Transdiagnostic and Transcultural: Pilot Study of Unified Protocol for Depressive and Anxiety Disorders in Japan

Unified protocol (UP) is a transdiagnostic cognitive behavior therapy for emotional disorders. It remains unknown whether UP is applicable for use in non-Western countries and for depressive disorders. We therefore examined its feasibility for a Japanese clinical population using this clinical trial design, which is multicentered, open-labeled, and single-armed (Clinical registry: UMIN000008322). The primary outcome was severity of anxiety symptoms, as assessed using Structured Interview Guide for the Hamilton Anxiety Rating Scale. Secondary outcomes were depressive symptoms, clinical global impression, functioning, quality of life, affectivity, emotion regulation, and adverse events. Of the 28 prospective participants, 17 were eligible and enrolled (depressive disorders = 9, anxiety disorders = 8). Severity of anxiety symptoms, which decreased significantly after the intervention, remained low for 3 months (Hedges’ g = 1.29, 95% CI = 0.56–2.06). Similar tendencies were observed for secondary outcome measures. No severe adverse event occurred. Two participants dropped out of the intervention. High treatment adherence and interrater reliability were confirmed. Results suggest the feasibility of UP in the Japanese context sufficient to warrant a larger clinical trial.     

The Spanish validation of the Short Health Anxiety Inventory: Psychometric properties and clinical utility

Background/ObjectiveThe Short Health Anxiety Inventory (SHAI) is a widely used self-report instrument to evaluate health anxiety. To assess the SHAI's factor structure, psychometric properties, and accuracy in differentiating Spanish non-clinical individuals from patients with severe health anxiety or hypochondriasis.MethodA total of 342 community participants (61.6% women; M_age = 34.60, SD = 14.91) and 31 hypochondriacal patients (51.6% women; M_age = 32.74, SD = 9.69) completed the SHAI and other self-reports assessing symptoms of hypochondriasis, depression, anxiety sensitivity, worry, and obsessive-compulsive.ResultsThe original two-factor structure was selected as the best structure, based on its parsimony and empirical support (Factor 1: Illness likelihood; Factor 2: Negative consequences of illness). Moreover, the Spanish version of the SHAI demonstrated good construct and concurrent and discriminant validity, and internal consistency. A cutoff of 40.5 (total score) accurately distinguished non-clinical individuals from patients with severe health anxiety or hypochondriasis.ConclusionsThe SHAI is an adequate screening instrument to measure health anxiety in Spanish-speaking community adults.     

The effectiveness of cognitive behavioral group intervention on depression and anxiety in patients with type II diabetes

IntroductionDepression and anxiety are important risk factors for diabetes and high blood pressure.ObjectiveThis study investigated the effectiveness of the Cognitive-Behavioral Group Intervention for Diabetes Disease (CBGI-DD) in reducing depression and anxiety in female patients with type 2 diabetes (T2D).MethodThe CBGI-DD program includes 12 weekly 2.5 h sessions, spread weekly over the course of 3 months. The present study was semi-experimental and controlled, with assessments at pre-test and post-test. It included diagnostic criteria for the diagnosis of T2D in the patient's medical records by a diabetes specialist. Participants (62 female volunteers aged 25 to 75 years) were randomly allocated to a control or test group. Both groups responded to the Second edition of the Beck Depression Inventory (BDI-II) and the Beck Anxiety Inventory (BAI) before (pretest) and immediately after the intervention (posttest). Participants in the test group received CBGI-DD (from April up to the end of September 2018) at Mashhad Diabetes Center. The control group received only medical care during this period.ResultsAn analysis of covariance showed that compared to the control group, the test group had a significant reduction in anxiety and depression from pre-test to post-test (p < 0.05). It was compared post-test scores between the two groups, controlling for pre-test scores.ConclusionThe CBGI-DD program seems to be effective in reducing anxiety and depression in female patients with T2D. However, further research exploring the potential for long-term improvements in depression and anxiety is needed.     

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.     

