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BACKGROUND: Rates of treatment seeking for cannabis are increasing, and relapse is common. Management of cannabis withdrawal is an important intervention point. No psychometrically sound measure for cannabis withdrawal exists, and as a result treatment developments cannot be optimally targeted. The aim is to develop and test the psychometrics of the Cannabis Withdrawal Scale and use it to explore predictors of cannabis withdrawal. METHODS: A volunteer sample of 49 dependent cannabis users provided daily scores on the Cannabis Withdrawal Scale during a baseline week and 2 weeks of abstinence. RESULTS: Internal reliability (Cronbach's alpha=0.91), test-retest stability (average intra-class correlation=0.95) and content validity analysis show that the Cannabis Withdrawal Scale has excellent psychometric properties. Nightmares and/or strange dreams was the most valid item (Wald [chi](2)=105.6, P<0.0001), but caused relatively little associated distress (Wald [chi](2)=25.11, P=0.03). Angry outbursts were considered intense (Wald [chi](2)=73.69, P<0.0001) and caused much associated distress (Wald [chi](2)=45.54, P<0.0001). Trouble getting to sleep was also an intense withdrawal symptom (Wald [chi](2)=42.31, P<0.0001) and caused significant associated distress (Wald [chi](2)=47.76, P<0.0001). Scores on the Severity of Dependence Scale predicted cannabis withdrawal. CONCLUSIONS: The Cannabis Withdrawal Scale can be used as a diagnostic instrument in clinical and research settings where regular monitoring of withdrawal symptoms is required. [ABSTRACT FROM AUTHOR]

Hoarding Disorder (HD) is marked by the inability to discard possessions, and often excessive acquiring, which results in cluttered living spaces that substantially disrupt daily life. While the Saving Inventory-Revised (SI-R) serves as a reliable and valid tool for assessing hoarding severity, its length may preclude routine use. We aimed to develop a valid shorter version of the scale using Item Response Theory and Confirmatory Factor Analysis in a non-selected sample of 2890 individuals and a clinical HD sample of 200 participants, which were divided into test and confirmatory samples in a 2:1 ratio. This led to a 9-item SI-R9, containing the original three subscales of discarding, clutter and acquiring; and an ultra-brief 3-item scale, the SI-R3. The original and revised versions demonstrated construct, convergent, and divergent validity. Significant gender differential was noted on some items, particularly those from the full SI-R, but was small in nature. Clinical cut-offs for all three scales showed good sensitivity and specificity. In conclusion, the SI-R3 and SI-R9 were successfully developed from the original scale, we hope that clinicians and researchers will benefit from reduced administration time, improved compliance, and more cost-effectiveness, and this will lead to greater use in clinical and research settings., Competing Interests: Declaration of competing interest This research was supported by an Australian Government Research Training Program Scholarship awarded to Jonathan David for completion of their PhD. Macquarie University and the Psyche Foundation provided funding to Jonathan David and Melissa M. Norberg to support this research but were not involved in the conduct of the research, the writing of the report, nor in the decision to submit the article for publication., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: Perfectionism is linked to a variety of mental health conditions in university students. The Perfectionism Social Disconnection Model posits that perfectionistic individuals exhibit off-putting interpersonal behaviors (i.e., rejection sensitivity and hostility), which lead to social disconnection, and in turn contribute to psychological distress. Although several longitudinal studies have found that social disconnection mediates the link between perfectionistic traits and psychological distress, less is known about how perfectionism leads to social disconnection. The present study aimed to address this gap., Methods: A sample of 877 university students completed one survey a month for three consecutive months., Results: Our random-intercept cross-lagged panel model results showed significant positive associations between the random intercepts of socially prescribed and self-oriented perfectionism with rejection sensitivity, hostility, and loneliness, with stronger associations for socially prescribed perfectionism. In addition, the random intercept of other-oriented perfectionism showed positive associations with hostility but not rejection sensitivity or loneliness. Moreover, almost all cross-lagged paths were nonsignificant., Conclusion: Collectively, these findings indicate that although perfectionistic traits may be associated with rejection sensitivity and hostility to varying degrees at the between-person level, these behaviors may not cause social disconnection at the within-person level., (© 2023 The Authors. Journal of Personality published by Wiley Periodicals LLC.)

Our consumer-driven culture has negative impacts for individuals who are vulnerable to clinical hoarding and compulsive shopping. Because of this, there is an ever-present need to have standardized tools to assess why we acquire and save things we might not need. In this article, we present the development of the Acquiring Motives Questionnaire (AMQ) and Saving Motives Questionnaire (SMQ), which were written based on a thorough literature review and consultation with 22 experts in the field. After piloting with two large nonclinical samples, we administered the measures to another large nonclinical sample (N = 535; Mage = 24.4, 74.2% female, 54.6% White) and then a community sample of individuals with hoarding disorder and/or compulsive buying-shopping disorder and controls without any mental health diagnoses (N = 159; Mage = 42.54, 85.5% female, 59.7% White). Confirmatory factor analyses supported a 14-factor model for the AMQ and a 14-factor model for the SMQ. All subscales demonstrated good internal consistency (ω = 0.81-0.96), 2-week test-retest reliability (intraclass correlation coefficient = 0.67-0.83), and convergent, divergent, and criterion validity. The measures also distinguished between controls and individuals with hoarding and/or compulsive buying diagnoses. Findings highlight that acquiring and saving behaviors are both motivated by the pursuit of positive emotions and the avoidance of negative emotions, which is consistent with our theoretical understanding of these clinical issues. Based on our findings, we make suggestions for psychological interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background and Aims: The prominent cognitive-behavioral model of hoarding posits that information processing deficits contribute to hoarding disorder. Although individuals with hoarding symptoms consistently self-report attentional and impulsivity difficulties, neuropsychological tests have inconsistently identified impairments. These mixed findings may be the result of using different neuropsychological tests, tests with poor psychometric properties, and/or testing individuals in a context that drastically differs from their own homes., Methods: One hundred twenty-three participants (hoarding = 63; control = 60) completed neuropsychological tests of sustained attention, focused attention, and response inhibition in cluttered and tidy environments in a counterbalanced order., Results: Hoarding participants demonstrated poorer sustained attention and response inhibition than the control group (CPT-3 Omission and VST scores) and poorer response inhibition in the cluttered environment than when in the tidy environment (VST scores). CPT-3 Detectability and Commission scores also indicated that hoarding participants had greater difficulty sustaining attention and inhibiting responses than the control group; however, these effect sizes were just below the lowest practically meaningful magnitude. Posthoc exploratory analyses demonstrated that fewer than one-third of hoarding participants demonstrated sustained attention and response inhibition difficulties and that these participants reported greater hoarding severity and greater distress in the cluttered room., Discussion and Conclusions: Given these findings and other studies showing that attentional difficulties may be a transdiagnostic factor for psychopathology, future studies will want to explore whether greater sustained attention and response inhibition difficulties in real life contexts contribute to comorbidity and functional impairment in hoarding disorder.

