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Recent models propose reward system dysfunction as a key mediator of the relationship between sleep and depression and anhedonia. This study explored interrelationships among sleep disturbance, depressive symptoms, anhedonia, and reward responsiveness. Two-hundred and sixty undergraduate students completed questionnaires and a daily diary paradigm assessing sleep, reward responsiveness, depression, anhedonia, and positive affect over 1 week. Baseline sleep disturbance was associated with depressive symptoms, anhedonia, and reward responsiveness. Daily diary sleep parameters showed differential associations with anticipatory versus consummatory reward responsiveness and positive affect. Poorer sleep quality, shorter sleep duration, and longer awakening after sleep onset predicted blunted anticipatory and consummatory reward responsiveness, while increased sleep onset latency and lower sleep efficiency predicted only decreased consummatory reward responsiveness. All sleep indices, except sleep onset latency, were associated with positive affect. Findings demonstrate unique associations between disparate sleep disturbance and reward responsiveness elements, highlighting new treatment mechanisms for anhedonia and depression.

Growing evidence has linked cardiorespiratory fitness (CRF) to more conserved white matter (WM) microstructure. Additional research is needed to determine which WM tracts are most strongly related to CRF and if the neuroprotective effects of CRF are age-dependent. Participants were community-dwelling adults (N = 499; ages 20−85) from the open-access Nathan Kline Institute – Rockland Sample (NKI-RS) with CRF (bike test) and diffusion tensor imaging (DTI) data. Mixed-effect modeling tested the interaction between CRF and age on global (main effect across 9 tracts) and local (individual tract effects) WM microstructure. Among older participants (age ≥ 60), CRF was significantly related to whole-brain (z-score slope = 0.11) and local WM microstructure within several tracts (| z-score slope | range = 0.13 – 0.27). Significant interactions with age indicated that the CRF–WM relationship was weaker (z-score slope ≤ 0.11) and more limited (one WM tract) in younger adults. The findings highlight the importance of aerobic exercise to maintain brain health into senescence. CRF may preferentially preserve a collection of anterior and posterior WM connections related to visuomotor function.

Efforts to improve the implementation of evidence-based treatments (EBT) have recently made important strides. One such example is understanding the vital role that weekly consultation plays as therapists learn to deliver an EBT. Because mechanism-based research can further support EBT implementation, the present study sought to examine the potential relationship between therapist self-efficacy in relation to treatment fidelity and outcomes. We examined therapist self-efficacy ratings from 80 therapists working with 188 patients. These data were collected as part of a randomized controlled implementation trial testing cognitive processing therapy (CPT). Across post-workshop training conditions, we ran multilevel models to assess (1) changes in therapist self-efficacy, (2) therapist self-efficacy in relation to treatment fidelity, and (3) therapist-self-efficacy in relation to patient PTSD symptom outcomes. We found that therapist self-efficacy significantly improved over the course of 6 months of CPT training. Baseline therapist self-efficacy was differentially associated with client outcomes based on post-workshop training condition. Specifically, therapists with low self-efficacy that did not receive post-workshop consultation tended to have poorer outcomes than therapists with low self-efficacy that received consultation. In the present sample, therapist self-efficacy was not related to treatment fidelity. As this was the first study to examine therapist self-efficacy in the implementation of an evidence-based treatment, our findings suggest that self-efficacy may be an important implementation factor in treatment outcomes and worthy of ongoing research.

We evaluated the impact of homework completion on change in PTSD symptoms in the context of two randomized controlled trials of Cognitive Processing Therapy for PTSD (CPT). Female participants (n = 140) diagnosed with PTSD attended at least one CPT session and were assigned homework at each session. The frequency of homework completion was assessed at the beginning of each session and PTSD symptoms were assessed every other session. Piecewise growth models were used to examine the relationship between homework completion and symptom change. CPT version (with vs without the written trauma account) did not moderate associations between homework engagement and outcomes. Greater pretreatment PTSD symptoms predicted more Session 1 homework completion, but PTSD symptoms did not predict homework completion at other timepoints. More homework completion after Sessions 2 and 3 was associated with less change in PTSD from Session 2 to Session 4, but larger pre-to-post treatment changes in PTSD. Homework completion after Sessions 2 and 3 was associated with greater symptom change among patients who had fewer years of education. More homework completion after Sessions 8 and 9 was associated with larger subsequent decreases in PTSD. Average homework completion was not associated with client characteristics. In the second half of treatment, homework engagement was associated with less dropout. The results suggest that efforts to increase engagement in homework may facilitate symptom change.

