Is a brief mindfulness ecological momentary intervention more efficacious than a self-monitoring app for social anxiety disorder? A randomized controlled trial.

Despite their proliferation, limited knowledge exists regarding possible benefits of brief mindfulness ecological momentary interventions (MEMIs) for social anxiety disorder (SAD). Propositions that MEMIs could alleviate SAD symptoms and related clinical outcomes remain untested. This trial evaluated a 14-day MEMI for SAD. Participants with self-reported SAD were randomized to MEMI (n = 96) or self-monitoring app (SM; n = 95). Whereas MEMI instructed mindfulness exercises, SM prompted only self-monitoring five times daily for 14 days. Participants completed state-level self-reports of depression, anxiety, and mindfulness pre-post-mindfulness practice and SAD symptoms, worry, depression severity, repetitive negative thinking, and trait mindfulness at pre-randomization, post-intervention, and 1-month follow-up (1MFU). Hierarchical linear modeling was conducted. The MEMI yielded statistically significantly larger improvements in momentary depression, anxiety, and mindfulness (Cohen's d = -0.10-0.11). Although no between-group effects emerged in alleviating SAD fear and avoidance, excessive worry, depression severity, repetitive negative thinking, and trait mindfulness (-0.13-0.15), within-group effects were significantly small-to-large from pre-post and pre-1MFU (-4.62-0.67). A significant reduction in depression severity occurred in MEMI (-0.63--0.60) but not SM (-0.31--0.29). Brief MEMI and SM yielded nondifferent sustained effects on SAD, comorbid symptoms, and risk factors, highlighting its potential value within stepped-care delivery settings.

The influence of socio-economic status on child temperament and psychological symptom profiles.

The influence of socio-economic status (SES) on child temperament and psychological symptoms was examined using a nationally representative sample in Singapore. Data were available for 2169 children from 1987 families. Caregivers' reports were obtained on children aged 4-6. SES was operationalized as an aggregation of household income per capita, parental education level and housing type. Compared to their counterparts from higher SES families, children from low-SES families tended to exhibit (a) higher negative affectivity but lower effortful control, and (b) higher internalizing and externalizing symptoms. In addition, children with a 'resilient' temperamental profile (i.e. low negative affectivity and high effortful control) were more likely to come from families with much higher SES, relative to children with other profiles. Children with high internalizing symptoms tended to come from low-SES backgrounds, regardless of their externalizing symptoms. Among children with low internalizing symptoms, those with high externalizing symptoms came from lower SES backgrounds compared to those with low externalizing symptoms. Parental warmth and distress mediated the association between SES and child temperament and symptom profiles, with the exception of distress in the SES-temperament link. These findings supported the family stress model and highlighted the novel perspective of SES's influence on configurations of child temperament and symptom characteristics.

Validating the biosocial model of borderline personality disorder: Findings from a longitudinal study.

This longitudinal study aimed to validate the biosocial theory of borderline personality disorder (BPD) by examining the transactional relationship between individual vulnerabilities and parental invalidation, and their links to BPD symptoms. We recruited a sample of 332 adolescents (mean age = 14.18 years; 58.3% female) residing in Singapore and administered self-report measures across three time-points (six months apart). Results from our path analytic model indicated that parental invalidation, impulsivity, and emotional vulnerability exhibited unique predictive associations with emotion dysregulation six months later. There was also a reciprocal prospective relationship between emotion regulation difficulties and BPD symptoms. Using random-intercepts cross-lagged panel models, we found partial evidence for a within-individual reciprocal relationship between parental invalidation and emotional vulnerability, and a unidirectional relationship of within-individual changes in impulsivity positively predicting changes in parental invalidation six months later. Overall, the study provided partial empirical support for the biosocial model in a Singaporean context.

Emotion dysregulation and symptoms of anxiety and depression in early adolescence: Bidirectional longitudinal associations and the antecedent role of parent-child attachment.

Difficulties in emotion regulation have been consistently associated with various psychological difficulties, including anxiety and depression; however, less is known about the directionality of this relationship, particularly in adolescents. In addition, early parent-child attachment quality has been closely linked to the development of emotion regulation. Previous studies have proposed an overarching model in attempt to describe the developmental trajectory of anxiety and depression from early attachment, albeit with several limitations that are discussed in this paper. This study adds to this field of research by investigating the longitudinal associations between emotion dysregulation (ED) and symptoms of anxiety and depression among 534 early adolescents in Singapore over three timepoints in a school year, and the antecedent role of attachment quality on individual differences on these variables. Bidirectional influences were found between ED and anxiety and depression symptoms, respectively, between T1 and T2, but not T2 and T3, at the between- and within-individual levels of analysis. Additionally, attachment anxiety and avoidance were both significantly predictive of individual differences in ED and for both psychological symptoms. The current findings provide preliminary evidence of a mutually reinforcing relationship between ED and symptoms of anxiety and depression in early adolescence, where attachment quality serves as a developmental antecedent that sets these longitudinal associations in motion.

