Examining time-varying dynamics of co-occurring depressed mood and anxiety.

BACKGROUND: Dimensional frameworks of psychopathology call for multivariate approaches to map co-occurring disorders to index what symptoms emerge when and for whom. Ecological momentary assessment (EMA) offers a method for assessing and differentiating the dynamics of co-occurring symptoms with greater temporal granularity and naturalistic context. The present study used multivariate mixed effects location-scale modeling to characterize the time-varying dynamics of depressed mood and anxiety for women diagnosed with social anxiety disorder (SAD) and major depression (MDD). METHODS: Women completed five daily EMA surveys over 30 days (150 EMA surveys/woman, T ≈ 5250 total observations) and two clinical diagnostic and retrospective self-report measures administered approximately two months apart. RESULTS: There was evidence of same-symptom lagged effects (bs = 0.08-0.09), but not cross-symptom lagged effects (bs < 0.01) during EMA. Symptoms co-varied such that momentary spikes from one's typical level of anxiety were associated with increases in momentary depressed mood (b = 0.19) and greater variability of depressed mood (b = 0.06). Similarly, spikes from one's typical levels of depressed mood were associated with increases in momentary anxiety (b = 0.19). Furthermore, the presence and magnitude of effects demonstrated person-specific heterogeneity. LIMITATIONS: Our findings are constrained to the dynamics of depressed and anxious mood among cisgender women with primary SAD and current or past MDD. CONCLUSIONS: Findings from this work help to characterize how daily experiences of co-occurring mood and anxiety fluctuate and offer insight to aid the development of momentary, person-specific interventions designed to regulate symptom fluctuations.

Avoidance and fear day by day in social anxiety disorder.

OBJECTIVE: Theories assert that avoidance maintains maladaptive anxiety over time, yet a clear prospective test of this effect in the day-by-day lives of people with social anxiety disorder (SAD) is lacking. METHOD: We used intensive longitudinal data to test prospective relationships between social fear and social avoidance in 32 participants with SAD who reported on a total of 4256 time points. RESULTS: Results suggested that avoidance strongly predicted future anxiety, but only in a minority of people with SAD. Relationships between anxiety and avoidance varied considerably across individuals. Pre-registered tests found that the strength of autocorrelation for social fear is a good target for future testing of prediction of exposure response. Participants with lower autocorrelations were less likely to show between-session habituation. CONCLUSIONS: Overall, results suggest avoidance maintains fear in SAD for at least some individuals, but also indicates considerable variability. Further intensive longitudinal data is needed to examine individuals with SAD across varying time courses.

An investigation of the potential clinical utility of critical slowing down as an early warning sign for recurrence of depression.

BACKGROUND AND OBJECTIVES: Much of the burden of depressive illness is due to relapses that occur after treatment into remission. Prediction of an individual's imminent depressive relapse could lead to just-in-time interventions to prevent relapse, reducing depression's substantial burden of disability, costs, and suicide risk. Increasingly strong relationships in the form of autocorrelations between depressive symptoms, a signal of a phenomenon described as critical slowing down (CSD), have been proposed as a means of predicting relapse. METHODS: In the current study, four participants in remission from depression, one of whom relapsed, responded to daily smartphone surveys with depression symptoms. We used p-technique factor analysis to identify depression factors from over 100 survey responses. We then tested for the presence of CSD using time-varying vector autoregression and detrended fluctuation analysis. RESULTS: We found evidence that CSD provided an early warning sign for depression in the participant who relapsed, but we also detected false positive indications of CSD in participants who did not relapse. Results from time-varying vector autoregression and detrended fluctuation analysis were not in agreement. LIMITATIONS: Limitations include use of secondary data and a small number of participants with daily responding to a subset of depression symptoms. CONCLUSIONS: CSD provides a compelling framework for predicting depressive relapse and future research should focus on improving detection of early warning signs reliably. Improving early detection methods for depression is clinically significant, as it would allow for the development of just-in-time interventions.

Even mild internalized stigma merits attention among adults with serious mental illness.