Promoting mental health, preventing the development of depression, and providing treatment to first-year college students are crucial areas in need of attention and resources. Online programs may be a cost-effective and efficient way to reach a large numbers of students who may not otherwise seek out mental health services. We tested the feasibility and efficacy of an online version of a previously studied acceptance-based behavioral (ABBT) program, the Mindful Way through the Semester (MWTS), for decreasing levels of depression and enhancing acceptance in first year college students. The current study also sought to examine the impact of engagement in mindfulness and values practice on depression, as well as to replicate the finding that change in acceptance is associated with change in depression. This study also examined whether students' participation in the workshop was associated with improvements in depression in comparison to the control condition. One hundred three students were randomly assigned to either the online MWTS workshop condition or the waitlist control condition (in which the students were not contacted until follow-up). Results revealed that the workshop did not significantly affect depression or acceptance. However, changes in acceptance were negatively associated with changes in depression (i.e., larger increases in acceptance were associated with larger decreases in depression) across conditions. Lastly, level of engagement in mindfulness and values practice was significantly associated with decreases in depression in the workshop condition. Implications of these findings for future interventions are discussed.

The current study examined the effect of total, as well as different sources (i.e., family, friends, significant other) of, pretreatment/baseline social support on posttraumatic stress disorder (PTSD) severity and treatment response to cognitive-behavioral conjoint therapy (CBCT) for PTSD. Thirty-six patients were randomized to receive treatment immediately or to a waitlist condition. Those in the treatment condition were offered CBCT for PTSD, a couple-based therapy aimed at reducing PTSD symptoms and improving relationship functioning. PTSD symptoms were assessed at pre-/baseline, mid-/4 weeks of waiting, and posttreatment/12 weeks of waiting using the Clinician-Administered PTSD Scale, and patients self-reported on their levels of pretreatment/baseline social support using the Multidimensional Scale of Perceived Social Support. Total support, as well as social support from family and friends, was not associated with initial PTSD severity or treatment response. However, there was a significant positive association between social support from a significant other and initial PTSD severity (g = .92). Additionally, significant other social support moderated treatment outcomes, such that higher initial significant other support was associated with larger decreases in PTSD severity for those in the treatment condition (g = -1.14) but not the waitlist condition (g = -.04). Social support from a significant other may influence PTSD treatment outcomes within couple therapy for PTSD. The inclusion of intimate partners and other family members may be a fruitful avenue for improving PTSD treatment outcomes; however, future studies are needed to examine whether support can be increased with treatment and whether those improvements lead to greater PTSD symptom response.

Preventing and reducing depression in first-year college students are crucial areas in need of attention and resources. Programs that are cost-effective and time-efficient, that have replicable benefits across samples, are sorely needed. This study aims to examine whether a previously studied acceptance-based behavioral (ABBT) program, the Mindful Way Through the Semester (MWTS), is effective in comparison to a control condition at decreasing levels of depression and enhancing acceptance and academic values when integrated into a first-year undergraduate experience course. The current study also sought to examine the association between change in acceptance, mindfulness practice, and values practice on outcomes. Two hundred thirteen students were assigned to either the MWTS workshop condition or the control condition (in which the first-year experience curriculum as usual was received). Results revealed that the workshop condition produced larger decreases in depression over the course of the semester relative to the control condition, but only for participants endorsing higher levels of depression at baseline. Further, for participants in the workshop condition, changes in depression were negatively associated with changes in acceptance (i.e., larger increases in acceptance associated with larger decreases in depression), an association that was not statistically significant in the control group. Lastly, for participants in the workshop condition who endorsed higher levels of depression at baseline, mindfulness and values practice was associated with greater reductions in depression. Implications of these findings for future interventions are discussed.

Emotional granularity (EG) and emotion differentiation (ED) both refer to the specificity of representations/experiences of emotion, or, in other words, the ability to make fine-grained, nuanced distinctions between similar emotions. Research on EG and ED is in its infancy; however, as reviewed in this paper, accumulating evidence suggests that EG and ED are associated with psychosocial adjustment. Studies have demonstrated that schizophrenia, borderline personality disorder, major depression, autism, and alcohol problems are associated with lower levels of EG/ED. This evidence strongly suggests that EG/ED may represent emotion regulation resources that buffer against the deleterious consequences of negative emotions. Research more clearly establishing the nature and construct validity of EG/ED and more clearly specifying their role in the development of psychosocial adjustment problems is needed.