Objectives: Individuals with hoarding disorder are more likely to be overweight or obese than the general population for unknown reasons., Methods: One hundred and twenty-nine individuals (Hoarding Group: n = 63; Control Group: n = 66) completed self-report measures and were offered snacks in a tidy and a cluttered environment in a counterbalanced order. Groups were based on the self-reporting of high or low hoarding symptoms., Results: The hoarding group reported being less able to use their kitchen and prepare food at home and experiencing more impulsivity, distress intolerance and problematic eating beliefs than did the control group. The hoarding group consumed more cookies in the tidy room, whereas the control group consumed more cookies in the cluttered room. Greater impulsivity, distress intolerance and problematic body and eating beliefs were related to greater cookie consumption for the hoarding group., Conclusions: Early interventions that help individuals to tolerate distress and to engage in goal-directed behaviour regardless of their emotional state may have benefits for both hoarding and eating behaviour. We encourage future researchers to examine this hypothesis., (© 2023 The Authors. British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Internalised shame has been linked to psychopathology and consistently identified as a predictor of poor treatment outcomes and premature therapy termination. We conducted a scoping review of therapist-delivered psychosocial interventions to reduce internalised shame to learn how to improve outcomes for individuals experiencing shame., Six bibliographical databases were searched for studies measuring internalised shame pre- and post-treatment. We screened 6846 abstracts; 42 full-text manuscripts were retrieved, with 16 studies meeting the inclusion criteria. Of these, 10 studies examined between- and within-subject effects, and 6 studies exclusively examined within-subject effects., Twelve of the sixteen included studies reported small to moderate within-group reductions in internalised shame. Between group analyses showed that shame interventions may be more effective than no treatment or treatment as usual, but not more effective than an active comparator., Successful treatments often involved psychoeducation, experiential exercises, and techniques to increase social support and emotional expression; however, study quality was weak to moderate and the importance of each of these techniques for reducing internalised shame was not determined.

Background and Aims: Object attachment is the emotional bond or connection that we have with possessions. Although thought to be ubiquitous, when excessive, object attachment is presumed to contribute to compulsive buying and hoarding problems. Unfortunately, our understanding of this relationship has been limited by the constraints of existing object attachment measures. In this paper, we developed and validated a new self-report questionnaire, called the Object Attachment Security Measure (OASM)., Methods: We developed an item pool based on previous measures and consultation with 24 experts in the field. After piloting, we administered this measure to a large sample (Final N = 365), along with self-report measures of hoarding, compulsive buying, and previous object attachment measures., Results: We found that the OASM distinguished between secure and insecure object attachment. Both subscales showed excellent internal consistency and test-retest reliability over a two-week period. Additionally, they demonstrated excellent convergent and divergent validity, and criterion validity with measures of hoarding and compulsive buying symptoms. We also found that insecure, but not secure object attachment, was uniquely related to hoarding and compulsive buying symptomology., Discussion and Conclusion: Our findings extend theoretical models, highlighting the role of insecure object attachment. Future research in both clinical and consumer behaviour fields should utilise the OASM, as reducing insecure object attachment and potentially encouraging secure object attachment could decrease maladaptive possession use and increase sustainable consumption.

Perfectionism is linked to a variety of mental health conditions in university students. Guided by the Perfectionism Social Disconnection Model, the purpose of the current mixed methods feasibility study was to evaluate the acceptability and potential effectiveness of a brief online intervention designed to reduce the negative consequences of perfectionism in university students. Seventy university students (83.9% female; M age  = 19) reporting moderate to extreme levels of perfectionism completed the two hour 'Intentional Imperfection Program' (IIP). The IIP includes techniques to increase mindfulness, compassion for self and others, distress tolerance, and social skills. Participants completed self-report measures at baseline and at a two-week follow-up. Quantitative data showed statistically significant small to moderate reductions in self-oriented perfectionism ( d  = -0.48, p  < .001), socially-prescribed perfectionism ( d  = 0.40, p  < .001), hostility ( r  = 0.53, p  < .001), rejection sensitivity ( d  = 0.37, p  < .001), depression ( r  = -0.47, p  < .001), and anxiety ( r  = -0.33, p  = .010) and a small increase in perceived social support ( r  = -0.29, p  = .023). Thematic analyses of qualitative data indicated that participants found the IIP feasible, enjoyable, and useful. A brief online intervention may be a feasible way of reducing the negative consequences of perfectionism among university students. A randomised control trial is warranted to further evaluate the efficacy of the IIP. This research was registered with the Australian New Zealand Clinical Trials Registry (no. ACTRN12620000574943)., Competing Interests: Competing InterestsAll authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript., (© The Author(s) 2022.)