Reprint of “Co-occurring motor,language and emotional–behavioral problems in children 3–6 years of age”

PurposeDevelopmental Coordination Disorder (DCD) has been shown to co-occur with behavioral and language problems in school-aged children, but little is known as to when these problems begin to emerge, or if they are inherent in children with DCD. The purpose of this study was to determine if deficits in language and emotional–behavioral problems are apparent in preschool-aged children with movement difficulties.MethodTwo hundred and fourteen children (mean age 4 years 11 months, SD 9.8 months, 103 male) performed the Movement Assessment Battery for Children 2nd Edition (MABC-2). Children falling at or below the 16th percentile were classified as being at risk for movement difficulties (MD risk). Auditory comprehension and expressive communication were examined using the Preschool Language Scales 4th Edition (PLS-4). Parent-reported emotional and behavioral problems were assessed using the Child Behavior Checklist (CBCL).ResultsPreschool children with diminished motor coordination (n = 37) were found to have lower language scores, higher externalizing behaviors in the form of increased aggression, as well as increased withdrawn and other behavior symptoms compared with their typically developing peers.ConclusionsMotor coordination, language and emotional–behavioral difficulties tend to co-occur in young children aged 3–6 years. These results highlight the need for early intervention.     

Co-occurring motor,language and emotional–behavioral problems in children 3–6 years of age

PurposeDevelopmental Coordination Disorder (DCD) has been shown to co-occur with behavioral and language problems in school-aged children, but little is known as to when these problems begin to emerge, or if they are inherent in children with DCD. The purpose of this study was to determine if deficits in language and emotional–behavioral problems are apparent in preschool-aged children with movement difficulties.MethodTwo hundred and fourteen children (mean age 4 years 11 months, SD 9.8 months, 103 male) performed the Movement Assessment Battery for Children 2nd Edition (MABC-2). Children falling at or below the 16th percentile were classified as being at risk for movement difficulties (MD risk). Auditory comprehension and expressive communication were examined using the Preschool Language Scales 4th Edition (PLS-4). Parent-reported emotional and behavioral problems were assessed using the Child Behavior Checklist (CBCL).ResultsPreschool children with diminished motor coordination (n = 37) were found to have lower language scores, higher externalizing behaviors in the form of increased aggression, as well as increased withdrawn and other behavior symptoms compared with their typically developing peers.ConclusionsMotor coordination, language and emotional–behavioral difficulties tend to co-occur in young children aged 3–6 years. These results highlight the need for early intervention.     

Is the link between autistic traits and ability to succeed in science independent of other psychopathological dimensions?

IntroductionBesides the well-established link between autistic traits and scientific skills, the role of personality in students involved in science has not been thoroughly examined.ObjectiveThis study aimed at reexamining the link between scientific aptitudes and personality, by considering autistic features and other psychopathological dimensions.MethodTwo hundred and ninety-four individuals from French scientific universities answered questionnaires assessing autistic, schizotypal and bipolar dimensions, as well as depressive symptomatology and other variables.ResultsA cluster analysis led to the identification of 4 different groups, among which a cluster was characterized by high scores in autistic, schizotypal and bipolar dimensions. This group, representing nearly 30% of the sample, displayed higher level of depression symptoms (M = 28.5, SD = 12.0) in comparison with other groups (M = 11.7 to 19.1, SD = 5.4 to 9.2). Moreover, the suicidal ideation score was much more important in this cluster (M = 1.6, SD = 2.3) than in the three other groups (M = 0.1 to 0.5, SD = 0.3 to 1.3). This suggested that autistic features, when associated with other personality traits, interfere negatively with the ability of individuals to succeed in science studies, which was partly confirmed by comparing the academic level and results of the different clusters.ConclusionOne may reconsider the link between elevated autistic traits and the ability to accomplish science studies, considering that autistic features are thus frequently associated with other psychopathological traits which may, altogether, lead to depression or other comorbidities negatively interfering with the accomplishment of an academic cursus.     

Social anxiety and depressive symptoms mediate instrumentality and maladaptive interpersonal styles

This study sought to examine the relationships between stereotypically masculine (instrumentality) and feminine (expressiveness) personality traits, social anxiety and depressive symptoms, and three interpersonal styles of relating: destructive overdependence (DO), dysfunctional detachment (DD), and healthy dependence (HD). Based on theories of social anxiety and recent research on social anxiety and close relationships, it is argued that individuals with higher levels of social anxiety would display greater detachment and overdependence in their interpersonal relationships. Students at an Australian university (n = 524) completed a battery of online self-report measures. The findings suggest that low levels of instrumentality are related to social anxiety and depressive symptoms, which both mediate the relationship between instrumentality and the two maladaptive interpersonal styles of relating: DO and DD.     

