred over those without such credentials within each profession, and that certification status trumped professional standing such that certified masters-level clinicians were rated more highly than noncertified PhD-level clinicians. These findings are indicative of a schism between how the field of clinical psychology conceptualizes itself and how it is seen by its consumers. Implications of our findings for mental health consumers, clinicians, and professional organizations are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Augmenting the efficacy of benzodiazepine taper with telehealth-delivered cognitive behavioral therapy for anxiety disorders in patients using prescription opioids: A pilot randomized controlled trial.

The risks of concomitant benzodiazepine (BZ) and opioid use are significant. Despite the urgent need to reduce BZ use among patients taking opioids, no treatment intervention research to our knowledge has addressed treatment for this concurrent, high-risk use. The current study will evaluate the efficacy of augmenting BZ taper procedures with CBT for anxiety disorders that has been adapted specifically for patients with concomitant BZ and opioid use (either use as prescribed or misuse), a high-risk patient population. Research combining rapidly scalable behavioral interventions ancillary to pharmacological approaches delivered via telehealth in primary care settings is innovative and important given concerning trends in rising prevalence of BZ/opioid co-prescription, BZ-associated overdose deaths, and known barriers to implementation of behavioral health interventions in primary care. CBT delivery using telehealth has the potential to aid adherence and promote access and dissemination of procedures in primary care. Lastly, the current study will utilize an experimental therapeutics approach to preliminarily explore the mechanism of action for the proposed interventions. The overall aim of the present pilot randomized controlled trial is to examine the feasibility and preliminary efficacy of a BZ taper with CBT for anxiety disorders adapted for patients with concomitant BZ (BZT + CBT) and opioid use to a BZ taper with a control health education program (BZT + HE) in a sample of individuals (N = 54) who have been prescribed and are taking benzodiazepines and opioids for at least 3 months prior to baseline and experience anxious distress. Screening and outcome measures, methods, and implications are described. Trial Registration: ClinicalTrials.gov (NCT05573906).

Initial assessment of the feasibility and efficacy of a scalable digital CBT for generalized anxiety and associated health behaviors in a cardiovascular disease population.

Generalized anxiety disorder (GAD) is a significant yet modifiable risk factor for worse cardiovascular disease (CVD) outcomes. The treatment of GAD in an accessible manner represents an unmet need in CVD, given that patients with CVD experience numerous barriers to in-person treatment engagement. This paper presents the rationale and design for an investigation of a strategy to enhance care for patients with CVD by introducing a scalable, affordable, and system-friendly digital intervention that targets a prominent modifiable risk factor (generalized anxiety and associated worry) for negative health behaviors in CVD. In the context of a randomized clinical trial design, we describe an experimental medicine approach for evaluating the degree to which a digital cognitive behavior therapy (dCBT), relative to a waitlist control group, engages anxiety and worry outcomes in a sample of 90 adults who have experienced an acute CVD event and who have comorbid GAD symptoms. We also investigate the degree to which dCBT leads to greater changes in GAD symptoms compared to the control condition and whether reductions in these symptoms are associated with corresponding reductions in cardiac anxiety and cardiac health behaviors (including smoking, physical activity, heart-healthy diet, and medication adherence). We propose that by targeting GAD symptoms in CVD in a way that does not tax ongoing medical care provision, we have the potential to improve the uptake of effective care and address both GAD and associated health behaviors.

CO2 reactivity as a biomarker of exposure-based therapy non-response: study protocol.

BACKGROUND: Exposure-based therapy is an effective first-line treatment for anxiety-, obsessive-compulsive, and trauma- and stressor-related disorders; however, many patients do not improve, resulting in prolonged suffering and poorly used resources. Basic research on fear extinction may inform the development of a biomarker for the selection of exposure-based therapy. Growing evidence links orexin system activity to deficits in fear extinction and we have demonstrated that reactivity to an inhaled carbon dioxide (CO2) challenge-a safe, affordable, and easy-to-implement procedure-can serve as a proxy for orexin system activity and predicts fear extinction deficits in rodents. Building upon this basic research, the goal for the proposed study is to validate CO2 reactivity as a biomarker of exposure-based therapy non-response. METHODS: We will assess CO2 reactivity in 600 adults meeting criteria for one or more fear- or anxiety-related disorders prior to providing open exposure-based therapy. By incorporating CO2 reactivity into a multivariate model predicting treatment non-response that also includes reactivity to hyperventilation as well as a number of related predictor variables, we will establish the mechanistic specificity and the additive predictive utility of the potential CO2 reactivity biomarker. By developing models independently within two study sites (University of Texas at Austin and Boston University) and predicting the other site's data, we will validate that the results are likely to generalize to future clinical samples. DISCUSSION: Representing a necessary stage in translating basic research, this investigation addresses an important public health issue by testing an accessible clinical assessment strategy that may lead to a more effective treatment selection (personalized medicine) for patients with anxiety- and fear-related disorders, and enhanced understanding of the mechanisms governing exposure-based therapy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05467683 (20/07/2022).

