Eating Disorder Symptom and Fear Change Trajectories During Imaginal Exposure Therapy: A Slope Network Analysis

Eating disorders (EDs) are characterized by fears related to food, body image, and social evaluation. Exposure-based interventions hold promise for targeting a range of ED fears and reducing ED psychopathology. We investigated change mechanisms and optimal fear targets in imaginal exposure therapy for EDs using a novel approach to network analysis. Individuals with an ED (N = 143) completed up to four online imaginal exposure sessions. Participants reported ED symptoms and fears at pretreatment, posttreatment, and 6-month follow-up. We constructed networks of symptoms (Model 1), fears (Model 2), and combined symptoms and fears (Model 3). Change trajectory networks from the slopes of symptoms/fears across timepoints were estimated to identify how change in specific ED symptoms/fears related to change in other ED symptoms/fears. The most central changing symptoms and fears were feeling fat, fear of weight gain, guilt about one’s weight/shape, and feared concerns about consequences of eating. In Model 3, change in ED fears bridged to change in desire to lose weight, desiring a flat stomach, following food rules, concern about eating with others, and guilt. As slope networks present averages of symptom/fear change slopes over the course of imaginal exposure therapy, further studies are needed to examine causal relationships between symptom changes and heterogeneity of change trajectories. Fears of weight gain and consequences of eating may be optimal targets for ED exposure therapy, as changes in these fears were associated with maximal change in ED pathology. Slope networks may elucidate change mechanisms for EDs and other psychiatric illnesses.     

Duty-Related Posttraumatic Stress Symptoms in 911 Telecommunicators: The Roles of Childhood Trauma Exposure and Emotion-Focused Coping

A history of childhood trauma exposure has been linked to the development of posttraumatic stress symptoms in adulthood following new exposure. Unhealthy coping behaviors that could develop or be utilized in response to early trauma could lend themselves to psychological issues in adulthood. Emotion-focused and problem-focused coping strategies in relation to stressful duty-related situations are examined as indirect pathways through which childhood trauma exposure could be associated with duty-related posttraumatic stress symptoms in 911 telecommunicators (N = 808). Multiple mediation models revealed that 3 of the 4 emotion-focused coping strategies, but not the problem-focused strategies, functioned as significant mediators in the association between childhood exposure and duty-related posttraumatic stress symptoms. Pairwise comparisons showed that self-controlling and escape-avoidance strategies were the strongest pathways of the indirect childhood trauma exposure–posttraumatic stress symptoms association. Implications of results regarding coping in response to new traumatic events in adulthood and potential research and intervention directions are discussed.     

Avoidance Behavior Following Terror Event Exposure: Effects of Perceived Life Threat and Jewish Religious Coping

The current research was designed to examine associations of perceived life threat (PLT) and religious coping with the development of avoidance behavior following terror event exposure. Based upon the terror management theory (TMT), we hypothesized that religious coping, through its effect on religious beliefs as a meaning system, would moderate the impact of threat, as expressed in PLT, on an individual's reaction to terror event exposure, as manifested in avoidance behavior. Participants were 591 Israeli Jewish students who were vicariously or directly exposed to a terror event in the past. We report a significant interaction between PLT and negative religious coping. PLT was positively associated with avoidance behavior but this relationship was more profound among persons who reported high negative religious coping. Secular students reported higher rates of avoidance behavior and negative religious coping and were more likely than religious students to report intrapersonal religious conflict. Our findings suggest that terror event exposure is associated with an elevated sense of threat, which is, at least in part, associated with a weakening of prior religious beliefs.     