Examining the intergenerational transmission of parental invalidation: Extension of the biosocial model.

This study examined the intergenerational transmission of parental invalidation and whether parental difficulties in emotion regulation mediated the association between past experiences of invalidation and current invalidating parenting practices. We also aimed to investigate whether gender might influence the transmission of parental invalidation. We recruited a community sample of 293 dual-parent families (adolescent and their parents) based in Singapore. Parents and adolescents each completed measures of childhood invalidation, whereas parents additionally reported on their difficulties in emotion regulation. Results based on path analyses demonstrated that past parental invalidation experienced by fathers positively predicted current perceived invalidation by their children. The association between mothers' childhood invalidation and current invalidating practices was fully mediated by mothers' difficulties with emotion regulation. Further analyses revealed that parents' current invalidating behaviors were not predicted by their past experiences of paternal or maternal invalidation. These findings point to the importance of considering the family invalidating environment as a whole when examining the influence of past experienced parental invalidation on emotion regulation and invalidating behaviors of second-generation parents. Our study provides empirical support for the intergenerational transmission of parental invalidation and highlights the need to address childhood experiences of parental invalidation in parenting programs.

Longitudinal associations between academic competence-building and depression symptoms in early adolescence.

The longitudinal associations between academic competence-building and depression symptoms were investigated among 741 early adolescents in Singapore. Extending from past studies on academic achievement and depression, the current research tested two competing hypotheses - the academic incompetence hypothesis versus the adjustment erosion hypothesis using a 3-wave longitudinal study over an academic year. The former hypothesis suggests that prior deficits in academic competence-building lead to subsequent depression symptoms, whereas the latter posits that previous depression leads to subsequent deficits in competence-building. Longitudinal associations between a higher-order competence-building factor (operationalized using multiple constituent motivational variables) and depression were examined using a random intercept cross-lagged panel model. Results indicated that within-individual decreases in competence-building prospectively predicted subsequent within-individual increases in depression symptoms, but the opposite effect was not observed. Within-individual fluctuations in competence-building also predicted end-of-year grades and teacher-reported adjustment problems. Overall, the current findings were consistent with the academic incompetence hypothesis, suggesting that interventions aimed at sustaining academic competence-building could offer protection against the worsening of depression. These results clarified the within-individual developmental dynamics between academic competence-building and depression symptoms in adolescents over time.

Pathways Linking the Big Five to Psychological Distress: Exploring the Mediating Roles of Stress Mindset and Coping Flexibility.

Personality affects the vulnerability to the emotional symptoms of depression and anxiety. This study investigated whether stress mindset (general belief about the nature of stress) and coping flexibility (the ability to terminate ineffective coping strategies and adopt alternative ones) mediate the relations of the Big Five personality traits to psychological distress. A total of 260 undergraduate students (60.4% female) in Singapore completed self-reported questionnaires. A series of path analyses was performed. Firstly, a dual-pathway model of stress coping was established, which consisted of (a) a stress-threat-distress pathway where a stress-is-a-threat mindset mediated the association between stressful experiences and psychological distress and (b) a challenge-flexibility-enhancement pathway where coping flexibility mediated the relation of a stress-is-a-challenge mindset to a lower level of psychological distress, without being influenced by stressful experiences. Furthermore, Neuroticism was associated with the stress-threat-distress pathway, with stressful experiences and a stress-is-a-treat mindset mediating the relation of Neuroticism to psychological distress. Conscientiousness was associated with the challenge-flexibility-enhancement pathway, with a stress-is-a-challenge mindset and coping flexibility mediating the relation of Conscientiousness to less psychological distress. Extraversion, Agreeableness, and Openness were directly associated with greater coping flexibility. The findings enrich the literature on personality and stress coping and inform future interventions to promote mental health.

Pathological personality, situations, and their joint influences on daily emotional symptoms.

