Prospective predictors of suicidality: defeat and entrapment lead to changes in suicidal ideation over time

Theoretical perspectives into suicidality have suggested that heightened perceptions of defeat and entrapment lead to suicidality. However, all previous empirical work has been cross-sectional. We provide the first longitudinal test of the theoretical predictions, in a sample of 79 students who reported suicidality. Participants completed self-report measures of suicidal ideation, depression, defeat, and entrapment at two time points, approximately 12 months apart. People higher in defeat became more suicidal over time (β= .45), with baseline levels of suicidality and depressive symptoms controlled. The current results support the posited role of perceived defeat in driving suicidal ideation.     

Visuospatial and mathematical dysfunction in major depressive disorder and/or panic disorder: A study of parietal functioning

The parietal cortex is critical for several different cognitive functions, including visuospatial processing and mathematical abilities. There is strong evidence indicating parietal dysfunction in depression. However, it is less clear whether anxiety is associated with parietal dysfunction and whether comorbid depression and anxiety are associated with greater impairment. The present study compared participants with major depression (MDD), panic disorder (PD), comorbid MDD/PD and controls on neuropsychological measures of visuospatial processing, Judgement of Line Orientation (JLO), and mathematical abilities, Wide Range Achievement Test (WRAT) Arithmetic. Only comorbid MDD/PD was associated with decreased performance on JLO, whereas all psychopathological groups exhibited comparably decreased performance on WRAT Arithmetic. Furthermore, the results were not accounted for by other comorbid disorders, medication use or psychopathology severity. The present study suggests comorbid depression and anxious arousal are associated with impairment in visuospatial processing and provides novel evidence indicating mathematical deficits across depression and/or anxiety. Implications for understanding parietal dysfunction in internalising psychopathology are discussed.     

A Brief,Early Cognitive-Behavioral Program for Cancer-Related PTSD,Anxiety, and Comorbid Depression

Depression and anxiety disorders, including PTSD, are highly prevalent and frequently co-occur in newly diagnosed head and neck cancer (HNC) patients, as well as in longer-term survivors. There is, however, scant empirical evidence to inform clinicians how to best treat distressed HNC patients, particularly in the initial months following their diagnosis. The present article describes the development of a brief, early cognitive-behavioral intervention (the HNC-CBT program) in treating cancer-related PTSD and/or comorbid anxiety and depressive disorders in recently diagnosed HNC patients. The program was developed to be implemented concurrently with patients’ medical treatment(s) to help individuals manage their acute anxiety and PTSD reactions, as well as prevent chronic psychopathology in the postmedical treatment recovery phase. A case study is also presented to illustrate how to apply this intervention with clinically distressed HNC patients. Feasibility issues are also discussed in the implementation of this program during the course of medical treatment.     

Relationships between health behaviors,posttraumatic stress disorder,and comorbid general anxiety and depression

Poor health outcomes associated with posttraumatic stress disorder (PTSD) may reflect engagement in unhealthy behaviors that increase morbidity risk and disengagement in healthy behaviors that decrease morbidity risk. Although research supports this pattern, findings are not definitive, particularly for healthy behaviors. Many studies have not controlled for effects of concurrent generalized anxiety and depression, which might explain conflicting findings. To address this limitation, we used an online cross-sectional research design and multivariate multilevel modelling to evaluate associations between a multitude of health behaviors (i.e. sedentary behavior, sleep quality, physical activity, eating habits, alcohol use and substance use) and PTSD, while adjusting for comorbid generalized anxiety and depression, in a sample of trauma-exposed individuals (N = 246). Our results indicate that PTSD and comorbid generalized anxiety and depression symptoms were differentially associated with specific health constructs. Specifically, sedentary behavior and poor sleep quality were associated with PTSD, whereas low physical activity, poor sleep quality, and unhealthy eating habits were associated with depression. Both increased alcohol and substance use were associated with generalized anxiety. Results from our study highlight the need to conceptualize associations between health behaviors and specific psychological symptoms in a comprehensive manner as part of clinical presentations of PTSD.     

Changes in Emotions Over the Course of Dialectical Behavior Therapy and the Moderating Role of Depression,Anxiety, and Posttraumatic Stress Disorder

Evidence-based borderline personality disorder (BPD) treatments such as dialectical behavior therapy (DBT) emphasize the acquisition and use of strategies to down regulate negative emotion. However, little research examines whether specific emotions change during DBT. Further, it is unclear if BPD-relevant comorbidities that involve heightened emotion—namely, depression, anxiety disorders, and posttraumatic stress disorder (PTSD)—moderate these outcomes. This study investigated which specific emotions (hostility/anger, fear, shame/guilt, and sadness) decrease during DBT, and whether comorbid depression, anxiety disorders, and PTSD moderate these outcomes. Individuals with BPD (N = 101) completed 6 months of standard DBT and provided measurements of specific emotions at every session and at pre-, mid-, and posttreatment. Generalized estimating equations revealed moderate effect-sized reductions in anger at major assessment time points. Anxiety disorders and PTSD moderated the effect of time on fear, shame, and guilt. PTSD also moderated the effect of time on sadness. For all moderating effects, individuals with the comorbidity exhibited greater reductions than those without. These findings corroborate that DBT reduces several specific emotions, and comorbid PTSD and anxiety disorders may facilitate this effect for fear, shame/guilt, and sadness (clinical trial registration number = NCT03123198).     

