30 research outputs found
Clinical Correlates and Cognitive Underpinnings of Uncontrollable Worry
Uncontrollable anxious thought characterizes a number of emotional disorders and has been linked to impaired emotional and physical health. The present research aimed to clarify the nature of uncontrollable worry as a clinical and cognitive construct. Chapter 1 evaluated uncontrollability of worry as a diagnostic criterion for generalized anxiety disorder (GAD). This study was conducted in response to the proposed removal of the uncontrollability of worry requirement from the diagnostic criteria for GAD in DSM-5. Uncontrollability of worry incrementally predicted an array of clinical severity indicators--including GAD severity, co-occurrence of other mood and anxiety disorders, and treatment utilization--over and above existing GAD criteria, underscoring the importance of uncontrollability of worry to the conceptualization of GAD. In Chapter 2, the Beliefs about Thought Control scale (BATC) was developed to investigate metacognitive beliefs about thought control as a cognitive correlate of--and potential risk factor for--GAD and other disorders characterized by uncontrollable thought. The BATC showed strong convergent and discriminant validity and incrementally predicted trait worry and GAD severity over and above an existing worry-specific measure. Chapter 3 aimed to identify the cognitive underpinnings of attempts to control worry using an experimental approach in which worry was induced in the laboratory. Two components of executive control--working memory and inhibition--were impaired during attempts to control worry, suggesting that these processes may play a role in the worry control process. Collectively, these studies highlight the importance of uncontrollability in defining clinically significant worry, point to cognitive and metacognitive processes that may contribute to the onset or maintenance of uncontrollable worry, and suggest several promising directions for future basic and applied research
Psychometric Properties of the Difficulties in Emotion Regulation Scale (DERS) and Its Short Forms in Adults With Emotional Disorders
Objective: The Difficulties in Emotion Regulation Scale (DERS) is a widely used self- report measure of subjective emotion ability, as defined by a prominent clinically derived model of emotion regulation (Gratz and Roemer, 2004). Although the DERS is often used in treatment and research settings for adults with emotional (i.e., anxiety, mood, obsessive-compulsive, or trauma-related) disorders, its psychometric properties are not well-characterized in this population.
Method: We examined the psychometric properties of the DERS and three popular short forms (DERS-16; DERS-18; and DERS-SF) in a large (N = 427) sample of treatment-seeking adults with one or more DSM-5 emotional disorders.
Results: For the original DERS, internal consistency was strong for all subscales except Awareness. A bifactor structure consisting of one general emotion dysregulation factor and five uncorrelated specific factors corresponding to the original DERS subscales (excluding Awareness) provided the best fit. A series of structural equation models (SEMs) demonstrated unique incremental contributions of the general factor and several specific factors to explaining concurrent clinical severity. The general factor and one specific factor (Goals) also prospectively predicted treatment outcome following a naturalistic course of outpatient cognitive-behavioral therapy (CBT) in a subset of participants (n = 202) for whom discharge data were available. Specifically, more severe emotion dysregulation at intake predicted better CBT response, while more severe impairment in goal-directed activity when distressed predicted worse CBT response. All three short forms showed a robust bifactor structure and good internal consistency and convergent validity vis-à -vis the original measure, albeit with a slight decrement in incremental utility (1–3% less variance explained in clinical severity).
Conclusion: With the Awareness items excluded, the DERS showed good internal consistency and a robust bifactor latent structure. The general factor and several specific factors incrementally and prospectively predicted clinical severity and treatment outcome, which suggests that the DERS may have clinical and predictive utility in treatment-seeking adults with emotional disorders. Additional research is needed to establish convergent and discriminant validity in this population. The use of a short form in lieu of the full DERS may be sufficient for many general clinical and research purposes, particularly when participant burden is a concern
Neurocognitive Predictors of Treatment Response to Randomized Treatment in Adults with Tic Disorders
Tourette\u27s disorder (TS) and chronic tic disorder (CTD) are neurodevelopmental disorders characterized by involuntary vocal and motor tics. Consequently, TS/CTD have been conceptualized as disorders of cognitive and motor inhibitory control. However, most neurocognitive studies have found comparable or superior inhibitory capacity among individuals with TS/CTD relative to healthy controls. These findings have led to the hypothesis that individuals with TS/CTD develop increased inhibitory control due to the constant need to inhibit tics. However, the role of cognitive control in TS/CTD is not yet understood, particularly in adults. To examine the role of inhibitory control in TS/CTD, the present study investigated this association by assessing the relationship between inhibitory control and treatment response in a large sample of adults with TS/CTD. As part of a large randomized trial comparing behavior therapy versus supportive psychotherapy for TS/CTD, a battery of tests, including tests of inhibitory control was administered to 122 adults with TS/CTD at baseline. We assessed the association between neuropsychological test performance and change in symptom severity, as well as compared the performance of treatment responders and non-responders as defined by the Clinical Global Impression Scale. Results indicated that change in symptoms, and treatment response were not associated with neuropsychological performance on tests of inhibitory control, intellectual ability, or motor function, regardless of type of treatment. The finding that significant change in symptom severity of TS/CTD patients is not associated with impairment or change in inhibitory control regardless of treatment type suggests that inhibitory control may not be a clinically relevant facet of these disorders in adults
Towards implementation of cognitive bias modification in mental health care: State of the science, best practices, and ways forward
Cognitive bias modification (CBM) has evolved from an experimental method testing cognitive mechanisms of psychopathology to a promising tool for accessible digital mental health care. While we are still discovering the conditions under which clinically relevant effects occur, the dire need for accessible, effective, and low-cost mental health tools underscores the need for implementation where such tools are available. Providing our expert opinion as Association for Cognitive Bias Modification members, we first discuss the readiness of different CBM approaches for clinical implementation, then discuss key considerations with regard to implementation. Evidence is robust for approach bias modification as an adjunctive intervention for alcohol use disorders and interpretation bias modification as a stand-alone intervention for anxiety disorders. Theoretical predictions regarding the mechanisms by which bias and symptom change occur await further testing. We propose that CBM interventions with demonstrated efficacy should be provided to the targeted populations. To facilitate this, we set a research agenda based on implementation frameworks, which includes feasibility and acceptability testing, co-creation with end-users, and collaboration with industry partners
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Attention bias to emotional faces varies by IQ and anxiety in Williams syndrome
Individuals with Williams syndrome (WS) often experience significant anxiety. A promising approach to anxiety intervention has emerged from cognitive studies of attention bias to threat. To investigate the utility of this intervention in WS, this study examined attention bias to happy and angry faces in individuals with WS (N=46). Results showed a significant difference in attention bias patterns as a function of IQ and anxiety. Individuals with higher IQ or higher anxiety showed a significant bias toward angry, but not happy faces, whereas individuals with lower IQ or lower anxiety showed the opposite pattern. These results suggest that attention bias interventions to modify a threat bias may be most effectively targeted to anxious individuals with WS with relatively high IQ