Search

The purpose of this review is to provide (1) a synopsis on relations of mindfulness with cardiovascular disease (CVD) and major CVD risk factors, and (2) an initial consensus-based overview of mechanisms and theoretical framework by which mindfulness might influence CVD. Initial evidence, often of limited methodological quality, suggests possible impacts of mindfulness on CVD risk factors including physical activity, smoking, diet, obesity, blood pressure, and diabetes regulation. Plausible mechanisms include (1) improved attention control (e.g., ability to hold attention on experiences related to CVD risk, such as smoking, diet, physical activity, and medication adherence), (2) emotion regulation (e.g., improved stress response, self-efficacy, and skills to manage craving for cigarettes, palatable foods, and sedentary activities), and (3) self-awareness (e.g., self-referential processing and awareness of physical sensations due to CVD risk factors). Understanding mechanisms and theoretical framework should improve etiologic knowledge, providing customized mindfulness intervention targets that could enable greater mindfulness intervention efficacy.

Cognitive diathesis stress models of depression emphasize individual styles of attributing causal explanations to negative and positive events in life. The Attributional Style Questionnaire (ASQ) has traditionally been used to measure explanatory style, defined as an individual's habitual way of assigning causes to negative events. Explanatory flexibility, rather than focusing on the content of one's thoughts, emphasizes the extent to which individuals are able to make different attributions depending on the particular context of each event. The underlying notion is that individuals who are better able to adapt to the cues and demands of a stressful situation may be able to respond more effectively and are thereby less vulnerable to depression. Despite evidence attesting to its relevance to depression and anxiety disorders, explanatory flexibility has yet to be examined in a purely treatment-seeking sample of patients clinically diagnosed with Axis I psychopathology. The current study examined baseline levels of explanatory flexibility, along with explanatory style, in a sample of 171 treatment-seeking patients diagnosed with either major depressive disorder (MDD), generalized anxiety disorder (GAD), or at least one other Axis I disorder. Overall, the results replicate and extend past results indicating a distinction between explanatory flexibility and explanatory style. Furthermore, patients with MDD and GAD demonstrated lower levels of explanatory flexibility relative to patients with other Axis I disorders. Thus, explanatory flexibility may assist in our understanding of the etiology, maintenance, and treatment of emotional disorders, with particular relevance to MDD and GAD.

The capacity to shift experiential perspective-from within one's subjective experience onto that experience-is fundamental to being human. Scholars have long theorized that this metacognitive capacity-which we refer to as decentering-may play an important role in mental health. To help illuminate this mental phenomenon and its links to mental health, we critically examine decentering-related constructs and their respective literatures (e.g., self-distanced perspective, cognitive distancing, cognitive defusion). First, we introduce a novel metacognitive processes model of decentering. Specifically, we propose that, to varying degrees, decentering-related constructs reflect a common mental phenomenon subserved by three interrelated metacognitive processes: meta-awareness, disidentification from internal experience, and reduced reactivity to thought content. Second, we examine extant research linking decentering-related constructs and their underlying metacognitive processes to mental health. We conclude by proposing future directions for research that transcends decentering-related constructs in an effort to advance the field's understanding of this facet of human experience and its role in (mal)adaptation., Competing Interests: Declaration of Conflicting Interests The authors declared that they had no conflicts of interest with respect to their authorship or the publication of this article., (© The Author(s) 2015.)

Background: Although CBT is efficacious for a wide variety of psychiatric conditions, relatively fewer GAD patients achieve high endstate functioning as compared to patients receiving CBTs for other disorders. Moreover, GAD trials that utilized patient samples without prominent depression have tended to report that effect sizes for depressive outcomes were small or diminished to pretreatment levels in the follow-up period. Emotion regulation therapy (ERT) integrates principles from traditional and contemporary cognitive behavioral treatments with basic and translational findings from affect science to offer a blueprint for improving intervention by focusing on motivational, regulatory, and contextual learning mechanisms., Method: The purpose of this investigation was to provide initial support for the efficacy of ERT in an open trial of patients with GAD and cooccurring depressive symptoms. Twenty-one patients received a 20-session version of ERT delivered in weekly individual sessions. Standardized clinician ratings and self-report measures were assessed at pre-, mid-, and posttreatment as well as at three- and nine-month follow-ups. Intent-to-treat analyzes were utilized., Results: GAD patients, half with comorbid major depression, evidenced statistically, and clinically meaningful improvements in symptom severity, impairment, quality of life, and in model-related outcomes including emotional/motivational intensity, mindful attending/acceptance, decentering, and cognitive reappraisal. Patients maintained gains across the three and nine month follow-up periods., Conclusions: These findings, although preliminary, provide additional evidence for the role of emotion dysregulation in the onset, maintenance, and now treatment of conditions such as GAD and cooccurring depressive symptoms., (© 2015 Wiley Periodicals, Inc.)

