Cross-Lagged Relationships Between Insomnia and Posttraumatic Stress Disorder in Treatment-Receiving Veterans

Insomnia is a risk factor for the development of posttraumatic stress disorder (PTSD) while it is also plausible that PTSD symptoms can maintain insomnia symptoms. The present study examined longitudinal bidirectional relationships between insomnia and PTSD symptoms in treatment-seeking veterans. Participants were 693 ex-serving members of the Australian Defence Force who participated in an accredited, hospital-based outpatient PTSD program. Participants completed self-reported assessments of PTSD and insomnia symptoms at four time points: intake, discharge, 3-month, and 9-months posttreatment follow-up.Cross-lagged pathway analyses indicated significant bi-directional pathways between insomnia symptoms and PTSD symptoms at most time points. A final cross-lagged model between insomnia symptoms and the PTSD symptom clusters indicated that the PTSD symptom paths on insomnia symptoms, between intake and discharge, were attributable to reexperiencing PTSD symptoms. In contrast, across posttreatment follow-up time points there were significant paths of insomnia symptoms on all PTSD symptom clusters except from insomnia at 3-months to avoidance symptom at 9-months. PTSD symptoms and insomnia symptoms have bidirectional associations over time that may lead to the mutual maintenance or exacerbation of each condition following PTSD treatment. Where residual insomnia symptoms are present post-treatment, a sleep-focussed intervention is indicated and a sequenced approach to treatment recommended.     

Positive Interpretation Bias Predicts Longitudinal Decreases in Social Anxiety

Theoretical models of social anxiety suggest that distorted interpretation processes contribute to its development and maintenance, although the pathways through which this occurs are not well understood. Therefore, the present longitudinal study sought to determine whether negative interpretation bias, positive interpretation bias, and interpretation inflexibility (the degree to which participants correctly revise initial interpretations) predict changes in social anxiety over time. In an important advance over prior studies, individual differences in working memory capacity (WMC) were accounted for, as WMC is thought to play a crucial role in the generation and maintenance of interpretation biases. Following a baseline assessment of social anxiety, interpretation biases, and WMC, participants completed follow-up assessments of social anxiety both 2 weeks (n = 106) and 4 weeks (n = 96) later. After controlling for baseline social anxiety and WMC, greater positive interpretation bias was found to predict lower social anxiety at both follow-ups. Neither negative interpretation bias nor interpretation inflexibility was significantly associated with follow-up social anxiety. These results provide support for greater positive interpretation bias as a facilitator of decreases in social anxiety and a potential target for clinical intervention.     

LONG-TERM FOLLOW-UP OF ECHOLALIA AND QUESTION ANSWERING

A long-term follow-up of echolalia and correct question answering was conducted for 6 subjects from three previously published studies. The follow-up periods ranged from 26 to 57 months. In a training site follow-up, subjects were exposed to baseline/posttraining conditions in which the original trainer and/or a novel person(s) presented trained and untrained questions. Four subjects displayed echolalia below baseline levels, and another did so in some assessments. Overall, echolalia was lower than in baseline in 80.6% of the follow-ups. Five subjects displayed correct responding above baseline levels. No clear differences were noted in correct responding or echolalia between the trainer and novel-person presentations or between trained and untrained questions. In a follow-up in a natural environment conducted by a novel person, lower than baseline levels of echolalia were displayed by 3 subjects; 2 subjects displayed lower than baseline levels in some assessments. Two subjects consistently displayed correct responding above baseline, and 3 did so occasionally. Issues related to the study of maintenance are discussed.     

Psychological and social predictors of changes in fruit and vegetable consumption over 12 months following behavioral and nutrition education counseling.

This study assessed psychological and social factors predicting 12-month changes in fruit and vegetable consumption achieved by 271 men and women from a low-income population randomized to brief behavioral and nutrition education counseling. Greater increases in fruit and vegetable intake were achieved in the behavioral than in the nutrition education condition (1.49 vs. 0.87 portions per day, p=.021). Increases were predicted by baseline social support for dietary change but not by baseline psychological measures. However, short-term (8-week) changes in dietary self-efficacy, encouragement, anticipated regret, perceived benefits, and knowledge of recommended intake predicted 12-month changes in fruit and vegetable consumption independently of gender, age, ethnicity, income, and baseline intake. These factors accounted for 51% of the superiority of behavioral counseling over nutrition education.     