Internalized or self-stigma can be damaging to psychological and social functioning and recovery, especially for people with serious mental illness. Most studies have focused on the effects of high self-stigma, which has included both moderate and high self-stigma, versus low levels of self-stigma which has included no, minimal, or mild self-stigma. Therefore, little is known about the variation within these categories (e.g., minimal versus mild self-stigma) and its impact on recovery. This article examines differences in the demographic, clinical, and psychosocial variables associated with different levels of self-stigma severity. Baseline data (N = 515) from two concurrent randomized controlled trials of a psychosocial intervention aimed at reducing internalized stigma, and its effects among adults with serious mental illnesses were examined. We found that participants with greater psychological sense of belonging, and greater perceived recovery were significantly less likely to have mild or moderate/high internalized stigma than minimal stigma. Those reporting a greater frequency of stigma experiences, however, were more likely to have mild or moderate/high internalized stigma than minimal stigma. Our findings further underscore the multifaceted nature and impact of self-stigma, particularly in interpersonal relationships and interactions, and demonstrate the importance of attending to even mild levels of self-stigma endorsement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Interpersonal problems in social anxiety disorder across different relational contexts.

People with social anxiety disorder (SAD) frequently report interpersonal problems across various domains; however, it is unclear whether these problems are observable by others or represent negatively biased self-report. We assessed the interpersonal problems of people with and without SAD using self-report, friend, and romantic partner report. We hypothesized that SAD diagnosis would predict self-reported problems across multiple interpersonal domains, but restricted domains of informant report. Additionally, we hypothesized that diagnosis would predict discrepancy between self and informant report either in the form of a bias toward reporting more problems or in the form of lack of concordance between self and informant reporters. Using structural equation and multilevel models, we found evidence for differences between people with and without SAD in terms of domains of impairment observed by self and informants as well as differences in correspondence across relationship types. Results highlight the utility of multi-informant assessment of SAD.

Associations between depression, anxious arousal and manifestations of psychological inflexibility.

BACKGROUND AND OBJECTIVES: Psychological inflexibility exhibits across multiple facets of functioning, including thinking styles, personality, cognitive shifting, emotion, and physiology, with many of these manifestations showing associations with depression. As such, these facets might be part of an overarching latent construct of psychological inflexibility that explains associations with depression. We predicted that (1) five facets of inflexibility (perseverative thinking, personality rigidity, attention-shifting, negative emotional inertia, and low respiratory sinus arrhythmia reactivity) would load onto a unique latent construct of psychological inflexibility. Further, we hypothesized this latent construct of psychological inflexibility would be (2) significantly associated with higher depression; and (3) associated with depression to a greater extent than anxious arousal. METHODS: Seventy-five adult community participants completed measures assessing the five indices of inflexibility and self-report measures of depression and anxious arousal. RESULTS: Structural equation modeling identified a latent inflexibility construct reflected by perseverative thinking, personality rigidity, and emotional inertia, but did not include attention-shifting or RSA reactivity. The inflexibility construct was positively associated with depression and anxious arousal, but more strongly associated with depression than with anxious arousal. LIMITATIONS: Limitations included a small sample size, cross-sectional approach, and dimensional measures of depression and anxious arousal. CONCLUSIONS: Findings provide preliminary support that multiple facets of inflexibility may emerge from a broader overarching vulnerability for internalizing psychopathology. This overarching inflexibility construct may have stronger associations with depression than with anxious arousal.

Symptoms of social anxiety disorder and major depressive disorder: A network perspective.

BACKGROUND: We used network analyses to examine symptoms that may play a role in the co-occurrence of social anxiety disorder (SAD) and major depressive disorder (MDD). Whereas latent variable models examine relations among latent constructs, network analyses have the advantage of characterizing direct relations among the symptoms themselves. METHOD: We conducted network modeling on symptoms of social anxiety and depression in a clinical sample of 130 women who met criteria for SAD, MDD, both disorders, or had no lifetime history of mental illness. RESULTS: In the resulting network, the core symptoms of social fear and depressed mood appeared at opposite ends of the network and were weakly related; so-called "bridges" between these symptoms appeared to occur via intervening variables. In particular, the worthless variable appeared to play a central role in the network. LIMITATIONS: Because our data were cross-sectional, we are unable to draw conclusions about the direction of these effects or whether these variables are related to each other prospectively. CONCLUSIONS: Continued testing of these pathways using longitudinal data will help facilitate the development of more effective clinical interventions for these disorders.

