Change in Seasonal Beliefs Mediates the Durability Advantage of Cognitive-Behavioral Therapy Over Light Therapy for Winter Depression.

In treating an acute episode of winter depression, cognitive-behavioral therapy for seasonal affective disorder (CBT-SAD) and light therapy are comparably efficacious, with improvement in depression symptoms during CBT-SAD mediated by reduced seasonal beliefs (i.e., maladaptive thoughts about the seasons, light availability, and weather). Here, we tested whether the enduring benefit of CBT-SAD over light therapy following treatment is associated with offsetting seasonal beliefs during CBT-SAD. Currently depressed adults with Major Depression, Recurrent with Seasonal Pattern (N = 177) were randomized to 6 weeks of light therapy or group CBT-SAD and followedup one and two winters after treatment. Outcomes measured during treatment and at each follow-up included depression symptoms on the Structured Clinical Interview for the Hamilton Rating Scale for Depression-SAD Version and Beck Depression Inventory-Second Edition. Candidate mediators measured at pre-, mid-, and posttreatment were SAD-specific negative cognitions (Seasonal Beliefs Questionnaire; SBQ); general depressogenic cognitions (Dysfunctional Attitudes Scale; DAS); brooding rumination (Ruminative Response Scale-Brooding subscale; RRS-B); and chronotype (Morningness-Eveningness Questionnaire; MEQ). Latent growth curve mediation models found a significant positive path from treatment group to the slope of SBQ during treatment, with CBT-SAD showing larger improvements in seasonal beliefs with overall change in seasonal beliefs in the medium-effect range, and significant positive paths from SBQ slope to depression scores at the first and second winter follow-ups, indicating greater change towards more flexible seasonal beliefs during active treatment was associated with less severe depression symptoms following treatment. Estimated indirect effects (treatment group → SBQ change * SBQ change → outcome) were also significant at each follow-up for each outcome with ßindirect ranging from .091 to .162. Models also found significant positive paths from treatment group to the slope of MEQ and RRS-B during treatment, with light therapy showing a greater increase in "morningness" and CBT-SAD showing a greater decrease in brooding during active treatment; however, neither construct emerged as a mediator of follow-up depression scores. Change in seasonal beliefs during treatment mediates both the acute antidepressant and long-term effects of CBT-SAD and explains lower depression severity following CBT-SAD relative to light therapy.

Development and Validation of the Smoker Self-Stigma Questionnaire.

INTRODUCTION: Researchers have become increasingly concerned with the stigmatizing impact that regulations and policies aimed to curve down cigarette smoking may have on smokers. Given the lack of psychometrically validated tools available to assess smoking stigma, we developed and evaluated the Smoker Self-Stigma Questionnaire (SSSQ). AIMS AND METHODS: A total of 592 smokers recruited through Amazon's Mechanical Turk (MTurk) completed an online, Qualtrics survey that included 45 items developed and vetted by tobacco-research experts. The items were assigned a priori to three, theoretical stigma factors or domains (enacted, felt, and internalized). We first conducted a confirmatory factor analysis (CFA) on the responses from one-half of the participants with the goal of distilling the 45-item pool to an 18-item instrument with 6 items per factor. A promising, 18-item, three-factor measure was then cross-validated with the second half of the sample. RESULTS: The second CFA yielded excellent fit indices, as well as adequate and significant factor loadings. Subscale scores obtained from the separated factors differentially predicted nicotine dependence and motivation to quit cigarettes, providing convergent and discriminant validity for the SSSQ and its proposed, three-factor structure. CONCLUSIONS: Overall, the SSSQ fills an important research gap by providing a psychometrically sound measure that investigators can use to study smoking stigma. IMPLICATIONS: Prior research on smoking self-stigma has used a wide variety of psychometrically invalid measures and reported inconsistent findings. This is the first study that presents a measure of smoking self-stigma that is not a merely and arbitrary adaptation of a mental illness stigma measure, but that is theoretically driven and created from a large and comprehensive pool of items vetted by tobacco-research experts. Having demonstrated and then cross-validated its excellent psychometric properties, the SSSQ provides the field with a promising tool to assess, investigate, and replicate the causes and effects of smoking self-stigma.