Research into the aetiology, maintenance, and treatment of obsessive-compulsive disorder (OCD) has largely been informed by models of anxiety. However, non-experimental research suggests that some individuals may engage in compulsions to neutralise shame, with repugnant obsessions associated with more shame than other obsessions. Violent and sexual obsessions and shame have been linked with poorer treatment outcomes, and thus, treatment modifications are needed. This experimental study aimed to examine if and how shame fits into a cognitive behavioural model of OCD. Fifty-five individuals experiencing subclinical (n = 9) to clinical (n = 46) OCD symptoms were randomly administered four different obsession induction paradigms focused on harm, sexual, contamination, and symmetry obsessions. After each induction, participants reported on their emotional states, gave appraisal ratings regarding their urges to engage in compulsions and avoidant behaviour, and completed manipulation checks. Harm and sexual inductions elicited greater shame and anxiety and were considered more immoral than contamination and symmetry inductions. Shame responses were also independently associated with compulsion and avoidance behaviours in repugnant obsessions, controlling for anxiety. Theoretical models and treatment for OCD should be adapted to address shame., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Psychological treatment for hoarding problems has historically been associated with poor outcomes. When treated as a subgroup of obsessive-compulsive disorder, individuals with hoarding beliefs were less likely to respond to treatment than individuals exhibiting other obsessive-compulsive beliefs and behaviours. When treated as its own disorder using cognitive behavioural therapy, individuals report approximately 25% improvement in symptoms on average. However, less than a third of people experience clinically meaningful change. Further, changes in functioning and quality of life are not routinely assessed. In this paper, we review the current conceptualization and treatment of hoarding problems to shed light on how treatment for hoarding disorder may be improved. Utilizing a harm reduction approach before administering treatment may be important to ensure the safety of individuals. Research should test whether treatment outcomes improve by including strategies that enhance a client's interpersonal functioning and ability to regulate emotions (i.e., based on dialectal behaviour therapy and mentalization-based treatments), especially while discarding and organizing belongings. We should also use modern learning theory to improve the delivery of exposure activities., (© 2021 John Wiley & Sons, Ltd.)

The COVID-19 pandemic led to panic buying in many countries across the globe, preventing vulnerable groups from accessing important necessities. Some reports inaccurately referred to the panic buying as hoarding. Although hoarding is a separate issue characterised by extreme saving behaviour, the two problems may be influenced by similar factors. Participants from Australia and the United States (final N = 359) completed online self-report measures of panic buying, hoarding, shopping patterns, perceived scarcity, COVID-19 illness anxiety, selfishness, and intolerance of uncertainty. Our findings showed that panic buying was related to hoarding symptoms (r's = .23 - .36), and yet, both were uniquely associated with different psychological factors. Whilst panic buying was most strongly related to greater perceived scarcity (r's = .38 - .60), hoarding was most related to a general intolerance of uncertainty (r's = .24 - .57). Based on our findings, future strategies to prevent panic buying should focus on reducing perceived scarcity cues in the community, as this seems to be the primary driver of panic buying. Another preventative strategy to reduce excessive acquiring and saving may be to implement educational programs to increase people's ability to tolerate distress and uncertainty., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Excessive attachment towards possessions can be maladaptive because it can lead individuals to excessively acquire and save objects. Little is known about how attachment to objects develops and changes over time; however, interpersonal factors have been theorized to play a role. The current study examined whether interpersonal factors, specifically interpersonal attachment style and empathy, moderate changes in object attachment over time. A total of 145 participants with excessive acquiring and discarding difficulties rated their level of attachment to a novel object just after receiving it, and 1 week later. Participants also completed measures of interpersonal anxious attachment and interpersonal functioning. We found that changes in object attachment over time were moderated by interpersonal anxious attachment. Also, our findings suggested that individuals with hoarding problems are likely not impaired in their ability to empathize with others, but rather have difficulty displaying empathy in tense social situations and also have more empathy for fictional characters. Further, greater discomfort in tense social situations and greater empathy for fictional characters interacted to predict greater object attachment. Taken together, these findings indicate that individuals with an interpersonal anxious attachment style may be those at risk of forming greater attachments to objects over time. A learning history that includes inconsistent support from caregivers may result in individuals experiencing more empathy for fictional characters and discomfort in tense social situations, which may produce a vulnerability for becoming excessively attached to objects. Our results are in line with theories of hoarding which propose that individuals use objects to compensate for unmet interpersonal needs and suggest that treatment may need to target interpersonal functioning to reduce hoarding symptoms., (Copyright © 2021 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved.)

Motives for acquiring and saving objects are closely linked to object attachment, but the nature of these associations has not been established. A better understanding of the motives for acquiring and saving possessions and how they relate to object attachment may reveal insights into the underpinnings of hoarding disorder. In turn, these insights can aid in identifying optimal targets for interventions for hoarding problems. In this paper, we propose a simple theoretical model of the dynamic associations among motives to acquire objects, object attachment, and motives to save objects, grounded in a review of the extant literature. Our hope is that this model provides a useful framework to structure future research., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Approximately 50% of individuals fail to obtain treatment benefits when undergoing cognitive-behavioral therapy (CBT) for binge-eating behaviors, making it necessary to evaluate additional approaches. Cue exposure and response prevention (CERP) is one such approach, although its effectiveness across studies has been inconsistent. This may be due to inconsistent implementation of theoretically based CERP strategies. This possibility has not yet been systematically investigated. To address this gap, this review investigated which CERP strategies have been incorporated into treatment protocols for binge eating, and if the use of certain strategies improves treatment effectiveness. Relevant studies were identified through reference lists, grey literature, and searches of electronic databases using multiple search terms related to CERP and binge eating, which resulted in 18 eligible studies. Most studies were underpowered, many were of low methodological quality, and none of the included studies utilized all of the strategies that have been recommended to optimize CERP. Despite these weaknesses, CERP appeared to reduce the frequency of binge eating in the short and long term. This review underscores the need for higher quality research that utilizes larger samples and uniform outcome measures that are more strongly grounded in theory. Such research would help improve treatment outcomes for binge eating., (Copyright © 2020. Published by Elsevier Ltd.)