Does centrality in a cross-sectional network suggest intervention targets for social anxiety disorder?

OBJECTIVE: Network analysis allows us to identify the most interconnected (i.e., central) symptoms, and multiple authors have suggested that these symptoms might be important treatment targets. This is because change in central symptoms (relative to others) should have greater impact on change in all other symptoms. It has been argued that networks derived from cross-sectional data may help identify such important symptoms. We tested this hypothesis in social anxiety disorder. METHOD: We first estimated a state-of-the-art regularized partial correlation network based on participants with social anxiety disorder (n = 910) to determine which symptoms were more central. Next, we tested whether change in these central symptoms were indeed more related to overall symptom change in a separate dataset of participants with social anxiety disorder who underwent a variety of treatments (n = 244). We also tested whether relatively superficial item properties (infrequency of endorsement and variance of items) might account for any effects shown for central symptoms. RESULTS: Centrality indices successfully predicted how strongly changes in items correlated with change in the remainder of the items. Findings were limited to the measure used in the network and did not generalize to three other measures related to social anxiety severity. In contrast, infrequency of endorsement showed associations across all measures. CONCLUSIONS: The transfer of recently published results from cross-sectional network analyses to treatment data is unlikely to be straightforward. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The behavioral economics of social anxiety disorder reveal a robust effect for interpersonal traits.

Recent evidence suggests that reduced generosity among individuals with social anxiety disorder (SAD) in behavioral economic tasks may result from constraint in changing behavior according to interpersonal contingencies. That is, people with SAD may be slower to be more generous when the situation warrants. Conversely, more global effects on generosity may be related to interpersonal vindictiveness, a dimension only somewhat related to SAD. A total of 133 participants, 73 with the generalized form of SAD, completed self-report instruments and a behavioral economic task with simulated interpersonal (friend, romantic partner, stranger) interactions. In a separate visit, friends (n = 88) also came to the lab and rated participants on vindictiveness. Interpersonal vindictiveness was associated with reduced initial and overall giving to simulated friends. SAD predicted a lack of increased giving to a simulated friend, and attenuated an increase in giving to simulated known versus unknown players compared to participants without SAD. Friend-reported vindictiveness predicted in the same direction as diagnosis. However, the findings for SAD were less robust than those for vindictiveness. SAD is perhaps weakly related to behavioral constraint in economic tasks that simulate interpersonal interactions, whereas vindictiveness is strongly related to lower overall generosity as well as (via friend report) behavioral constraint. Further study is needed to better characterize the construct of vindictiveness. Our findings dovetail with the suggestion that SAD is related to impairment in the proposed affiliation and attachment system, but further suggest that direct study of that system may be more fruitful than focusing on disorders.

Measuring Social Motivation Using Signal Detection and Reward Responsiveness.

BACKGROUND: Recent trends in psychiatry have emphasized the need for a shift from categorical to dimensional approaches. Of critical importance to this transformation is the availability of tools to objectively quantify behaviors dimensionally. The present study focuses on social motivation, a dimension of behavior that is central to a range of psychiatric conditions but for which a particularly small number of assays currently exist. METHODS: In Study 1 (N = 48), healthy adults completed a monetary reward task and a social reward task, followed by completion of the Chapman Physical and Social Anhedonia Scales. In Study 2 (N = 26), an independent sample was recruited to assess the robustness of Study 1's findings. RESULTS: The reward tasks were analyzed using signal detection theory to quantify how much reward cues bias participants' responses. In both Study 1 and Study 2, social anhedonia scores were negatively correlated with change in response bias in the social reward task but not in the monetary reward task. A median split on social anhedonia scores confirmed that participants with high social anhedonia showed less change in response bias in the social reward task compared to participants with low social anhedonia. CONCLUSIONS: This study confirms that social anhedonia selectively affects how much an individual changes their behavior based on the presence of socially rewarding cues and establishes a tool to quantify social reward responsiveness dimensionally.