Latent Classes of Perceived Addictiveness Predict Marijuana, Alcohol, and Tobacco Use in Youth and Young Adults.

Background: Mass media substance use prevention efforts target addiction perceptions in young people. This study examined youth and young adults' (YAs) perceived addictiveness across several substances and the associations between addiction perceptions and substance use. Methods: Data were collected in 2019 in an online cohort study of Vermonters aged 12-25. Latent class analyses grouped participants by perceived addictiveness of nicotine, caffeine, alcohol, marijuana, cigarettes, electronic vapor products (EVPs), and opioids. Bivariate multinomial logistic and modified Poisson regression estimated associations between sociodemographics, substance use correlates, and subsequent use across latent classes. Results: Four latent classes captured addiction perceptions: high perceived addictiveness of EVPs, cigarettes, marijuana, and alcohol (Class 1: n = 317; 31.3%), low perceived addictiveness of marijuana, alcohol, and caffeine (Class 2: n = 151; 14.3%), low perceived addictiveness of marijuana (Class 3: n = 581; 46.5%), and low perceived addictiveness of nicotine, cigarettes, and EVPs (Class 4: n = 83; 7.9%). For each year increase in age, there was a 36% increased likelihood of being in Class 2 (vs. Class 1) and a 148% increased likelihood of belonging to Class 3 (vs. Class 1). Low perceived addictiveness classes were associated with ever and past 30-day marijuana and alcohol use and predicted past 30-day alcohol use at three-month follow-up. Membership in Classes 2 and 3 also predicted past 30-day marijuana use at Wave 3. Discussion: The strong association between age and latent classes defined by low perceived addictiveness suggests age group differences in addiction perceptions. Findings suggest that YAs may benefit from prevention messaging on addictiveness.

An examination of the heterogeneity of the relationships between posttraumatic stress disorder, self-compassion and gratitude.

Previous research has found both self-compassion and gratitude to be protective against overall posttraumatic stress disorder (PTSD) symptom severity. PTSD is a highly heterogeneous disorder; however, it is unclear if these protective constructs are differentially associated with each cluster of PTSD. The present study examined differences in the association of self-compassion and gratitude with the four clusters of PTSD as indicated by the DSM-5. Participants were 1424 trauma-exposed individuals recruited via Amazon's Mechanical Turk. The mean age of participants was 31.49 (SD = 11.25) years old, and 55.3% of the sample identified as female. A structural equation model (SEM) approach was used to examine relationships between factors of gratitude, self-compassion and the four PTSD symptom clusters. A two-factor model of self-compassion best fits the data. Both the self-compassion and gratitude factors were significantly associated with all symptom clusters of PTSD. Wald chi-square tests indicated self-compassion and gratitude to have the strongest association with negative alterations in cognitions and mood (NACM) PTSD symptoms. These findings may have important implications for treatment targets to reduce specific symptoms of PTSD, particularly in PTSD symptoms related to negative affect.

Applying experimental therapeutics to examine cognitive and chronological vulnerabilities as mediators of acute outcomes in cognitive-behavioral therapy and light therapy for winter depression.

OBJECTIVE: We applied the experimental therapeutics approach to test whether acute treatment outcomes for winter seasonal affective disorder (SAD) are mediated by a cognitive mechanism in cognitive-behavioral therapy (CBT-SAD) versus a chronobiologic mechanism in light therapy (LT). METHOD: Currently depressed adults with major depression, recurrent with seasonal pattern (N = 177; 83.6% female, 92.1% non-Hispanic White, M age = 45.6) were randomized to 6 weeks of LT or group CBT-SAD. SAD symptoms were assessed weekly on the Structured Clinical Interview for the Hamilton Rating Scale for Depression-SAD Version. At pre-, mid-, and posttreatment, participants completed measures of general depressogenic cognitions (Dysfunctional Attitudes Scale; DAS); SAD-specific negative cognitions (Seasonal Beliefs Questionnaire; SBQ); chronotype (Morningness-Eveningness Questionnaire; MEQ); and depressive symptoms (Beck Depression Inventory-Second Edition). RESULTS: Parallel-process growth models showed evidence for hypothesized mechanisms. For SAD-specific negative cognitions (SBQ), both symptom measures showed (1) an effect of treatment group on the slope of the mediator, with CBT-SAD demonstrating greater decreases, and (2) an effect of the slope of the mediator on the slope of the outcome. These effects held for the SBQ but not the broader measure of depressogenic cognitions (DAS). For the chronotype measure (MEQ), treatment assignment affected change, whereby LT was associated with reduced "eveningness," but this was unrelated to change in symptoms. CONCLUSIONS: CBT-SAD promoted decreases in SAD-specific negative cognitions, and these changes were related to decreases in symptoms. Consistent with the theory that LT corrects misaligned circadian rhythms, LT reduced eveningness, but this did not correspond to symptom improvement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Exploration of the Factor Structure of ADHD in Adolescence through Self, Parent, and Teacher Reports of Symptomatology.