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.     

Mechanisms underlying the self-talk–performance relationship: The effects of motivational self-talk on self-confidence and anxiety

ObjectivesThe present study examined the effects of motivational self-talk on self-confidence, anxiety, and task performance in young athletes.MethodsParticipants were 72 tennis players. The experiment was conducted in five sessions: baseline assessment, three training sessions, and final assessment. After the baseline assessment participants were divided and assigned randomly into experimental and control groups. The two groups followed the same training program with the experimental group practicing the use of self-talk. In the last session, the final assessment took place. A forehand drive test was used to evaluate task performance, and the Competitive Anxiety Inventory-2R was used to assess self-confidence and anxiety.ResultsA two-way mixed model MANOVA revealed that task performance improved for the experimental group (p < .01) and remained stable for the control group; self-confidence increased (p < .01) and cognitive anxiety decreased (p < .05) for the experimental group, whereas no changes were observed for the control group. Correlation analysis revealed that changes in task performance were moderately related to changes in self-confidence (p < .05).ConclusionsThe results of the study showed that self-talk can enhance self-confidence and reduce cognitive anxiety. Furthermore, it is suggested that increases in self-confidence can be regarded as a viable function explaining the facilitating effects of self-talk on performance.     

Longitudinal examination of objectively-measured physical activity and sedentary time among children with and without significant movement impairments

BackgroundChildren with Developmental Coordination Disorder (DCD) tend to be less active than typically-developing (TD) children. Current evidence, however, is based on cross-sectional and self-reported activity, and little is known about sedentary time among children with significant movement impairments such as DCD. The current study examines the longitudinal patterns of objectively measured physical activity and sedentary time in children with and without possible DCD (pDCD).MethodsData is from a longitudinal nested case-control study, with 103 participants (n = 60 males ages = 12 and 13 at baseline). Participants averaging ⩽16th percentile on the Movement Assessment Battery for Children were considered having significant movement impairments and pDCD (n = 49). All participants wore accelerometers for seven days.ResultsThere were significant main effects for time (Estimate = −23.98, p < .01) and gender (Estimate = 59.86, p < .05) on total physical activity, and time spent being sedentary (Estimate = 15.58, p < .05). Significant main effects for pDCD (Estimate = −5.38, p < .05) and gender (Estimate = 26.89, p < .01), and time by gender interaction (Estimate = −7.50, p < .05) were found for moderate-to-vigorous physical activity (MVPA). Sedentary time did not differ between children with and without DCD.ConclusionsResults suggest children with pDCD engaged in less MVPA compared to TD children. Consistent patterns of MVPA over time, however, suggest that the divergence in MVPA occurs earlier in childhood. Further longitudinal research following a younger cohort is necessary to identify the specific point that differences in MVPA emerge.     

Cognitive flexibility and response inhibition in patients with Obsessive-Compulsive Disorder and Generalized Anxiety Disorder

Background/ObjectiveThe main aim of this study was to analyze differences in inhibition and cognitive flexibility, taking into account some variables that may influence results (non verbal reasoning, depression, anxiety, intolerance of uncertainty, comorbidity, medication consumption).MethodThe participants were 95 adults aged 17-61 years old (M = 33.48, SD = 11.13), primary (most severe) Generalized Anxiety Disorder or Obsessive-Compulsive Disorder and a healthy control group. Neuropsychological neasures were completed using computerized Wisconsin Card Sorting Test, Stroop Color Word Test and Go/NoGo Task.ResultsClinical groups presented worse results in cognitive flexibility to the control group. The obsessive-compulsive group showed worse scores in flexibility than the generalized anxiety group, once non-verbal reasoning and tolerance to uncertainty were controlled. Comorbidity and medication use did not affect results in the obsessive compulsive group but did however influence the generalized anxiety group.ConclusionsCognitive flexibility could be included treatment in the treatment of obsessive-compulsive disorder and generalized anxiety disorder.     