Objective: We sought to examine psychological mechanisms of treatment outcomes of a mindfulness meditation intervention for Generalized Anxiety Disorder (GAD)., Methods: We examined mindfulness and decentering as two potential therapeutic mechanisms of action of generalized anxiety disorder (GAD) symptom reduction in patients randomized to receive either mindfulness-based stress reduction (MBSR) or an attention control class (N=38). Multiple mediation analyses were conducted using a non-parametric cross product of the coefficients approach that employs bootstrapping., Results: Analyses revealed that change in decentering and change in mindfulness significantly mediated the effect of MBSR on anxiety. When both mediators were included in the model, the multiple mediation analysis revealed a significant indirect effect through increases in decentering, but not mindfulness. Furthermore, the direct effect of MBSR on decrease in anxiety was not significant, suggesting that decentering fully mediated the relationship. Results also suggested that MBSR reduces worry through an increase in mindfulness, specifically by increases in awareness and nonreactivity., Conclusions: Improvements in GAD symptoms resulting from MBSR are in part explained by increased levels of decentering., Competing Interests: Disclosure Statement: Authors E. Hoge, E. Bui, E. Goetter, D. Robinaugh, R. Ojserkis, and D. Fresco state that they have no financial or other relationships which would create a conflict of interest with regard to this manuscript.

A number of studies have attempted to identify the factor structure of the Dysfunctional Attitude Scale (DAS). However, no studies have done so using a clinical sample of outpatients likely to generalize to the clinical trials in which the DAS is commonly used. The current investigation utilized exploratory structural equation modeling in an outpatient sample (N = 982) and found support for a one-factor solution (composed of 19 items). This solution was largely confirmed in a second outpatient sample (N = 301). Construct validity was demonstrated in correlations with measures of depression, social interaction anxiety, and symptoms of obsessive-compulsive disorder., (© The Author(s) 2014.)

The fourth edition of the Generalized Anxiety Disorder Questionnaire (GAD-Q-IV) is a self-report measure that is commonly used to screen for the presence of generalized anxiety disorder (GAD). The current investigation attempted to identify an optimal cut score using samples obtained from an outpatient psychiatric (n=163) and primary care clinic (n=99). Results indicated that a cut score of 7.67 provided an optimal balance of sensitivity (.85) and specificity (.74) comparable to a previously identified cut score (5.7) across both samples (sensitivity=.90, specificity=.66). However, both cut scores were consistently outperformed by a score representing the criteria for GAD described in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (sensitivity=.89, specificity=.82)., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: Mindfulness-based stress reduction (MBSR) is an increasingly popular practice demonstrated to alleviate stress and treat certain health conditions. MBSR may reduce elevated blood pressure (BP). Treatment guidelines recommend life-style modifications for BP in the prehypertensive range (systolic BP [SBP] 120-139 mm Hg or diastolic BP [DBP] 80-89 mm Hg), followed by antihypertensives if BP reaches hypertensive levels. MBSR has not been thoroughly evaluated as a treatment of prehypertension. A randomized clinical trial of MBSR for high BP was conducted to determine whether BP reductions associated with MBSR exceed those observed for an active control condition consisting of progressive muscle relaxation (PMR) training., Methods: Fifty-six men (43%) and women (57%) averaging (standard deviation) 50.3 (6.5) years of age (91% white) with unmedicated BP in the prehypertensive range were randomized to 8 weeks of MBSR or PMR delivered in a group format. Treatment sessions were administered by one treatment provider and lasted approximately 2.5 hours each week. Clinic BP was the primary outcome measure. Ambulatory BP was a secondary outcome measure., Results: Analyses were based on intent to treat. Patients randomized to MBSR exhibited a 4.8-mm Hg reduction in clinic SBP, which was larger than the 0.7-mm Hg reduction observed for PMR (p = .016). Those randomized to MBSR exhibited a 1.9-mm Hg reduction in DBP compared with a 1.2-mm Hg increase for PMR (p = .008). MBSR did not result in larger decreases in ambulatory BP than in PMR., Conclusions: MBSR resulted in a reduction in clinic SBP and DBP compared with PMR. Trial Registration ClinicalTrials.gov identifier: NCT00440596.

Rumination, worry, and other forms of negative self-referential processing (NSRP) are familiar to everyone, as reflecting on the self is perhaps our most human characteristic. However, for a substantial subgroup of patients, NSRP arises in response to intense emotionality, worsening the clinical presentation, and diminishing the treatment response. The combination of emotionality and NSRP likely reflects an endophenotype of complicated and treatment refractory patients who fail to achieve a satisfactory treatment response in our trials and our clinics. An important next step is to personalize treatments by deliberately targeting NSRPs within established treatment protocols or in as yet novel treatments. Enriching treatments with mindfulness meditation is one possible avenue for personalized care of patients with this hypothesized endophenotype.

