Acceptance and Commitment Therapy Group Treatment for Symptoms of Borderline Personality Disorder: A Public Sector Pilot Study

A pilot study of a brief group-based Acceptance and Commitment Therapy (ACT) intervention (12 two-hour sessions) was conducted with clients of public mental health services meeting four or more criteria for borderline personality disorder (BPD). Participants were randomly assigned to receive the ACT group intervention in addition to their current treatment (ACT + TAU; N = 21) or to continue with treatment as usual alone (TAU; N = 20). There was significantly more improvement from baseline for the ACT + TAU condition than the TAU condition on the primary outcome variable—self-rated BPD symptoms. The ACT + TAU gain was both clinically and statistically significant. The ACT + TAU condition also had significantly more positive change on anxiety and hopelessness, and on the following ACT consistent process variables: psychological flexibility, emotion regulation skills, mindfulness, and fear of emotions. For all but anxiety, the improvements for the ACT + TAU condition were significant, while the TAU condition had no significant changes on any measure. Follow-up was possible for only a small number of participants. The improvements gained by the ACT + TAU participants were maintained except for fear of emotions. Anxiety continued to improve, becoming significantly different from baseline at follow-up. Examination of mediators found that psychological flexibility, emotion regulation skills and mindfulness, but not less fear of emotions, mediated BPD symptoms. Psychological flexibility and emotion regulation skills also mediated hopelessness. There is a need for a larger trial, for comparison with other established treatments for BPD, and for conducting a trial of a longer intervention. Nonetheless, this pilot study suggests that a brief group-based ACT intervention may be a valuable addition to TAU for people with BPD symptoms in the public sector.     

A randomized controlled trial of strong minds: A school-based mental health program combining acceptance and commitment therapy and positive psychology

To date, most early intervention programs have been based on emotion regulation strategies that address dysfunctional cognitive appraisals, problem-solving skills, and rumination. Another emotion regulation strategy, ‘acceptance’ training, has largely been overlooked. To examine the efficacy of this strategy, a school-based mental health program combining positive psychology with acceptance and commitment therapy (Strong Minds) was evaluated in a randomized controlled trial with a sample of 267 Year 10 and 11 high-school students in Sydney, Australia. Mixed models for repeated measures examined whether the program led to reductions in symptoms amongst students who commenced the program with high depression, anxiety, and stress scores, and increased wellbeing scores amongst all students. Results demonstrated that compared to controls, participants in the Strong Minds condition with elevated symptom scores (n = 63) reported significant reductions in depression (p = .047), stress (p = .01), and composite depression/anxiety symptoms (p = .02) with medium to strong effect sizes (Cohen's d = 0.53, 0.74, and 0.57, respectively). Increased wellbeing (p = .03) in the total sample and decreased anxiety scores (p = .048) for students with elevated symptoms were significant for Year 10 students with medium effect sizes (Cohen's d = 0.43 and 0.54, respectively). This study tentatively suggests that including the emotion regulation strategy of acceptance in early intervention programs may be effective in reducing symptoms and improving wellbeing in high school students. Further research to investigate the generalizability of these findings is warranted.     

Effects of a self-regulation intervention on exercise are moderated by depressive symptoms: A quasi-experimental study

This study investigated whether a computer-based self-regulation intervention increases physical exercise in individuals with or without depressive symptoms. A total of 361 individuals in orthopedic rehabilitation, 36 of them with depressive symptoms, were recruited in Germany. In a quasi-experimental study, individuals were allocated to either a computer-based self-regulation intervention or an online questionnaire. Exercise was measured at the beginning of rehabilitation and six weeks after rehabilitation. Depressive symptoms were assessed at the end of rehabilitation. An analysis of covariance was conducted, controlling for exercise baseline, sex, and phase of assessment. A main effect for depressive symptoms (p = .005) and intervention group (p = .011), as well as a marginal interaction of intervention x depressive symptoms were found (p = .076). Results indicate that the self-regulation exercise intervention in an orthopedic rehabilitation setting seem to be only effective in non-depressed individuals. Future research should examine how health behavior change programs can be designed more effectively for individuals with depressive symptoms.     