OBJECTIVE: The present research aims to advance current understanding on how individuals with pathological personality traits construe their day-to-day situational experiences. METHOD: College students (N = 231) completed a measure of personality pathology, followed by six assessments of everyday situations and anxiety/depression symptoms over two weeks. RESULTS: Multilevel analyses indicated that personality pathology was meaningfully associated with situational experiences. Major findings suggested that situations that entailed aggravations and interpersonal confrontations were associated with negative affectivity, antagonism, and psychoticism. Detached individuals were less likely to experience pleasant and social situations. Exploratory analyses suggested an amplification effect where individuals high on personality pathology were more anxious or depressed when they perceived certain situational features, compared to their low trait counterparts. However, such cross-level interactions constituted a small minority; most personality traits and situations exerted additive effects on symptoms. CONCLUSION: Situational experiences appear to be driven in part by personality pathology. The exacerbation of daily negative symptoms can be attributed to the joint (largely additive) influence of the trigger situations and pathological personality traits.

Parental invalidation and its associations with borderline personality disorder symptoms: A multivariate meta-analysis.

Childhood invalidation has been postulated to be implicated in the development of borderline personality disorder (BPD), according to the biosocial model. Despite its significance, most systematic reviews and meta-analyses have focused on examining the associations between extreme forms of invalidation, such as sexual abuse, and BPD. Nonetheless, individuals could experience mild-to-severe levels of parental invalidation, with or without abuse. This study examined the relationship between parental invalidation as an overall construct and BPD symptoms, synthesized across 21 studies (total N = 7,198). As most reviewed studies utilized retrospective self-report measures, the effect sizes derived pertained largely to the association between reported childhood parental invalidation and BPD symptoms. We conducted a multivariate meta-analysis to account for the dependence of multiple effect sizes obtained from a single study and to maintain precision in obtained effect sizes. Maternal, paternal, and overall parental invalidation were positively associated with BPD symptoms, with small-to-moderate effect sizes of .26, .23, and .25, respectively. The mean effect size of maternal invalidation was greater than that of paternal invalidation. We also investigated if the parental invalidation-BPD associations were moderated by child gender, age, and culture (degree of individualism). Only overall parental invalidation and BPD symptoms association was moderated by child's gender, with larger effect sizes found for samples with a greater proportion of males. Age and culture did not moderate the parental invalidation-BPD association. Risk of publication bias was low. Our findings provide support for the invalidating childhood environment component of the biosocial model. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Primer on Meta-Analytic Structural Equation Modeling: the Case of Depression.

In this paper, we show how the methods of systematic reviewing and meta-analysis can be used in conjunction with structural equation modeling to summarize the results of studies in a way that will facilitate the theory development and testing needed to advance prevention science. We begin with a high-level overview of the considerations that researchers need to address when using meta-analytic structural equation modeling (MASEM) and then discuss a research project that brings together theoretically important cognitive constructs related to depression to (a) show how these constructs are related, (b) test the direct and indirect effects of dysfunctional attitudes on depression, and (c) test the effects of study-level moderating variables. Our results suggest that the indirect effect of dysfunctional attitudes (via negative automatic thinking) on depression is two and a half times larger than the direct effect of dysfunctional attitudes on depression. Of the three study-level moderators tested, only sample recruitment method (clinical vs general vs mixed) yielded different patterns of results. The primary difference observed was that the dysfunctional attitudes → automatic thoughts path was less strong for clinical samples than it was for general and mixed samples. These results illustrate how MASEM can be used to compare theoretically derived models and predictions resulting in a richer understanding of both the empirical results and the theories underlying them.

Cross-Cultural and Gender Invariance of Transdiagnostic Processes in the United States and Singapore.

The Research Domain Criteria define cognitive and emotional processes (e.g., rumination, intolerance of uncertainty, anxiety sensitivity, emotion dysregulation) as key transdiagnostic elements of psychopathology. However, there is currently a dearth of construct equivalence studies on measures of these processes. We thus aimed to validate the latent structures of five transdiagnostic constructs using established and newer measures: two-factor Rumination-Reflection Questionnaire, six-factor Perseverative Cognitions Questionnaire, two-factor Intolerance of Uncertainty Scale, three-factor Anxiety Sensitivity Index-3, two-factor Cognitive and Behavioral Processes Questionnaire (CBPQ). Measurement equivalence was examined across 292 American and 144 Singaporean undergraduates. Cross-cultural confirmatory factor analyses revealed strict invariance for all measures, with interfactor association differences on the Perseverative Cognitions Questionnaire and CBPQ. Across gender, full invariance was found on all measures except the CBPQ. Theoretical and clinical implications are discussed.

Evaluating Structural Models of Cognitive Vulnerabilities: Transdiagnostic and Specific Pathways to Internalizing Symptoms.

