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The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) has demonstrated efficacy for treating anxiety and depression. However, there are limited effectiveness data when conducted in real-world settings with diverse populations, including those with trauma. We evaluated treatment outcomes in a naturalistic, community setting among 279 adults who received UP following Hurricane Harvey. We examined change in overall clinical severity, depression and anxiety symptoms, functional impairment, and baseline outcome predictors (i.e., demographic characteristics, impact from Hurricane Harvey, co-occurrence of depression and anxiety symptoms). Global clinical severity, depression and anxiety symptoms, and functional impairment decreased by end-of-treatment. Participants experienced global symptom improvement to a lesser degree than demonstrated in efficacy trials. Participants who experienced greater storm impact reported larger reductions in anxiety symptoms than those less impacted by Harvey. Further studies evaluating the effectiveness of the UP post-disaster and with diverse samples are needed. [ABSTRACT FROM AUTHOR]

Distress tolerance (DT) is a transdiagnostic risk factor for psychopathology. The Behavioral Indicator of Resiliency to Distress (BIRD) task assesses DT by measuring task persistence in the face of distress. BIRD task performance has been associated with internalizing and externalizing symptoms in nonclinical youth, but these relationships have not been explored in clinical youth. Validating this task in a clinical sample would clarify its utility as a more objective indicator of DT. We aimed to investigate the correlates and predictors of BIRD task performance in a clinical sample of 348 youth assessed at pretreatment in community mental health clinics (CMHC; n = 209; ages 12–18; 66.8% female) or at a university-based research clinic (RC; n = 139; ages 10–18; 49.6% female). We aimed to evaluate the concurrent validity of the BIRD task by examining the associations between quitting the task and pre-task subjective units of distress (SUDs) and youth- and parent-reported anxiety, depressive, and externalizing symptoms, as well as youth-reported DT. Youth who reported greater subjective units of distress (SUDS) prior to the task reported greater anxiety and depressive symptoms, externalizing symptoms, and poorer DT. Those who quit the task early reported greater parent-reported school and separation anxiety. Surprisingly, fewer participants quit the task in this study compared with previous studies. The current results provide evidence that the BIRD may not be measuring the same construct as self-reported DT. Whereas a self-report measure captures one's perceived ability to handle negative emotions, the BIRD captures one's actual ability to persist in the face of frustration. These results suggest that youth's perception of their ability to handle negative emotions may be distinct from their actual persistence when faced with distress. Assessing both perceived and actual DT may have clinical utility for youth with internalizing symptoms. [ABSTRACT FROM AUTHOR]

Obsessive-compulsive disorder (OCD) commonly co-occurs with depression, resulting in heightened severity and poorer treatment response. Research on the associations between specific obsessive-compulsive symptoms (OCS) and depressive symptoms has utilized measures that have not fully considered the relationship across OCS dimensions. Little is known about which factors explain the overlap between OCS and depressive symptoms. OCS and depressive symptoms may be related via depressive cognitive styles, such as rumination or dampening (i.e., down-regulating positive emotions). We evaluated the associations of OCS dimensions with depressive symptoms and cognitive styles. We also examined the indirect effects of rumination and dampening in the relationship between OCS and depressive symptoms. Participants (N = 250) completed questionnaires online. Greater depressive symptoms, rumination, and dampening were associated with greater levels of all OCS dimensions. Path analysis was utilized to examine a model including the direct effect of depressive symptoms on overall OCS and two indirect effects (through rumination and dampening). There was a significant indirect effect of depressive cognitive styles on the relationship between OCS and depressive symptoms, through rumination and dampening. Replication in a clinical sample and experimental manipulations may bear important implications for targeting depressive cognitive styles in treatments for OCD and depression. [ABSTRACT FROM AUTHOR]

