Mechanisms of change in treatments for transdiagnostic emotion dysregulation: The roles of skills use, perceived control and mindfulness.

Emotion dysregulation (ED) is a key target for change among empirically supported treatments for emotional disorders, including dialectical behaviour therapy skills training (DBT-ST), yet how treatments improve ED is poorly understood. Using data from a randomised trial of DBT-ST versus supportive group therapy for transdiagnostic ED, we tested whether three mechanistic variables-behavioural skills use, mindfulness, and perceived control-explain variability in ED within people over time. We additionally explored the mediating roles of these variables between conditions. Adults with transdiagnostic ED (N = 44) participated in weekly groups for 4 months, with assessments at pre-, mid- and post-treatment and at 2-month follow-up. As hypothesised, multilevel models disaggregating within- and between-person effects indicated that skills use, mindfulness, and perceived control each had significant total and unique within-person associations with ED at concurrent time points, net the effect of time. Unexpectedly, these within-person relations were not significant for mechanistic variables predicting ED 2 months later. Further, unique between-person variability in skills use, mindfulness, and perceived control did not significantly mediate the relationship between condition and ED improvements. The present study is an important step in clarifying ED mechanisms of change, both within and between persons.

On the evolving nature of exposure therapy.

Four articles examining methodological applications of exposure therapy and its limited dissemination were briefly reviewed. Methodological articles included those by Abramowitz et al., Gryczkowski et al., and Weiner and McKay, which addressed couple treatment of obsessive-compulsive disorder (OCD), modification of evidence-based anxiety treatments for children, and novel exposure methods for depersonalization and derealization, respectively. The creative aspects of these innovations are highlighted as well as historical parallels in the empirical literature for both anxiety and other clinical phenomena. Underutilization and limited dissemination concerns are discussed in the context of the fourth article by Hipol and Deacon and as related to the field as a whole. A unique concept, exposaphobia, is hypothesized to explain the lack of clinicians' utilization of this technique, due to their own anxiety-driven inhibitions in using it. Suggestions for the future of exposure research and dissemination are made.

Aviophobia assessment: validating the Flight Anxiety Situations Questionnaire as a clinical identification measure.

An Internet survey was conducted to validate the Flight Anxiety Situations Questionnaire (FAS; Van Gerwen, Spinhoven, Van Dyck, & Diekstra, 1999) as a clinical identification measure for aviophobia. Nine hundred and seventy six people completed the survey. Using further criteria, the total pool was reduced to 98 aviophobics and 474 non-phobics. Receiver operating characteristic analysis and chi-square tests of associations indicated that minimal scores of 56 (as previously reported in research) and 70 on the FAS were useful predictors of being a flying phobic. However, the empirically derived cut-off score of 70 on the FAS had the best overall balance of Type I and Type II error, such that the diagnostic standard for flying phobia was set neither too low nor too high. Given that 60.3% of participants were university students, results may not be generalizable to the general population but may be particularly useful for researchers at these settings.