Factor analytic studies of attention-deficit/hyperactivity disorder (ADHD) in children and adults have shown that second-order and bifactor models better represent ADHD symptoms than two- or three-factor models, yet there is far less evidence for a bestfitting model of ADHD in adolescence. Thus, the current study examined the factor structure of ADHD in adolescence and further evaluated the external validity of the best fitting model. Participants were 588 adolescents (22 % female; 366 with a childhood ADHD diagnosis; mean age 15.9 years) from the 8-year assessment of the Multimodal Treatment Study of Children with ADHD (MTA). ADHD symptoms were assessed via adolescent self-report, parent report, and teacher report on the SNAP-IV scale. Potential factor structures for the 18 symptoms of ADHD were tested for each informant, which included traditional one-factor, two-factor, and three-factor models of ADHD, as well as second-order factor (specific factors loading onto general factor) and bifactor (items loading onto both specific and general factors) models. Unique associations between external criteria and the identified factors of each informant's best fitting model were examined. Although several of the proposed models exhibited good fit, the second-order two-factor model best accounted for ADHD in adolescence according to self-report and parent report, and the second-order three-factor model was optimal according to teacher report. Several key measurement issues emerged for the hierarchical bifactor models, such as numerous Heywood cases and out-of-bound parameter estimates, which rendered them unfit as optimal representations of ADHD in adolescence. These findings and the implications of the best fitting model of ADHD in adolescence suggest that a possible reorganization of this disorder may eventually aid clinicians in the accurate diagnosis of ADHD in adolescents.

Structural brain correlates of adolescent resilience.

BACKGROUND: Despite calls for integration of neurobiological methods into research on youth resilience (high competence despite high adversity), we know little about structural brain correlates of resilient functioning. The aim of the current study was to test for brain regions uniquely associated with positive functioning in the context of adversity, using detailed phenotypic classification. METHODS: 1,870 European adolescents (Mage  = 14.56 years, SDage  = 0.44 years, 51.5% female) underwent MRI scanning and completed behavioral and psychological measures of stressful life events, academic competence, social competence, rule-abiding conduct, personality, and alcohol use. RESULTS: The interaction of competence and adversity identified two regions centered on the right middle and superior frontal gyri; grey matter volumes in these regions were larger in adolescents experiencing adversity who showed positive adaptation. Differences in these regions among competence/adversity subgroups were maintained after controlling for several covariates and were robust to alternative operationalization decisions for key constructs. CONCLUSIONS: We demonstrate structural brain correlates of adolescent resilience, and suggest that right prefrontal structures are implicated in adaptive functioning for youth who have experienced adversity.

Moderating Effects of Coping on Associations between Autonomic Arousal and Adolescent Internalizing and Externalizing Problems.

Few published studies have looked at the moderating role of coping styles on the association between stress reactivity and internalizing/externalizing problems despite theory suggesting that particular constellations of stress reactivity and coping may be uniquely problematic. The present study aimed to test the interactive effects of coping and psychophysiology on self- and parent-report broad-spectrum problems in a normative adolescent sample. Sixty-six late adolescents (ages 16-17; 60% female, 13% ethnic minority) completed questionnaires on coping, stressful life events, and behavioral/emotional problems, with parents also providing data on problems. In addition, skin conductance and heart rate data were obtained during a brief interview designed to elicit the feeling of reexperiencing a recent stressful experience. Path analytic results suggested evidence for several interaction effects between coping and skin conductance. Most commonly, the pattern of effects was consistent with a buffering effect for productive (or problem-focused) coping strategies against elevated internalizing and externalizing problems for individuals who demonstrated high physiological stress reactivity. Evidence for interaction effects related to respiratory sinus arrhythmia was less frequent and less consistent with a priori hypotheses. Although our cross-sectional results should be interpreted cautiously, the interactions reported here suggest that improving coping skills may be particularly beneficial for youth with high psychophysiological arousal.