Memories of Childhood Threat,Fear of Disclosure and Paranoid Ideation: A Mediation Analysis Using a Nonclinical Sample

This study investigated whether associations between childhood memories of threat and adult paranoia could be partially mediated by factors associated with impeded interpersonal communication (concealment and fear of disclosure of personal and distressing information). University undergraduates (N = 179) completed a battery of psychometric scales. Mediation analysis identified a direct effect between early memories of threat and paranoid ideation (B = 0.11, 95% CI = [0.07, 0.14], p = .00). A mediated effect between these variables was also significant (B = .05, 95% CI = [0.02, 0.07], p = .01). However, although significant associations were identified between memories of threat and each of the mediating variables (self-concealment, fear of self-disclosure, anxiety, depression) only fear of self-disclosure displayed a significant association with paranoid ideation (B = .05, 95% CI = [0.02, 0.07], p = .01).     

Exposure,Resource Loss,and Posttsunami Trauma

This study analyzed whether survivors’ resource loss mediates the effects of exposure on posttsunami trauma. Fourteen months posttsunami, 416 survivors were interviewed from the nine worst-affected habitations of the Nagapattinam district in Tamil Nadu (India). Exposure was measured using a checklist; trauma and resource loss were assessed using inventories. Findings indicate that the indirect effects of tsunami exposure on trauma via resource loss were a more potent predictor than the direct effects of exposure on trauma. Resource loss was a vehicle through which the effects of exposure passed on to posttsunami trauma.     

Coping with Severe Mental Illness: Relations of the Brief COPE with Symptoms, Functioning, and Well-Being

The way patients cope with the experience of having an episode and being hospitalized for psychiatric disorder may relate to symptom severity, social functioning, and psychological well-being. Coping was assessed among 70 psychiatric inpatients diagnosed primarily with schizophrenia, major depressive disorder, and schizoaffective disorder. The Brief COPE—a questionnaire developed in health psychology (C. S. Carver, 1997)—was administered in interviewer-assisted format during patients' stay on the ward. Thirty patients were re-interviewed an average of 6 weeks after discharge. Among patients with schizophrenia, schizophrenia symptom severity correlated inversely with adaptive coping (e.g., acceptance, planning, seeking support) but did not correlate with maladaptive coping (e.g., self-blame, denial). Among those with schizophrenia, deficits in adaptive coping also predicted relative increases in schizophrenia symptoms over time, controlling for intake symptom severity. Among patients without schizophrenia, maladaptive coping correlated concurrently with depressive symptoms. Several hypothesized associations between concurrent coping, functioning, and well-being were also documented.     

Threat, Authoritarianism, and Selective Exposure to Information

We examined the hypothesis that threat alters the cognitive strategies used by high authoritarians in seeking out new political information from the environment. In a laboratory experiment, threat was manipulated through a "mortality salience" manipulation used in research on terror management theory ( Pyszczynski, Solomon & Greenberg, 2003 ). Subjects (N = 92) were then invited to read one of three editorial articles on the topic of capital punishment. We found that in the absence of threat, both low and high authoritarians were responsive to salient norms of evenhandedness in information selection, preferring exposure to a two-sided article that presents the merits of both sides of an issue to an article that selectively touts the benefits of the pro or con side of the issue. However, in the presence of threat, high but not low authoritarians became significantly more interested in exposure to an article containing uniformly pro-attitudinal arguments, and significantly less interested in a balanced, two-sided article. Finally, a path analysis indicated that selective exposure to attitude-congruent information led to more internally consistent policy attitudes and inhibited attitude change. Discussion focuses on the role of threat in conditioning the cognitive and attitudinal effects of authoritarianism.     

Exposure,Agency, Perceived Threat,and Guilt as Predictors of Posttraumatic Stress Disorder in Veterans

Using a sample of 289 Iraq/Afghanistan veterans, this study examined the contributions of combat exposure, agency, perceived threat, and guilt to posttraumatic stress disorder (PTSD) symptoms. Regression analyses indicated the four variables (together with demographic variables) accounted for 79% of the variance in PTSD symptoms. Guilt was the most important predictor. In addition, guilt mediated between exposure and PTSD symptoms, perceived threat and PTSD symptoms, and agency and PTSD symptoms. Implications of these findings are discussed.     

