If a safety aid is present, there must be danger: the paradoxical effects of hand sanitizer during a contamination exposure task

Perceptions of danger often arise in the context of feared threat cues, but individuals also rely on other heuristics that lead them to infer danger in ambiguous situations. For example, individuals may interpret their own anxiety or safety-seeking behaviors as indicators of threat. Another potential source of danger information is the mere availability of safety aids in the environment. Although assumed to be helpful, safety aids might paradoxically elicit, rather than alleviate, anxiety. The present study was designed to assess the degree to which concern-relevant safety aids exacerbate distress. Participants (N = 71) completed several self-report measures and engaged in a contamination-related behavioral avoidance task (BAT) in the presence or absence of a 2L hand sanitizer dispenser. Results showed that participants higher in trait contamination aversion and in the presence of hand sanitizer endorsed greater inferences of danger, hypervigilance, peak BAT anxiety and disgust, BAT avoidance, and urges to wash following the BAT. Theoretical and clinical implications of the paradoxical inference of danger from the presence of safety aids are discussed

Response Prevention or Response Permission? A Randomized Controlled Trial of the “Judicious Use of Safety Behaviors” during Exposure Therapy

Safety behaviors (i.e., actions performed to prevent, escape, or minimize feared catastrophe and/or associated distress) are typically eliminated during exposure therapy for clinical anxiety (i.e., response prevention). Yet some experts have called for the strategic and “judicious use” of safety behaviors during exposure to improve treatment acceptability/tolerability without diminishing its efficacy. Empirical findings regarding this debate are mixed and existing work is subject to several methodological limitations. The current randomized controlled trial incorporated longitudinal design and multimethod assessment to compare the efficacy and acceptability of traditional exposure and response prevention (E/RP) and exposure with judiciously used safety behaviors (E/JU). Adults with DSM-5 spider phobia (N = 60) were randomized to four twice-weekly sessions of E/RP or E/JU. Self-report and behavioral measures were administered at pretreatment (PRE), posttreatment (POST), and 1-month follow-up (F/U). Participants exhibited large effects on all measures from PRE to POST with no change from POST to F/U. There were no significant group differences on primary or secondary outcomes. Exploratory analyses suggest that safety behaviors promote swifter behavioral approach toward feared stimuli but interfere with facets of inhibitory learning. Clinical implications, study limitations, and future directions are discussed in terms of inhibitory learning theory.Doctor of Philosoph

The Relative Contributions of Experiential Avoidance and Distress Tolerance to OC Symptoms

Background: Obsessive beliefs account for substantial (but not all) obsessive-compulsive (OC) symptoms. Intolerance of internal experiences (IIE), which encompasses the constructs of experiential avoidance (EA) and distress tolerance (DT), refers to difficulty managing unwanted thoughts, emotions, and other internal states, and might add to current explanatory models. Although IIE appears to be conceptually relevant to obsessive-compulsive (OC) symptoms, scant research has examined this relationship empirically. Aim: The present study examined the relative contributions of EA and DT as predictors of OC symptom dimensions. Method: A nonclinical sample ( n = 496) completed self-report questionnaires measuring general distress, EA, DT and OC symptom dimensions. Results: All variables of interest were significantly (all p s ≤ .001) correlated with one another, such that higher general distress, higher EA, and lower DT were associated with greater OC symptom severity for all symptom dimensions; however, only EA independently predicted obsessional symptoms, but not other OC symptom dimensions. Conclusions: One's willingness to endure (i.e. EA), rather than their ability to tolerate (i.e. DT) unpleasant internal experiences best predicts obsessional symptoms (i.e. obsessing) above and beyond general distress. Potential implications for understanding, assessing, and treating OC symptoms are discussed

Anxiety sensitivity as a predictor of outcome in the treatment of obsessive-compulsive disorder

BACKGROUND AND OBJECTIVES: To address the fact that not all individuals who receive cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) exhibit complete symptom reduction, research has examined factors that predict outcome; however, no studies have examined anxiety sensitivity (AS) as a predictor of outcome of CBT for OCD. AS refers to the fear of anxious arousal that results from mistaken beliefs about the dangerousness of anxiety-related body sensations. It is important to understand whether AS influences OCD treatment outcome, considering that (a) some obsessions directly relate to AS, and (b) OCD patients with high AS may be reluctant to engage in anxiety-provoking components of CBT for OCD. METHODS: Patients (N = 187) with a primary diagnosis of OCD who received residential CBT for OCD participated in this study, which involved completing a self-report battery at pre- and post-treatment. RESULTS: Results supported study hypotheses, in that (a) baseline AS positively correlated with baseline OCD severity, and (b) greater baseline AS prospectively predicted higher posttreatment OCD symptom severity even after controlling for pretreatment OCD and depression severity. LIMITATIONS: The study was limited by its use of an older measure of AS, reliance on self-report measures, and nonstandardized treatment across participants. CONCLUSIONS: Findings highlight the importance of AS in the nature and treatment of OCD. Clinical implications and future directions are discussed

Enhancing the ecological validity of the Beads Task as a behavioral measure of intolerance of uncertainty

To broaden the measurement of intolerance of uncertainty (IU) beyond self-report methods, recent research has examined the Beads Task as a behavioral measure of IU. In the present study, we enhanced this task to increase its ecological validity by maximizing decisional uncertainty and the importance of a correct response. Undergraduate participants (n=102) completed the Beads Task with instructions that they would complete the Cold Pressor Task (CPT) if they answered incorrectly. As hypothesized, baseline CPT endurance time and self-reported pain level were weakly associated with later Beads Task distress during the decision-making process. Furthermore, in vivo Beads Task distress was associated with self-report inhibitory IU, which measures avoidance and paralysis in the face of uncertainty, but not with prospective IU, perfectionism, or general psychological distress after making statistical adjustments for multiple comparisons. Comparisons to previous work using the Beads Task, clinical implications, and avenues for future research are discussed