Despite the success of cognitive behavioral therapies (CBT) for emotional disorders, a sizable subgroup of patients with complex clinical presentations, such as patients with generalized anxiety disorder, fails to evidence adequate treatment response. Emotion Regulation Therapy (ERT) integrates facets of traditional and contemporary CBTs, mindfulness, and emotion-focused interventions within a framework that reflects basic and translational findings in affect science. Specifically, ERT is a mechanism-targeted intervention focusing on patterns of motivational dysfunction while cultivating emotion regulation skills. Open and randomized controlled psychotherapy trials have demonstrated considerable preliminary evidence for the utility of this approach as well as for the underlying proposed mechanisms. This article provides an illustration of ERT through the case of "William." In particular, this article includes a case-conceptualization of William from an ERT perspective while describing the flow and progression of the ERT treatment approach.

For the past half century, behavior therapy has served as the theoretical basis for successful inquiries into the nature and treatment of many emotional disorders. Although there are core principles shared by all behavior therapies, two primary approaches, traditional cognitive behavior therapy (CBT) and acceptance and commitment therapy (ACT), have emerged as the most viable treatment approaches, even though they achieve their success through different methods and are predicated in different assumptions, principles, questions, and scientific strategies. In this special series, theorists and therapists with allegiances to one of these two approaches articulate the philosophical and theoretical underpinnings of their approach, summarize the evidence to date, point out current gaps or inconsistencies, and map out future directions with predictions informed by theory. The series concludes with a capstone paper that seeks to find common ground within the family of behavior therapies while also positing ways for behavior therapy to remain relevant in a world that increasingly emphasizes neuroscience and biobehavioral approaches to understand and reduce human suffering., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Cognitive behavioral therapy (CBT) has a rich history of alleviating the suffering associated with mental disorders. Recently, there have been exciting new developments, including multicomponent approaches, incorporated alternative therapies (e.g., meditation), targeted and cost-effective technologies, and integrated biological and behavioral frameworks. These field-wide changes have led some to emphasize the differences among variants of CBT. Here, we draw attention to commonalities across cognitive-behavioral therapies, including shared goals, change principles, and therapeutic processes. Specifically, we offer a framework for examining common CBT characteristics that emphasizes behavioral adaptation as a unifying goal and three core change principles, namely (a) context engagement to promote adaptive imagining and enacting of new experiences; (b) attention change to promote adaptive sustaining, shifting, and broadening of attention; and (c) cognitive change to promote adaptive perspective taking on events so as to alter verbal meanings. Further, we argue that specific intervention components, including behavioral exposure/activation, attention training, acceptance/tolerance, decentering/defusion, and cognitive reframing, may be emphasized to a greater or lesser degree by different treatment packages but are still fundamentally common therapeutic processes that are present across approaches and are best understood by their relationships to these core CBT change principles. We conclude by arguing for shared methodological and design frameworks for investigating unique and common characteristics to advance a unified and strong voice for CBT in a widening, increasingly multimodal and interdisciplinary, intervention science., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

The current investigation represents the first meta-analysis of the depressive realism literature. A search of this literature revealed 75 relevant studies representing 7305 participants from across the US and Canada, as well as from England, Spain, and Israel. Results generally indicated a small overall depressive realism effect (Cohen's d=-.07). Overall, however, both dysphoric/depressed individuals (d=.14) and nondysphoric/nondepressed individuals evidenced a substantial positive bias (d=.29), with this bias being larger in nondysphoric/nondepressed individuals. Examination of potential moderator variables indicated that studies lacking an objective standard of reality (d=-.15 versus -.03, for studies possessing such a standard) and that utilize self-report measures to measure symptoms of depression (d=.16 versus -.04, for studies which utilize structured interviews) were more likely to find depressive realism effects. Methodological paradigm was also found to influence whether results consistent with depressive realism were found (d's ranged from -.09 to .14)., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Langer's theory of mindfulness proposes that a mindful person seeks out and produces novelty, is attentive to context, and is flexible in thought and behavior. In three independent studies, the factor structure of the Langer Mindfulness/Mindlessness Scale was examined. Confirmatory factor analysis failed to replicate the four-factor model and a subsequent exploratory factor analysis revealed the presence of a two-factor (mindfulness and mindlessness) solution. Study 2 demonstrated that the two factors assessed discrete constructs and were not merely products of acquiescence. Support was also found for a nine-item, one-factor model comprised solely of mindfulness items. On comparing models, Study 3 suggested the superiority of the one-factor mindfulness model. Finally, a preliminary investigation of the concurrent validity of the revised nine-item Langer Mindfulness/Mindlessness Scale is presented. The current article offers researchers a revised version of a mindfulness measure derived from a cognitive perspective.

