Mapping the Path to Cognitive Balance: Applying the States of Mind Model and Network Analysis to Eating Disorder Patients.

Background: In eating disorders (EDs), cognitive-behavioral therapy (CBT) represents one of the first-line treatment options albeit with sub-optimal results. The assessment of cognitive balance through an index measuring increased adaptive thinking and reduced maladaptive thinking, the desired outcomes, and the ultimate goal of CBT treatments warrants attention. The states of mind model (SOM) provides a framework through which a cognitive balance index can be defined. The current cross-sectional controlled study tested the clinical utility of the SOM model in a sample of ED outpatients. Methods: ED outpatients (n = 199) were assessed at baseline with the attitudes and beliefs scale-2 (ABS-2) for rational beliefs (RBs) and irrational beliefs (IBs), from which a SOM ratio score index (RBs/(RBs + IBs)) was calculated, the eating disorder inventory-3 (EDI-3) for ED symptoms and ED-related psychopathological features, the psychological well-being scales (PWB) for positive psychological functioning. A matched control sample (n = 95) was also assessed with the ABS-2. Results: ED patients exhibited significantly lower SOM and RB scores compared to controls. Network analysis results highlighted the centrality of the SOM-cognitive balance index, PWB-self-acceptance, and EDI-3-general psychological maladjustment, as well as the importance of the influence that cognitive balance and general psychological maladjustment exert on each other. Conclusions: The findings support the clinical utility of the SOM ratio applied to cognitions in EDs. This demonstrates its ability to differentiate such patients from controls and in capturing worse ED-related general psychopathology as well as compromised aspects of psychological well-being, in particular self-acceptance and environmental mastery. It thus might be considered in CBT treatment of EDs a potential cognitive clinimetric and clinical index of ED severity indicating key difficulties in counteracting maladaptive thinking with adaptive thinking.

Effectiveness of Outpatient Rational Emotive Behavior Therapy Over One Decade.

OBJECTIVE: The aim of this article was to explore the effectiveness of rational emotive and cognitive-behavioral therapy (REBT) in a clinical setting. METHODS: This study included 349 patients of the Albert Ellis Institute who sought psychotherapy from 2007 to 2016. Analyses were conducted by using the intent-to-treat principle, and outcomes were measured after three sessions of therapy (to measure early response) and at the end of 20 sessions. Outcome Questionnaire-45 was used to measure patient functioning. RESULTS: Patients reported significant improvements in their functioning after participating in REBT, with a medium effect size for early response after three sessions of psychotherapy and at the end of the 20 sessions. CONCLUSIONS: The authors' findings documented that REBT can be effectively transported from a research setting to clinical practice.

Do metacognitions mediate the relationship between irrational beliefs, eating disorder symptoms and cognitive reappraisal?

Objective: Cognitively oriented therapies, first-line treatment for eating disorders (EDs), still show room for improvement in treatment retention and outcomes. Despite the development of additional cognitive models and therapies, few studies examine the relationship between traditional and third-wave cognitive targets in EDs. The study explores the relationship between irrational beliefs (IBs) and metacognitions and their relationship with ED psychopathology and cognitive reappraisal in ED outpatients. Method: Seventy-seven patients (mean age 27.49 ± 12.28 years) were assessed with The Attitudes and Beliefs Scale-ABS-2, Meta-cognitions Questionnaire-MCQ-65, Eating Disorder Inventory 3-EDI-3, Eating Attitudes Test-EAT-40, Emotion Regulation Questionnaire-ERQ. Results: Correlational analyses showed that IBs and metacognitions significantly correlated with each other. Metacognitions partially mediated the relationship between IBs and ED-related general psychological maladjustment and completely mediated the relationship between IBs and ED symptom severity. Cognitive reappraisal was predicted only by IBs and metacognitions were not significant mediators. Conclusions: While IBs are sufficient in explaining ED-related psychopathology and reduced use of cognitive reappraisal, a potential integration of metacognitions about need to control thoughts in CBT models for EDs may offer incremental validity given their contribution to ED severity. Treatment implications include targeting metacognitions concerning need to control thoughts, as a potential maintenance mechanism of ED symptomatology through cognitive restructuring.

Irrational Beliefs, Cognitive Distortions, and Depressive Symptomatology in a College-Age Sample: A Mediational Analysis.