An Anxiety Sensitivity Reduction Smoking-Cessation Program for Spanish-Speaking Smokers (Argentina)

The present study evaluated a Spanish-language version of an Anxiety Sensitivity Reduction Program for Smoking Cessation among a sample of daily adult smokers from Argentina (n = 6; M_age = 49.4, SD = 15.43) in an open trial methodological design. To be eligible, each participant expressed a current desire to quit smoking and previous difficulties with anxiety/mood symptoms during past quit attempts (e.g., anxiety, stress, depression, irritability). Participants completed a baseline assessment and received eight 90-minute weekly group sessions. The study involved one doctoral-level and two graduate-level therapists. Follow-up visits were scheduled at 1, 2, 4, 8, and 12 weeks post-quit day. Smoking status was confirmed biochemically and via self-report at quit day and each follow-up assessment. The treatment yielded positive results in terms of attendance, positive smoking cessation outcome (5 out of 6 were abstinent at 12-week follow-up), and significant reductions in anxiety sensitivity. The results suggest potential clinical utility among Spanish-speaking smokers for an anxiety-sensitivity smoking cessation program in regard to cessation outcome.     

Time Course of Attention in Socially Anxious Individuals: Investigating the Effects of Adult Attachment Style

Theoretical models of social anxiety propose that attention biases maintain symptoms of social anxiety. Research findings regarding the time course of attention and social anxiety disorder have been mixed. Adult attachment style may influence attention bias and social anxiety, thus contributing to the mixed findings. This study investigated the time course of attention toward both negative and positive stimuli for individuals diagnosed with social anxiety disorder (SAD) and assessed whether attachment style moderates this relationship.One hundred and thirty participants (age: M = 29.03) were assessed using a semistructured clinical interview. Those meeting eligibility criteria for the clinical sample met DSM-IV criteria for SAD (n = 90, age: M = 32.18), while those in the control sample did not meet criteria for any mental disorder (n = 23, age: M = 26.04, 11 females). All participants completed self-report measures examining depression, social anxiety, adult attachment style, and completed an eye-tracking task used to measure the time course of attention. Eye-tracking data were analysed using growth curve analysis.The results indicate that participants in the control group overall displayed greater vigilance towards emotional stimuli, were faster at initially fixating on the emotional stimulus, and had a greater percentage of fixations towards the emotional stimulus as the stimulus presentation time progressed compared to those in the clinical group. Thus, the clinical participants were more likely to avoid fixating on emotional stimuli in general (both negative and positive) compared to those in the control group.These results support the Clark and Wells (1995) proposal that socially anxious individuals avoid attending to emotional information. Attachment style did not moderate this association, however anxious attachment was related to greater vigilance toward emotional compared to neutral stimuli.     

The mediating role of self-esteem in the relationship between big five personality traits and depressive symptoms among Chinese undergraduate medical students

The objectives of this study were to examine the correlations between big five personality traits and depressive symptoms among Chinese undergraduate medical students, and to explore the mediating role of self-esteem on the correlations. Self-reported questionnaires, including Big Five Inventory, the Center for Epidemiologic Studies Depression Scale, Rosenberg’s Self-Esteem scale, and socio-demographic section were distributed to 2000 undergraduate medical students at four medical colleges and universities in Liaoning province, China, in June 2014. 1738 students became the final subjects. After adjustment for age and gender, agreeableness (β = −0.329) and openness (β = −0.096) were negatively related to depressive symptoms, while neuroticism (β = 0.245) was positively related to the symptoms. Self-esteem functioned as a mediator in the relationship between agreeableness (a * b = −0.154, 95% CI: −0.182, −0.127)/openness (a * b = −0.097, 95% CI: −0.124, −0.069)/neuroticism (a * b = 0.031, 95% CI: 0.007, 0.058) and depressive symptoms. Therefore, identifying at-risk students and undertaking appropriate intervention strategies that focus on both personality traits and self-esteem may be effective in preventing and reducing depressive symptoms among Chinese medical students.     