Worrying But Not Acting: The Role of Intolerance of Uncertainty in Explaining the Discrepancy in COVID-19-Related Responses.

Research indicates that Intolerance of Uncertainty (IU) is associated with COVID-19 emotional responses, but not necessarily with engaging in COVID-19 preventative behaviors. The current study was designed to further evaluate this discrepancy. Participants (N = 454) completed self-report forms about COVID-19 emotional responses (i.e., fear, worry, sensitivity to symptoms) and COVID-19 behavioral interference/responses (i.e., interference in daily activities, interference due to worry, and engagement in preventative behaviors). IU was positively associated with COVID-19-related emotional responses as well as two of the COVID-19-related behavioral interference/responses (i.e., interference in daily activities and interference due to worry), but negatively predicted engagement in COVID-19 preventative behaviors. Exploratory analyses revealed a significant indirect effect of IU on lower engagement in preventative behaviors through lower belief in the effectiveness of such behaviors. Thus, we further document the role of IU in statistically predicting higher distress but lower levels of adaptive health behaviors. Furthermore, we provide preliminary support for the hypothesis that these relationships may be explained by associations between IU and lower belief in the efficacy of health behaviors. Because some current analyses indicate small effect sizes, future studies should investigate IU alongside other potentially important markers. Supplementary Information: The online version contains supplementary material available at 10.1007/s10608-022-10321-0.

Acceptability of telehealth CBT during the time of COVID-19: Evidence from patient treatment initiation and attendance records.

The COVID-19 pandemic provided unique conditions for examining outpatient psychotherapy clinics' rapid transition to telehealth. The current study utilized data from a large, specialty CBT clinic to investigate attendance and treatment engagement changes when services were provided via telehealth versus in-person. Results indicate that, following a complete transition to telehealth services, clinic referrals were maintained. Further, telehealth treatment appeared to be entirely acceptable as assessed by a decreased missed visit rate of telehealth appointments compared to in-person appointments. Given the elimination of commuting times, telehealth has the potential to address disparities in care linked to physical distance from the clinic and/or differential ability to take time off work for appointments.

Evaluating the Indirect Effects of Trait Mindfulness Facets on State Tripartite Components Through State Rumination and State Experiential Avoidance.

The present study investigated whether specific trait mindfulness facets indirectly influenced state negative affect (NA), positive affect (PA), and physiological hyperarousal (PH) through state rumination and state experiential avoidance. Participants (n = 360, 68% female) rated trait mindfulness facets, then completed an interview task about life experiences intended to elicit state NA, PA, and PH. After the interview task, participants completed measures of state NA, PA, and PH, and state measures of rumination and experiential avoidance. Indirect effect results indicated that the relationships between Nonjudge, Nonreact, and Describe, and each of the state tripartite components indirectly flowed through state rumination. Further, there was a significant indirect effect of Nonjudge and Actaware on each of the three state tripartite components through experiential avoidance. Overall, strengthening the mindfulness skills of Nonjudge, Nonreact, Describe, and Actaware may have positive downstream effects via reducing reliance on maladaptive emotion regulation strategies, such as rumination or experiential avoidance.

Perfectly imperfect: The use of cognitive bias modification to reduce perfectionism.

BACKGROUND AND OBJECTIVES: Perfectionism is a transdiagnostic risk and maintenance factor for psychopathology. The current study developed and evaluated a cognitive bias modification, interpretation retraining (CBM-I) intervention targeting maladaptive perfectionistic beliefs. METHODS: Participants were undergraduate students randomized to complete the perfectionism CBM-I (n = 33) or control condition task (n = 36) at two time points. Additionally, participants completed measures of perfectionistic interpretations and trait perfectionism, as well as an impossible anagram task designed to elicit perfectionistic concerns. RESULTS: Results indicated that after the intervention, participants who completed the perfectionism CBM-I endorsed fewer perfectionistic interpretations than participants in the control condition. Furthermore, although the study groups self-reported comparably low confidence in their anagram task performance, participants who completed the perfectionism CBM-I reported wanting to re-do significantly fewer anagrams than participants in the control condition, suggesting greater acceptance of imperfect performance following the intervention. Moreover, supporting a key hypothesized mechanism of effect in CBM-I, reductions in perfectionistic interpretations mediated the effect of condition on the desire to re-do anagram task items. LIMITATIONS: The study results should be viewed in light of limitations, including the short time-span of the study, and the use of a relatively small, non-clinical, and demographically homogenous convenience sample. CONCLUSIONS: Further research and development of the perfectionism CBM-I intervention are needed, but the present findings add to a nascent evidence base that suggests CBM-I holds promise as an accessible and transdiagnostic intervention for perfectionism.