The structure of cognitive vulnerabilities to anxiety and depression was examined via a hierarchical approach to examine the usefulness of a bifactor model for identifying a broad transdiagnostic (i.e., common core) factor versus disorder-specific variables (i.e., unique dimensions) in predicting internalizing psychopathology. Several models (i.e., single factor, correlated factor, single hierarchical, and bifactor models) were evaluated in undergraduate (n = 351) and adolescent (n = 385) samples. Across both samples, the bifactor model exhibited comparable good fit as the correlated and single hierarchical models. This model comprised a core transdiagnostic vulnerability factor and six specific factors (i.e., negative cognitive style, dysfunctional attitudes, ruminative style, intolerance of uncertainty, anxiety sensitivity, and fear of negative evaluation). Although the transdiagnostic factor predicted a general internalizing symptom factor, unique fear-related specific-level associations between individual vulnerability and symptom remained significant. Moreover, the transdiagnostic vulnerability factor predicted internalizing symptoms, even after controlling for personality and gender. These findings highlight the importance of advancing an integrative etiologic model of internalizing psychopathology.

Subjective status and perceived legitimacy across countries.

The relationships between subjective status and perceived legitimacy are important for understanding the extent to which people with low status are complicit in their oppression. We use novel data from 66 samples and 30 countries (N = 12,788) and find that people with higher status see the social system as more legitimate than those with lower status, but there is variation across people and countries. The association between subjective status and perceived legitimacy was never negative at any levels of eight moderator variables, although the positive association was sometimes reduced. Although not always consistent with hypotheses, group identification, self-esteem, and beliefs in social mobility were all associated with perceived legitimacy among people who have low subjective status. These findings enrich our understanding of the relationship between social status and legitimacy.

Increasing intolerance of uncertainty over time: the potential influence of increasing connectivity.

Anxiety levels have increased for several decades, despite objective indicators of historically unprecedented safety. A perceived inability to tolerate uncertainty or distress motivates individuals experiencing anxiety to engage in safety behaviors. Mobile phones provide unrestricted access to safety cues intended to reduce uncertainty and therein anxiety; however, recurrent engagement in reassurance seeking behaviors paradoxically increases anxiety. The current research was designed to assess whether self-reported intolerance of uncertainty (IU) levels may have been increasing and, if so, whether the increases correlate positively with mobile phone penetration and Internet usage. A cross-temporal meta-analysis was conducted using data from 52 North American studies exploring IU as well as social indicator data from several public sources. A statistically significant increase in IU levels occurred from 1999 to 2014, correlated with increases in mobile phone penetration and Internet usage. As hypothesized, IU levels appeared to be increasing over time and the increases correlate positively with mobile phone penetration and Internet usage. The results support the possibility that mobile phones increase reassurance seeking, acting as safety cues, and reducing spontaneous, everyday exposures to uncertainty, which may ultimately potentiate psychopathology by increasing IU and anxiety. Subsequent experimental research to assess for causality appears warranted. Limitations and directions for future research are presented.

Becoming more or less mature? The decline of self-control in middle childhood.

OBJECTIVE: This study examined the developmental change in self-control and its association with daily stressful events during middle childhood, as well as the factors that contribute to individual differences in the trajectory of self-control. METHOD: A community sample of 302 Singaporean children (42% female, 69% Chinese) and their parents were recruited when the children were age 7. Follow-up assessments were made when the children were ages 8, 9, and 11. Developmental changes were examined using latent growth and autoregressive cross-lagged models. RESULTS: Self-control showed a normative decline over time, and this trajectory was associated with an increase in daily stressful events. There was partial evidence for a reciprocal relationship between self-control and daily stressful events over time. Moreover, the child temperament dimension of effortful control (assessed at age 7) mitigated the decline in self-control, whereas low socioeconomic status predicted lower initial levels of self-control. CONCLUSIONS: This study advances current understanding on the developmental change in self-control during middle childhood, as well as the factors that shape the direction and magnitude of this change.

Associations Between the DSM-5 Section III Trait Model and Impairments in Functioning in Singaporean College Students.

The Alternative Model for Personality Disorders (AMPD) in Section III of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, recommends the joint consideration of personality disorder severity (i.e., dysfunction) and style (i.e., trait profile) in personality disorder diagnosis. The current study examined the association between maladaptive personality dysfunction and traits using a Singaporean student sample (N = 360). A subsample (n = 151) had informant ratings of personality traits on target participants. Results indicated that dysfunctions and traits were substantially correlated, calling into question their distinctiveness. However, the overlap was less pronounced when informant ratings were used. Consistent with prior research, the validity of the PID-5 trait model appeared to be supported, as observed in the meaningful differential relations with different impairment outcomes. These findings represent a preliminary yet critical test of the generalizability of the AMPD to a non-Western cultural group.