Caffeinated alcoholic beverage (CAB) consumption is a risky drinking practice for young people. The purpose of the current set of studies was to develop and psychometrically evaluate a theory-based CAB motives measure to understand what drives CAB consumption and its ensuing consequences. Using 4 different samples, we pilot tested the items of the Caffeinated Alcohol Beverages Motives Questionnaire (CABMQ) and then evaluated its factor structure and its convergent, concurrent, and discriminant validity. Factor analyses supported a 5-factor structure. The coping and conformity subscales assessed negative reinforcement from internal and external sources, respectively. The social subscale assessed positive reinforcement derived from external sources, whereas the intoxication and energy enhancement subscales assessed positive reinforcement derived from internal sources. Differential relationships between the intoxication and energy enhancement subscales and existing motives measures provided compelling support for their individual distinctiveness. Greater endorsement of all subscales was related to experiencing more adverse alcohol-related consequences, whereas all subscales but the conformity subscale were related to greater CAB consumption. After controlling for general drinking motives, coping motives, energy enhancement motives, intoxication enhancement motives, and social motives were significantly correlated with CAB use, whereas only energy enhancement motives were significantly correlated with alcohol-related consequences. In sum, these results show that the CABMQ helps us understand CAB use and its consequences, with the energy enhancement subscale being particularly helpful. Future research should examine if energy enhancement motives explain why CABs pose more risk than drinking alcohol on its own. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

This shorter communication explores the concept of clinically significant change in treatment outcome studies for hoarding disorder. We argue that cross-study comparisons have been hindered due to researchers using different formulations to assess individual change. As a result, we propose that researchers adopt a standardized approach to calculating rates of clinically significant change for the Saving Inventory-Revised (SI-R) based on Jacobson and Truax's (1991) two-step method. Specifically, we recommend that individuals whose SI-R total scores have reduced by at least 20 points and whose post-treatment score is 38 or less be classified as recovered . Individuals whose total score decreases by 20 points or more, but whose post-treatment score remains above 38, should be classified as improved but not recovered . Individuals whose total score increases by 20 or more points should be classified as deteriorated . Any individual whose total score has changed by less than 20 points should be classified as not changed . By adopting these criteria, researchers will facilitate cross-study treatment outcome comparisons and aid in our understanding of the impact that hoarding treatment has on its recipients., Competing Interests: Conflict of Interest All authors declare that they have no conflicts of interest.

Approximately half of individuals with binge eating disorder (BED) fail to improve when treated with cognitive behavioral therapy; thus, better treatments are needed. Cue exposure and response prevention (CERP) may be one option, but its full potential for reducing binge eating remains unknown because prior applications for binge eating have not utilized the broad range of strategies believed to optimize exposure therapy. The current single-subject AB design investigated the acceptability and effectiveness of a comprehensive CERP treatment among 8 women who met DSM-5 criteria for binge eating disorder. Changes in the number of binges were measured from baseline to the end of treatment, and desire to eat, salivation, and idiographic expectancies of aversive outcomes to food-cue exposure (idiographic CS-US expectancies), including expectancies about ability to tolerate distress when exposed to food cues were measured across the course of treatment. Statistical analysis revealed a significant reduction in the number of binges from baseline to the end of treatment. Across the course of treatment, desire to eat and idiographic CS-US expectancies reduced, and distress tolerance expectancies increased. No participants dropped out and all reported being maximally satisfied with the treatment. Based on these findings, future randomized-control trials with larger samples should examine the efficacy of CERP and mechanisms underlying change with the aim of establishing a more effective treatment for binge eating disorder., (Copyright © 2020. Published by Elsevier Ltd.)

Background and Aims: Individuals who meet criteria for compulsive buying-shopping disorder (i.e., acquiring problems only) or hoarding disorder (i.e., acquiring and discarding problems) may acquire possessions to compensate for unmet belonging needs, but may do so in different ways. Those with compulsive buying-shopping disorder may acquire objects that they believe will relieve the distress associated with unmet belonging needs (e.g., objects that distract or comfort), whereas those with hoarding disorder may acquire objects that they believe achieve belonging needs (e.g., objects that have interpersonal connotations). Accordingly, this study examined whether a belongingness threat would drive individuals who excessively acquire possessions to choose a human-like object (person-shaped tea holder) or a comfort item (box of chamomile tea)., Methods: One hundred seventy-five participants (57 self-reported excessive acquiring only; 118 self-reported excessive acquiring and difficulty discarding) recalled a time when they either felt supported or unsupported by a significant other before choosing an object to take home with them. Participants rated how anthropomorphic and comforting the objects were as well as how attached they became to their chosen object., Results: Unsupported individuals were more likely to acquire the comfort item than supported individuals; however, individuals with both acquiring and discarding problems were more likely to acquire the human-like item than those with an acquiring problem only. Comfort and anthropomorphism ratings predicted object choice and attachment., Discussions and Conclusion: The current findings extend the Compensatory Consumer Behavior Model to include what factors determine strategy choice and object attachment.

Evidence from analogue samples suggests that deficits in emotional functioning, namely elevated emotional reactivity and distress intolerance, are implicated in the development and maintenance of hoarding disorder. We aimed to extend previous research in this area by investigating emotional reactivity and distress intolerance in a sample of individuals diagnosed with hoarding disorder (n = 24) in comparison to clinical controls (n = 21) and nonclinical community controls (n = 26) using a combination of self-report, physiological, and behavioral measures. We found that trait distress intolerance was significantly and independently associated with greater hoarding severity. The hoarding and clinical control groups reported more trait emotional reactivity and distress intolerance than the community control group, but did not differ from each other on these traits. The hoarding group reported more subjective distress before beginning a frustrating behavioral task, but did not evidence more physiological arousal. Moreover, the hoarding group experienced similar increases in distress during the task and did not differ from either group in regard to time persisting on this task. The clinical control group, however, terminated the frustrating task significantly faster than the community control group, who tended to persist until the task timed out. Lastly, trait distress intolerance evidenced a small-to-moderate but nonstatistically significant independent relationship with task persistence time. Given the desynchrony between subjective distress and physiological arousal, we encourage researchers to utilize multimodal assessment in the future. We also suggest that clinicians start to use behavioral experiments, as has been done with other psychological disorders, to improve distress intolerance among persons who experience hoarding disorder., (Copyright © 2019. Published by Elsevier Ltd.)

