Behavioral Approach System (BAS) Sensitivity and Bipolar Spectrum Disorders: A Retrospective and Concurrent Behavioral High-Risk Design

In this article, we tested the vulnerability hypothesis of the behavioral approach system (BAS) hypersensitivity model of bipolar disorders. We examined whether self-reported BAS sensitivity predicts lifetime bipolar spectrum diagnoses as well as symptoms and personality characteristics associated with bipolar disorder using a retrospective and concurrent behavioral high-risk design. Participants with high (HBAS; n=28) or moderate (MBAS; n=24) BAS sensitivity were selected and given a lifetime psychiatric diagnostic interview and self-report measures of proneness to bipolar symptoms, current symptoms, and personality characteristics relevant to bipolarity. HBAS participants were significantly and substantially more likely to have a lifetime bipolar spectrum disorder diagnosis than were MBAS participants, but did not differ from MBAS participants in their likelihood of a unipolar depression diagnosis. Also, the HBAS group exhibited higher impulsivity and proneness to hypomanic symptoms than the MBAS group, and BAS-reward responsiveness predicted hypomanic personality characteristics. Finally, high behavioral inhibition system (BIS) sensitivity was associated with proneness to and current depressive symptoms.

Neuropsychological Behavioral Inhibition System (BIS) and Behavioral Approach System (BAS) assessment: a shortened Sensitivity to Punishment and Sensitivity to Reward Questionnaire version (SPSRQ-20)

This research was designed to investigate the items and factor structure of the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ) proposed by Torrubia, Avila, Moltó, and Caseras ( 2001 ), as a measure of the behavioral inhibition system and behavioral activation system in Gray's reinforcement sensitivity theory. Recent studies that analyzed this instrument by exploratory and confirmatory factor analysis suggest the need for structural refinement. The Spanish version of the SPSRQ was analyzed by exploratory and confirmatory procedures in calibration (n = 2,102) and validation (n = 746) independent samples. In addition, convergent and discriminant validity was evaluated with the Zuckerman-Kuhlman Personality Questionnaire (Zuckerman, Kuhlman, Teta, Joireman, & Kraft, 1993 ), the Impulsiveness, Venturesomeness and Empathy Inventory (S. B. G. Eysenck, Pearson, Easting, & Allsopp, 1985 ) the Neuroticism, Extraversion and Openness Five Factor Inventory (Costa & McCrae, 1992 ), and the Barratt Impulsiveness Scales (Barratt, 1985 ). Results showed the robustness of a 20-item structure of the SPSRQ, with satisfactory fit adjustment, validity, and reliability. The findings are discussed in terms of the better functioning and sound psychometric properties of the SPSRQ 20-item version for Gray's personality theory.     

Positive overgeneralization and Behavioral Approach System (BAS) sensitivity interact to predict prospective increases in hypomanic symptoms: a behavioral high-risk design

Recent work has identified Behavioral Approach System (BAS) sensitivity as a risk factor for the first onset and recurrence of mood episodes in bipolar disorder, but little work has evaluated risk factors for the prospective development of hypomanic symptoms in individuals at risk for, but without a history of, bipolar disorder. The present study used a prospective behavioral high-risk design to evaluate the impact of positive overgeneralization, a cognitive correlate of risk for hypomania, on hypomanic symptoms in individuals with high vs. moderate BAS sensitivity, but without a history of mood elevation. Hierarchical linear regressions indicated that upward positive overgeneralization and BAS sensitivity interacted to predict increased levels of hypomanic symptoms at follow-up, controlling for initial hypomanic symptoms. The pattern of this interaction was such that positive overgeneralization predicted higher levels of hypomanic symptoms among high-BAS, but not moderate-BAS, individuals. Thus, the self-reported tendency to experience grandiose increases in confidence following success may confer additional risk for mood elevation among individuals already at risk for developing bipolar disorder. Potential implications for prevention and treatment are discussed.     

Relational Stressors and Depressive Symptoms in Late Adolescence: Rejection Sensitivity as a Vulnerability

The role of rejection sensitivity as a critical diathesis moderating the link between adolescent relational stressors and depressive symptoms was examined using multi-method, multi-reporter data from a diverse community sample of 173 adolescents, followed from age 16 to 18. Relational stressors examined included emotional abuse, maternal behavior undermining adolescents’ autonomy and relatedness, and lack of support from close peers. As hypothesized, multiple relational stressors were found to predict the future development of depressive symptoms, but as hypothesized predictions existed primarily for adolescents who were highly rejection sensitive. Results are discussed in terms of a diathesis-stress model of depression and suggest that though relational stressors have previously shown consistent modest links to depressive symptoms, understanding pre-existing intrapsychic vulnerabilities of the adolescent may be critical to identifying the processes by which such stressors lead to depressive symptoms.     