Acceptability and Efficacy of Group Behavioral Activation for Depression Among Adults: A Meta-Analysis

The evidence base for behavioral activation (BA) as a front-line treatment for depression is grounded in individual delivery. No valid previous meta-analytic reviews of BA delivered in groups have been conducted. This study therefore examined the efficacy and acceptability of group BA drawn from clinical trial evidence. Randomized controlled trials of group BA were identified using a comprehensive literature search. Depression outcomes at posttreatment/follow-up, recovery and dropout rates were extracted and analyzed using a random-effects meta-analysis. Treatment moderators were analyzed using meta-regression and subgroup analyses. Nineteen trials were quantitatively synthesized. Depression outcomes postgroup BA treatment were superior to controls (SMD 0.72, CI 0.34 to 1.10, k = 13, N = 461) and were equivalent to other active therapies (SMD 0.14, CI -0.18 to 0.46, k = 15, N = 526). Outcomes were maintained at follow-up for group BA and moderators of treatment outcome were limited. The dropout rate for group BA (14%) was no different from other active treatments for depression (17%). Further research is required to refine the conditions for optimum delivery of group BA and define robust moderators and mediators of outcome. However, BA delivered in groups produces a moderate to large effect on depressive symptoms and should be considered an appropriate front-line treatment option.     

Body image in social anxiety disorder,obsessive–compulsive disorder,and panic disorder

Body dysmorphic disorder falls under the category of obsessive–compulsive and related disorders, yet research has suggested it may also be highly associated with social anxiety disorder. The current study examined body image variables among 68 outpatients with primary obsessive–compulsive disorder (OCD; n = 22), social anxiety disorder (SAD; n = 25), and panic disorder (PD; n = 21). Participants filled out self-report measures of body image disturbance, attitudes toward one's appearance, and anxiety. Body image disturbance and attitudes toward appearance did not significantly differ between the groups. However, SAD symptoms predicted body image disturbance, Appearance Evaluation and Body Areas Satisfaction, and OCD symptoms predicted Appearance Orientation. These findings suggest that SAD and OCD may be associated with different facets of body image. Implications for the treatment of anxiety disorders and for future research are discussed.     

Exploring the Effectiveness of a Mixed-Diagnosis Group Cognitive Behavioral Therapy Intervention Across Diverse Populations

Depression and anxiety are the most common mental health disorders seen in clinical practice and they are highly comorbid. Cognitive behavioral therapy (CBT) has been demonstrated as an effective treatment for both depression and anxiety but is often not available to all individuals who could benefit from it. This paper investigates the effectiveness of a mixed-diagnosis group CBT intervention that incorporates mindfulness meditation for individuals presenting with depression and/or anxiety: CBT Basics II. This intervention was evaluated across two distinct mental health programs to determine both if it can demonstrate positive results and if it is feasible to implement in these types of programs. Sample 1 (n = 42 completers) consisted of higher-functioning individuals in a general mental health program. Sample 2 (n = 53 completers) consisted of individuals with more chronic and severe mental health diagnoses. Overall, intent-to-treat analyses revealed improvements in psychiatric symptoms, and increases in CBT knowledge and mindfulness skill across both programs. This indicates that CBT Basics II is effective across diverse mental health populations and shows promise for improving access to CBT.     

Does Worrying Mean Caring Too Much? Interpersonal Prototypicality of Dimensional Worry Controlling for Social Anxiety and Depressive Symptoms

Worry, social anxiety, and depressive symptoms are dimensions that have each been linked to heterogeneous problems in interpersonal functioning. However, the relationships between these symptoms and interpersonal difficulties remain unclear given that most studies have examined diagnostic categories, not accounted for symptoms’ shared variability due to general distress, and investigated only interpersonal problems (neglecting interpersonal traits, interpersonal goals, social behavior in daily life, and reports of significant others). To address these issues, students (Study 1; N = 282) endorsed symptoms and interpersonal circumplex measures of traits and problems, as well as event-contingent social behaviors during one week of naturalistic daily interactions (N = 184; 7,036 records). Additionally, depressed and anxious patients (N = 47) reported symptoms and interpersonal goals in a dyadic relationship, and significant others rated patients’ interpersonal goals and impact (Study 2). We derived hypotheses about prototypical interpersonal features from theories about the functions of particular symptoms and social behaviors. As expected, worry was uniquely associated with prototypically affiliative tendencies across all self-report measures in both samples, but predicted impacting significant others in unaffiliative ways. As also hypothesized, social anxiety was uniquely and prototypically associated with low dominance across measures, and general distress was associated with cold-submissive tendencies. Findings for depressive symptoms provided less consistent evidence for unique prototypical interpersonal features. Overall, results suggest the importance of multimethod assessment and accounting for general distress in interpersonal models of worry, social anxiety, and depressive symptoms.     