Recent research suggests that repetitive negative thinking is a transdiagnostic phenomenon that is present across affective disorders. Notably, multiple measures of repetitive negative thinking exist, including some that are disorder-specific and others that are transdiagnostic. To date, no studies have examined whether these measures are captured by a latent Repetitive Negative Thinking factor or how these measures are differentially associated with symptoms of affective disorders, including mood, anxiety, and obsessive-compulsive spectrum disorders. Across two separate studies, Mechanical Turk participants completed measures of rumination, post-event processing, dampening of positive affect, and two transdiagnostic measures of repetitive thinking, as well as measures of depression, physiological anxiety, social anxiety, obsessive-compulsive disorder, and body dysmorphic disorder. Using structural equation modeling, evidence of a single Repetitive Negative Thinking latent factor was found. Moreover, positive associations emerged between the latent factor and all five clinical symptom measures. Notably, few differences emerged in the magnitude of the associations between measures of repetitive negative thinking and psychological symptoms. Together, findings support a transdiagnostic conceptualization of repetitive negative thinking. [ABSTRACT FROM AUTHOR]

Objective: Preoccupation with perceived bodily odor has been described in neuropsychiatric disorders for more than a century; however, empirical research on olfactory reference syndrome (ORS) is scarce. This study investigated the phenomenology of ORS in a broadly ascertained, diverse sample.Method: Data were obtained from 253 subjects in an internet-based survey that operated from January - March 2010. Measures included the Yale-Brown Obsessive Compulsive Scale Modified for ORS (ORS-YBOCS), Work and Social Adjustment Scale (WSAS), Depression Anxiety Stress Scales (DASS), and symptom specific questionnaires developed for this study.Results: Individuals reported, on average, moderately severe ORS symptoms. The average age of onset of ORS symptoms was 21.1 years, with 54% reporting a chronic, unremitting course. Individuals endorsed a lifetime average of two malodorous preoccupations, most commonly stool, garbage, and ammonia. Odors were most often reported to emanate from the armpits, feet, and breasts. Nearly all participants engaged in time-consuming rituals to try to hide or fix their perceived malodor (e.g., checking and camouflaging). Eighteen percent reported poor or delusional insight and 64.0% reported ideas or delusions of reference. More severe ORS symptoms were moderately associated with female gender, poorer insight, and higher levels of impairment (in work, social leisure, ability to maintain close relationships, and consecutive days housebound).Conclusion: This is the largest study on ORS to date. Results underscore the clinical significance and psychosocial impact of this understudied disorder, and highlight the need for subsequent research to examine clinical features and inform treatment. [ABSTRACT FROM AUTHOR]

Though research indicates that individuals with social anxiety disorder may experience elevated levels of thwarted belongingness and perceived burdensomeness, two interpersonal risk factors critical for the development of suicidal desire, it remains unclear why. The current investigation considered how shame and depression may help to explain the relationship between social anxiety and interpersonal suicide risk factors. Participants ( N =259), recruited using Amazon.com's Mechanical Turk, completed measures of social anxiety, interpersonal suicide risk factors, shame, and depression. Social anxiety was associated with greater thwarted belongingness and perceived burdensomeness. In addition, shame partially explained the association between social anxiety and thwarted belongingness, though the indirect effect was no longer significant after considering depression as a moderator. As predicted, shame was found to fully explain the association between social anxiety and perceived burdensomeness and this indirect effect was most pronounced among individuals with high comorbid depression. The clinical implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Abstract Emotional disorders, encompassing a range of anxiety and depressive disorders, are the most prevalent and comorbid psychiatric disorders in adolescence. Unfortunately, evidence-based psychosocial therapies typically focus on single disorders, are rarely adopted by community mental health center clinicians, and effect sizes are modest. This article describes the protocol for a comparative effectiveness study of two novel interventions designed to address these challenges. The first intervention is a transdiagnostic treatment (the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents, UP-A), a promising new approach that uses a small number of common strategies to treat a broad range of emotional disorders, and their underlying shared emotional vulnerabilities. The second intervention is a standardized measurement feedback system, the Youth Outcomes Questionnaire (YOQ), designed to improve clinical decision making using weekly symptom and relational data. The three study arms are treatment as usual (TAU), TAU plus the YOQ (TAU+), and UP-A (used in combination with the YOQ). The primary aims of the study are to [1] compare the effects of the UP-A and TAU+ to TAU in community mental health clinics, [2] to isolate the effects of measurement and feedback by comparing the UP-A and TAU+ condition, and [3] to examine the mechanisms of action of both interventions. Design considerations and study methods are provided to inform future effectiveness research. [ABSTRACT FROM AUTHOR]