Given the substantial comorbidity between generalized anxiety disorder (GAD) and unipolar depressive disorders (UDDs), some have suggested that these disorders be combined in future editions of the DSM. However, decisions regarding nosology should not only account for current manifestations of symptom profiles, but also the potential diagnostic utility of associated characteristics, which, given past research, may suggest greater distinctiveness between these disorder classes. In the present investigation, we examined the role of one-item indices of physical, emotional/motivational, and cognitive symptoms in differentiating GAD from UDDs. We assessed these symptoms with one-item measures in order to provide an initial examination of the viability of these constructs as diagnostic criteria. In Study 1, in an unselected college sample, muscle pains and aches, gastrointestinal symptoms, emotion intensity, and intolerance of uncertainty were associated with GAD symptoms; conversely, low positive affect was associated with UDDs symptoms. In Study 2, we extended these findings to a clinical population and found that muscle pains and aches, positive affect, goal motivation, emotion intensity, and intolerance of uncertainty were higher in GAD than in UDDs., (Copyright 2009 Elsevier Ltd. All rights reserved.)

Context: Medication and cognitive behavioral treatment are the best-established treatments for social anxiety disorder, yet many individuals remain symptomatic after treatment., Objective: To determine whether combined medication and cognitive behavioral treatment is superior to either monotherapy or pill placebo., Design: Randomized, double-blind, placebo-controlled trial., Setting: Research clinics at Columbia University and Temple University., Participants: One hundred twenty-eight individuals with a primary DSM-IV diagnosis of social anxiety disorder., Interventions: Cognitive behavioral group therapy (CBGT), phenelzine sulfate, pill placebo, and combined CBGT plus phenelzine., Main Outcome Measures: Liebowitz Social Anxiety Scale and Clinical Global Impression (CGI) scale scores at weeks 12 and 24., Results: Linear mixed-effects models showed a specific order of effects, with steepest reductions in Liebowitz Social Anxiety Scale scores for the combined group, followed by the monotherapies, and the least reduction in the placebo group (Williams test = 4.97, P < .01). The CGI response rates in the intention-to-treat sample at week 12 were 9 of 27 (33.3%) (placebo), 16 of 34 (47.1%) (CBGT), 19 of 35 (54.3%) (phenelzine), and 23 of 32 (71.9%) (combined treatment) (chi(2)(1) = 8.76, P < .01). Corresponding remission rates (CGI = 1) were 2 of 27 (7.4%), 3 of 34 (8.8%), 8 of 35 (22.9%), and 15 of 32 (46.9%) (chi(2)(1) = 15.92, P < .01). At week 24, response rates were 9 of 27 (33.3%), 18 of 34 (52.9%), 17 of 35 (48.6%), and 25 of 32 (78.1%) (chi(2)(1) = 12.02, P = .001). Remission rates were 4 of 27 (14.8%), 8 of 34 (23.5%), 9 of 35 (25.7%), and 17 of 32 (53.1%) (chi(2)(1) = 10.72, P = .001)., Conclusion: Combined phenelzine and CBGT treatment is superior to either treatment alone and to placebo on dimensional measures and on rates of response and remission.

Social anxiety disorder is a prevalent and impairing disorder for which viable cognitive-behavioral therapies exist. However, these treatments have not been easily packaged for dissemination and may be underutilized as a result. The current study reports on the findings of a randomized controlled trial of a manualized and workbook-driven individual cognitive-behavioral treatment for social anxiety disorder (Hope, Heimberg, Juster, & Turk, 2000; Hope, Heimberg, & Turk, 2006). This treatment package was derived from an empirically supported group treatment for social anxiety disorder and intended for broad dissemination, but it has not previously been subjected to empirical examination on its own. As a first step in that examination, 38 clients seeking treatment for social anxiety disorder at either the Adult Anxiety Clinic of Temple University or the Anxiety Disorders Clinic of the University of Nebraska-Lincoln were randomly assigned to receive either immediate treatment with this cognitive-behavioral treatment package or treatment delayed for 20 weeks. Evaluation at the posttreatment/postdelay period revealed substantially greater improvements among immediate treatment clients on interviewer-rated and self-report measures of social anxiety and impairment. Three-month follow-up assessment revealed maintenance of gains. Clinical implications and directions for future research are discussed.

Objective: This study examined whether the self-report version of the Liebowitz Social Anxiety Scale (LSAS-SR) could accurately identify individuals with social anxiety disorder and individuals with the generalized subtype of social anxiety disorder. Furthermore, the study sought to determine the optimal cutoffs for the LSAS-SR for identifying patients with social anxiety disorder and its generalized subtype., Methods: Two hundred and ninety-one patients with clinician-assessed social anxiety disorder (240 with generalized social anxiety disorder) and 53 control participants who were free from current Axis-1 disorders completed the LSAS-SR., Results: Receiver Operating Characteristic analyses revealed that the LSAS-SR performed well in identifying participants with social anxiety disorder and generalized social anxiety disorder. Consistent with Mennin et al.'s [2002: J Anxiety Disord 16:661-673] research on the clinician-administered version of the LSAS, cutoffs of 30 and 60 on the LSAS-SR provided the best balance of sensitivity and specificity for classifying participants with social anxiety and generalized social anxiety disorder, respectively., Conclusions: The LSAS-SR may be an accurate and cost-effective way to identify and subtype patients with social anxiety disorder, which could help increase the percentage of people who receive appropriate treatment for this debilitating disorder., ((c) 2008 Wiley-Liss, Inc.)