Responsiveness to Threat and Incentive in Bipolar Disorder: Relations of the BIS/BAS Scales with Symptoms

Over the past 10 years, theorists have suggested that bipolar disorder symptoms result from increases and decreases in the activity of the Behavioral Activation or Facilitation System (BAS or BFS) and the Behavioral Inhibition System (BIS). These neurobehavioral systems are thought to determine the intensity of affective and behavioral responses to incentives and threats. This study examined cross-sectional and prospective associations of self-reported BIS and BAS with mania and depression in a sample of 59 individuals diagnosed with Bipolar I disorder. Depression was tied to BIS, pointing to the importance of sensitivity to threats in depression. However, links between BIS and depression appeared state-dependent. BAS subscales did not correlate with manic symptoms in a state-dependent manner; however, BAS (total scale and reward responsiveness subscale) predicted relative intensification of manic symptoms over time. Thus, evidence suggests that BAS sensitivity may constitute a vulnerability to mania among persons diagnosed with bipolar disorder. Discussion focuses on the integrative potential of the BIS/BAS constructs for linking psychosocial and biological research on bipolar disorder.     

High Behavioral Approach System (BAS) sensitivity, reward responsiveness, and goal-striving predict first onset of bipolar spectrum disorders: a prospective behavioral high-risk design

A prospective, behavioral high-risk design provided a theoretically guided examination of vulnerability to first onset of bipolar spectrum disorder based on the Behavioral Approach System (BAS) model. Adolescents (ages 14-19) at an "age of risk" for bipolar disorder onset were screened on BAS sensitivity by interviewers blind to current symptoms, lifetime history, and family history of psychopathology. Participants were selected with high versus moderate levels of BAS sensitivity and administered a lifetime diagnostic interview. Those with a bipolar spectrum disorder, psychosis, or hypomanic episode with onset prior to the BAS sensitivity assessment were excluded. High BAS (n = 171) and moderate BAS (n = 119) sensitivity participants in the final sample completed baseline measures of symptoms, goal-setting, and reward responsiveness and were followed prospectively with semistructured diagnostic interviews every 6 months. Consistent with the vulnerability hypothesis of the BAS model of bipolar disorder, high BAS participants had a greater likelihood, and shorter time to onset, of bipolar spectrum disorder than moderate BAS participants across an average of 12.8 months of follow-up (12.9% vs. 4.2%), controlling for baseline depressive and hypomanic symptoms, and family history of bipolar disorder. High reward responsiveness on a behavioral task and ambitious goal-striving for popular fame and financial success (but not impulsivity) also predicted first onset of bipolar spectrum disorder controlling for the covariates and BAS risk group, and ambitious goal-striving partially mediated the BAS risk group effect. We discuss implications of the findings for the BAS model of bipolar disorder and early intervention efforts.     

The Relationship Between a Hierarchical Transdiagnostic Model of Vulnerability Factors and Posttraumatic Stress Disorder Symptom Clusters

The latent structure of Post-Traumatic Stress Disorder (PTSD) symptomology is the subject of ongoing deliberation. The cognitive vulnerabilities of Negative Affect, Anxiety Sensitivity and Intolerance of Uncertainty have been shown to explain symptoms clusters in multiple anxiety and mood disorders, and may be able to offer further insight to explain PTSD symptomology. Using structural equation modelling, this study examines whether a hierarchical model consisting of the general cognitive factor of Negative Affect and the transdiagnostic risk factors of Anxiety Sensitivity and Intolerance of Uncertainty can explain variability among PTSD symptom clusters as defined by the DSM-5 and/or Dysphoria models of PTSD. Anxiety Sensitivity and Intolerance of Uncertainty were tested as mid-level factors between Negative Affect and the PTSD symptom constructs. The hierarchical model fit the data well in both the DSM-5 and Dysphoria models. Negative Affect consistently showed significant direct effects on each symptoms cluster in both models. Anxiety Sensitivity served as a significant mediator of Negative Affect for several symptom clusters in both models. Intolerance of Uncertainty was non-significant either as a direct effect or as a mediator of Negative Affect in all analyses. This study demonstrates how the hierarchical model of Negative Affect, Anxiety Sensitivity and Intolerance of Uncertainty may fit upon multiple PTSD symptom constructs and offers new directions for conceptualizing this disorder.

