Using pre-treatment de novo threat conditioning outcomes to predict treatment response to DCS augmentation of exposure-based CBT.

BACKGROUND: Over a decade and a half of research has resulted in inconsistent evidence for the efficacy of d-cycloserine (DCS), a partial glutamatergic N-methyl-D-aspartate agonist, for augmenting exposure-based cognitive behavioral therapy (CBT) for anxiety- and fear-based disorders. These variable findings have motivated the search for moderators of DCS augmentation efficacy. METHODS: In this secondary analysis of a previous randomized clinical trial, we evaluated the value of de novo threat conditioning outcomes-degree of threat acquisition, extinction, and extinction retention-for predicting treatment response to exposure-based CBT for social anxiety disorder, applied with and without DCS augmentation in a sample of 59 outpatients. RESULTS: We found that average differential skin conductance response (SCR) during extinction and extinction retention significantly moderated the prediction of clinical response to DCS: participants with poorer extinction and extinction retention showed relatively improved treatment response with DCS. No such effects were found for expectancy ratings, consistent with accounts of DCS selectively aiding lower-order but not higher-order extinction learning. CONCLUSIONS: These findings provide support for extinction and extinction retention outcomes from threat conditioning as potential pre-treatment biomarkers for DCS augmentation benefits. Independent of DCS augmentation, the current study did not support threat conditioning outcomes as useful for predicting response to exposure-based CBT.

Underscoring the F in FoMO: How does anxiety sensitivity contribute to fear of missing out?

Fear of missing out (FoMO) is a prevalent phenomenon associated with a range of mental health symptoms, such as depression and anxiety. To our knowledge, the question of whether FoMO can be explained by other well-known mechanistic variables-namely, loneliness, rumination, and anxiety sensitivity (AS) - has not been previously evaluated. The current study investigated the predictive power of loneliness, rumination, and AS for explaining variance in FoMO within two independent samples of undergraduate students at a large Northeastern university. Participants completed an online battery of questionnaires. In Study 1, it was found that loneliness and rumination offered significant prediction of FoMO when AS was not considered in the model; however, when these three predictors were considered together, only AS offered significant, non-redundant prediction. Study 2 revealed that both rumination and AS offered significant prediction of FoMO, with AS offering stronger unique prediction. Such findings provide a new frame for understanding the nature of the relatively new concept of FoMO, and in particular, suggest that it may be important to consider AS and rumination in future studies.

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.

Misguided and Modest: Reflections of Our Youth Voice Research.

In recent years, Physical Education (PE) has seen a growth in the commitment to youth voice research. This approach foregrounds the practice of researching with young people, rather than conducting research on or about them. Whilst we are cognisant of the many possibilities youth voice research offers, we are also concerned that there is a tendency to overlook the challenges of supporting youth voice activities. This paper draws on our collective reflections to bring to the fore some of the complexities we have encountered when attempting to engage in school-based youth voice research. We explore the following questions: How can youth voice research engage with different young people to capture a diversity of voices? What are the challenges of undertaking youth voice research? What are the possibilities of change through youth voice research? We consider these questions by drawing upon four principles of student voice work including communication as dialogue, participation and democratic inclusivity, unequal power relations, and change and transformation. We use these principles to critique our own research and, in doing so, draw on entries from our research diaries. The paper questions whether young people need help to share their insights and experiences about PE, or whether it is us - researchers, teachers and schools - who need help to more readily recognize and be attentive to young people's voices. We also point to the importance of recognizing modest change through youth voice research and the need to secure adult allies to support activities and potential outcomes. Engaging in youth voice research is an immersive and messy encounter that involves navigating a journey that is anything but straightforward. Even though this is the case, our moral and ethical compass continues to point us in this direction and we remain firm advocates of youth voice work. This paper offers a starting point for others to begin to grapple with the pitfalls and possibilities when supporting youth voice research.

Stage models for major depression: Cognitive behavior therapy, mechanistic treatment targets, and the prevention of stage transition.

Stage models encourage a longitudinal perspective on the care of those with major depression: supporting vigilance to the risk for stage progression and the selection of interventions to address that risk. A central goal for this article is to evaluate the role of cognitive-behavior therapy (CBT) in addressing stage progression in the treatment of major depression. We summarize the evidence supporting depression-focused CBT for: (1) preventing depression onset, (2) treating syndromal depression, (3) treating residual symptoms, (4) preventing relapse, and (5) addressing pharmacologic treatment resistance. In addition, consistent with the goal of aiding prevention and intervention development by refining mechanistic treatment targets, we evaluate the role of two specific risk-factors for stage progression: insomnia and rumination. These risk factors have a feed-forward relationship with stress, both being amplified by stress and amplifying the negative consequences of stress. Moreover, each of these risk factors predict depression stage transmissions across multiple stages, and both are modifiable with treatment. Accordingly, insomnia and rumination appear to serve as excellent mechanistic targets for the prevention of depression stage progression. These findings are discussed in relation to current limitations and future research directions for targeting these risk factors and furthering the effective treatment of depression.