Differential association between food craving,food addiction and eating-related characteristics in persons at risk for eating disorders

IntroductionFood craving is a key feature of eating disorders, but its association with medical and psychological outcome might depend on the type of eating disorder.ObjectivesThis study investigated the factors associated with food craving in individuals at risk for DSM-5 eating disorder.MethodSeventy-six women were recruited from a non-clinical population (n = 372) based on their positive screening (EDDS, QEWP-R) for binge eating disorder (BED; n = 29), anorexia nervosa (AN; n = 28) or bulimia nervosa (BN; n = 19). They completed self-administered questionnaires assessing food craving (FCQ- T-r), Body Mass Index (BMI), eating behaviour (DEBQ), food addiction (YFAS 2.0), and anxiety and depressive symptoms (HADS).ResultsIndividuals at risk for BED or BN had higher food craving than those at risk for AN. Food craving was associated with BMI only in the BED group. Food craving was positively correlated with external eating in all groups, and with emotional eating in the AN and BED groups and correlated with anxiety only in BN. Food addiction prevalence was higher in the BN group than in the AN or BED groups (respectively 94.7%, 46.4% and 65.5%; p < 0.01). In this non-clinical population, we demonstrated that food craving was differentially associated with BMI and eating-related characteristics according to the type of eating disorder.ConclusionThis suggests that food craving is a transdiagnostic dimension that should be differentially targeted depending on the type of eating disorder; future studies should test this hypothesis in clinical populations.     

Assessing Decentering: Validation,Psychometric Properties,and Clinical Usefulness of the Experiences Questionnaire in a Spanish Sample

Decentering is defined as the ability to observe one’s thoughts and feelings in a detached manner. The Experiences Questionnaire (EQ) is a self-report instrument that originally assessed decentering and rumination. The purpose of this study was to evaluate the psychometric properties of the Spanish version of EQ-Decentering and to explore its clinical usefulness. The 11-item EQ-Decentering subscale was translated into Spanish and psychometric properties were examined in a sample of 921 adult individuals, 231 with psychiatric disorders and 690 without. The subsample of nonpsychiatric participants was also split according to their previous meditative experience (meditative participants, n = 341; and nonmeditative participants, n = 349). Additionally, differences among these three subgroups were explored to determine clinical validity of the scale. Finally, EQ-Decentering was administered twice in a group of borderline personality disorder, before and after a 10-week mindfulness intervention. Confirmatory factor analysis indicated acceptable model fit, _sbχ² = 243.8836 (p < .001), CFI = .939, GFI = .936, SRMR = .040, and RMSEA = .06 (.060–.077), and psychometric properties were found to be satisfactory (reliability: Cronbach’s α = .893; convergent validity: r > .46; and divergent validity: r < − .35). The scale detected changes in decentering after a 10-session intervention in mindfulness (t = − 4.692, p < .00001). Differences among groups were significant (F = 134.8, p < .000001), where psychiatric participants showed the lowest scores compared to nonpsychiatric meditative and nonmeditative participants. The Spanish version of the EQ-Decentering is a valid and reliable instrument to assess decentering either in clinical and nonclinical samples. In addition, the findings show that EQ-Decentering seems an adequate outcome instrument to detect changes after mindfulness-based interventions.     