Cognitive predictors of symptom return following depression treatment

This study tested whether poor cognitive change during depression treatment predicted time to return of depressive symptoms. Depressed participants (N = 121) completed assessments of dysfunctional attitudes and extreme thinking (i.e., number of totally agree and totally disagree responses) during hospitalization and again after 6 months of outpatient treatment. Participants then completed monthly depression assessments for 1 year. Survival analyses for time to symptom recurrence during follow-up were conducted among participants who reported 50% improvement in their depressive symptoms and were at least partially asymptomatic at the end of treatment (n = 53). Poor change in dysfunctional attitudes and poor change in extreme thinking both predicted shorter time to return of depressive symptoms.     

Do processes of change predict smoking stage movements? A prospective analysis of the transtheoretical model.

The transtheoretical model (TTM) posits that processes of change and the pros and cons of smoking predict progressive movement through the stages of change. This study provides both a cross-sectional replication and a prospective test of this hypothesis. As part of a larger study of worksite cancer prevention (the Working Well Trial), employees of 26 manufacturing worksites completed a baseline and 2 annual follow-up surveys. Of the 63% of employees completing baseline surveys, 27.7% were smokers (N = 1,535), and a cohort of these smokers completed the 2-year follow-up. Cross-sectional results replicated previous studies with virtually all the processes of change and the cons of smoking increasing in linear fashion from precontemplation to preparation (all ps < .00001), and the pros of smoking decreasing (p < .01). However, contrary to the hypothesis, the baseline processes of change and the pros and cons of smoking failed to predict progressive stage movements at either the 1- or the 2-year follow-ups. Possible explanations for these findings and concerns about the conceptual internal consistency of the TTM are discussed.     

Risk Factors for Disordered Eating During Early and Middle Adolescence: A Two Year Longitudinal Study of Mainland Chinese Boys and Girls

Even though reliable eating disorder risk factors have been identified among adolescent girls, little is known about predictors of increased vulnerability within specific phases of adolescence or among adolescent boys, particularly in highly populated non-Western contexts. In this study, early and middle adolescent boys (n?=?1,271) and girls (n?=?1,415) from Chongqing, China completed validated measures of eating disorder pathology and putative risk factors at baseline and 2 years follow-up. Multivariate models for boys of each age group indicated increases in disordered eating at follow-up were predicted by higher initial body mass index, negative affect and body dissatisfaction levels as well as attendant increases in perceived appearance pressure from mass media, body dissatisfaction, negative affect between assessments. High baseline levels of reported appearance pressure from parents and dating partners contributed, respectively, to prediction models of younger and older boys. More distinct constellations of significant predictors emerged in multivariate models of early versus middle adolescent girls. Together, findings indicated body dissatisfaction and negative affect were fairly robust risk factors for exacerbations in disturbances across samples while risk factors such as perceived pressure from desired/prospective dating partners were salient only during particular phases of adolescence.     

The relationship of attributional style to agoraphobia severity, depression, and treatment outcome

The present study examined the relationship of attributional style, as measured with a revised version of the Attributional Style Questionnaire (ASQ) and measures of agoraphobia severity, depression, and treatment outcome in 73 Ss who met DSM-III criteria for agoraphobia with panic attacks and participated in one of three 13-week treatment conditions: paradoxical intention, graduated exposure, or progressive deep muscle relaxation training. Subjects completed assessments at four periods: pretreatment, midtreatment, posttreatment, and at 3 month follow-up. In addition to the three dimensions typically examined on the ASQ, this revised version also measured Ss' estimates of the perceived importance, and future likelihood for both positive and negative events. Congruent with previous research, moderate but somewhat inconsistent associations were observed between attributional style and depression both within and across assessment periods. Predictions about associations between attributional style and agoraphobic severity were not supported; however, an interaction was observed between depression and attributional style with respect to severity of agoraphobia. There was no evidence of group differences across treatment types, although there were several significant changes in attributional style across time. Attributions for health related events were also examined. Conceptual, clinical, and research issues related to the findings are discussed.     

Cognitive performance in older adults with stable heart failure: Longitudinal evidence for stability and improvement

Cognitive impairment is prevalent in heart failure (HF), though substantial variability in the pattern of cognitive impairment is found across studies. To clarify the nature of cognitive impairment in HF, we examined longitudinal trajectories across multiple domains of cognition in HF patients using latent growth class modeling. 115 HF patients completed a neuropsychological battery at baseline, 3-months and 12-months. Participants also completed the Beck Depression Inventory-II (BDI-II). Latent class growth analyses revealed a three-class model for attention/executive function, four-class model for memory, and a three-class model for language. The slope for attention/executive function and language remained stable, while improvements were noted in memory performance. Education and BDI-II significantly predicted the intercept for attention/executive function and language abilities. The BDI-II also predicted baseline memory. The current findings suggest that multiple performance-based classes of neuropsychological test performance exist within cognitive domains, though case-controlled prospective studies with extended follow-ups are needed to fully elucidate changes and predictors of cognitive function in HF.     