Dysfunctional cognitions such as irrational beliefs (IBs) of Ellis' rational emotive behavior therapy (REBT) model and cognitive distortions (CDs) or cognitive errors from Beck's cognitive behavioral therapy (CBT) model are known to correlate with depressive symptomatology. However, most studies focus on one cognitive theoretical model in predicting psychopathology. The current study examined the relationship between both IBs and CDs in predicting depression. A college-age sample of 507 participants completed the Attitudes and Beliefs Scale-2, the Cognitive Distortions Scale, and the Beck Depression Inventory-II. Half of the sample showed minimal depression, while the remaining sample exhibited mild-moderate (37.4%) to severe (11.1%) depression symptomatology. Through regression analyses, the study aimed to examine whether IBs accounted for more of the variance in depression symptomatology after the effects of CDs were considered. Moreover, it tested whether CDs served as a moderator or mediator between IBs and depression. Each of Ellis' IBs (demandingness, awfulizing, self-downing, and low frustration tolerance) accounted for significantly more variance in depression after the variance of CDs was entered with the IB of self-downing explaining the most variance in depression severity. Moreover, while no moderation effect was found, CDs partially mediated the effect of IBs on depression. Both IBs and CDs contributed unique variance in predicting depression. Findings support the clinical notion that IBs and CDs are associated as well as highlight the clinical utility of both conceptualizations of dysfunctional cognitions in explaining depressive symptomatology. Clinicians might consider that each dysfunctional cognition might not be subject to change if not directly targeted. Rather than choosing to focus exclusively on IBs or CDs underlying negative automatic thoughts, psychotherapeutic efforts might benefit from identifying and challenging both types of dysfunctional cognitions.

Anger and aggression treatments: a review of meta-analyses.

In the last several decades, researchers have begun to recognize dysregulated anger as a common and debilitating psychological problem among various psychiatric populations. Accordingly, the treatment of anger and aggression has received increasing attention in the literature. The current article reviews existing meta-analyses of psychosocial intervention for anger and aggression with the aims of (1) synthesizing current research evidence for these interventions, and (2) identifying interventions characteristics associated with effectiveness in specific populations of interest. Results demonstrate that cognitive behavioral treatments are the most commonly disseminated intervention for both anger and aggression. Anger treatments have consistently demonstrated at least moderate effectiveness among both non-clinical and psychiatric populations, whereas aggression treatment results have been less consistent. We discuss the implication of these findings and provide directions for future research in the treatment of anger and aggression.

Defining and measuring irritability: Construct clarification and differentiation.

Irritability is a symptom of 15 disorders in the DSM-5 and is included in Mood Disorders, Addictive Disorders, Personality Disorders, and more (American Psychiatric Association, 2013). However, the term irritability is defined and measured inconsistently in the scholarly literature. In this article, we reviewed the scholarly definitions of irritability and the item content of irritability measures. Components of definitions and items measuring irritability were divided into three categories: a) causes, b) experience, and c) consequences. We also reviewed potential causes and biomarkers of irritability. We found much overlap between definitions and measures of irritability and related constructs such as anger and aggression. Consequently, the validity of research on irritability needs to be questioned including the role of irritability in psychopathology and the presence of irritability as a symptom in any disorder. Research on irritability's role in behavioral disorders needs to be repeated after more well defined measures are developed. We proposed a more precise definition of irritability that clearly differentiates it from related constructs. Suggested items for measuring irritability are also provided.

You are such a bad child! Appraisals as mechanisms of parental negative and positive affect.

Although parent cognitions are considered important predictors that determine specific emotional reactions and parental practices, models on the cognitive strategies for regulating parental distress or positive emotions are not well developed. Our aim was to investigate the nature of cognitions involved in parental distress and satisfaction, in terms of their specificity (parental or general) and their processing levels (inferential or evaluative cognitions). We hypothesized that parent's specific evaluative cognitions will mediate the impact of more general and inferential cognitive structures on their affective reactions. We used bootstrapping procedures in order to test the mediation models proposed. Results obtained show indeed that rather specific evaluative parental cognitions are mediating the relationship between general cognitions and parental distress. In terms of the cognitive processing levels, it seems that when parents hold both low self-efficacy and parental negative global evaluations for the self/child, this adds significantly to their distress.

Developing a clinical typology of dysfunctional anger.

BACKGROUND: This study attempted to validate a clinical typology of dysfunctional anger proposed by DiGiuseppe and Tafrate (2007) using assessment data obtained from 197 participants assessed at an outpatient clinic for anger problems. METHODS: Several self-report scales assessing anger, hostility, impulsivity and aggression, as well as a structured interview regarding anger experience and expression, were administered; Axis I and II comorbidity were assessed using clinical assessment and the SCID-II PQ. RESULTS: We found support for four of the proposed eight types described by DiGiuseppe and Tafrate - Pervasive Dysfunctional Anger, Impulsive Type; Pervasive Dysfunctional Anger, Mixed Type; Impulsive Aggressive Dysfunctional Anger; and Suppressed Dysfunctional Anger - with significant, predicted group differences on self-report measures of anger, aggression, and impulsivity, as well as differences in Axis I and II diagnoses. LIMITATIONS: Patients were rarely assigned to the other four dysfunctional anger types and thus we could not examine the validity of these types. We relied heavily on self-report data. CONCLUSIONS: Anger is a common symptom in outpatient psychiatry clinics. It is associated with both mood and anxiety disorder diagnoses, and often co-occurs with substance use problems. Different types of angry patients will likely require different assessment and treatment approaches.