Risk factors of anxiety and depression in children and adolescents with headache: A cross-sectional study

IntroductionDespite numerous studies on the association between headache and psychological difficulties in children, the results remain inconclusive.ObjectiveThis cross-sectional study was conducted to clarify the links between anxiety-depression and headache in children. We evaluated the levels of anxious and depressive symptoms and the influence of risk factors: age, sex, headache diagnosis, frequency and history to identify and treat headache sufferers most at risk.MethodData were collected from a clinical sample of 368 children aged 8 to 17 years. First, a structured interview using the International Classification of Headache Disorders (ICHD-II) was used to diagnose 88 patients with migraine (M), 32 with tension-type headache (TTH), and 248 with a combination syndrome (M + TTH). Second, levels of anxiety and depressive symptoms were assessed with the Revised Children's Manifest Anxiety Scale (R-CMAS) and the Multiscore Depression Inventory for Children (MDI-C).ResultsAn ANOVA analysis showed that the mean scores for anxiety and depressive symptom levels were significantly higher among older patients and that only the M + TTH diagnosis was significantly associated with anxiety. Children with clinically significant levels of anxiety symptoms were more prevalent in our sample than in the general population (13% versus 5%). Anxiety and depression were not associated with child sex, headache frequency and history.ConclusionWe propose systematic screening for anxiety in children presenting with headache, particularly adolescents and patients with a combination diagnosis.     

Demonstration of an Integrated Treatment for Smoking Cessation and Anxiety Symptoms in People With HIV: A Clinical Case Study

Despite high rates of co-occurring tobacco use and anxiety symptoms and disorders among persons with HIV, evidence-based interventions for these individuals are not yet available. The present study sought to evaluate an integrated treatment model addressing smoking cessation and anxiety sypmtoms among HIV-positive smokers. Treatment was an 8-week intervention integrating a standard smoking cessation protocol (i.e., cognitive-behavioral therapy [CBT], nicotine replacement therapy) with CBT for anxiety. Inclusion criteria were 18–65 years of age, ≥ 10 cigarettes/day, State–Trait Anxiety Inventory [STAI-T] score of > 39, and moderate motivation (i.e., ≥ 5 out of 10 on a 10-point Likert scale) to quit smoking. Primary outcomes included scores on the Anxiety Sensitivity Index (ASI) and cigarettes smoked per day. Self-reported abstinence was biochemically verified by carbon monoxide breath analysis. Three male participants (mean age 49.3, SD = 9.1) completed through 2-month follow-up. At baseline all participants reported smoking an average of 20 cigarettes per day. Two participants quit smoking and maintained abstinence by the 2-month follow-up, and demonstrated a reduction in ASI scores. Participant 3 continued to smoke but at a reduced rate. Participants’ response to cognitive and behavioral strategies (e.g., creating balanced thoughts, interoceptive exposures) will be discussed. Clinical lessons learned include use of a flexible approach to cognitive restructuring, use of imaginal and in vivo exposures in session to better prepare patients for homework practice, and flexibility in delivering the treatment in an individual or group format. This clinical presentation provides preliminary support for the feasibility and initial effectiveness of an integrated treatment to reduce anxiety symptoms and aid in smoking cessation in anxious, HIV-positive smokers.     

Interpersonal rejection sensitivity predicts burnout: A prospective study

We examined whether interpersonal rejection sensitivity (IRS) – the hallmark of atypical depression – prospectively predicted burnout, controlling for baseline symptoms, history of depressive disorders, antidepressant intake, gender, age, and length of employment (mean between-assessment duration: 21 months; n = 578; 74% female). IRS was related to a 119% increased risk of burnout at follow-up. Three of four burned out participants reported to be affected by IRS, or 2.5 times the rate observed in participants with no (or subthreshold) burnout symptoms. Our study highlights a dispositional factor in burnout’s etiology also known to be a key component of atypical depression’s etiology. The ontogenesis of individual vulnerabilities to burnout should be further examined in future research.     

Adolescents with and without a facial difference: The role of friendships and social acceptance in perceptions of appearance and emotional resilience

This study investigated the role of friendships and social acceptance in self-perceptions of appearance and depressive symptoms, comparing adolescents with and without a facial difference. Adolescents with a visible cleft (n = 196) were compared with adolescents with a non-visible cleft (n = 93), and with a comparison group (n = 1832). Boys with a visible difference reported significantly more positive perceptions of friendships and less depressive symptoms than the comparison group. These results were interpreted in the context of indicators of emotional resilience. The objective measure of facial difference did not explain levels of depressive symptoms, while subjective measures did. Subjective ratings of appearance mediated the association between social acceptance and depressive symptoms in all samples. Gender did not contribute in explaining the paths between friendships, appearance, and depressive symptoms. The associations between perceptions of social acceptance, appearance, and emotional distress, support the possible utility of strengthening social experiences in preventing and treating appearance-concerns.     