The Social Appearance Anxiety Scale (SAAS) was created to measure anxiety about being negatively evaluated by others because of one's overall appearance, including body shape. This study examined the psychometric properties of the SAAS in three large samples of undergraduate students (respective ns = 512, 853, and 541). The SAAS demonstrated a unifactorial structure with high test-retest reliability and internal consistency. The SAAS was positively associated with measures of social anxiety. The SAAS was also related to greater disparity between perceived, actual, and ideal physical attributes, beliefs that one's appearance is inherently flawed and socially unacceptable and that being unattractive is socially deleterious, feelings of unattractiveness, emphasis on appearance and its maintenance, and a preoccupation with being overweight. It was a unique predictor of social anxiety above and beyond negative body image indicators. Findings suggest that the SAAS is a psychometrically valid measure of social anxiety regarding one's overall appearance.

Generalized anxiety disorder (GAD) and major depressive disorder (MDD) demonstrate a strong relationship to each other at both genotypic and phenotypic levels, and both demonstrate substantial loadings on a higher-order negative affectivity factor [see Watson, 2005: J Abnorm Psychol 114:522-536]. On the basis of these findings, there have been a number of calls to reclassify GAD in the same category as MDD (the "distress disorders"). However, any consideration of the reclassification of GAD should also take into account a number of other factors not only related to GAD and MDD but also to the overlap of these disorders with other anxiety and mood disorders. First, GAD has established reliability and validity in its own right, and specific features (e.g., worry) may become obscured by attempts at reclassification. Second, examination of the nature of the overlap of GAD and MDD with each other and with other disorders suggests a more complex pattern of differences between these conditions than has been suggested (e.g., MDD has strong relationships with other anxiety disorders, and GAD may be more strongly related to fear than it may first appear). Third, although findings suggest that GAD and MDD may have overlapping heritable characteristics, other evidence suggests that the two disorders may be distinguished by both environmental factors and temporal presentations. Finally, although overlap between GAD and MDD is reflected in their relationships to negative affectivity, temporal relationships between these disorders may be demonstrated by functional changes in emotional responsivity.

Traditional cognitive vulnerability-stress models regarding the etiology of depression emphasize the content of the depressed individual's thoughts. One important cognitive content index, explanatory style, represents the habitual way that individuals assign causes to events that occur in their lives. A more contemporary model, however, emphasizes the cognitive process by which these attributions are made and to what extent the individual can make different attributions depending on the particular context of the event. This process is referred to as explanatory flexibility. Given that both indices of causal explanation are derived from the same assessment instrument, the Attributional Style Questionnaire, the current investigation sought to examine the extent to which the two variables can be differentiated from one another. Results indicated that explanatory style (a measure of cognitive content) and explanatory flexibility (a cognitive process measure) are empirically related, but distinct, constructs.

Decentering is defined as the ability to observe one's thoughts and feelings as temporary, objective events in the mind, as opposed to reflections of the self that are necessarily true. The Experiences Questionnaire (EQ) was designed to measure both decentering and rumination but has not been empirically validated. The current study investigated the factor structure of the EQ in both undergraduate and clinical populations. A single, unifactorial decentering construct emerged using 2 undergraduate samples. The convergent and discriminant validity of this decentering factor was demonstrated in negative relationships with measures of depression symptoms, depressive rumination, experiential avoidance, and emotion regulation. Finally, the factor structure of the EQ was replicated in a clinical sample of individuals in remission from depression, and the decentering factor evidenced a negative relationship to concurrent levels of depression symptoms. Findings from this series of studies offer initial support for the EQ as a measure of decentering.

Two studies sought to elucidate the components of emotion and its dysregulation and examine their role in both the overlap and distinctness of the symptoms of 3 highly comorbid anxiety and mood disorders (i.e., generalized anxiety disorder, major depression, and social anxiety disorder). In Study 1, exploratory factor analyses demonstrated that 4 factors--heightened intensity of emotions, poor understanding of emotions, negative reactivity to emotions, and maladaptive management of emotions--best reflected the structure of 4 commonly used measures of emotion function and dysregulation. In Study 2, a separate sample provided support for this 4-factor model of emotion dysregulation. Poor understanding, negative reactivity, and maladaptive management were found to relate to a latent factor of emotion dysregulation. In contrast, heightened intensity of emotions was better characterized separately, suggesting it may relate more strongly to dispositional emotion generation or emotionality. Finally, the 4 components demonstrated both common and specific relationships to self-reported symptoms of generalized anxiety disorder, major depression, and social anxiety disorder.