Is parenting the mediator of change in behavioral parent training for externalizing problems of youth?

Change in parenting behavior is theorized to be the mediator accounting for change in child and adolescent externalizing problems in behavioral parent training (BPT). The purpose of this review is to examine this assumption in BPT prevention and intervention programs. Eight intervention and 17 prevention studies were identified as meeting all criteria or all but one criterion for testing mediation. Parenting behaviors were classified as positive, negative, discipline, monitoring/supervision, or a composite measure. Forty-five percent of the tests performed across studies to test mediation supported parenting as a mediator. A composite measure of parenting and discipline received the most support, whereas monitoring/supervision was rarely examined. More support for the mediating role of parenting emerged for prevention than intervention studies and when meeting all criteria for testing mediation was not required. Although the findings do not call BPT into question as an efficacious treatment, they do suggest more attention should be focused on examining parenting as a putative mediator in BPT.

A test of the DSM-5 severity scale for alcohol use disorder.

BACKGROUND: For the DSM-5-defined alcohol use disorder (AUD) diagnosis, a tri-categorized scale that designates mild, moderate, and severe AUD was selected over a fully dimensional scale to represent AUD severity. The purpose of this study was to test whether the DSM-5-defined AUD severity measure was as proficient a predictor of alcohol use following a brief intervention, compared to a fully dimensional scale. METHODS: Heavy drinking primary care patients (N=246) received a physician-delivered brief intervention (BI), and then reported daily alcohol consumption for six months using an Interactive Voice Response (IVR) system. The dimensional AUD measure we constructed was a summation of all AUD criteria met at baseline (mean=6.5; SD=2.5). A multi-model inference technique was used to determine whether the DSM-5 tri-categorized severity measure or a dimensional approach would provide a more precise prediction of change in weekly alcohol consumption following a BI. RESULTS: The Akaike information criterion (AIC) for the dimensional AUD model (AIC=7623.88) was four points lower than the tri-categorized model (AIC=7627.88) and weight of evidence calculations indicated there was 88% likelihood the dimensional model was the better approximating model. The dimensional model significantly predicted change in alcohol consumption (p=.04) whereas the DSM-5 tri-categorized model did not. CONCLUSION: A dimensional AUD measure was superior, detecting treatment effects that were not apparent with tri-categorized severity model as defined by the DSM-5. We recommend using a dimensional measure for determining AUD severity.

Comparison of categorical alcohol dependence versus a dimensional measure for predicting weekly alcohol use in heavy drinkers.

BACKGROUND: The DSM specifies categorical criteria for psychiatric disorders. In contrast, a dimensional approach considers variability in symptom severity and can significantly improve statistical power. The current study tested whether a categorical, DSM-defined diagnosis of Alcohol Dependence (AD) was a better fit than a dimensional dependence measure for predicting change in alcohol consumption among heavy drinkers following a brief alcohol intervention (BI). DSM-IV and DSM-5 alcohol use disorder (AUD) measures were also evaluated. METHODS: Participants (N=246) underwent a diagnostic interview after receiving a BI, then reported daily alcohol consumption using an Interactive Voice Response system. Dimensional AD was calculated by summing the dependence criteria (mean=4.0; SD=1.8). The dimensional AUD measure was a summation of positive Alcohol Abuse plus AD criteria (mean=5.8; SD=2.5). A multi-model inference technique was used to determine whether the DSM-IV categorical diagnosis or dimensional approach would provide a more accurate prediction of first week consumption and change in weekly alcohol consumption following a BI. RESULTS: The Akaike information criterion (AIC) for the dimensional AD model (AIC=7625.09) was 3.42 points lower than the categorical model (AIC=7628.51) and weight of evidence calculations indicated there was 85% likelihood that the dimensional model was the better approximating model. Dimensional AUD models fit similarly to the dimensional AD model. All AUD models significantly predicted change in alcohol consumption (p's=.05). CONCLUSION: A dimensional AUD diagnosis was superior for detecting treatment effects that were not apparent with categorical and dimensional AD models.