Examining the Relation Between Adolescent Social Anxiety and Positive Affect Regulation: Self-Report vs. Observation.

Social anxiety symptomatology is associated with disruptions in positive affect, though no study has examined deficits in responses to positive affect related to adolescent social anxiety symptoms. The present study tested whether adolescents' self-reported and observed social anxiety symptoms were uniquely associated with specific responses to positive affect. Moreover, we examined whether adolescent gender moderated these relations. Ninety adolescents (ages 11 to 18, Mage = 14.26, SD = 2.03; girls = 62%; white = 79%) completed self-report measures, participated in a social stressor task, and engaged in two positively-valenced interaction tasks with their female caregivers. Adolescent self-reported social anxiety symptoms were not uniquely associated with responses to positive affect. However, observed social anxiety symptoms were uniquely related to greater self-reported inhibiting positive affect responses and fewer observed positive affect maximizing behaviors. These findings highlight the need to examine self-reported and observed social anxiety symptoms in understanding associated disruptions in positive affect regulation.

Mindfulness Facets, Social Anxiety, and Drinking to Cope with Social Anxiety: Testing Mediators of Drinking Problems.

This cross-sectional study tested social anxiety symptoms, trait mindfulness, and drinking to cope with social anxiety as potential predictors and/or serial mediators of drinking problems. A community-based sample of individuals with co-occurring social anxiety symptoms and alcohol dependence were recruited. Participants (N = 105) completed measures of social anxiety, drinking to cope with social anxiety, and alcohol use and problems. As well, participants completed the Five Facet Mindfulness Questionnaire, which assesses mindfulness facets of accepting without judgment, acting with awareness, not reacting to one's internal experiences, observing and attending to experiences, and labeling and describing. As predicted, the relationship between social anxiety symptoms and drinking problems was mediated by social anxiety coping motives across each of the models. Further, the relationship between specific mindfulness facets (acting with awareness, accepting without judgment, and describe) and drinking problems was serially mediated by social anxiety symptoms and drinking to cope with social anxiety. This research builds upon existing studies that have largely been conducted with college students to evaluate potential mediators driving drinking problems. Specifically, individuals who are less able to act with awareness, accept without judgment, and describe their internal experiences may experience heightened social anxiety and drinking to cope with that anxiety, which could ultimately result in greater alcohol-related problems.

Body Dysmorphic, Obsessive-Compulsive, and Social Anxiety Disorder Beliefs as Predictors of In Vivo Stressor Responding.

This study tested the potential transdiagnostic nature of body dysmorphic disorder (BDD), obsessive-compulsive disorder (OCD), and social anxiety disorder (SAD) beliefs, in addition to testing the specificity of those beliefs, in predicting how individuals responded to symptom-specific stressors. Participants included 127 adults (75% women) with a broad range of symptom severity. Path analysis was used to evaluate whether specific maladaptive beliefs predicted distress in response to symptom-relevant stressors over and above other beliefs and baseline distress. SAD beliefs emerged as a significant predictor of distress in response to a mirror gazing (BDD-relevant), a thought (OCD-relevant), and a public speaking (SAD-relevant) task, controlling for other disorder beliefs and baseline distress. BDD beliefs were also a robust predictor of BDD stressor responding. Results suggest that social anxiety-relevant beliefs may function as a transdiagnostic risk factor that predicts in vivo symptoms across a range of problem areas.

Evaluating Change in Beliefs About the Importance/Control of Thoughts as a Mediator of CBM-I and Responses to an ICT Stressor.

This study evaluated an adaptation of a Cognitive Bias Modification-Interpretation (CBM-I) procedure designed to shift interpretations of intrusive thoughts related to beliefs about the Importance and Control of Thoughts (ICT). Individuals high in the ICT belief domain were randomly assigned to one of two conditions: (a) a positive (n = 38) condition in which scenarios about intrusive thoughts were repeatedly paired with benign interpretations; or (b) a control (n = 39) condition in which scenarios about intrusive thoughts were paired with 50% benign and 50% threatening interpretations. Further, participants engaged in an ICT stressor task. Structural equation modeling with bias-corrected bootstrapping was used to examine the effects of training on ICT-relevant interpretations, beliefs, and ICT stressor responding. As predicted, individuals in a positive (vs. control) training condition reported decreases in ICT-relevant interpretations and beliefs. Further, there was a small, statistically significant indirect (i.e., mediated) effect of training on measures of ICT stressor responding, which occurred via decreases in ICT-relevant beliefs. In sum, results indicate that training was effective in influencing interpretations and beliefs tied to Importance/Control of Thoughts and that there may be clinical utility to shifting this belief domain.