Self-report measures of defeat and entrapment during a brief depressive mood induction

Recent studies have reported that depression is strongly associated with perceptions of defeat and entrapment, and have proposed that such perceptions are central features of depression. This study used experimental mood induction procedures to investigate the putative causal relationship between perceptions of defeat/entrapment and depressed mood. Two groups of female undergraduate volunteers (n = 16) completed visual analogue mood scales, as well as Defeat and Entrapment scales, before and after either a negative or a positive musical mood induction procedure (MIP). Scores on the Defeat and Entrapment Scales were significantly correlated with scores on the Beck Depression Inventory (BDI). The negative MIP caused a worsening of mood and significantly increased perceptions of defeat and entrapment, particularly internal entrapment. The positive MIP caused a small but significant improvement in mood, and significantly decreased defeat scores. Individuals with elevated BDI or internal entrapment scores prior to the negative MIP showed the greatest increases in internal entrapment after the negative mood induction. The results demonstrate that induction of a depressed mood increases perceptions of defeat and entrapment, and suggest that, in the case of internal entrapment, this effect increases with the initial level of depression or entrapment.     

Relation of early menarche to depression, eating disorders, substance abuse, and comorbid psychopathology among adolescent girls

This prospective study tested whether early menarche partially accounts for the increases in depression, eating pathology, substance abuse, and comorbid psychopathology that occur among adolescent girls, with structured interview data from a community sample (N = 496). Early menarche (prior to 11.6 years) was associated with elevated depression, substance abuse, and "any" disorder but did not confer increased risk for anorexia nervosa, bulimia nervosa, or binge eating disorder. Although there was significant comorbidity across all three classes of pathology, early menarche was associated only with comorbid depression and substance abuse. Results provide partial support for the assertion that early menarche is a general risk factor for psychopathology among adolescent girls but suggest that this risk may not apply to certain disorders and that the effects are modest in size.     

Prolonged Exposure Therapy and Irritable Bowel Syndrome: A Case Study Examining the Impact of a Trauma-Focused Treatment on a Physical Condition

Previous research has shown that psychological treatments, particularly those employing cognitive techniques, are particularly effective in the treatment of irritable bowel syndrome (IBS). It is presumed that these psychological interventions are effective at ameliorating the IBS by treating an underlying psychological disorder (often an anxiety disorder), which may be contributing to the autonomic reactivity. This case study examined the change in the physical symptoms of IBS for a patient seeking treatment for rape-related PTSD with comorbid conditions of major depression and panic. At posttreatment, the patient no longer met criteria for PTSD, major depression, or panic. In addition, her primary symptom of IBS, diarrhea frequency, was significantly improved. These findings were maintained at 3 and 9 months posttreatment. Implications for the assessment and treatment of IBS patients with PTSD are discussed.     

Comorbidity In Post-Traumatic Stress Disorder An Analysis of Community and Clinical Studies1

Post-traumatic stress disorder (PTSD) is alleged to be associated with high rates of concurrent psychological disorders. This paper considers the available literature regarding comorbidity in PTSD and reviews in detail the findings to date. This critical evaluation includes studies of clinical samples, veterans community surveys, and population surveys. It also presents new data drawn from 50 PTSD cases assessed at the Boston PTSD Center using a comprehensive, multidimensional diagnostic procedure. The data firmly support the notion that PTSD, regardless of the nature of the trauma, is associated with high rates of other major psychological disorders including substance abuse, major depression, and personality disorders. Despite these findings the issue of cause and effect surrounding comorbidity remains open at this time. More research is needed to determine if exposure to extreme stressors in fact produces the broad spectrum of psychopathology suggested by individuals with PTSD or whether individuals with intrinsic vulnerability are more likely to develop PTSD when exposed to extreme stressors. Implications of the findings from this review are discussed with respect to concepts in diagnosis and comorbidity.     