Purpose: Evidence suggests that people drink more alcohol and experience more adverse alcohol-related consequences (ARCs) on occasions when they also consume caffeine. The current study examined whether this increase in risk is a result of caffeine attenuating the subjective effects of alcohol intoxication (i.e., the masking hypothesis)., Methods: Undergraduate students (n = 148) reported their drinking patterns using a modified Timeline Followback approach. For each recalled drinking occasion, alcohol consumption, caffeine consumption, perceived blood alcohol concentration, and ARCs were assessed. Generalized linear mixed models were used to examine the influence that alcohol and caffeine consumption had on perceived intoxication and the experience of ARCs., Results: At the occasion level, greater caffeine consumption was associated with increased consumption of alcohol and increased ARCs. There was also a significant curvilinear relationship between the amount of alcohol consumed and perceived intoxication, such that the more alcohol was consumed on each occasion the less each additional drink increased perceived intoxication. Increased caffeine consumption weakened the association between alcohol consumption and perceived intoxication and it also weakened the association between alcohol consumption and ARCs. Specifically, the weakest relationship between ARCs and alcohol consumption existed at the highest level of caffeine consumption (240+ mg). Caffeine increased subjective intoxication., Conclusions: These findings do not support the masking hypothesis. Caffeine was strongly associated with ARCs when consumed at high doses and this effect does not appear to be the result of drinking more alcohol or underestimating one's blood alcohol content. Efforts to reduce caffeinated alcohol beverage use are greatly needed., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: A prior study found that over 50% of treatment-seeking individuals who hoard incur at least one psychiatric work impairment day (i.e., they are unable to work or are less effective at work due to poor mental health) each month. The aim of the current study was to assess work-related variables associated with workplace impairment in a non-treatment-seeking sample., Design: Cross-sectional. Self-report questionnaires were administered via Amazon's Mechanical Turk., Methods: One hundred and eighty-five employed individuals who reported elevated hoarding symptoms completed questionnaires regarding hoarding symptoms, work engagement, psychiatric work impairment, work control, attention and concentration difficulties at work, and quality of workplace relationships., Results: Greater workplace control and higher quality workplace relationships were associated with greater work engagement. Greater hoarding symptoms and attention difficulties at work were associated with more psychiatric work impairment days. Work engagement statistically mediated the association between the quality of workplace relationships and work impairment, though mediation was also significant when reversing the mediating and outcome variables., Conclusions: Among a community sample of employed individuals, greater hoarding symptoms were associated with greater psychiatric work impairment. Work-related variables, such as co-worker relationships and attention difficulties, contributed additional variance above that accounted for by hoarding symptoms. There were significant associations between co-worker relationships, work engagement, and workplace impairment, though the direction of the mediation model is unclear. Future research should examine factors associated with unemployment in hoarding disorder., Practitioner Points: Clinicians should be aware that greater hoarding severity directly contributes to greater workplace impairment. Clinicians should consider prioritizing the reduction in clutter in living areas that impact one's daily activities and subsequent ability to attend work. Clinicians should assess and treat workplace impairment by helping individuals achieve greater control at work, developing higher quality interpersonal relationships, and improving their attentional abilities., (© 2018 The British Psychological Society.)

Background: Smartphone applications (apps) offer a promising alternative to face-to-face treatment due to their ease of access and convenience. However, there is a lack of evidence-based apps for cannabis users wishing to reduce their use., Objectives: The current study evaluated the feasibility and acceptability of a smartphone app intervention (called Assess, Plan, Track, and Tips [APTT]) for cannabis users wanting to reduce their use., Method: The current study included 111 cannabis users (68% male, aged 18-50 yrs) who had used cannabis in the past month, were not currently in treatment, and who wanted to reduce/quit their use. Participants were given access to APTT for 1 month. Participants reported on their cannabis use and related problems, confidence in resisting use, severity of dependence, and stage of change at baseline, post-intervention (4 weeks), and at 1-month follow-up. At post-intervention, participants also reported on their usage and satisfaction with the app., Results: The current study found that APTT was acceptable, with over 40% of participants using the app over 20 times over the course of a month. Participants showed a reduction in dependence and cannabis related problems over the course of the study. Further, participants' stage of change at baseline predicted changes in cannabis use., Conclusions/importance: These findings support the feasibility and acceptability of APTT as an engaging app for cannabis users wishing to better manage their use and support the need for future RCTs to assess the efficacy of mobile-based interventions for cannabis users.

Research shows that individuals who experience distress when discarding their possessions are more indecisive than individuals who do not experience such difficulty. These individuals report more intense emotional responses and greater intolerance to distress when faced with a discarding task. The aim of this study was to determine whether an insecure attachment style contributes to indecisiveness among individuals with discarding difficulties and whether this association is mediated by emotional reactivity and distress intolerance. This study used a within-group cross-sectional design. One hundred fifty-six participants with clinically significant discarding problems (82.7% female; Mean age = 21.96, SD = 7.38) from a population of university students and community members completed self-report questionnaires that assessed severity of hoarding behaviours, insecure attachment styles, emotional reactivity, distress intolerance, and indecisiveness. Analyses revealed that an anxious attachment style was associated with greater indecisiveness, and this relationship was mediated by emotional reactivity, but not distress intolerance. Furthermore, avoidant attachment was not related to indecisiveness. Clinical interventions should consider the role of attachment styles in hoarding disorder and address emotional reactivity difficulties in treatment through the use of discarding exposures, as emotion plays an important role in these decision-making processes., (Copyright © 2019. Published by Elsevier B.V.)