Prior research has found that depressed individuals are more realistic in their interpretations of certain events than nondepressed individuals. However, the implications of this finding for the etiology of depressive disorders have never been clarified. The current investigation sought to remedy this situation by exploring realism in the context of a well-validated, cognitive diathesis-stress theory of the etiology of a subtype of depression: hopelessness theory (Abramson, L. Y., Metalsky, G. I., & Alloy, L. B. (1989). Hopelessness depression: A theory-based subtype of depression. Psychological Review, 96, 358-372). A sample of 239 college students, including groups of participants with depressogenic versus nondepressogenic attributional styles, recorded the causes they assigned to events; the extent to which their attributions were objectively realistic was evaluated. A comparison of the degree of objectivity was also made between dysphoric and nondysphoric individuals. Contrary to expectations derived from the depressive realism hypothesis, dysphoric individuals exhibited less realistic attributions as compared to nondysphoric individuals. Further, individuals at risk for depression evidenced a pessimistic bias, while individuals not at risk evidenced an optimistic bias.

Z. V. Segal et al. (2006) demonstrated that depressed patients treated to remission through either antidepressant medication (ADM) or cognitive-behavioral therapy (CBT), but who evidenced mood-linked increases in dysfunctional thinking, showed elevated rates of relapse over 18 months. The current study sought to evaluate whether treatment response was associated with gains in decentering-the ability to observe one's thoughts and feelings as temporary, objective events in the mind-and whether these gains moderated the relationship between mood-linked cognitive reactivity and relapse of major depression. Findings revealed that CBT responders exhibited significantly greater gains in decentering compared with ADM responders. In addition, high post acute treatment levels of decentering and low cognitive reactivity were associated with the lowest rates of relapse in the 18-month follow-up period., (Copyright 2007 APA.)

The authors examined extreme response style in recurrently and chronically depressed patients, assessing its role in therapeutic outcome. During the acute phase, outpatients with major depressive disorder (N = 384) were treated with fluoxetine for 8 weeks. Remitted patients (n = 132) entered a continuation phase during which their fluoxetine dose increased and they were randomly assigned to treatment with or without cognitive-behavioral therapy (CBT). Results showed a predictive relationship between extreme response style and clinical outcome. Patients in the medication-only group showed a significant increase in the frequency of extreme responses, whereas patients receiving CBT showed no significant change. These results are consistent with recent findings suggesting that metacognitive factors may be as important as changes in thought content when treating depression., (Copyright 2007 APA, all rights reserved.)

Once considered to be a disorder associated with minimal impairment, the link between generalized anxiety disorder (GAD) and impairment across a broad constellation of domains is now well established. However, less is known about how comorbidity affects these relationships or how GAD impacts one's perceived life satisfaction or quality of life. To investigate these questions, data from 52 treatment-seeking individuals with GAD (33 with comorbid Axis I diagnoses) were compared to data from 55 nonanxious controls. Individuals with GAD reported more impairment at work and in their social functioning than they did with home and family responsibilities. They also reported lower quality of life than nonanxious controls, particularly in regard to self-esteem, goals and values, money, work, play, learning, creativity, friends, and relatives. Trait worry was positively correlated with impairment and inversely related to life satisfaction within the clinical sample. Individuals with GAD, with and without comorbid Axis I diagnoses, showed few differences on measures of impairment (differing only on impairment in social functioning). However, individuals with GAD and comorbid disorders perceived their lives as less satisfying than did individuals with GAD without comorbid diagnoses.

Burke and Stephens (1999) [Burke, R.S., Stephens, R.S. Social anxiety and drinking in college students: A social cognitive theory analysis. Clinical Psychology Review, 19, (1999) 513-530.] proposed a social cognitive theory of heavy drinking in college students. According to this theory, alcohol expectancies for social facilitation and self-efficacy for refusing heavy drinking in anxiety-producing social situations moderate the relationship between social anxiety and drinking. In the current study, a significant three-way interaction was observed among social anxiety, expectancies, and self-efficacy when amount and frequency of drinking was the dependent variable. As predicted by the model, socially anxious college students with low self-efficacy for avoiding heavy drinking in social situations and high positive expectancies for social facilitation reported more alcohol consumption than other socially anxious individuals.

Three studies provide preliminary support for an emotion dysregulation model of generalized anxiety disorder (GAD). In study 1, students with GAD reported heightened intensity of emotions, poorer understanding of emotions, greater negative reactivity to emotional experience, and less ability to self-soothe after negative emotions than controls. A composite emotion regulation score significantly predicted the presence of GAD, after controlling for worry, anxiety, and depressive symptoms. In study 2, these findings were largely replicated with a clinical sample. In study 3, students with GAD, but not controls, displayed greater increases in self-reported physiological symptoms after listening to emotion-inducing music than after neutral mood induction. Further, GAD participants had more difficulty managing their emotional reactions. Implications for GAD and psychopathology in general are discussed.