Adolescent Coping and Neighborhood Violence: Perceptions, Exposure, and Urban Youths' Efforts to Deal with Danger

Neighborhood violence is a persistent source of danger, stress, and other adverse outcomes for urban youth. We examined how 140 African American and Latino adolescents coped with neighborhood danger in low, medium, and high crime neighborhoods throughout Chicago. Participants reported using a range of coping strategies (measured via a modified version of the Ways of Coping Scale; R. S. Lazarus & S. Folkman, 1984). In low and medium crime rate areas, using confrontive strategies was significantly correlated with increased exposure to violence, and no strategies were associated with perceptions of safety. Coping strategies were associated with perceived safety to a substantial degree only in high crime neighborhoods, and none were associated with exposure to violence. A k means cluster analysis identified groups that differed in coping profiles and varied in rates of exposure to violence. Moderating effects of gender, ethnicity, and neighborhood were found for both person level and variable level analyses.     

Foreign Language Exposure,Cultural Threat,and Opposition to Immigration

In the present article, we extend the notion of cultural threat posed by immigrants beyond its current conceptualization as symbolic, collective‐level threats to American culture and identity. Instead, we argue that routine encounters with non‐English‐speaking immigrants cause many individuals to feel threatened because of real barriers to interpersonal communication and exchange. We draw upon survey and experimental data to demonstrate that local contact with immigrants who speak little to no English, as well as incidental exposure to the Spanish language, heighten feelings of cultural threat, which increases anti‐immigrant sentiment and policy preferences.     

Keeping Engaged During Deployment: The Interplay Between Self-Efficacy,Family Support,and Threat Exposure

This study investigated the importance of 2 resilience resources for service members’ ability to deal with threat during deployment. Military self-efficacy and family support were measured before deployment and related to work engagement and burnout levels of service members during deployment. We hypothesized that in high threat situations, low self-efficacy would lead to unfavorable outcomes, whereas in low threat situations, high self-efficacy could have negative consequences. In addition, we hypothesized that family support would compensate for both effects. The results showed these expected 3-way interactions. We found that strong self-efficacy helped service members deal with exposure to threatening situations during deployment, leading to more work engagement and less burnout. However, having strong self-efficacy without being exposed to threat during deployment reduced service members’ work engagement and increased burnout. In addition, we found that the presence of family support compensated for these effects. Service members with low self-efficacy benefitted from family support when threat exposure was high, whereas service members with high self-efficacy benefitted from family support when threat exposure was low. As such, family support seemed to act as a compensatory mechanism for the potential negative effects of self-efficacy. This underlines the importance of studying the interplay between resources that help service members deal with deployment experiences. Practical implications relate to supporting service members’ resilience through enhancing multiple resources.     

Social,Religious and Spiritual Capital and Physical/Emotional Functioning in a National Sample of African Americans

Spiritual and religious capital are forms of the broader construct of social capital. The present study, using probability‐based sampling methods, surveyed a national sample of African American adults to examine the relative contributions of spiritual and religious capital to their physical and emotional functioning. Analyses were conducted to determine if these constructs made a unique contribution above and beyond general social capital. African American men and women (N = 803) were interviewed by telephone. Hierarchical linear regressions revealed that, across the full sample, although social capital was a positive predictor of physical and emotional functioning (p < .05 and p < .001), neither religious nor spiritual capital made an additional contribution to these outcomes. However, the relationships among these variables differed for men and women. Among men, social capital predicted positive emotional functioning (p < .001) but not physical functioning; spiritual and religious capital made no additional contribution to either outcome variable. Among women, social capital predicted positive emotional functioning (p < .01) but not physical functioning. However, religious capital did make a significant additional contribution to the prediction of emotional functioning (ΔR², p < .01). Dividing the sample into different age groups did not produce any different findings from those found with the sample as a whole. Findings are discussed in terms of implications for church‐ and faith‐based health promotion interventions aimed at health disparities reduction. Copyright © 2011 John Wiley & Sons, Ltd.     