Precursors of social emotional functioning among full-term and preterm infants at 12 months: Early infant withdrawal behavior and symptoms of maternal depression

This study forms part of a longitudinal investigation of early infant social withdrawal, maternal symptoms of depression and later child social emotional functioning. The sample consisted of a group of full-term infants (N = 238) and their mothers, and a group of moderately premature infants (N = 64) and their mothers. At 3 months, the infants were observed with the Alarm Distress Baby Scale (ADBB) and the mothers completed the Edinburgh Postnatal Depression Scale (EPDS). At 12 months, the mothers filled out questionnaires about the infants’ social emotional functioning (Infant Toddler Social Emotional Assessment and the Ages and Stages Questionnaire-Social Emotional). At 3 months, as we have previously shown, the premature infants had exhibited more withdrawal behavior and their mothers reported elevated maternal depressive symptoms as compared with the full-born group. At 12 months the mothers of the premature infants reported more child internalizing behavior. These data suggest that infant withdrawal behavior as well as maternal depressive mood may serve as sensitive indices of early risk status. Further, the results suggest that early maternal depressive symptoms are a salient predictor of later child social emotional functioning. However, neither early infant withdrawal behavior, nor gestational age, did significantly predict social emotional outcome at 12 months. It should be noted that the differences in strength of the relations between ADBB and EPDS, respectively, to the outcome at 12 months was modest. An implication of the study is that clinicians should be aware of the complex interplay between early infant withdrawal and signs of maternal postpartum depression in planning ports of entry for early intervention.     

Does “feeling down” mean seeing down? Depressive symptoms and vertical selective attention

Prior research reveals that the encoding of affective stimuli is biased in a metaphorically consistent manner (e.g., good = up; bad = down). For example, negative words are evaluated faster if they are presented in a low versus high vertical position. The present studies extended this view by investigating whether such biases also correlate with individual differences in emotional experience. Specifically, in two studies, we examined whether vertical metaphor would be useful in understanding negative affect as manifested in neuroticism and depressive symptoms. We found support for this premise. That is, the higher the neuroticism (Studies 1 and 2) or depressive symptoms (Study 2) of participants, the faster they were to respond to or detect lower (versus higher) spatial attention targets. These results suggest that negative affect in general, and depressive symptoms in particular, appear to bias selective attention in a direction that favors lower regions of physical space.     

Maternal postpartum depressive symptoms and infant externalizing and internalizing behaviors

Maternal postpartum depression has been shown to be one of the main predictors of externalizing and internalizing behaviors in toddlers and adolescents. Research suggests that presence of such behaviors can be observed as early as infancy. The current study uses longitudinal data from 247 mothers to examine the relationship between postpartum depressive symptoms at 8 weeks and the infant's externalizing and internalizing behaviors at 12 months. In unadjusted linear regression models, there were associations between postpartum depressive symptoms and infant externalizing behaviors (β = 0.082, SE = 0.032, p = 0.012) and internalizing behaviors (β = 0.111, SE = 0.037, p = 0.003). After controlling for potential confounding factors, including maternal age, race, education, home ownership, smoking status in the postpartum period, marital status, parenting stress, and happiness from becoming a parent, the associations between postpartum depressive symptoms and infant externalizing (β = 0.051, SE = 0.034, p = 0.138) and internalizing behaviors (β = 0.077, SE = 0.040, p = 0.057) were reduced and became non-significant. Furthermore, in these models the total amount of variance explained was 17.2% (p < 0.0001) for externalizing behaviors and 10.5% (p < 0.01) for internalizing behaviors; the only significant predictor of externalizing behaviors was maternal age (β = −0.074, SE = 0.030, p = 0.014), and of internalizing behaviors was white non-Hispanic ethnicity (β = −1.33, SE = 0.378, p = 0.0005). A combined effect of the confounding factors seems to explain the finding of no significant independent association between postpartum depressive symptoms and infant externalizing and internalizing behaviors.