Changes in cannabis use in emerging adulthood: The influence of peer network,impulsivity, anxiety and depression

IntroductionCannabis is the most commonly used illicit drug with the highest prevalence reported among 15- to 24-year-olds. This specific period of emerging adulthood constitutes a critical age for substance use and for future consumption. Cannabis use patterns change during college or university and the post-college transition; users are at greater risk of adverse health outcomes (especially if they start or maintain a pattern of frequent use).ObjectivesThe overall aim of this study was to highlight psychological and relational factors that might be associated with changes (including cessation and fluctuation) in cannabis use during this specific period, separately for males and females.MethodsThe subjects were 682 first-year college students (69.94% of female), aged between 18 and 25 years (M = 18.59 years, SD = 1.56). Four groups were formed according to cannabis consumption: “non-users” (54.64%), “desisting users” (14.04%), “fluctuating users” (16.23%), and “persistent users” (15.07%). A self-report questionnaire was administered to evaluate prevalence, frequency and trajectory of use, number of peer cannabis users, alcohol use, impulsivity, anxiety (trait and social) and depression.ResultsFemales appear more sensitive to the romantic partner's consumption than males. For both sexes, having more friends who use cannabis appears to be a determinant. Depression and anxiety were not related to changes in cannabis use. Impulsivity is a significant factor for the maintenance of cannabis use in emerging adulthood, with higher lack of premeditation for males and higher sensation seeking for females among fluctuating and persistent users.ConclusionsResults are discussed in terms of maintenance of use and the spiral of consumption, including clinical implications for prevention and interventions.     

Perinatal depression influences on infant negative affectivity: Timing,severity, and co-morbid anxiety

Accumulating evidence suggests that antenatal depression predicts infants’ negative affectivity, albeit with variable effect sizes. With a prospective longitudinal design, we sought to explain that variability by addressing questions about timing of the depression across pregnancy and the early postpartum, the role of high symptom levels relative to diagnosed depression, comorbidity with anxiety, and the potential mediating role of neuroendocrine functioning. Primiparous women (n = 77) with histories of depression prior to pregnancy were assessed for cortisol levels monthly beginning by mid-pregnancy. Depression symptom levels and diagnostic status were similarly assessed monthly in pregnancy and also until infants reached three months of age, when mothers completed the Infant Behavior Questionnaire-Revised to measure infant negative affectivity. Antenatal depression symptoms and infant negative affectivity were positively associated (r = .39). Controlling for depression symptom levels in other trimesters, only second trimester depression symptoms predicted higher infant negative affectivity (β = .44). With postpartum depression symptom levels in the model, only antenatal depression symptoms predicted infant negative affectivity (β = .45). In the context of depression, neither antenatal anxiety symptoms nor anxiety disorder diagnosis were associated with infant NA scores. The hypothesized role of elevated maternal cortisol as a mechanism for the association between antenatal depression and infant NA was not supported. Our findings contribute to efforts to more precisely identify infants of perinatally depressed mothers who are at greater risk for elevated negative affectivity, suggesting a window of vulnerability in mid pregnancy and the need for further study of potential mechanisms.     

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.     

The role of BIS/BAS in the vulnerability for depression in adolescent girls

Reinforcement Sensitivity Theory (RST), the original (i.e. Gray, 1982) or revised (Gray & McNaughton, 2000), has yet to be used as a framework for investigating vulnerability to Major Depressive Disorder (MDD) in adolescents. The present study employed a high-risk design to examine whether aberrant BIS-FFFS/BAS activity was similarly present in both depressed girls and girls at high risk for depression.MethodsN = 85 age-matched biological daughters of mothers with differential MDD status: (a) MDD (n = 17), (b) high-risk (n = 34), and (c) healthy controls (n = 34) completed measures of the BIS/BAS, depression, and anxiety.ResultsMDD girls scored significantly higher on BIS than healthy controls but not high-risk girls, and the high-risk and control groups did not differ. No group differences were found on BAS or FFFS-Fear.ConclusionsElevated BIS was not identified as a vulnerability factor for MDD; however, it does distinguish depressed adolescents from healthy controls.     