Trauma-focused therapies, including Cognitive Processing Therapy (CPT; Resick et al., 2016), are effective at reducing clients' PTSD symptoms. A limitation to these treatments, however, is client completion of them. The current study examined temporal patterns of treatment non-completion and the relationships among non-completion, PTSD, and overall mental health functioning outcomes, among clients in a randomized controlled CPT implementation trial. Two models of symptom change were tested: 1) dose-effect model (i.e., clients uniformly improve with additional sessions at a negatively accelerating rate); and 2) the good-enough level model (i.e., clients remain in therapy until they have achieved sufficient improvement, thus clients who attend fewer sessions improve at quicker rates). Results indicated that 42% of clients did not complete treatment, with most discontinuing between sessions two and five. Data did not fit the dose-effect or good-enough level model. Rather, clients who improved at a greater rate in their PTSD symptoms and overall mental health functioning attended more sessions. The average client had the best outcomes when they completed all 12 sessions. Identifying clients who may be at risk for discontinuing treatment, and making a concerted effort toward retaining them, is imperative to reduce non-completion rates and ultimately improve client outcomes.

Intimate partner violence (IPV) exposure was examined as a predictor of treatment engagement (i.e., starting and completing therapy) and treatment outcome in 150 women taking part in a dismantling study of cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD; Resick et al., 2008). Results indicate that women in a current intimate relationship with recent IPV (i.e., past year) were less likely to begin treatment relative to women who reported past IPV only or no history of IPV. For women who began treatment, IPV exposure was not predictive of whether or not they completed treatment. Among women who began treatment, the frequency of IPV was associated with treatment outcome such that women who experienced more frequent IPV exhibited larger reductions in PTSD and depression symptoms over the course of treatment, but experienced similar levels of PTSD and depression severity at the 6-month follow-up. Findings highlight the importance of targeting treatment engagement among women who report recent IPV and suggest that women who have experienced frequent IPV respond well to CPT treatment in spite of their IPV experiences.

The current study examined the impact of both the tendency to worry (trait worry) and the process of worry (state worry) on subsequent behavioral responding in a schedule discrimination learning task. High and low trait worriers were randomly assigned to a state worry or relaxation incubation condition and completed a test of executive functioning and a dual contingency learning task that utilized neutral discriminative cues over the course of 2 contingency phases. Although state and trait worry did not impact executive functioning, the state worry condition was associated with diminished sensitivity to learning task contingencies over the course of the first contingency learning trials in comparison to the relaxation condition. This relationship was unique to the state worry condition above and beyond shared variance with subjective anxiety level. Results suggest that state worry may lead to a decrement in selective behavioral responding to neutral discriminative cues in the environment. The findings suggest that the process of worry may lead to less adaptive responding to neutral cues and interfere with adaptive behaviors, which may thereby contribute to and maintain anxiety.

Cognitive-behavior therapy (CBT) for Social Phobia is effective in both group and individual formats. However, the impact of group processes on treatment efficacy remains relatively unexplored. In this study we examined group cohesion ratings made by individuals at the midpoint and endpoint of CBT groups for social phobia. Symptom measures were also completed at the beginning and end of treatment. We found that cohesion ratings significantly increased over the course of the group and were associated with improvement over time in social anxiety symptoms, as well as improvement on measures of general anxiety, depression, and functional impairment. In conclusion, findings are consistent with the idea that changes in group cohesion are related to social anxiety symptom reduction and, therefore, speak to the importance of nonspecific therapeutic factors in treatment outcome.

To study sex differences in the recognition of human faces with different facial expressions, 65 female and 64 male participants learned to associate names with various male and female neutral faces. During the recall phase, participants were then asked to name the same persons depicting different emotional expressions (neutral, happy, angry, and fearful). Females were faster than males at naming male faces, and males were faster than females at naming female faces. All participants were faster at naming neutral or happy female faces than neural or happy male faces. These results suggest that opposite-sex faces require less processing time than same-sex faces, which is consistent with an evolutionary account.

Psychological group treatments, such as behavioral or cognitive-behavioral therapy, are generally effective interventions for social phobia. However, a substantial number of individuals discontinue these treatments prematurely. Participant attrition can threaten the validity of treatment outcome studies if attrition during therapy does not occur randomly. In order to examine this issue, we studied 133 individuals with a principal diagnosis of social phobia who initiated a 12-week behavioral or cognitive-behavioral group treatment for social phobia. Thirty-four participants discontinued therapy prematurely. These dropouts were compared to treatment completers in demographic characteristics, Axis I and II psychopathology, and their attitude toward treatment. The results only showed a small difference between treatment completers and dropouts in their attitude toward treatment: dropouts rated the treatment rationale as less logical than completers at the beginning of treatment. No other differences between dropouts and completers were observed. Therefore, dropouts are unlikely to present a serious threat to the external validity of treatment outcome studies for social phobia.