Construct Validity of the McLean Screening Instrument for Borderline Personality Disorder in Two Singaporean Samples.

This study examined the construct validity of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) in a consecutive sample of adult psychiatric patients (n = 128) and a separate sample of undergraduate students (n = 289) in Singapore. Participants were administered the MSI-BPD and other measures assessing related symptoms of BPD. Patients were also administered a semistructured interview by interviewers blind to their MSI-BPD scores. Confirmatory factor analyses revealed a unique three-factor solution, consisting of affect dysregulation, self-disturbances, and behavioral and interpersonal dysregulation. In both samples, the MSI-BPD demonstrated good internal consistency and convergent validity. The measure also showed good discriminant validity and predictive accuracy (AUC = .82), with an optimal cut-off score of 7.5. Overall, the findings suggest that BPD is a valid and coherent clinical construct in Singapore, and point to the need to further clarify the presentation and etiology of BPD in this cultural context.

Applications of meta-analytic structural equation modelling in health psychology: examples, issues, and recommendations.

Statistical methods play an important role in behavioural, medical, and social sciences. Two recent statistical advances are structural equation modelling (SEM) and meta-analysis. SEM is used to test hypothesised models based on substantive theories, which can be path, confirmatory factor analytic, or full structural equation models. Meta-analysis is used to synthesise research findings in a particular topic. This article demonstrates another recent statistical advance - meta-analytic structural equation modelling (MASEM) - that combines meta-analysis and SEM to synthesise research findings for the purpose of testing hypothesised models. Using the theory of planned behaviour as an example, we show how MASEM can be used to address important research questions that cannot be answered by univariate meta-analyses on Pearson correlations. Specifically, MASEM allows researchers to: (1) test whether the proposed models are consistent with the data; (2) estimate partial effects after controlling for other variables; (3) estimate functions of parameter estimates such as indirect effects; and (4) include latent variables in the models. We illustrate the procedures with an example on the theory of planned behaviour. Practical issues in MASEM and suggested solutions are discussed.

The Looming Maladaptive Style Questionnaire: Measurement invariance and relations to anxiety and depression across 10 countries.

The Looming Maladaptive Style Questionnaire (LMSQ) is a self-report measure designed to assess the looming cognitive style, a tendency to interpret threats as rapidly approaching and increasing in magnitude. To date, no systematic evaluation on the psychometric properties of the LMSQ across diverse cultural contexts has been done. In the present research, the measurement invariance of the LMSQ test scores was examined in 10 countries (N=4000). Confirmatory factor analysis suggested that a two-factor model (i.e., physical looming and social looming) fitted the data well across countries. Partial measurement invariance was established for the LMSQ scores across the countries whereas full measurement invariance was achieved across gender. Meta-analytic structural equation modeling was applied to examine the unique contributions of the two looming factors to anxiety and depression symptoms. Results indicated that the test scores underlying two looming factors were crucial and valid predictors of symptoms. The LMSQ shows promise as a measure with cross-cultural generalizability and opens new avenues for its use in diverse cultural settings.

Developmental Trajectories of Maladaptive Perfectionism in Middle Childhood.

The developmental trajectories of maladaptive perfectionism, along with their consequences and origins, were examined in middle childhood. A sample of Singaporean children and their parents (N = 302) were recruited for a longitudinal study when the children were 7 years old. Subsequent follow-up assessments were made at ages 8, 9, and 11. A multimethod approach was adopted where parent reports, child reports, and observational data on a dyadic interaction task were obtained. Using latent class growth modeling, four distinct classes were obtained for critical self-oriented perfectionism (SOP-C), whereas two classes emerged for socially prescribed perfectionism (SPP). Children with high and/or increasing SOP-C and SPP trajectories constituted 60% and 78% of the sample, respectively. For both SOP-C and SPP, trajectories with high initial status were associated with higher internalizing and externalizing symptoms. Parental intrusiveness and negative parenting predicted high and/or increasing SOP-C trajectories, whereas the child temperament dimension of surgency predicted high SPP trajectory. Both SOP-C and SPP trajectories tended to co-occur, suggesting a mutually reinforcing process. This study yields important findings that help advance current understanding of the emergence and developmental pathways of maladaptive perfectionism in children.