The Brief Fear of Negative Evaluation Scale (BFNE; M. R. Leary, 1983a) is often used to assess fear of negative evaluation, the core feature of social anxiety disorder. However, few studies have examined its psychometric properties in large samples of socially anxious patients. Although the BFNE yields a single total score, confirmatory factor analysis indicated a 2-factor solution to be more appropriate, with the 1st factor consisting of all straightforwardly worded items (BFNE-S) and the 2nd of all reverse-scored items (BFNE-R). Support was obtained for the convergent and discriminant validity of the BFNE and BFNE-S, but not the BFNE-R. These results suggest that standard scoring of the BFNE may not be optimal for patients with social anxiety disorder.

The current study sought to understand better the psychological characteristics of socially anxious individuals who seek information on the internet about social anxiety disorder and its treatment. Participants were 434 individuals who responded to an internet-based survey linked to the website of an anxiety specialty clinic. Using established cut-off scores, 92% of the sample met criteria for social anxiety disorder. Internet survey respondents who met these criteria reported greater severity of and impairment due to social anxiety than a treatment-seeking sample of persons with social anxiety disorder. Nevertheless, only about one-third of these internet respondents reported having received psychotherapy, and a similar percentage reported having received pharmacotherapy. Those with the most severe social interaction anxiety and who spent the most time interacting on the internet endorsed positive effects of internet use. However, a significant number of negative effects also were endorsed.

We report on the use of the Penn State Worry Questionnaire (PSWQ) to identify individuals with generalized anxiety disorder (GAD). Fifty individuals with primary or secondary GAD and 114 individuals with social anxiety disorder (without GAD) completed the PSWQ. In receiver operating characteristic analyses, a score of 65 simultaneously optimized sensitivity and specificity in discriminating individuals with GAD from individuals with social anxiety disorder. Results support the use of the PSWQ in screening individuals likely to meet criteria for GAD who present for treatment at an anxiety disorders specialty clinic.

Background: The clinical Global Impression Scale (CGI) is commonly used as a primary outcome measure in studies evaluating the efficacy of treatments for anxiety disorders. The current study evaluated the psychometric properties and predictors of clinicians' ratings on an adapted version of the CGI among individuals with social anxiety disorders., Method: An independent assessor administered the CGI Severity of Illness and Improvement ratings to 123 patients at baseline and the subset of treated patients again mid- and post-treatment., Results: Improvement ratings were strongly related to both concurrent Severity of Illness and changes in Severity of Illness ratings from baseline. Additionally, both CGI ratings were positively correlated with both self-report and clinician-administered measures of social anxiety, depression, impairment and quality of life. Measures of social anxiety symptoms accounted for a large portion of the variance in Severity of Illness ratings, with significant additional variance accounted for by measures of impairment and depression. Changes in social anxiety symptoms from baseline accounted for significant variance in Improvement ratings, but no significant additional variance was accounted for by changes in impairment and depressive symptoms., Conclusions: Our findings support the utility of the CGI as an index of global severity and symptom-specific improvement among individuals with social anxiety disorder.

The Interpersonal Sensitivity Measure (IPSM) was developed to assess hypersensitivity to interpersonal rejection, a suggested trait of depression-prone personality (Aust NZ J Psychiatry 23 (1989) 341). Although studies of the IPSM and interpersonal rejection sensitivity have primarily been conducted in depressed populations, it is important to investigate interpersonal rejection sensitivity as a relevant construct in the assessment of social anxiety. This study examined the psychometric properties of the IPSM in treatment-seeking individuals with social anxiety disorder. The results of this investigation support the convergent and divergent validity and internal consistency of the IPSM in socially anxious individuals. An exploratory factor analysis of the scale was also conducted after the original factor and subscale structure was shown to be a poor fit for the present data. Three factors emerged (Interpersonal Worry and Dependency, Low Self-Esteem, and Unassertive Interpersonal Behavior), and 29 items were retained. Because they demonstrated negative factor loadings on Factor 2, it is suggested that the scoring for four items of the original IPSM be reversed. In summary, the revised IPSM assesses three aspects of interpersonal rejection sensitivity and appears to be a valid and reliable instrument for its assessment in social anxiety disorder.

Worry is often assessed with the 16-item Penn State Worry Questionnaire (PSWQ; Meyer, Miller, Metzger, & Borkovec, 1990. Behaviour Research and Therapy, 28, 487-495), but the factor structure of the PSWQ is not well articulated. Three factor analyses of the PSWQ have been conducted, with two (Brown, Antony, & Barlow, 1992. Behaviour Research and Therapy, 30, 33-37; van Rijsoort, Emmelkamp, & Vervaeke, 1999) retaining a unifactorial solution and one (Stöber, 1995) retaining a two-factor solution. We sought to determine the relative strengths of these solutions. Seven hundred eighty-eight undergraduates completed the PSWQ and measures of depression and anxiety. Confirmatory factor analyses indicated that the two-factor solution provided a better fit to the data. There was also evidence for a higher order worry factor. Multiple regression analyses revealed that factor 1 (Worry Engagement) explained the majority of the variance in the symptom measures. The higher order worry factor also accounted for variance in some measures. Compared to the PSWQ total score, Worry Engagement demonstrated slightly higher internal consistency and significantly stronger correlations with most measures of depression and anxiety. Factor 2 (Absence of Worry) demonstrated moderate negative correlations with Worry Engagement and the PSWQ Total Score but only modest correlations with depression and anxiety.