Impact of the telephone motivational interviewing on the colorectal cancer screening participation. A randomized controlled study

IntroductionWhile high participation rates ensure the cost-effectiveness of colorectal cancer screening programs, it is well known that postal requests do not achieve acceptable levels of participation.ObjectiveThis randomized controlled study aimed to test the impact of individualized phone counseling to prompt people aged 50 to 74 to take a colorectal cancer test.MethodTwo phone strategies were compared. The first involved computer-aided individualized counseling while the second was based on motivational interviewing. A total of 49,972 people were randomly assigned to a control group (CG) and to the individualized counseling (IC) and motivational interviewing (MI) telephone groups.ResultsA simple call doubled the participation rate per protocol (19.2% > 9.2%; p < .001; r = .131; OR = 2.374), and tripled it when the interview was conducted (30.4% > 9.2%; p < .001; r = .219; OR = 4.321). In an intention-to-treat analysis, the benefit of calling by phone remained even higher than postal requests (10% > 9.2%; p < .01; r = .014; OR = 1.103). However, there was no impact of the type of interview on participation rates.ConclusionThe results are discussed for future research.     

Rumination and depression in Chinese university students: The mediating role of overgeneral autobiographical memory

ObjectiveIn this study, we examined the mediator effects of overgeneral autobiographical memory (OGM) on the relationship between rumination and depression in 323 Chinese university students.Method323 undergraduates completed the questionnaires measuring OGM (Autobiographical Memory Test), rumination (Ruminative Response Scale) and depression (Center for Epidemiologic Studies Depression Scale).ResultsResults using structural equation modeling showed that OGM partially-mediated the relationship between rumination and depression (χ² = 88.61, p < .01; RMSEA = .051; SRMR = .040; and CFI = .91). Bootstrap methods were used to assess the magnitude of the indirect effects. The results of the bootstrap estimation procedure and subsequent analyses indicated that the indirect effects of OGM on the relationship between rumination and depressive symptoms were significant.ConclusionThe results indicated that rumination and depression were partially mediated by OGM.     

The effects of a motivational general-arousal imagery intervention upon preperformance symptoms in male rugby union players

ObjectivesTo investigate the efficacy of a motivational general-arousal based imagery strategy in modifying precompetitive symptom interpretations.MethodA staggered multiple baseline single-subject design was employed with five male collegiate rugby union players (M = 24.5; SD = 3.05). The dependent variable was monitored over a full competitive season via measures of precompetitive anxiety and affect together with follow-up social validation procedures.ResultsMore facilitative interpretations of symptoms associated with competitive anxiety, and greater self-confidence levels were reported postintervention, together with changes in positive and negative affect.ConclusionsThe findings highlight the importance of employing individualized imagery with motivational general-arousal content to modify performers' perceptions of their precompetitive experiences. This effect is proposed to occur directly through adaptive changes in individuals' psychological response systems and indirectly via the protection mechanisms associated with enhanced efficacy expectations.     

Maternal self-confidence during the first four months postpartum and its association with anxiety and early infant regulatory problems

Maternal self-confidence has become an essential concept in understanding early disturbances in the mother-child relationship. Recent research suggests that maternal self-confidence may be associated with maternal mental health and infant development. The current study investigated the dynamics of maternal self-confidence during the first four months postpartum and the predictive ability of maternal symptoms of depression, anxiety, and early regulatory problems in infants. Questionnaires assessing symptoms of depression (Edinburgh Postnatal Depression Scale), anxiety (State-Trait Anxiety Inventory), and early regulatory problems (Questionnaire for crying, sleeping and feeding) were completed in a sample of 130 women at three different time points (third trimester (T1), first week postpartum (T2), and 4 months postpartum (T3). Maternal self-confidence increased significantly over time. High maternal trait anxiety and early infant regulatory problems negatively contributed to the prediction of maternal self-confidence, explaining 31.8% of the variance (R = .583, F_3,96 = 15.950, p < .001).Our results emphasize the transactional association between maternal self-confidence, regulatory problems in infants, and maternal mental distress. There is an urgent need for appropriate programs to reduce maternal anxiety and to promote maternal self-confidence in order to prevent early regulatory problems in infants.