Background and Aims: People who hoard form intense attachments to their possessions and save items for sentimental and instrumental reasons. Feeling socially excluded may encourage these individuals to anthropomorphize objects (i.e., perceive them as human-like) to fulfill unmet belonging needs, which may increase the sentimental and instrumental values of objects, and then lead to stronger object attachment., Methods: We randomly assigned 331 participants with excessive acquisition tendencies to be excluded, included, or overincluded in an online ball-tossing game before presenting them with five objects that had human characteristics. Participants then completed measures assessing anthropomorphism, sentimental and instrumental values, and object attachment., Results: Inconsistent with this study hypothesis, socially excluded participants did not rate unowned objects as more human-like than the included or overincluded participants; however, stronger anthropomorphism predicted greater instrumental and sentimental values, which then predicted greater object attachment., Discussion and Conclusions: Sentimental and instrumental values may explain how stronger anthropomorphism may lead to greater object attachment. Learning that leads to anthropomorphism may help us better understand object attachment.

Background: While exposure therapy effectively reduces anxiety associated with specific phobias, not all individuals respond to treatment and some will experience a return of fear after treatment ceases., Aims: This study aimed to test the potential benefit of increasing the intensity of exposure therapy by adding an extra step that challenged uncontrollability (Step 15: allowing a spider to walk freely over one's body) to the standard fear hierarchy., Method: Fifty-one participants who had a severe fear of spiders completed two 60-min exposure sessions 1 week apart in a context that was either the same or different from the baseline and follow-up assessment context. Participants were categorized into groups based on the last hierarchy step they completed during treatment (Step 14 or fewer, or Step 15)., Results: Those who completed Step 15 had greater reductions in fear and beliefs about the probability of harm from baseline to post-treatment than those who completed fewer steps. Although completing Step 15 did not prevent fear from returning after a context change, it allowed people to maintain their ability to tolerate their fear, which earlier steps did not. Despite some fear returning after a context change, individuals who completed Step 15 tended to report greater reductions in fear from baseline to the follow-up assessment than participants who completed 14 or fewer steps., Conclusions: Overall, these results suggest that more intensive exposure that directly challenges harm beliefs may lead to greater changes in fear and fear beliefs than less intensive exposure.

Hoarding disorder (HD) is characterized primarily by difficulty discarding possessions, leading to severe clutter and significant distress and impairment. Although promising psychological treatments have emerged, treating HD remains a clinical challenge. A greater understanding of the role of psychological vulnerability factors in predicting hoarding symptoms in a clinical HD sample could further enhance treatments. To investigate the role of proposed individual difference factors (i.e., distress tolerance, anxiety sensitivity, intolerance of uncertainty), we administered a diagnostic and self-report battery to 73 individuals diagnosed with HD who were seeking treatment for hoarding at a community clinic. Results indicated that when controlling for depression and anxiety symptoms, only distress tolerance predicted the severity of hoarding symptoms. Furthermore, meditation analyses revealed that the impact of distress tolerance on hoarding severity was partially mediated by hoarding beliefs. These results have important theoretical and clinical implications for HD., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Home visits can improve treatment outcomes for hoarding disorder, but factors influencing the success of home visits remain unknown. As home visits expose individuals to clutter and fear, the present study examined the effect that fear and emotional reactivity have on the relationship between clutter and discarding behaviour., Methods: Participants with at least subclinical discarding problems (n = 143) were asked to save or discard personal possessions of varying value following an emotional induction that took place in either a tidy or cluttered context. Participants also completed questionnaires assessing hoarding severity, emotional state, and emotional reactivity, as defined by one's sensitivity, persistence, and intensity of reactions to emotional stimuli., Results: As expected, participants discarded more items in the presence of clutter and when feeling fearful. However, emotional reactivity moderated the relations between environmental context, acute emotional state, and discarding. Low sensitivity, low persistence, and high emotional intensity negatively influenced discarding in the cluttered context. When feeling fearful, low dispositional emotional intensity negatively influenced discarding in the tidy context., Limitations: Individuals in the tidy environment reported higher levels of fear and anxiety than individuals in the cluttered environment after the fear induction. These differences could have contributed to the difference noted between the two contexts when examining the effect of emotional intensity tendencies., Conclusions: Providing treatment in an environment more representative of the cluttered home can improve discarding or at the very least give therapists a more accurate picture of what clients do in the context that matters most., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background and aims Most individuals with hoarding disorder (HD) are prone to excessively acquiring new possessions. Understanding the factors that contribute to this collecting behavior will allow us to develop better treatment approaches for HD. The aim of this study was to test our assumption that an anxious attachment style is associated with a tendency to anthropomorphize comforting objects and an inability to tolerate distress, which in turn leads to excessive acquisition. Methods A total of 361 participants with subclinical to clinical acquisition problems (77.8% female) completed a series of self-report measures. Results As expected, greater anxious attachment was related to greater distress intolerance and stronger tendencies to anthropomorphize inanimate objects. In turn, greater distress intolerance and anthropomorphism were related to more excessive buying and greater acquisition of free items. Examination of the pathways and indirect effects showed support for double mediation rather than serial mediation, as distress intolerance did not predict anthropomorphism. Discussion and conclusion These novel findings, if replicated, suggest that adding treatment modules that target improving distress tolerance and reducing anthropomorphism to standard treatment for HD may lead to further reductions in excessive acquiring.