Investigation of the predictive influence of personal and gubernatorial politics on COVID-19 related behaviors and beliefs.

Given the varied emotional and behavioral responses to the COVID-19 pandemic across the United States, further attention to the personal and societal influences on such responses is necessary. We investigated the predictive influence of personal political affiliation and the congruity of personal and governor political affiliation on COVID-19 emotional and behavioral responses, with specific attention to the influence of intolerance of uncertainty (IU) on emotional response. These factors were assessed in two studies of adults in the United States (N = 480, N = 272). We utilized a series of hierarchical linear and logistic regressions to assess predictors of 4 outcomes: (1) trust in governor's response to the pandemic, (2) COVID-19 related worry, and the (3) usage and (4) perceived efficacy of protective health behaviors (e.g., wearing a mask). Across these studies, we found that IU predicted increased COVID-19 related worry. Further, age and personal political affiliation, but not concordance with governor affiliation, predicted COVID-19 behavioral responses. These findings are discussed in relation to the potential importance of linking health messaging to personal characteristics.

Efficacy of the Unified Protocol for the treatment of comorbid alcohol use and anxiety disorders: Study protocol and methods.

Alcohol Use Disorder (AUD) and anxiety disorders (ANX) are each highly prevalent and frequently co-occur, resulting in a complex clinical presentation. The existing literature to date has not yet identified how to best treat comorbid AUD/ANX, partially due to limitations in understanding what factors and mechanisms are implicated in their co-occurrence. This manuscript describes the rationale and methods for an ongoing randomized-controlled trial designed to evaluate the efficacy of a cognitive behavioral intervention, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), compared to Take Control (TC), a psychosocial and motivational treatment serving as a control condition in this study, for comorbid AUD/ANX. Sixty individuals with comorbid AUD/ANX will be randomized to UP or TC, and complete assessments at pre- and post-treatment, as well as one- and six-month follow-up points. We hypothesize that the UP, compared to TC, will result in significantly greater reductions in drinking-related outcomes, as well as anxiety and depressive-related outcomes. Additionally, the current study is designed to evaluate exploratory aims to contribute to our theoretical understanding of why AUD and ANX frequently co-occur. Specifically, we will examine the relationship between changes in AUD and ANX symptoms in relation to changes in emotional disorder mechanisms, such as emotion regulation. Because the UP is a transdiagnostic treatment that specifically targets underlying components of emotional disorders generally, it may be well suited to effectively target comorbid AUD/ANX.

Anxiety Sensitivity as a Malleable Mechanistic Target for Prevention Interventions: A Meta-Analysis of the Efficacy of Brief Treatment Interventions.

Anxiety sensitivity (AS) is a transdiagnostic risk factor and potential treatment target for prevention of associated psychopathology and negative health behaviors. We conducted a meta-analysis evaluating the efficacy of brief interventions in at-risk samples for reducing AS and associated clinical/behavioral outcomes (e.g., depression, alcohol use) across 28 studies (1,998 participants). AS targeted interventions, compared to control conditions, evidenced a significant moderate effect size for alleviating AS from pre- to post-treatment (d = 0.54) and approached a large effect size from pre-treatment to short-term follow-up (d = 0.78). The effect size for long-term follow-up did not reach significance (d = 0.29). For clinical/behavioral outcomes, AS interventions demonstrated significant small-to-moderate effect sizes for the three timepoints examined (d's = 0.20-0.41). Our findings help validate AS as a modifiable mechanistic target for prevention efforts.

"I'm a Referee, Not a Female Referee": The Experiences of Women Involved in Football as Coaches and Referees.