Molecular-genetic correlates of infant attachment: a cautionary tale.

This paper advises caution in relation to the increasing interest in molecular-genetic association studies in developmental psychology based on a set of empirical examples from the NICHD Study of Early Child Care and Youth Development (SECCYD) that highlight the fragility of effects reported in the literature on the molecular-genetic correlates of infant attachment. Specifically, this paper updates and provides three extensions to results reported in Luijk et al. (2011), which recently failed to replicate evidence from smaller-sample studies that a set of dopaminergic, serotonergic, and oxytonergic markers are significantly associated with infant attachment security or disorganization. First, we report here that the average effect of "usual suspect" polymorphisms on infant attachment security and disorganization in the SECCYD is approximately zero. Second, because Luijk et al. (2011) reported data based exclusively on the White infants in the SECCYD, this paper reveals that the average effect of polymorphisms featured in this literature is also of trivial magnitude in the non-White sub-sample (cf. Chen, Barth, Johnson, Gotlib, & Johnson, 2011). Third, this paper attempts, but fails, to replicate a recent finding by Raby et al. (2012) suggesting that, although molecular-genetic polymorphisms might not be implicated in security versus insecurity, the serotonin transporter gene contributes to variation in emotional distress during the Strange Situation Procedure. Implications for future research on the genetics of developmental phenotypes in general and attachment in particular are discussed, with a focus on statistical power and model-based theory testing.

Resilience in the transition to adulthood.

The emerging adulthood years, commonly defined as the late teens and twenties, represent a period of significant variability and change for much of the population. Thus, it is important for the field to consider pathways of at-risk youth as they move through this key window of development. We review research on positive outcomes in the transition to adulthood following a history of experienced adversity, including both investigations focused on resilience in diverse specific populations as well as broader longitudinal studies. There is compelling evidence for major protective and promotive factors identified in younger age periods continuing to exert an influence at this stage of development, along with evidence for new factors unique to this developmental time and/or to specific populations. We conclude by noting recommendations for future work in this area, emphasizing Garmezy's call for the testing of competing models.

In search of security: the latent structure of the Adult Attachment Interview revisited.

Building on Roisman, Fraley, and Belsky, who produced evidence for two modestly correlated dimensions (i.e., dismissing and preoccupied states of mind) underlying individual differences in attachment as assessed by the Adult Attachment Interview using the Main and Goldwyn classification system, this report replicates and extends relevant evidence in a large sample of adults (N = 842) who completed the Adult Attachment Interview coded using Kobak's Adult Attachment Interview Q-Sort. Principal components analysis of item-level Q-Sort data yielded two state of mind (dismissing vs. free to evaluate and preoccupied vs. not) and two inferred experience (maternal and paternal) components that were associated with two domains of theoretical significance to attachment theory: interpersonal functioning in a romantic context and symptoms of psychopathology. Results revealed distinctive behavioral correlates of dismissing versus preoccupied states of mind and emphasize the differential predictive significance for developmental adaptation of attachment states of mind versus adults' recollections of their early experiences. Implications for adult attachment methodology and theory are discussed.

Competence and psychopathology: cascade effects in the NICHD Study of Early Child Care and Youth Development.

Existing longitudinal research on the interplay between externalizing problems, internalizing problems, and academic and social competence has documented "cascading" effects from early aggressive/disruptive behavior through impairments in competence, leading to symptoms of depression and anxiety. The primary aim of the current study was to replicate such work using the NICHD Study of Early Child Care and Youth Development while also extending the developmental window of investigation of cascades back into early childhood. Participating families (N = 1,160) completed questionnaire measures of externalizing, internalizing, and social competence (maternal report), as well as individual assessment of academic achievement, spanning five time points from age 54 months through age 15 years. A series of nested structural equation models tested predicted links across various domains of competence and psychopathology. Results were consistent with prior research, demonstrating cross-domain effects from early externalizing problems through effects on both academic and social competence into later internalizing problems. Effects held across gender and were largely unaffected by inclusion of socioeconomic status, early caregiving, and early cognitive ability as covariates in the model.