Young people are increasingly consuming alcohol mixed with energy drinks (AmEDs). As coingestion of these beverages results in greater adverse consequences than from drinking alcohol alone, we need to understand what factors contribute to and deter coingestion. Existing studies in this area have not utilized a theoretically based or empirically validated measure of outcome expectancies for drinking AmEDs. Our study modified Morean, Corbin, and Treat's (2012) Anticipated Effects of Alcohol Scale to assess the expected effects of drinking AmEDs. We evaluated the factor structure and concurrent validity of the Anticipated Effects of Alcohol Mixed with Energy Drinks (AEAMEDS) among 549 university students, aged 18-25, who had a lifetime history of consuming alcohol (231 had consumed AmEDs in the past 90 days). Exploratory and confirmatory factor analysis supported a 4-factor structure. Consistent with hypotheses, stronger high arousal/positive expectancies and weaker low arousal/negative expectancies were associated with greater AmED use. At the bivariate level, stronger low arousal/positive expectancies were associated with greater quantities of AmED use, but this relationship disappeared when taking into account other outcome expectancies. Moreover, students expected low arousal/positive expectancies to be less intense when consuming AmEDs than alcohol alone, but ratings for all other AmED expectancies were equivalent to consuming alcohol alone. These findings contribute to our knowledge of risk and protective factors for AmED use. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Previous studies have shown brief online self-help interventions to be a useful method of treating cannabis use and related problems; however, no studies have compared the effects of brief versus extended feedback for online brief intervention programs., Objectives: The current study was a two arm randomised trial aimed at testing the short term effectiveness of a brief and extended feedback version of Grassessment, a brief online intervention for cannabis users that provides individualised feedback regarding use, motives, and harms., Methods: Participants (n=287) reporting at least one symptom of DSM IV cannabis abuse or dependence were recruited using online and offline advertising methods. Participants were randomised to receive either a brief or extended feedback version of the Grassessment program and were required to complete a one month follow up questionnaire., Results: One hundred and ninety four participants completed the one month follow up. Wilcoxon analyses showed a significant decrease in past month quantity and frequency of cannabis use (ps<0.001; r=-0.41 and -0.40 respectively) and lower severity of dependence scores (p=0.002; r=-0.31) among those in the brief feedback condition. Participants in the extended feedback group also demonstrated significant decreases in patterns of use (ps<0.002; r=-0.39 and -0.33) but not severity of dependence (p=0.09; r=0.18). A Generalized Estimating Equation (GEE) analysis showed no significant interaction between length of feedback received and past month cannabis use frequency (p=0.78), quantity (p=0.73), or severity of dependence (p=0.47)., Conclusion: This study adds support for the use of brief online self-complete interventions to reduce cannabis use and related problems in the short term. The findings suggest that in the case of the brief online screening and feedback program Grassessment, extended feedback does not lead to superior outcomes over brief feedback., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Aims: To estimate the magnitude of cannabis cue-reactivity responses in people who regularly use cannabis., Methods: EMBASE, PUBMED, PsycINFO, PsycEXTRA and Project CORK were searched for within-subject comparison studies published between January 2000 and December 2014. Eligible studies compared regular cannabis users' subjective craving or psychophysiological responding when exposed to cannabis cues to their responses to neutral cues and/or to their responses during a baseline assessment. Eligible studies presented original data and were written in English. Fourteen studies met inclusion criteria, but data were not available for two. The 12 included studies contained 393 participants (12-97 participants per study; mean age range: 16.4-32.6 years). Standardized effects sizes were computed for heart rate, skin conductance, skin temperature, blood pressure, event-related potentials (Pz P300) and self-reported craving (Visual Analogue Scales and Marijuana Craving Questionnaire) and synthesized using a multivariate meta-regression model., Results: On average, cannabis users experienced moderate cue-reactivity, as determined by comparisons with baseline conditions [d = 0.59, 95% confidence interval (CI) = 0.43, 0.74, P < 0.001] and with neutral cue comparisons (d = 0.47, 95% CI = 0.32, 0.62, P < 0.001). This model, which excluded studies at a greater than low risk of bias and included PzP300 studies as a moderator (due to having larger effect sizes), had a moderately low level of heterogeneity of effect size (I 2  = 45.6%, Q = 56.97, P = 0.003) and showed no evidence of publication bias. Cue-reactivity was most noticeable (large effect size) when assessed by Pz P300 waves (d = 1.71, 95% CI = 0.77, 2.64, P = 0.0003; I 2  = 86%, Q = 36.30, P < 0.001) and least noticeable (trivial effect size) when examining heart rate (d = 0.14, 95% CI = -0.34, 0.62, P = 0.58; I 2  = 80%, Q = 20.0, P < 0.001). These subgroup models demonstrated high heterogeneity of effect size., Conclusions: Regular cannabis users experience moderate to extremely intense cue-reactivity, such that their attentional biases towards cannabis cues are much stronger than their perceptions of craving for the drug., (© 2016 Society for the Study of Addiction.)

Background: Pregaming is a high-risk drinking behavior associated with increased alcohol consumption and alcohol-related problems. Quantity of alcohol consumed does not fully explain the level of problems associated with pregaming; yet, limited research has examined factors that may interact with pregaming behavior to contribute to the experience of alcohol-related problems., Objectives: The current study examined whether use of two emotion regulation strategies influence pregaming's contribution to alcohol-related problems., Methods: Undergraduates (N = 1857) aged 18-25 years attending 19 different colleges completed an online survey in 2008-2009. Linear mixed models were used to test whether emotion regulation strategies moderate the association between pregaming status (pregamers vs. non/infrequent pregamers) and alcohol-related problems, when controlling for alcohol consumption, demographic covariates, and site as a random effect., Results: Greater use of cognitive reappraisal was associated with decreased alcohol problems. Expressive suppression interacted with pregaming status. There was no relationship between pregaming status and alcohol problems for students who rarely used expression suppression; however, the relationship between pregaming status and alcohol problems was statistically significant for students who occasionally to frequently used expression suppression., Conclusions/importance: Findings suggest that the relationship between pregaming and alcohol-related problems is complex. Accordingly, future studies should utilize event-level methodology to understand how emotion regulation strategies influence alcohol-related problems. Further, clinicians should tailor alcohol treatments to help students increase their use of cognitive reappraisal and decrease their use of suppression.