The development of the Women's Super League (WSL) in English football, increased media coverage of the game, and an expansion of grassroots opportunities indicate a bright future for women and girls who want to play. Yet this vision must be tempered against compelling evidence of deep rooted and enduring gender inequalities within the game. This is the case for both players, and women who undertake non-playing roles, which is reflected in the relatively low numbers of women coaches and referees. Whilst The Football Association (The FA) has signalled addressing these inequalities as a key priority, critics argue that such efforts amount to superficial and limited efforts to support meaningful change. This paper departs from a concern with playing the game and responds to calls for more research to explore the experiences of women involved in football in non-playing roles. More specifically, it focuses on women coaches and referees, and addresses the following question: how do women in positions of power in football negotiate their place in what remains a distinctly male-dominated profession? In addressing this question, we take a theoretical position located at the nexus between radical and post-structural feminism, acknowledging the significance of structural power relations and individual agency in shaping daily lived social realities. Data were generated from interviews with 14 women coaches and 10 women referees. These interviews explored the structure and culture of the game and its impact on women's experiences of men's and women's competitive and grassroots football. Through a rigorous process of thematic analysis, three themes were identified: gendered entry into football careers; reinforcement of women's difference on the football field; and coping strategies for remaining in the game. Centralising the women's voices in this research highlights the insidious and persistent nature of gendered microaggressions, the sexism of football culture, and the ways in which these women negotiate this masculine terrain in their pursuit of being coaches and referees. "Andy Gray and Richard Keys hauled off air for sexist comments" (The Guardian, 24 January, 2011) "Crystal Palace Women goalkeeper accuses clubs of ignoring FA protocols after she was subjected to sexist abuse" (The Telegraph, 16 January, 2020) "Football manager demands ban on women referees" (The Guardian, 12 November, 2006) "Richard Scudamore sexism scandal intensifies as conspirator in sexist emails investigated by own law firm" (The Telegraph, 16 May, 2014) "Soccer chief's plan to boost women's game? Hotpants" (The Guardian, 16 January, 2004) "Women in Football survey a damning indictment of sexism in the workplace" (HRreview, 11 March, 2014) "Clattenburg criticised for claim female referees must pick career or children" (The Telegraph, 1 October, 2021).

Working memory moderates the predictive influence of distress intolerance on health-related goal attainment.

High distress intolerance (DI: often assessed as anxiety sensitivity) and low working memory capacity (WMC) have each been identified as risk factors for negative health behaviors. To our knowledge, these risk factors have only been studied independently. The current study investigated both the independent and interactive effects of DI and WMC in predicting health-related goal attainment in 118 undergraduates who self-selected a health-related goal. Participants received one of three interventions: values clarification, action planning, or a combination of the two. Across these interventions, we found that DI was at the point of significance (and reflected a small effect size) for predicting goal attainment, whereas WMC was not. Further, we found that when entered into the stepwise regression model together, the interaction of WMC and DI significantly predicted goal success one week later. Specifically, for individuals scoring one standard deviation below the mean in WMC, having worse DI significantly predicted worse goal attainment one week later. We believe this study represents the first published finding of the moderation of the predictive influence of DI by WMC, and underscores the importance of evaluating how risk factors that are typically examined independently operate together.

The association between cognitive coping strategies and treatment outcomes in smokers with PTSD.

OBJECTIVE: Numerous researchers have suggested that certain coping styles (e.g., maladaptive cognitive coping strategies) interfere with recovery from traumatic experiences and contribute to the onset/maintenance of posttraumatic stress disorder (PTSD). Further, given that individuals with PTSD have a high rate of smoking (e.g., Mahaffey et al., 2016) and that maladaptive coping strategies in general are associated with lower smoking quit rates, it is possible that use of maladaptive cognitive coping strategies are particularly problematic for the recovery of smokers with PTSD. The present study examined whether specific cognitive coping strategies are associated with poorer outcome among smokers with PTSD following an integrated treatment for both disorders. METHOD: Patients with chronic PTSD and nicotine dependence (N = 142) received up to 12 sessions of smoking cessation counseling combined with varenicline or integrated prolonged exposure therapy and cessation counseling combined with varenicline. We hypothesized that greater maladaptive, and lower adaptive, cognitive coping strategies at baseline would moderate degree of improvement in smoking and PTSD outcomes through to follow-up. RESULTS: Multilevel modeling revealed that neither maladaptive nor adaptive cognitive coping strategies moderated smoking abstinence outcomes over the course of the study (ps ≥ .271). However, greater use of catastrophizing and lower use of positive reappraisal at baseline were associated with less improvement in the hyperarousal PTSD symptom cluster over the course of the study (ps ≤ .01). CONCLUSIONS: These findings suggest that maladaptive cognitive coping strategies are not necessarily a contraindication for overall outcomes in integrated PTSD and smoking treatment, although they may influence improvement in hyperarousal symptoms. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The potential role of anxiety sensitivity in the risk for and recovery from heart attacks: Comment on Edmondson et al. (2018).

Edmondson et al. (2018) provided a compelling account of the causes and consequences of patients' perceptions of enduring somatic threat following a heart attack or related cardiac event. The purpose of the current article is to place some of these observations in the context of research on anxiety sensitivity and its role as a risk factor for cardiovascular disease, posttraumatic stress disorder, and negative health behaviors. By doing so, we hope to encourage attention to anxiety sensitivity and associated prevention-intervention strategies for at-risk cardiac patients. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Caffeine Use in Military Personnel With PTSD: Prevalence and Impact on Sleep.