Diagnostic Features,Symptom Severity,and Help-Seeking in a Media-Recruited Sample of Women with Driving Fear

This paper examines the clinical features, symptom severity, diagnostic profile, and help-seeking behaviour of a media-recruited sample of driving-fearful women. Results support previous findings of the primary foci of fear as motor vehicle accidents as well as specific driving situations and conditions. Consistent with prior research, there was difficulty relating the foci of fear to current diagnostic concepts. Social concerns were identified as having a role in driving fear for some individuals. Fearful participants exhibited high levels of fear and symptom severity according to various diagnostic and self-report measures, although most reported that they would be unlikely to seek professional psychological help or driving instruction. Assessment of cognitions indicated a range of errors likely to maintain anxiety and fear reactions that would be a target of treatment. There were no group differences in number of major recent accidents, although fearful drivers learnt to drive later than controls, suggesting early fearfulness.

Fear of fear,trait anxiety and aerobic fitness in relation to state anxiety during adrenalin provocation

Abstract

Psychological explanations of both spontaneous and experimentally induced panic anxiety stress the role of fear of fear, especially fear of bodily symptoms of arousal. Fear of fear is conceptually different from trait anxiety but may be associated with repeated experience of arousal symptoms in fearful situations, while frequent physical exercise may lead to habituation to these symptoms. To test this hypothesis, 44 healthy male volunteers, classified as having high or low trait anxiety and high or low aerobic fitness, underwent a single-dose adrenalin infusion (80 nanogram/kilogram bodyweight/minute). In both groups, during the experiment a significant rise in state anxiety was found; compared to the group with low trait anxiety, subjects with high trait anxiety reported higher levels of state anxiety, which could be attributed to differences in aerobic fitness. In the high-anxious group, subjects showed a greater decrease in state anxiety during the recovery phase. State anxiety during adrenalin was strongly associated with fear of bodily symptoms only in the high-anxious group. Correlations between trait anxiety and somatic anxiety were not significant; state anxiety scores tended to correlate negatively with physical fitness. It is concluded that these results lend support to a fear of fear-model of panic anxiety.     

Dropping Safety Aids and Maximizing Retrieval Cues: Two Keys to Optimizing Inhibitory Learning During Exposure Therapy

The inhibitory learning model of exposure therapy posits that clinical anxiety is most effectively treated when clinicians employ strategies that maximize the (a) violation of negative expectancies and (b) generalization of nonthreat associations. Translation of basic learning research to exposure therapy via this explanatory model underscores two keys to optimizing inhibitory learning during exposure: dropping safety aids and maximizing retrieval cues. Although topographically similar, safety aids and retrieval cues are functionally distinct as well as therapeutically incompatible. In the present article, we delineate safety aids and retrieval cues in the context of exposure therapy from an inhibitory learning perspective, providing illustrative case examples of how clinicians may address the two when treating patients with clinical anxiety.     

Perceived Threat,Social Identification,and Psychological Well‐Being: The Effects of Political Conflict Exposure

Using data drawn from the adult population in Northern Ireland (N = 1,515), this article examines the relationship between perceived intergroup threat and psychological well‐being, taking into consideration the mediating role of social identification and the moderating role of political conflict exposure. Results by and large confirmed our predictions that perceived threat would be directly associated with poorer well‐being but would also exert a positive indirect effect on well‐being via increased social identification. However, these relationships were dependent on individuals' prior conflict exposure, such that the positive indirect relationship between perceived threat and psychological well‐being emerged only for two subpopulations: individuals who had high direct and high indirect exposure to conflict, and individuals who had low direct, but high indirect conflict exposure. No indirect effects emerged for individuals with relatively lower conflict exposure. Results are discussed with regard to their implications for research on the consequences of intergroup threat in political conflict settings and beyond.     