Evaluation to Improve a High School Summer Science Outreach Program.

The goal of the Young Scientist Program (YSP) at Washington University School of Medicine in St. Louis (WUSM) is to broaden science literacy and recruit talent for the scientific future. In particular, YSP seeks to expose underrepresented minority high school students from St. Louis public schools (SLPS) to a wide variety of careers in the sciences. The centerpiece of YSP, the Summer Focus Program (SFP), is a nine-week, intensive research experience for competitively chosen rising high school seniors (Scholars). Scholars are paired with volunteer graduate student, medical student, or postdoctoral fellow mentors who are active members of the practicing scientific community and serve as guides and exemplars of scientific careers. The SFP seeks to increase the number of underrepresented minority students pursuing STEM undergraduate degrees by making the Scholars more comfortable with science and science literacy. The data presented here provide results of the objective, quick, and simple methods developed by YSP to assess the efficacy of the SFP from 2006 to 2013. We demonstrate that the SFP successfully used formative evaluation to continuously improve the various activities within the SFP over the course of several years and in turn enhance student experiences within the SFP. Additionally we show that the SFP effectively broadened confidence in science literacy among participating high school students and successfully graduated a high percentage of students who went on to pursue science, technology, engineering, and mathematics (STEM) majors at the undergraduate level.

Self-reported social skills impairment explains elevated autistic traits in individuals with generalized social anxiety disorder.

Screening for autism in individuals with generalized social anxiety disorder (GSAD) is complicated by symptom overlap between GSAD and autism spectrum disorder (ASD). We examined the prevalence of self-reported autistic traits within a sample of participants with a diagnosis of GSAD (n=37) compared to individuals without a GSAD diagnosis (NOSAD; n=26). Of the GSAD sample participants, 70.84% self-reported autistic traits above a cut-off of 65 on the Autism Quotient-Short (AQ-S) and reported significantly more autistic traits on 3 of 5 AQ-S subscales compared to the NOSAD group. Diagnosis uniquely predicted variation in the social skills subscale above and beyond the other subscales and other predictors. Furthermore, variation in the social skills subscale largely explained group differences on the other subscales. Our results suggest caution in utilizing measures like the AQ-S with clinical populations characterized by social difficulties such as individuals with a GSAD diagnosis.

Self and friend's differing views of social anxiety disorder's effects on friendships.

Social anxiety disorder is known to be associated with self-report of global friendship quality. However, information about specific friendships, as well as information beyond self-report, is lacking. Such information is crucial, because known biases in information processing related to social anxiety disorder render global self-ratings particularly difficult to interpret. We examined these issues focusing on diagnosed participants (n = 77) compared with community control participants (n = 63). We examined self-report regarding global (i.e., overall) friendship quality and a specific friendship's quality; in addition, we examined friend-report of that friendship's quality. Results suggested that social anxiety disorder has a negative impact on self-perception of friendship quality for a specific friendship, but that this effect is less evident as reported by the friends. Specifically, social anxiety disorder was associated with a tendency to report worse friendship quality in comparison to friend-report, particularly in participants who were younger or had less long-lasting friendships. However, friend-report did show clear differences based on diagnostic group, with friends reporting participants with social anxiety disorder to be less dominant in the friendship and less well-adjusted. Overall, the findings are consistent with results of other studies indicating that social anxiety disorder has a strong association with self-ratings of impairment, but that these ratings appear out of proportion with the report of observers (in this case, friends).

Susceptibility to the audience effect explains performance gap between children with and without autism in a theory of mind task.