Background: Caffeine use is highly prevalent among active duty military personnel and can be beneficial to performance in the short term. However, regular caffeine use has been found to contribute to sleep disturbances, which are elevated among the significant number of military personnel with posttraumatic stress disorder (PTSD). The current study is the first to examine caffeine use and its relationship with sleep disturbances in military personnel seeking treatment for PTSD. Participants: Active duty military personnel (N = 366) who had returned from deployments to Afghanistan or Iraq and were seeking treatment for PTSD. Methods: Pearson correlations were used to examine the relationships between caffeine use, sleep disturbances, and PTSD symptom clusters. Results: The majority of the sample (89%) reported some caffeine use, with coffee being the largest contributor to total caffeine intake. Contrary to hypotheses, higher caffeine use was associated with lower insomnia symptom severity; follow-up analysis indicated that this was due to elevated insomnia symptom severity in those reporting no caffeine use. Caffeine use was not associated with any other measures of sleep disturbance or with PTSD symptoms. Conclusions: Caffeine use was not associated with greater reported sleep disturbances in this sample, possibly because those with elevated insomnia symptom severity abstained from any caffeine, or because insomnia symptoms were elevated in this sample.

The efficacy of 90-minute versus 60-minute sessions of prolonged exposure for posttraumatic stress disorder: Design of a randomized controlled trial in active duty military personnel.

OBJECTIVE: Posttraumatic stress disorder (PTSD) can have devastating effects on multiple aspects of functioning. Thus, it is imperative to increase access to evidence-based treatment for PTSD. Prolonged Exposure therapy (PE) has extensive empirical support and is one of the first-line PTSD treatments included in civilian, veteran, and military clinical practice guidelines. However, the standard 90-min PE session format can constitute a significant barrier to its adoption in routine clinical care settings, which typically schedule 60-min appointment sessions. If the length of PE sessions could be reduced from 90 to 60 min without compromising treatment efficacy and efficiency, this would remove a major barrier to PE adoption. METHOD: This paper describes the rationale and methods of a randomized controlled noninferiority trial comparing 90-min versus 60-min PE sessions (including 40- vs. 20-min imaginal exposures, respectively) among 160 active duty military personnel with PTSD. The aims of this study are to: (1) examine the efficacy and efficiency (i.e., rate of symptom improvement) of 90- versus 60-min PE; (2) assess change in psychophysiological markers of treatment response across conditions; and (3) test mechanisms of change underlying the efficacy of PE. RESULTS/CONCLUSIONS: The results of this study will inform dissemination efforts in military, veteran, and civilian sectors. Further, identifying mechanisms of therapeutic change will answer important theoretical questions about how PE works, in order to refine and increase the efficacy and efficiency of PE to better meet the needs of individuals with PTSD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Contribution of Anxiety Sensitivity to Obsessive-Compulsive and Anxiety Symptoms in a Naturalistic Treatment Setting.

Anxiety sensitivity, a fear of arousal-related sensations, is prevalent in a number of disorders. We examined the relationship between internalizing symptoms and the anxiety sensitivity components of physical, social, and cognitive concerns in a sample of 165 patients seeking treatment in a clinic specializing in CBT for anxiety-related disorders. Social anxiety symptoms were associated with greater social concerns. Cognitive concerns were characteristic of both depression and generalized anxiety symptoms, suggesting these two classes of symptoms may share AS symptomatology. Physical concerns were specifically related to panic symptoms. Although obsessive-compulsive symptoms were related to cognitive concerns using univariate regression, these symptoms were not strongly related to any of the anxiety sensitivity components when the correlation between disorders was taken into account. Thus, within the internalizing symptoms studied here, the anxiety sensitivity domains were most relevant to panic, social anxiety, generalized anxiety, and depressive symptoms and less related to obsessive-compulsive symptoms.

Treating Posttraumatic Stress Symptoms Among People Living with HIV: a Critical Review of Intervention Trials.

The prevalence rate of posttraumatic stress disorder (PTSD) among people living with HIV (PLWH) is significantly higher than the rate among the general population. Moreover, PTS symptoms have been linked with numerous negative health-related outcomes in PLWH. While these findings suggest that studies evaluating the efficacy of treatments for PTS symptoms among PLWH are sorely needed, according to prior reviews, such studies are lacking. The purpose of the present systematic review was to provide an updated critical evaluation of treatment studies that targeted PTS among PLWH. Following PRIMSA guidelines, we searched PubMed and PsycINFO and identified eight articles (representing seven studies) evaluating the impact of various individual and group treatments on PTS symptoms. The limited evidence base to date precludes clinical recommendations for this population. Future studies should examine the efficacy of existing evidence-based treatments for PTSD among PLWH and then, if necessary, evaluate the impact of any treatment modifications for this population.