Shared Traumatic Reality and Boundary Theory: How Mental Health Professionals Cope With the Home/Work Conflict During Continuous Security Threats

ABSTRACT

In a shared traumatic reality, mental health professionals and their clients are exposed to the same communal disaster. Both living and working in the same high-stress community can create a conflict between the professional's work and his or her private life. The author analyzed three focus groups consisting of 30 mental health professionals who worked with traumatized populations in a missile-stricken area in southern Israel. The professionals’ experience was explored through the lens of boundary theory by examining the ways in which they created and maintained boundaries between the different domains of their lives. Findings demonstrated that these professionals presented a continuum of segmentation and integration of the domains as suggested by boundary theory, when both living and working in a highly stressed environment. The discussion deals with possible costs and benefits of the boundary theory continuum.     

Using Client Narratives to Identify Predictors of Outcome in Written Exposure Therapy and Cognitive Processing Therapy

Written exposure therapy (WET) is a brief, five-session treatment for posttraumatic stress disorder (PTSD) that aims to improve access to care. WET has been demonstrated to be an efficacious PTSD treatment with lower rates of dropout and noninferior PTSD symptom outcome compared to cognitive processing therapy (CPT), a 12-session, gold-standard treatment. To identify predictors of treatment outcome in both WET and CPT, the current study examined the content of participants’ written narratives. Participants were 123 adults with PTSD who were randomly assigned to receive WET (n = 61) or CPT (n = 62). The Change and Growth Experiences Scale (CHANGE) coding system was used to code all available narratives in both treatment conditions for variables hypothesized to be relevant to therapeutic change. Linear regression analyses revealed that in WET, higher average levels of accommodated (healthy, balanced) beliefs and an increase in accommodated beliefs from the first to the final impact statement predicted better PTSD symptom outcome at 12 weeks postrandomization. In CPT, higher average levels of overgeneralized and accommodated beliefs and lower levels of avoidance expressed in the narratives predicted better PTSD outcome. There were no significant predictors of outcome in analyses of change from the first to final impact statement in CPT. These findings add to research identifying predictors of change in WET and CPT by highlighting the importance of low avoidance in CPT and of trauma-related cognitions in both CPT and WET, even though WET is a brief written intervention that does not explicitly target cognitive change.     

Exposure to War Trauma, War-Related PTSD, and Psychological Impact of Subsequent Hurricane

This study explored the impact of psychological outcomes to war on response to subsequent natural disaster. Participants were 312 military personnel, 66% of whom saw Gulf War duty. All were exposed to the 1992 Hurricane Andrew. Troops were compared on reported traumatic events, hurricane impact responses, and psychological symptoms in subgroups defined by war or no war exposure prior to hurricane and by presence or absence of war-related posttraumatic stress disorder (PTSD). Data were gathered in face-to-face clinical assessments. War trauma prior to hurricane was associated with more reported traumatic events, greater fears for safety during the hurricane, and heightened psychological symptoms. Troops with preexisting war-related PTSD showed more adverse psychological hurricane sequelae and reported more traumatic events, higher depression, anxiety, anger, PTSD symptoms, and physical symptoms, and lower self-esteem than those free of diagnoses. Results point to the negative influence of exposure to one traumatic event on the experience of and response to a subsequent stressor.     

Exposure to violence and suicide risk in adolescents: a community study

The prevalence of violence exposure is relatively unexplored in adolescents in European communities, and reports on the association between exposure to community violence and suicidal behavior are rare. The aim of this study was to investigate (1) the prevalence of community violence in a European urban adolescent sample, (2) the relationship between exposure to community violence and suicidal ideation/deliberate self-harm, and (3) the influence of depressive symptoms and aggressive behavior on this relationship. Self-report surveys were administered to a representative school-based sample of 1509 adolescents in Antwerp (Belgium). The prevalence rate of violence exposure was still high but lower than that reported in U.S. communities. Suicidal ideation and deliberate self-harm were both related to violence exposure. The gender-specific influence of depressive symptomatology and aggressive behavior on the association between exposure to violence and suicidal behavior suggests the need for further research.