Testing a dual cascade model linking competence and symptoms over 20 years from childhood to adulthood.

This study examined the unique longitudinal effects linking academic competence, social competence, and internalizing symptoms from childhood to adulthood. A multimethod and multi-informant approach was used to assess psychopathology and competence in 205 participants during four developmental periods. Social competence in childhood had a cascading effect on internalizing symptoms in adolescence, whereas social and academic competence in emerging adulthood had dual cascading effects on internalizing in young adulthood. Results suggested a developmental cascade beginning with externalizing symptoms in childhood, which contributed to lower academic achievement in adolescence, which in turn influenced social competence in emerging adulthood and internalizing symptoms in young adulthood.

Intergenerational continuity in parenting quality: the mediating role of social competence.

Prospective studies of intergenerational continuity in parenting quality remain scarce, with little attention given to the potential role of social competence as a mediator of continuity. This study examined social competence as a mediator in the pathway from 1st generation (G1) to 2nd generation (G2) parenting quality. A normative sample of children and their parents were assessed in childhood, and again 10 and 20 years later. Parenting quality of G1 parents was assessed at each time point with multiple informants, as was G2 social competence. G2 parenting was assessed at the 20-year follow-up for those who were parents. The mediational role of social competence in G1 to G2 parenting quality was tested via nested path analytic models, accounting for continuity and cross-domain relations. Social competence mediated the intergenerational relation of parenting quality; results were invariant across gender and ethnic minority status and were unchanged after controlling for age, IQ, socioeconomic status, rule-abiding conduct, and personality (i.e., constraint). The authors discuss results regarding developmental theories of close relationships and the potential for cascading benefits within and across generations from interventions to improve G1 parenting or G2 social competence.

The interplay of social competence and psychopathology over 20 years: testing transactional and cascade models.

Associations among internalizing, externalizing, and social competence were examined in a longitudinal cohort (N = 205) of 8- to 12-year-old children reassessed after 7, 10, and 20 years. Theoretically informed nested structural equation models tested interconnections among broad multi-informant constructs across four developmental periods. Follow-up analyses examined gender invariance, measurement and age effects, and putative common causes. Key model comparisons indicated robust negative paths from social competence to internalizing problems from childhood to adolescence and from emerging adulthood to young adulthood. Social competence and externalizing problems showed strong initial associations in childhood but no longitudinal cross-domain paths. Using a developmental psychopathology framework, results are discussed in relation to cascade and transactional effects and the interplay between competence and symptoms over time.

Pathways of adaptation from adolescence to young adulthood: antecedents and correlates.

This study examines longitudinal change using a person-centered approach to differentiate patterns of adaptive functioning from adolescence to adulthood. Data are drawn from a 20-year longitudinal study of competence and resilience in the lives of 205 school children (29% minority). Results indicate five distinct pathways of adaptation: (1) low-declining, (2) low-improving, (3) middle-improving, (4) middle-declining, and (5) consistently high. The study also compares the five groups on childhood risks and resources, and on longitudinal assessment of competence and adversity. Interestingly, the most dramatic changes in pathways of adaptation occur during the period of emerging adulthood.

Developmental cascades: linking academic achievement and externalizing and internalizing symptoms over 20 years.

A developmental cascade model linking competence and symptoms was tested in a study of a normative, urban school sample of 205 children (initially 8 to 12 years old). Internalizing and externalizing symptoms and academic competence were assessed by multiple methods at the study outset and after 7, 10, and 20 years. A series of nested cascade models was tested through structural equation modeling. The final model indicated 2 hypothesized cascade effects: Externalizing problems evident in childhood appeared to undermine academic competence by adolescence, which subsequently showed a negative effect on internalizing problems in young adulthood. A significant exploratory effect was consistent with internalizing symptoms containing or lowering the net risk for externalizing problems under some conditions. These 3 cascade effects did not differ by gender and were not attributable to effects of IQ, parenting quality, or socioeconomic differences. Implications are discussed for developmental models of cascades, progressions, and preventive interventions.