Diagnostic morbidity and its relationship to severity of ideation for a nonpsychiatric sample of chronic and severe suicide ideators

This study examined the relationships of frequency and type of psychiatric diagnosis to suicidality within a sample of chronically and severely ideating college-aged students (N=78). The most common diagnoses were the depressive disorders, comprising 43% of all diagnoses, followed by anxiety disorders, comprising 17% of all diagnoses. Retrospective reports of childhood diagnoses were also quite common, comprising 38% of all diagnoses. Number of psychiatric diagnoses was significantly correlated with severity of suicidal ideation (r=.27,p<.02). Hierarchical regression analyses revealed that retrospective childhood diagnoses of attention deficit hyperactivity disorder (ADHD) and separation anxiety disorder significantly predicted 19% of the variance in severity of suicidal ideation after controlling for current diagnoses of major depression and PTSD. When entry of childhood and current diagnoses were reversed, PTSD significantly predicted 4% of the variance in severity of suicidal ideation, while major depression was rendered nonsignificant. Severe suicide ideation, therefore, may be a product of early psychological problems as well as the number of such problems.     

Are defeat and entrapment best defined as a single construct?

The concepts of defeat and entrapment have been employed in evolutionary accounts of clinical phenomena such as depression and suicide. Recently theorists have argued that both concepts may be best conceptualised as a single distinct factor. The current study is the first to empirically test this assertion. A sample of 305 students completed measures of defeat and entrapment. Their responses were then analysed via exploratory factor analysis. The results strongly suggest that a single factor underlies both defeat and entrapment. These findings have considerable implications for past studies and theoretical accounts that rely on the distinction between defeat and entrapment.     

The psychology of ongoing threat: relative risk appraisal, the September 11 attacks, and terrorism-related fears

There are now replicated findings that posttraumatic stress disorder (PTSD) symptoms related to the September 11, 2001, attacks occurred in large numbers of persons who did not fit the traditional definition of exposure to a traumatic event. These data are not explained by traditional epidemiologic "bull's eye" disaster models, which assume the psychological effects are narrowly, geographically circumscribed, or by existing models of PTSD onset. In this article, the authors develop a researchable model to explain these and other terrorism-related phenomena by synthesizing research and concepts from the cognitive science, risk appraisal, traumatic stress, and anxiety disorders literatures. They propose the new term relative risk appraisal to capture the psychological function that is the missing link between the event and subjective response in these and other terrorism-related studies to date. Relative risk appraisal highlights the core notion from cognitive science that human perception is an active, multidimensional process, such that for unpredictable societal threats, proximity to the event is only one of several factors that influence behavioral responses. Addressing distortions in relative risk appraisal effectively could reduce individual and societal vulnerability to a wide range of adverse economic and ethnopolitical consequences to terrorist attacks. The authors present ways in which these concepts and related techniques can be helpful in treating persons with September 11- or terrorism-related distress or psychopathology.     

Cigarette Smoking, Anxiety, and Depression

This review provides a detailed analysis of anxiety and depression as they relate to each stage of the cigarette smoking cycle: initiation, maintenance, and cessation with an emphasis on nicotine withdrawal. An analysis of the literature confirms that cigarette smoking is highly comorbid with anxiety disorders and clinical depression, and that this relationship appears to be moderated by factors such as age of the smoker, type of disorder, and level of nicotine dependence. Studies also offer evidence to suggest a relationship between smoking and both subclinical anxiety and depression. Research findings have not revealed whether common factors influence the development of anxiety, depression, and smoking, whether anxiety and depression lead to smoking, or whether the reverse is true. Nevertheless, a current understanding of the links among smoking, anxiety, and depression confirms current prevention and cessation techniques, as well as suggests new directions for research and clinical practice.     

Clinical Effectiveness of an Intensive Outpatient Program for Integrated Treatment of Comorbid Substance Abuse and Mental Health Disorders

Comorbid substance use disorders (SUDs) and mental health disorders are a pervasive problem among post-9/11 veterans and service members. Treatment of SUD and comorbid disorders has historically occurred separately and sequentially, and when treated concurrently has been primarily done in a weekly outpatient setting, which has high rates of dropout. The current study describes an integrated 2-week intensive outpatient treatment (IOP) using cognitive-behavioral therapy, including prolonged exposure for posttraumatic stress disorder (PTSD), unified protocol for anxiety and mood disorders, and relapse prevention for SUD. Forty-two patients completed the comorbid treatment program. Results indicated that self-reported substance use, PTSD, and depression symptoms significantly decreased following treatment, while satisfaction with participation in social roles increased. These preliminary effectiveness data indicate that comorbid SUD and mental health disorders can be effectively treated in a 2-week intensive outpatient program.     

A Preliminary Examination of Thought Suppression,Emotion Regulation,and Coping in a Trauma-Exposed Sample

Attempts to modulate negative emotional and cognitive symptoms of posttraumatic stress disorder (PTSD) may be related to psychopathology. Trauma-exposed undergraduates, 31 reporting severe PTSD symptoms (PTSD group) and 34 without PTSD symptoms (non-PTSD group), completed measures of PTSD, depression, anxiety, thought control, emotion regulation, and coping. The PTSD group had greater psychopathology and overall modulation strategy use than the non-PTSD group. Thought suppression, emotion suppression, and avoidant coping strategies were positively related to psychopathology, whereas emotion reappraisal and approach coping strategies were either not related or weakly negatively related. Hierarchical multiple regressions with psychopathologic variables as criteria and modulation strategies as predictors indicated significant models in all cases. Generally, thought suppression was the only significant independent predictor of psychopathology.     