Moderators and Processes of Change in Traditional Exposure and Response Prevention (ERP) Versus Acceptance and Commitment Therapy-Informed ERP for Obsessive-Compulsive Disorder

The present study evaluated moderators and processes of change in a randomized controlled trial comparing exposure and response prevention (ERP) delivered from a traditional framework versus ERP from an acceptance and commitment therapy framework (ACT+ERP) for obsessive-compulsive disorder (OCD). This paper presents baseline, weekly session, posttreatment, and follow-up data from the study. We examined (a) moderation effects of anxiety, depression, psychological inflexibility, and interpretation of intrusions and (b) the role of psychological inflexibility and interpretation of intrusions respectively as processes of change. Participants with less dysfunctional appraisals at pretreatment performed consistently better in ERP relative to ACT+ERP. In process analyses, psychological inflexibility and interpretation of intrusions positively influenced OCD severity over time in both conditions but OCD symptom severity also positively influenced psychological inflexibility and interpretation of intrusions in both conditions. Furthermore, whereas OCD symptom severity strongly and positively predicted dysfunctional appraisals over the course of treatment in ERP, symptom severity had a weaker positive effect on dysfunctional appraisals in ACT+ERP. Clinical and theoretical implications as well as study limitations are discussed

Differential symptom weighting in estimating empirical thresholds for underlying PTSD severity: Toward a “platinum” standard for diagnosis?

Objective: Symptom counts as the basis for Post-Traumatic Stress Disorder (PTSD) diagnoses in the DSM presume each symptom is equally reflective of underlying disorder severity. However, the “equal weight” assumption fails to fit PTSD symptom data when tested. The present study developed an enhanced PTSD diagnosis based on (a) a conventional PTSD diagnosis from a clinical interview and (b) an empirical classification of full PTSD that reflected the relative clinical weights of each symptom. Method: Baseline structured interview data from Project Harmony (N = 2658) was used. An enhanced diagnosis for full PTSD was estimated using an empirical threshold from moderated nonlinear factor analysis (MNLFA) latent PTSD scale scores, in combination with a full conventional PTSD diagnosis based on interview data. Results: One in 4 patients in the sample had a PTSD diagnosis that was inconsistent with their empirical PTSD grouping, such that the enhanced diagnostic standard reduced the diagnostic discrepancy rate by 20%. Veterans, and in particular female Veterans, were at greatest odds for discrepancy between their underlying PTSD severity and DSM diagnosis. Conclusion: Psychometric methodologies that differentially weight symptoms can complement DSM criteria and may serve as a platform for symptom prioritization for diagnoses in future editions of DSM

Cognitive Rehabilitation With Mobile Technology and Social Support for Veterans With TBI and PTSD: A Randomized Clinical Trial.

OBJECTIVE: To investigate effects of cognitive rehabilitation with mobile technology and social support on veterans with traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). PARTICIPANTS: There were 112 dyads, comprised by a veteran and a family member or friend (224 participants in total). DESIGN: Dyads were randomized to the following: (1) a novel intervention, Cognitive Applications for Life Management (CALM), involving goal management training plus mobile devices for cueing and training attentional control; or (2) Brain Health Training, involving psychoeducation plus mobile devices to train visual memory. MAIN MEASURES: Executive dysfunction (disinhibition, impulsivity) and emotional dysregulation (anger, maladaptive interpersonal behaviors) collected prior to randomization and following intervention completion at 6 months. RESULTS: The clinical trial yielded negative findings regarding executive dysfunction but positive findings on measures of emotion dysregulation. Veterans randomized to CALM reported a 25% decrease in anger over 6 months compared with 8% reduction in the control (B = -5.27, P = .008). Family/friends reported that veterans randomized to CALM engaged in 26% fewer maladaptive interpersonal behaviors (eg, aggression) over 6 months compared with 6% reduction in the control (B = -2.08, P = .016). An unanticipated result was clinically meaningful change in reduced PTSD symptoms among veterans randomized to CALM (P < .001). CONCLUSION: This preliminary study demonstrated effectiveness of CALM for reducing emotional dysregulation in veterans with TBI and PTSD

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

If a Safety Aid is Present, There Must be Danger: The Paradoxical Effects of Hand Sanitizer during a Contamination Exposure Task

Perceptions of danger often arise in the context of feared threat cues, but individuals also rely on other heuristics that lead them to infer danger in ambiguous situations. For example, individuals may interpret their own anxiety or safety-seeking behaviors as indicators of threat. Another potential source of danger information is the mere availability of safety aids in the environment. Although assumed to be helpful, safety aids might paradoxically elicit, rather than alleviate, anxiety. The present study was designed to assess the degree to which concern-relevant safety aids exacerbate distress. Participants (N = 71) completed several self-report measures and engaged in a contamination-related behavioral avoidance task (BAT) in the presence or absence of a 2L hand sanitizer dispenser. Results showed that participants higher in trait contamination aversion and in the presence of hand sanitizer endorsed greater inferences of danger, hypervigilance, peak BAT anxiety and disgust, BAT avoidance, and urges to wash following the BAT. Theoretical and clinical implications of the paradoxical inference of danger from the presence of safety aids are discussed