     

Suicidal Thinking and Perfectionism: The Role of Goal Adjustment and Behavioral Inhibition/Activation Systems (BIS/BAS)

The current study investigated the associations among perfectionism, goal adjustment, behavioral activation sensitivity (BAS), behavioral inhibition sensitivity (BIS), and suicidal thinking. Participants (n = 255) completed the Multidimensional Perfectionism Scale, the BIS/BAS scale, the Goal Adjustment scale, and a measure of suicidal thinking. The findings showed that socially prescribed perfectionism was the only perfectionism dimension associated with suicidal thinking. Goal reengagement (but not goal disengagement) is an important construct in the suicidal process. A series of hierarchical regression analyses showed that goal reengagement moderates and mediates the effect of socially prescribed perfectionism on suicidal thinking. BIS was also associated with suicidal behavior but its effect was mediated via socially prescribed perfectionism. The theoretical and treatment implications of the relationships between socially prescribed perfectionism, goal reengagement, and suicidal thinking and between BIS, socially prescribed perfectionism, and suicidal thinking are discussed. Future research is required to determine whether these relationships are predictive of suicidal thinking and behavior over time.     

Treatment Sensitivity of a Brief Rating Scale for Attention-Deficit Hyperactivity Disorder (ADHD) Symptoms

This study examined the treatment sensitivity of the ADHD Questionnaire (ADHD-Q), which is a brief rating scale for measuring symptoms of inattention, hyperactivity, and impulsivity in children. Parent, teacher, and child self-report data of the ADHD-Q were obtained for 17 clinically referred children with ADHD on the three occasions: (1) during the regular intake assessment, (2) just before the start of the stimulant medication (i.e., methylphenidate) intervention, and (3) four weeks after the start of the medication intervention. Results showed that ADHD-Q scores remained fairly stable in the period prior to the intervention, but then showed a substantial decline after the stimulant medication had been administered. Clearly, this finding supports the treatment sensitivity of the ADHD-Q.     

Developmental Trajectories of Anxiety Symptoms in Early Adolescence: The Influence of Anxiety Sensitivity

Children and adolescents seem to suffer from anxiety disorders at rates similar to adults. Interestingly, anxiety symptoms appear to generally decline over time within children as evidenced by lower rates in early and middle adolescence. There is some evidence that there may be heterogeneous subpopulations of adolescent children with different trajectories of anxiety symptoms, including a class of adolescents with elevated levels of anxiety that do not dissipate over time. Anxiety sensitivity has been identified as an important risk factor in the development of anxiety psychopathology. This study prospectively examined the development of anxiety symptoms in a sample of 277 adolescents (M _age?=?11.52; 44 % female, 56 % male) over a 3 year period including the influence of anxiety sensitivity on this development. Further, this study investigated whether there were distinct classes of adolescents based on their anxiety symptom trajectories and including anxiety sensitivity as a predictor. Consistent with other reports, findings indicated an overall decline in anxiety symptoms over time in the sample. However, three classes of adolescents were found with distinct anxiety symptom trajectories and anxiety sensitivity was an important predictor of class membership. Adolescents with elevated anxiety sensitivity scores were more likely to be classified as having high and increasing anxiety symptoms over time versus having moderate to low and decreasing anxiety symptoms over time. There are important implications for identification of adolescents and children who are at risk for the development of an anxiety disorder.     

Avoidance in Adolescence: The Balloon Risk Avoidance Task (BRAT)

Journal of Psychopathology and Behavioral Assessment - A large body of work documents the utility of behavioral risk tasks for making inferences about adolescent risk-taking proclivities and...     

Development of Borderline Personality Disorder in Adolescence and Young Adulthood: Introduction to the Special Section

Recognizable symptoms and features of borderline personality disorder (BPD) appear during adolescence. However, there has been resistance to diagnose or research this disorder prior to adulthood because of clinical lore that BPD is a long-standing illness and that personality traits are not stable until adulthood. This has resulted in little information regarding the development of and risk factors for BPD in youth. The goal of this special section is to examine the development of BPD in adolescence and young adulthood using a broad collection of approaches, including a theoretical review paper, two prospective studies, and a multi-method cross-sectional study. This body of work provides new insights into vulnerabilities that may transact with early attachment relationships and experiences to predict the emergence of BPD in adolescence and young adulthood. These papers also point to future research that is needed to better understand the etiology, development, and course of BPD.     