Contribution of cognitive factors to the prediction of post-traumatic stress disorder, phobia and depression after motor vehicle accidents

Past research into the psychological consequences of traumatic events has largely focused on post-traumatic stress disorder (PTSD), although other anxiety disorders and depression are also common in the aftermath of trauma. Little is known about differential predictors of these conditions. The present study investigated the extent to which theoretically derived cognitive variables predict PTSD, phobias and depression after motor vehicle accidents. The cognitive predictors were compared to a set of established, mainly non-cognitive predictors. In addition, we tested how disorder-specific the cognitive predictors are. Participants (n=101) were interviewed within a year after having been injured in a motor vehicle accident. Diagnoses of PTSD, travel phobias and depression, symptom severities and predictor variables were assessed with self-report questionnaires and structured interviews. In multiple regression analyses, the sets of cognitive variables derived from disorder-specific models explained significantly greater proportions of the variance of the symptom severities than the established predictors (PTSD 76% vs. 45%, depression 72% vs. 46% and phobia 66% vs. 40%), and than cognitive variables derived from the models of the other disorders. In addition, the majority of individual cognitive variables showed the expected pattern of differences between diagnostic groups. The results support the hypothesis that disorder-specific sets of cognitive factors contribute to the development and maintenance of PTSD, phobias and depression following traumatic events.     

Neuropsychological profiles of children with depressive and anxiety disorders

The neuropsychological functioning of 56 children and young adolescents with diagnoses of unipolar depression (n = 17), anxiety disorder (n = 19), or comorbid anxiety/depressive disorder (n = 20) was examined. The neuropsychological profiles of the three groups were parallel, but not equal in level of performance. The three groups displayed similar patterns of performance with profiles suggesting diminished attention abilities. The groups, however, were not equal in level of performance. While subjects with an anxiety or a depressive disorder were similar in level of performance, subjects with a comorbid anxiety/depressive disorder generally performed worse than those with either an anxiety or depressive disorder alone. There was no significant evidence of asymmetrical cerebral dysfunction in any of the diagnostic groups. Results are discussed in relation to adult models of psychopathology with an emphasis on the importance of considering developmental factors when formulating models of childhood psychopathology.     

Relationships among Proactive Coping,Posttrauma Gratitude,and Psychopathology in a Traumatized College Sample

Scant previous research has examined associations of proactive coping and psychopathology, although two preliminary findings suggest that proactive coping might be negatively associated with posttraumatic stress disorder (PTSD) and general depression symptom level. This study examined associations of proactive coping with PTSD and anhedonic depression in a sample of 169 traumatized undergraduates. As expected, women tended to report more severe PTSD symptoms and less life threat than men. No other gender differences were found. Most important, proactive coping and posttrauma state gratitude were independently negatively associated with PTSD symptom level, after controlling for trauma history and female gender. Further, proactive coping was independently negatively associated with anhedonic depression, beyond the effect of traumatic life threat. The implications of the findings for models of posttrauma psychopathology development are discussed.     

Improving Attendance and Behavior Change in a Weight Loss Program for Veterans: Feasibility and Acceptability of the HERO Intervention

Psychological distress, such as anxiety, depression, and posttraumatic stress disorder (PTSD), is commonly comorbid with obesity in veterans. The feasibility and acceptability of an integrated cognitive behavioral treatment approach has been tested in nonveteran settings but has yet to be tested among obese veterans with comorbid anxiety, depression, and PTSD. This paper describes such a framework, highlighting a flexible delivery method, transdiagnostic treatment approach, and attention to treatment barriers examined in a prior qualitative assessment. Brief vignettes are used to illustrate clinical decision-making procedures and treatment activities. The feasibility and acceptability as well as potential next steps for research and clinical benefits are also described.     

Introduction to the Special Issue: The Impact and Treatment of Sleep Disturbance

There is now widespread recognition that sleep disturbance is more than an epiphenomenon of psychopathology. Research on established evidence-based treatments for sleep disturbance have matured to focus on predictors and more flexible implementation modalities. Sleep disturbance overlaps and interacts with comorbid psychological disorders though a complex transdiagnostic process that impacts the development, maintenance, and treatment of psychological disorders. This special issue highlights a range of cutting-edge research on the management of common sleep disturbance and the interaction of sleep disturbance and psychological disorders. It is anticipated that the research described in these articles will stimulate additional investigations as well as provide important insights for clinicians working with individuals with sleep disturbance.