Diminished social motivation constitutes one of the core impairments of autism spectrum disorder (ASD) and is thought to have a strong impact on the way individuals with autism respond to the presence of others. In this study, we hypothesized that experimental contexts involving direct interaction with an experimenter might elicit different reactions in children with ASD and thus act as a potential confound in the interpretation of group differences during social cognitive tests. Following classic work in social psychology on the audience effect-wherein individuals act differently when they are being watched in a more or less conscious attempt to enhance their reputation in the eyes of others-we reasoned that social contexts are indeed likely to produce an increase in performance in typically developing (TD) individuals but that children with ASD would be less susceptible to such audience effects. More specifically, we were interested in testing the idea that susceptibility to the audience effect might explain part of the performance gap between children with autism (ASDs) and children without autism in theory of mind (ToM) tasks, which are typically administered by a human experimenter. We tested this hypothesis by comparing performance on a ToM task administered in a social versus a nonsocial setting. We found that ASDs and controls performed similarly when the task was administered using a nonsocial medium. However, control participants outperformed ASDs when an experimenter administered the task. Thus, TD controls demonstrated a relative improvement in performance when in the presence of an experimenter that children with ASD did not. The implications of this diminished audience effect in ASD are discussed.

Visual attention to dynamic faces and objects is linked to face processing skills: a combined study of children with autism and controls.

Although the extant literature on face recognition skills in Autism Spectrum Disorder (ASD) shows clear impairments compared to typically developing controls (TDC) at the group level, the distribution of scores within ASD is broad. In the present research, we take a dimensional approach and explore how differences in social attention during an eye tracking experiment correlate with face recognition skills across ASD and TDC. Emotional discrimination and person identity perception face processing skills were assessed using the Let's Face It! Skills Battery in 110 children with and without ASD. Social attention was assessed using infrared eye gaze tracking during passive viewing of movies of facial expressions and objects displayed together on a computer screen. Face processing skills were significantly correlated with measures of attention to faces and with social skills as measured by the Social Communication Questionnaire (SCQ). Consistent with prior research, children with ASD scored significantly lower on face processing skills tests but, unexpectedly, group differences in amount of attention to faces (vs. objects) were not found. We discuss possible methodological contributions to this null finding. We also highlight the importance of a dimensional approach for understanding the developmental origins of reduced face perception skills, and emphasize the need for longitudinal research to truly understand how social motivation and social attention influence the development of social perceptual skills.

An imputed dissociation might be an artifact: Further evidence for the generalizability of the observations of Durgin et al. 2010.

We recently showed that palm board measures are systematically inaccurate for full-cue surfaces within reach of one's hand, whereas free-hand gestures and reaching actions are quite accurate for such surfaces (Durgin, Hajnal, Li, Tonge, & Stigliani, 2010). Proffitt and Zadra (2010) claim that our demonstration that palm boards are highly inaccurate is irrelevant to interpreting past and present findings concerning dissociations between verbal reports and palm board estimates. In their paper they offer a theoretical representation of the findings of Bhalla and Proffitt (1999) and argue that our analysis is incompatible with their account. We offer here an alternative account of the findings of Bhalla and Proffitt, based on their actual data (which are fully compatible with our original analysis). We further show how our account generalizes to more recent studies that continue (1) to mistakenly describe null statistical effects on (insensitive) palm boards as evidence of a "dissociation" from (more sensitive) verbal measures that show a similar relative magnitude of change and (2) to introduce uncontrolled demand characteristics.

Palm boards are not action measures: an alternative to the two-systems theory of geographical slant perception.

Whereas most reports of the perception of outdoor hills demonstrate dramatic overestimation, estimates made by adjusting a palm board are much closer to the true hill orientation. We test the dominant hypothesis that palm board accuracy is related to the need for motor action to be accurately guided and conclude instead that the perceptual experience of palm-board orientation is biased and variable due to poorly calibrated proprioception of wrist flexion. Experiments 1 and 3 show that wrist-flexion palm boards grossly underestimate the orientations of near, reachable surfaces whereas gesturing with a free hand is fairly accurate. Experiment 2 shows that palm board estimates are much lower than free hand estimates for an outdoor hill as well. Experiments 4 shows that wrist flexion is biased and noisy compared to elbow flexion, while Experiment 5 shows that small changes in palm board height produce large changes in palm board estimates. Together, these studies suggest that palm boards are biased and insensitive measures. The existing literature arguing that there are two systems in the perception of geographical slant is re-evaluated, and a new theoretical framework is proposed in which a single exaggerated representation of ground-surface orientation guides both action and perception.