Context: The cultivation of mindfulness and acceptance has been theoretically and empirically associated with psychological ancillary well-being and has demonstrated efficacy in the treatment of various disorders. Hence, mindfulness and acceptance-based treatments (MABTs) have recently been explored for the treatment of social anxiety disorder (SAD). This review aims to evaluate the benefits of MABTs for SAD., Methods: Systematic review of studies investigating an MABT for individuals with SAD, using PsycInfo, Medline, PubMed, and Cochrane Central Register of Controlled Trials., Results: Nine studies were identified. Significant improvements in symptomatology were demonstrated following the MABT, but benefits were equivalent or less than yielded by cognitive-behavioral therapy (CBT)., Limitations: The few treatment studies available were compromised by significant methodological weaknesses and high risk of bias across domains. Studies were largely uncontrolled with small sample sizes. The hybrid nature of these interventions creates ambiguity regarding the specific utility of treatment components or combinations., Conclusions: MABTs demonstrate significant benefits for reducing SAD symptomatology; however, outcomes should be interpreted with caution until appropriate further research is conducted. Furthermore, the benefit of MABTs above and beyond CBT must be considered tentative at best; thus, CBT remains best practice for first-line treatment of SAD., (© 2014 Wiley Periodicals, Inc.)

Background and Objectives: Identification of risk factors for alcohol-related consequences is an important public health concern. Both gender and social anxiety have been associated with alcohol-related consequences broadly, but it is unknown whether these variables are differentially related to specific types of alcohol-related consequences for American college students., Methods: In the present study, 573 undergraduate students (M(age) = 19.86 years, SD = 1.40; range 18 to 25; 68.9% female) completed an on-line assessment of social anxiety, alcohol use, and four types of alcohol-related consequences (personal, social, physical, and role). Poisson regressions were run to examine social anxiety, gender, and the interaction between social anxiety and gender as predictors of each type of alcohol-related consequences., Results: After controlling for alcohol use, social anxiety was positively associated with all four types of consequences, and females endorsed higher rates of physical, personal, and role consequences. The interaction between social anxiety and gender was statistically significant only for physical consequences, with social anxiety having a stronger effect for males., Discussion and Conclusions: These findings, which diverge somewhat from those of a prior study with Australian college students, are discussed in the context of a biopsychosocial model of social anxiety and substance use problems., Scientific Significance: This study highlights the importance of further investigating cultural differences in the relationships among social anxiety, gender, and alcohol-related consequences.

Studies examining the ability of motivational enhancement therapy (MET) to augment education provision among ecstasy users have produced mixed results and none have examined whether treatment fidelity was related to ecstasy use outcomes. The primary objectives of this multi-site, parallel, two-group randomized controlled trial were to determine if a single-session of MET could instill greater commitment to change and reduce ecstasy use and related problems more so than an education-only intervention and whether MET sessions delivered with higher treatment fidelity are associated with better outcomes. The secondary objective was to assess participants' satisfaction with their assigned interventions. Participants (N=174; Mage=23.62) at two Australian universities were allocated randomly to receive a 15-minute educational session on ecstasy use (n=85) or a 50-minute session of MET that included an educational component (n=89). Primary outcomes were assessed at baseline, and then at 4-, 16-, and 24-weeks postbaseline, while the secondary outcome measure was assessed 4-weeks postbaseline by researchers blind to treatment allocation. Overall, the treatment fidelity was acceptable to good in the MET condition. There were no statistical differences at follow-up between the groups on the primary outcomes of ecstasy use, ecstasy-related problems, and commitment to change. Both intervention groups reported a 50% reduction in their ecstasy use and a 20% reduction in the severity of their ecstasy-related problems at the 24-week follow up. Commitment to change slightly improved for both groups (9%-17%). Despite the lack of between-group statistical differences on primary outcomes, participants who received a single session of MET were slightly more satisfied with their intervention than those who received education only. MI fidelity was not associated with ecstasy use outcomes. Given these findings, future research should focus on examining mechanisms of change. Such work may suggest new methods for enhancing outcomes. Australia and New Zealand Clinical Trial Registry: ACTRN12611000136909., (Copyright © 2014. Published by Elsevier Ltd.)

Background: The existence of an ecstasy-dependence syndrome is controversial. We examined whether the acute after-effects of ecstasy use (i.e. the 'come-down') falsely lead to the identification of ecstasy withdrawal and the subsequent diagnosis of ecstasy dependence., Methods: The Structured Clinical Interview for DSM-IV-TR Disorders: Research Version (SCID-RV) was administered to 214 Australian ecstasy users. Ecstasy withdrawal was operationalised in three contrasting ways: (i) as per DSM-IV criteria; (ii) as the expected after-effects of ecstasy (a regular come-down); or (iii) as a substantially greater or longer come-down than on first use (intense come-down). These definitions were validated against frequency of ecstasy use, readiness to change and ability to resist the urge to use ecstasy. Confirmatory factor analyses were used to see how they aligned with the overall dependence syndrome., Results: Come-down symptoms increased the prevalence of withdrawal from 1% (DSM-IV criterion) to 11% (intense come-downs) and 75% (regular come-downs). Past year ecstasy dependence remained at 31% when including the DSM-IV withdrawal criteria and was 32% with intense come-downs, but increased to 45% with regular come-downs. Intense come-downs were associated with lower ability to resist ecstasy use and loaded positively on the dependence syndrome. Regular come-downs did not load positively on the ecstasy-dependence syndrome and were not related to other indices of dependence., Conclusion: The acute after-effects of ecstasy should be excluded when assessing ecstasy withdrawal as they can lead to a false diagnosis of ecstasy dependence. Worsening of the ecstasy come-down may be a marker for dependence., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)