Are changes in beliefs and attitudes about sleep related to sleep improvements in the treatment of insomnia?

Dysfunctional beliefs and attitudes about sleep are presumed to play an important mediating role in perpetuating insomnia. The present study evaluated the impact of cognitive-behavioral and pharmacological treatments for insomnia on sleep-related beliefs and attitudes and the relationship between those changes and sleep improvements. The participants were older adults with chronic and primary insomnia. They received cognitive-behavior therapy (CBT), pharmacotherapy (PCT), combined CBT+PCT (COMB), or a medication placebo (PLA). In addition to daily sleep diaries and sleep laboratory measures, the participants completed the dysfunctional beliefs and attitudes about sleep scale (DBAS) at baseline and posttreatment, and at 3-, 12- and 24-month follow-up assessments. The results showed that CBT and COMB treatments produced greater improvements of beliefs and attitudes about sleep at posttreatment than PCT and PLA. Reductions of DBAS scores were significantly correlated with improvements of sleep efficiency as measured by daily sleep diaries and by polysomnography. In addition, more adaptive beliefs and attitudes about sleep at posttreatment were associated with better maintenance of sleep improvements at follow-ups. These findings highlight the importance of targeting sleep-related beliefs and attitudes in the treatment of insomnia.     

Conscientiousness predicts disease progression (CD4 number and viral load) in people living with HIV.

OBJECTIVE: Psychosocial factors (e.g., depression, avoidant coping, life stress) have been related to disease progression in HIV. This study examined the relationship between the Big Five Conscientiousness factor and HIV disease progression (CD4 cell and viral load) over 1 year in 119 seropositive participants. The study also examined whether Conscientiousness effects were mediated by adherence, perceived stress, depression, or coping measures. DESIGN: In a 1-year longitudinal design, participants completed the NEO Five-Factor Inventory Conscientiousness scale (P. T. Costa & R. R. McCrae, 1992). Participants also completed psychosocial assessments and underwent blood draws at initial assessments and 1-year follow-up. MAIN OUTCOME MEASURES: Multiple hierarchical regression models were used to predict change in CD4 cell numbers and viral load log 10, controlling for demographic variables, initial disease status, and antiretroviral medications. RESULTS: Conscientiousness predicted significant increases in CD4 number and significant decreases in viral load at 1 year. Conscientiousness was related positively to medication adherence and active coping and negatively to depression and perceived stress. Only perceived stress emerged as a possible mediator. CONCLUSION: The significant relationship between Conscientiousness and medication adherence, distress, and coping suggests that an assessment of Conscientiousness in patients with HIV may help specify or target behavioral interventions to promote optimal disease management.     

Tracking Substance Abusers in Longitudinal Research: Understanding Follow-Up Contact Difficulty

Studies examining follow-up contact difficulty provide useful information for planning longitudinal studies and for assessing the validity of follow-up data. Contact difficulty was examined among 96 substance abusers following substance abuse treatment. Interview completion rates at the 3-month and 6-month follow-ups were 93 and 97%, respectively. The extent of contact efforts required to complete follow-up interviews varied substantially but tended to be greater at the 3-month follow-up than at the 6-month follow-up. Contact difficulty was related to reuse of substances at the 3-month and at the 6-month follow-ups with reusers requiring greater contact efforts than abstainers. None of the baseline individual and contextual variables examined significantly predicted level of contact effort at follow-ups. Attrition-related validity implications are discussed along with practical suggestions for planning tracking efforts.     

Perceived Criticism and Marital Adjustment Predict Depressive Symptoms in a Community Sample

Depressive symptoms are related to a host of negative individual and family outcomes; therefore, it is important to establish risk factors for depressive symptoms to design prevention efforts. Following studies in the marital and psychiatric literatures regarding marital factors associated with depression, we tested two potential predictors of depressive symptoms: marital adjustment and perceived spousal criticism. We assessed 249 spouses from 132 married couples from the community during their first year of marriage and at three time points over the next 10 years. Initial marital adjustment significantly predicted depressive symptoms for husbands and wives at all follow-ups. Further, perceived criticism significantly predicted depressive symptoms at the 5- and 10-year follow-ups. However, at the 1-year follow-up, this association was significant for men but not for women. Finally, a model where the contributions of marital adjustment and perceived criticism were tested together suggested that both play independent roles in predicting future depressive symptoms. These findings highlight the potential importance of increasing marital adjustment and reducing perceived criticism at the outset of marriage as a way to reduce depressive symptoms during the course of marriage.     