The comorbidity of anger symptoms with personality disorders in psychiatric outpatients.

OBJECTIVES: Although many psychiatric disorders are "emotional" disorders, no disorders exist for which dysfunctional anger is a necessary feature. This study examined whether dysfunctional anger could be considered a diagnosis independent from Personality Disorders. DESIGN: We analyzed data on 1,158 psychiatric outpatients who underwent a semi-structured interview for Axis II disorders and ascertained the co-occurrence of dysfunctional anger and Personality Disorders. RESULTS: The overlap between dysfunctional anger and all Personality Disorders was low. Data analyses showed dysfunctional anger was not well accounted for by Axis II diagnoses. CONCLUSIONS: Dysfunctional anger can be viewed by researchers and clinicians as an independent diagnostic entity. The implications of these results for the diagnosis and treatment of patients with anger symptoms is discussed.

An open trial of a comprehensive anger treatment program on an outpatient sample.

BACKGROUND: This pilot study was designed to investigate the efficacy of a cognitive behavioral treatment for anger. METHOD: Twelve (5 men and 7 women) outpatient adults completed 2-hour group sessions for 16 sessions. Participants were diagnosed with 29 Axis I and 34 Axis II disorders with high rates of comorbidity. Empirically supported techniques of skills training, cognitive restructuring, and relaxation were utilized. In this protocol, cognitive restructuring emphasized the use of the ABC model to understand anger episodes and the Rational Emotive Behavior Therapy (REBT) techniques of disputing irrational beliefs and rehearsing rational coping statements, but additional cognitive techniques were used, e.g. self-instructional training (SIT). Skills training included problem-solving and assertiveness. Relaxation training was paced respiration. Motivational interviewing, imaginal exposure with coping, and relapse prevention were also included. RESULTS: Significant improvements were found from pre- to post-treatment on the following measures: the Trait Anger Scale of the State-Trait Anger Expression Inventory-II; and Anger Disorder Scale total scores; idiosyncratic anger measurements of situational intensity and symptom severity; and the Beck Depression Inventory-II. CONCLUSIONS: In order to extend the significant research findings of this pilot study, future investigations should involve larger sample sizes, populations drawn from various settings, and contact control groups.

Immersiveness and physiological arousal within panoramic video-based virtual reality.

In this paper, we discuss findings from a study that used panoramic video-based virtual environments (PVVEs) to induce self-reported anger. The study assessed "immersiveness" and physiological correlates of anger arousal (i.e., heart rate, blood pressure, galvanic skin response [GSR], respiration, and skin temperature). Results indicate that over time, panoramic video-based virtual scenarios can be, at the very least, physiologically arousing. Further, it can be affirmed from the results that hypnotizability, as defined by the applied measures, interacts with group on physiological arousal measures. Hence, physiological arousal appeared to be moderated by participant hypnotizability and absorption levels.

The roles of sex, gender, and coping in adolescent depression.

This study investigated the roles of coping and masculinity in higher rates of depressive symptoms among adolescent girls, as compared to boys. A model was designed and tested through path analysis, which involved the variables of sex, gender, problem-focused coping, rumination, and distraction. The Reynolds Adolescent Depression Scale and the Bem Sex Role Inventory, as well as a measure of coping with general stressors was completed by 246 adolescents. Results showed that adolescent girls were more depressed than boys, and that girls used more emotion-focused and ruminative coping than did boys. Greater degrees of ruminative coping were related to high levels of depressive symptoms. Problem-focused and distractive coping were positively correlated with masculinity and negatively associated with depression. Surprisingly, girls were more likely to use problem-focused coping. Problem-focused and distractive coping were found to mediate the negative relationship between masculinity and depression.

Clinicians' diagnosis of a case with anger problems.

Psychiatrists and psychologists responded to case vignettes to assess the prevalence, severity, and diagnostic confidence clinicians had concerning treating anger disordered clients compared with clients with generalized anxiety disorder. Five hundred and forty-two clinicians (a response rate of 30%) assessed one of two matched case histories by mail. One described generalized anxiety disorder (GAD) and the other a case of anger disorder (AD). Cases were identical except for thoughts and affect relevant to the disorders. Both male and female versions were used. More than 95% of the participants viewed the cases they received as pathological. The disorders were rated as equally common. The clinicians reported treating equal numbers of patients with similar anger or anxiety symptoms in the past year. Although the case histories were alike in length and detail, AD participants rated their case as less complete and had lower confidence in their diagnoses. The diagnostic consensus was high for GAD clinicians, but low for AD. Forty-three percent of participants selected an Axis II diagnosis for AD, compared with 3% for GAD. Clinicians appeared to encounter patients with chronic anger about as frequently as they see GAD, but they displayed diagnostic confusion and bias toward personality disorder diagnoses when presented with the anger symptoms. The findings support the development of a diagnostic category for primary anger. The wide dispersion of diagnoses for anger underscores the need for focused differential assessment.