Rethinking the Role of Worry in Generalized Anxiety Disorder: Evidence Supporting a Model of Emotional Contrast Avoidance

The Contrast Avoidance model (Newman & Llera, 2011) proposes that individuals with generalized anxiety disorder (GAD) are hypersensitive to sharp upward shifts in negative emotion that typically accompany negative events, and use worry to maintain sustained intrapersonal negativity in an attempt to avoid these shifts. Although research shows that worry increases negative emotionality and mutes further emotional reactivity to a stressor when compared to the worry period (e.g., Llera & Newman, 2010), no study has tracked changes in negative emotionality from baseline to worry inductions followed by a range of emotional exposures. Further, no study has yet assessed participants’ subjective appraisals of prior worry on helping to cope with such exposures. The present study tested the main tenets of the Contrast Avoidance model by randomly assigning participants with GAD (n = 48) and nonanxious controls (n = 47) to experience worry, relaxation, and neutral inductions prior to sequential exposure to fearful, sad, and humorous film clips. Both physiological (nonspecific skin conductance responses [NS-SCRs]) and self-reported emotional changes were observed. Results indicated that worry boosted negative emotionality from baseline, which was sustained across negative exposures, whereas low negative emotionality during relaxation and neutral inductions allowed for sharp increases in response to exposures. Furthermore, GAD participants found worry to be more helpful than other conditions in coping with exposures, whereas control participants reported the opposite pattern. Results provide preliminary support for the Contrast Avoidance model. This suggests that treatment should focus on underlying avoidance patterns before attempting to reduce worry behavior.     

The Contribution of Temperamental and Cognitive Factors to Childhood Anxiety Disorder Symptoms: A Closer Look at Negative Affect,Behavioral Inhibition,and Anxiety Sensitivity

This study examined the role of anxiety sensitivity as an explanatory variable in the link between two temperamental dimensions (i.e., behavioral inhibition and negative affect) and anxiety disorder symptom severity in a sample of children with anxiety disorders. Forty-four children (52?% African American) between 8 and 12 years of age and their mothers participated in this study. An assessment battery consisting of diagnostic interviews, questionnaires, and behavioral assessment of behavioral inhibition was administered. Findings revealed that anxiety sensitivity was a significant explanatory variable linking child self-reports of behavioral inhibition and negative affect to anxiety disorder symptom severity. For parent-completed measures, only direct effects of behavioral inhibition on anxiety disorder symptom severity were found. The clinical implications of our findings, including the importance and feasibility of anxiety sensitivity and behavioral inhibition assessments as part of routine clinical care of children with anxiety disorders are discussed, along with the limitations of our study.     

Psychosocial Considerations in Sickle Cell Disease (SCD): The Transition from Adolescence to Young Adulthood

Sickle cell disease (SCD) occurs in 1 of every 400 to 500 African American births. Despite its prevalence, there has been a relative dearth of attention paid to SCD in the psychological literature. African American SCD adolescents and young adults, individuals at an already vulnerable developmental stage, are at increased risk for psychological distress and psychosocial impairments (e.g., depression and low self-esteem, poor social and academic/vocational functioning). Such difficulties often result in problematic adherence to medical regimens, and thus represent a potentially serious clinical and public health problem that merits the attention of psychologists working in medical settings. This article (1) reviews the psychosocial needs peculiar to SCD patients transitioning from adolescence to young adulthood; (2) applies a culturally informed stress-coping-adjustment framework to assess and address the psychological status, psychosocial functioning, and disease outcomes of these individuals; and (3) describes a culturally and developmentally sensitive, psychoeducational group intervention.     

Understanding the Progression from Early Alcohol Use Experimentation to Alcohol Use Disorder: Testing Vulnerability by Experience Interactions Using a Two-Part Latent Growth Curve Model

Most adolescents experiment with alcohol, but a smaller percentage advance to heavy alcohol use (AU) and AU disorder (AUD). Understanding for whom and how early risk leads to AUD is of interest to prevention, treatment, and etiology of AUD. Informed by developmental and behavioral neuroscience theory, the current study tested whether temperament (effortful control, surgency, and negative affect), peer AU (multi-reporter), and AU with parents’ permission interacted to distinguish youth who experiment with alcohol from those who escalate to AUD. Community adolescents (N?=?765, 53% female) were assessed annually for seven years (M_age?=?11.8, range: 10–13 at Year 1; M_age?=?18.7; range?=?17–20 at year 7). Temperament by early experience interactions were expected to predict amount of AU. Amount of AU was expected to mediate the relationship between the interactions and AUD symptoms (assessed at Years 3 and 7, M_age?=?13.8 and 18.7) above and beyond a range of confounds (e.g., problem behavior and parental AU and AUD). Supporting hypotheses, effortful control and surgency interacted with AU with parents’ permission and peer AU, respectively, to predict higher amount of AU (R²?=?0.47) and AUD symptoms (R²?=?0.03). Results support developmental and behavioral neuroscience theory. High surgency and low effortful control in conjunction with peer AU and AU with parents’ permission were associated with large effects on AU and moderate mediated effects through AU to AUD. AU with parents’ permission was risky at low and high effortful control and protective when peers used alcohol.