Objective: We sought to determine optimal cutoff values for the Liebowitz Social Anxiety Scale (LSAS) total and subscale scores for the diagnosis of social anxiety disorder (SAD) and designation of the generalized subtype of SAD., Method: Three hundred and sixty-four patients from a multi-site sample who met criteria for SAD according to structured diagnostic interview, 262 of whom met criteria for the generalized subtype, and 34 control participants free of current Axis I disorders participated in this study. All participants were given the Liebowitz Social Anxiety Scale by an independent assessor., Results: Receiver Operating Characteristics analysis revealed that the LSAS performed well in identifying individuals who met criteria for SAD and for the generalized subtype of SAD. Cutoffs of 30 for SAD and 60 for its generalized subtype on the LSAS total score represented the best balance of specificity and sensitivity., Conclusions: These findings provide support for the use of the Liebowitz Social Anxiety Scale for the identification of individuals with SAD and its generalized subtype in clinical settings. Identification of patients with SAD should increase the percentage of these patients who receive appropriate treatment for this impairing disorder.

Background: The clinician-administered version of the Liebowitz Social Anxiety Scale (LSAS-CA) is a commonly used assessment device for the evaluation of social anxiety disorder and has been shown to have strong psychometric characteristics. Because of its apparently straightforward rating format and potential savings in time and effort, interest in the use of the LSAS as a self-report (LSAS-SR) measure has increased, and the LSAS-SR has been used in a number of studies. However, the psychometric properties of the LSAS-SR have not been well established., Methods: This study examined the psychometric properties of the LSAS-SR in comparison to the LSAS-CA in a sample of 99 individuals with a primary diagnosis of social anxiety disorder and 53 individuals with no current psychiatric disorder., Results: There was little difference between the two versions of the LSAS on any scale or subscale score. Both forms were internally consistent and the subscale intercorrelations for the two forms were essentially identical. Correlations of each LSAS-SR index with its LSAS-CA counterpart were all highly significant. Finally, the convergent and discriminant validity of the two forms of the LSAS was shown to be strong., Conclusion: Results of this study suggest that the self-report version of the LSAS compares well to the clinician-administered version and may be validly employed in the assessment of social anxiety disorder.

Cognitive-behavioral theorists (Clark & Wells, 1995: Clark, D. M. & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69-93). New York: Guilford Press; Rapee & Heimberg, 1997: Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741-756.) propose that individuals with social phobia form mental images of themselves as if from an external point of view. Research by Wells and colleagues has shown that, when recalling anxiety-provoking social situations, individuals with social phobia are more likely to take an observer perspective (seeing oneself as if from an external point of view) whereas control subjects are more likely to take a field perspective (as if looking out through one's own eyes). Furthermore, this pattern is specific to social events, as both groups recall non-social events from a field perspective (see Wells, Clark & Ahmad, 1998: Wells, A., Clark, D. M., & Ahmad, S. (1998). How do I look with my minds eye: perspective taking in social phobic imagery. Behaviour Research and Therapy, 36, 631-634; Wells & Papageorigou, 1999: Wells, A. & Papageorgiou, C. (1999). The observer perspective: Biased imagery in social phobia, agoraphobia, and blood/injury phobia. Behaviour Research and Therapy, 37, 653-658). In the current study, individuals with social phobia took more of an observer perspective than non-anxious controls when recalling high anxiety social situations. However, both groups took a predominantly field perspective for memories of medium or low anxiety social situations. As memory perspective has also been shown to be related to causal attributions, we examined this relationship in our sample. Memories of low, medium, and high anxiety social situations were differentially related to attributions for each group. Patients' attributions for their performance became more internal, stable, and global as the anxiety level of the situation increased, while the attributions of control subjects showed the opposite pattern.

This study examined the interaction of cognitive style (as assessed self-report and information-processing battery) and stressful life events in predicting the clinician-rated depressive and manic symptomatology of participants with Research Diagnostic Criteria lifetime diagnoses of bipolar disorder (n = 49), unipolar depression (n = 97), or no lifetime diagnosis (n = 23). Bipolar and unipolar participants' attributional styles, dysfunctional attitudes, and negative self-referent information processing as assessed at Time 1 interacted significantly with the number of negative life events that occurred between Times 1 and 2 to predict increases in depressive symptoms from Time 1 to Time 2. Within the bipolar group, participants' Time 1 attributional styles and dysfunctional attitudes interacted significantly, and their self-referent information processing interacted marginally, with intervening life events to predict increases in manic symptoms from Time 1 to Time 2. These findings provide support for the applicability of cognitive vulnerability-stress theories of depression to bipolar spectrum disorders.