Biased attention and dysphoria: Manipulating selective attention reduces subsequent depressive symptoms

Selective attention for dysphoric stimuli has been observed in individuals with depression and those at risk for depression. To date, no studies have investigated the effects of directly manipulating selective attention for dysphoric stimuli on depressive symptoms. Mild to moderately depressed college students (N=34) were randomly assigned to complete 4 sessions of either attention training (AT) or no training (NT) during a two-week period. Participants completed self-reported assessments of depressive symptoms at baseline, post-training, and follow-up. Participants in the AT condition had a significantly greater decrease in depressive symptoms from baseline to follow-up than participants in the NT condition. This group difference was mediated by change in attention bias. Our findings suggest that biased attention may have a causal role in the maintenance of depressive symptoms.     

Relationships between perceived social support and retention among patients in methadone maintenance treatment in mainland China

The study purpose was to explore relationships between perceived social support and retention in mainland Chinese patients receiving methadone maintenance treatment (MMT). Data collection included baseline information, perceived social support, and retention. A total of 1212 patients completed the cross-sectional survey; 809 (66.7%) perceived good social support and 458 (37.8%) had been re-admitted. Despite controlling baseline information, past retention did not significantly influence perceived social support. At the two-year follow-up, 527 (43.5%) patients terminated MMT. Patients with poorer perceived social support were more likely to terminate treatment, with hazard ratios of 1.31 (95% confidence interval [CI]: 1.10–1.57 without controlling baseline information and past retention) and 1.25 (95% CI: 1.04–1.51 controlling baseline information and past retention). Thus, while MMT retention does not significantly influence perceived social support, good perceived social support is a strong predictor of retention.     

Inconsistencies in the Reporting of Perceived Trauma Severity Among Acute Physical Injury Survivors

This study aimed to identify and predict inconsistency in perceived trauma severity reports over time among trauma survivors. Hospitalized adult survivors of a traumatic injury completed trauma exposure assessments within 40 days post-injury and 6 weeks later (n = 77). The following trauma severity characteristics were examined: (1) threat of loss of life, (2) threat of loss of a body part, (3) threat of serious injury, and (4) peritraumatic emotionality. Potential predictors of inconsistency were also examined. About half of the reports regarding perceived trauma severity characteristics were inconsistent between the baseline to 6-week assessment. The inconsistent reports were mostly small and equally likely to be either more or less severe over time. Increases in posttraumatic stress disorder (PTSD; especially avoidance) predicted increases in severity of life threat and threat of loss of a body part. Thus, acute reports of perceived trauma severity vary and are influenced by PTSD symptoms.     

MOTHERS AS EFFECTIVE THERAPISTS FOR AUTISTIC CHILDREN'S PHOBIAS

Two autistic children were treated for specific fears. A three-component participant modeling procedure was implemented within a multiple baseline design across subjects. Children were exposed gradually to fearful situations, with mothers serving as therapists and reinforcers. Dependent measures were (a) number of approach steps completed, (b) frequency of verbalizations and vocalizations of fear, and (c) overall appearance of fear. Following treatment, the children functioned effectively in previously fearful situations without verbalizations or appearance of fear. Five-month and 1-year follow-up assessments with 1 child showed maintenance of treatment effects.     

An exploratory study of social support, distress, and life disruption among low-income Hispanic women under treatment for early stage breast cancer.

Relationships between distress and perceived availability of social support were examined in 51 Hispanic women being treated for early stage breast cancer. Distress and different types (emotional, instrumental) and sources (spouse, women family members, other family members, friends) of support were measured at presurgery, postsurgery, and at 3-, 6-, and 12-month follow-ups. Emotional support from friends and instrumental support from spouse at presurgery predicted lower distress postsurgery. No other prospective benefits of perceived support emerged. Distress at several time points predicted erosion of subsequent support, particularly instrumental support from women in the family. In contrast to the adverse effects of distress (and independent of them), illness-related disruption of recreational and social activities at 6 months elicited greater support at 12 months.     

Evidence for Discontinuity Patterns Across the Stages of Change: A Role for Attitudinal Ambivalence

Cross-sectional analyses of the transtheoretical ("stages of change") model (TTM) can provide valuable information concerning the variables that are likely to shift individuals from one stage to the next. The present study was designed to investigate the roles of theory of planned behaviour (TPB) variables and attitudinal ambivalence across the stages of change. Two samples derived from the general population completed measures of stage, TPB and attitudinal ambivalence with respect to consuming a low-fat diet (n = 148) and eating five portions of fruit and vegetables per day (n = 151). Consistent with previous research, the present study found linear increases in TPB variables across the stages of change. However, as predicted, attitudinal ambivalence showed discontinuity patterns, displaying a quadratic relationship with the stages of change, such that least ambivalence was experienced in the precontemplation and maintenance stages. Discussion of the findings focuses on implications for the development of theory-driven interventions.