Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial

This study further evaluates the efficacy of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP). A diagnostically heterogeneous clinical sample of 37 patients with a principal anxiety disorder diagnosis was enrolled in a randomized controlled trial (RCT) involving up to 18 sessions of treatment and a 6-month follow-up period. Patients were randomly assigned to receive either immediate treatment with the UP (n=26) or delayed treatment, following a 16-week wait-list control period (WLC; n=11). The UP resulted in significant improvement on measures of clinical severity, general symptoms of depression and anxiety, levels of negative and positive affect, and a measure of symptom interference in daily functioning across diagnoses. In comparison, participants in the WLC condition exhibited little to no change following the 16-week wait-list period. The effects of UP treatment were maintained over the 6-month follow-up period. Results from this RCT provide additional evidence for the efficacy of the UP in the treatment of anxiety and comorbid depressive disorders, and provide additional support for a transdiagnostic approach to the treatment of emotional disorders.     

Investigating trajectories of change in psychological distress amongst patients with depression and generalised anxiety disorder treated with internet cognitive behavioural therapy

Internet based cognitive behavioural therapy (CBT) is efficacious for the treatment of anxiety and depression. The current study aimed to examine the effectiveness of internet based CBT prescribed by primary care clinicians for the treatment of depression and generalised anxiety disorder. Psychological distress data from 302 patients who completed an online CBT course for depression and 361 patients who completed an online CBT course for generalised anxiety disorder were subjected to growth mixture analysis. For both disorders psychological distress decreased across each lesson in a quadratic trend. Two classes of individuals were identified with different trajectories of change: a large group of individuals who responded well to the courses and a smaller group of individuals with a lower response. Both groups were similar with respect to socio-demographic characteristics however the Low Responders tended to have higher levels of symptom severity and psychological distress at baseline in comparison to the responders. For the majority of patients (75-80%) the internet CBT courses for depression and generalised anxiety disorder were effective. Further research is required to identify and effectively treat the smaller proportion of patients who did not improve during internet CBT.     

The role of negative affectivity and negative reactivity to emotions in predicting outcomes in the unified protocol for the transdiagnostic treatment of emotional disorders

The present study aimed to understand the contributions of both the trait tendency to experience negative emotions and how one relates to such experience in predicting symptom change during participation in the Unified Protocol (UP), a transdiagnostic treatment for emotional disorders. Data were derived from a randomized controlled trial comparing the UP to a waitlist control/delayed-treatment condition. First, effect sizes of pre- to post-treatment change for frequency of negative emotions and several variables measuring reactivity to emotional experience (emotional awareness and acceptance, fear of emotions, and anxiety sensitivity) were examined. Second, the relative contributions of change in negative emotions and emotional reactivity in predicting symptom (clinician-rated anxiety, depression, and severity of principal diagnosis) reductions were investigated. Results suggested that decreases in the frequency of negative emotions and reactivity to emotions following participation in the UP were both large in magnitude. Further, two emotional reactivity variables (fear of emotions and anxiety sensitivity) remained significantly related to symptom outcomes when controlling for negative emotions, and accounted for significant incremental variance in their prediction. These findings lend support to the notion that psychological health depends less on the frequency of negative emotions and more on how one relates to these emotions when they occur.     

Approaching stimuli bias attention in numerical space

Increasing evidence suggests that common mechanisms underlie the direction of attention in physical space and numerical space, along the mental number line. The small leftward bias (pseudoneglect) found on paper-and-pencil line bisection is also observed when participants 'bisect' number pairs, estimating (without calculating) the number midway between two others. Here we investigated the effect of stimulus motion on attention in numerical space. A two-frame apparent motion paradigm manipulating stimulus size was used to produce the impression that pairs of numbers were approaching (size increase from first to second frame), receding (size decrease), or not moving (no size change). The magnitude of pseudoneglect increased for approaching numbers, even when the final stimulus size was held constant. This result is consistent with previous findings that pseudoneglect in numerical space (as in physical space) increases as stimuli are brought closer to the participant. It also suggests that the perception of stimulus motion modulates attention over the mental number line and provides further support for a connection between the neural representations of physical space and number.     

Written exposure as an intervention for PTSD: A randomized clinical trial with motor vehicle accident survivors

The present study examined the efficacy of a brief, written exposure therapy (WET) for posttraumatic stress disorder (PTSD). Participants were 46 adults with a current primary diagnosis of motor vehicle accident-related PTSD. Participants were randomly assigned to either WET or a waitlist (WL) condition. Independent assessments took place at baseline and 6-, 18-, and 30-weeks post baseline (WL condition not assessed at 30 weeks). Participants assigned to WET showed significant reductions in PTSD symptom severity at 6- and 18-week post-baseline, relative to WL participants, with large between-group effect sizes. In addition, significantly fewer WET participants met diagnostic criteria for PTSD at both the 6- and 18-week post-baseline assessments, relative to WL participants. Treatment gains were maintained for the WET participants at the 30-week post baseline assessment. Notably, only 9% of participants dropped out of WET and the WET participants reported a high degree of satisfaction with the treatment. These findings suggest that a brief, written exposure treatment may efficaciously treat PTSD. Future research should examine whether WET is efficacious with other PTSD samples, as well as compare the efficacy of WET with that of evidence-based treatments for PTSD.     

Individual differences in adolescents' sympathetic and parasympathetic functioning moderate associations between family environment and psychosocial adjustment

The present study tested whether individual differences in autonomic nervous system functioning interact with environmental risk factors to predict adolescents' psychosocial functioning. The authors assessed skin conductance and respiratory sinus arrhythmia at rest and during laboratory stressors in 110 14-year-olds. Subsequently, adolescents and their mothers provided both questionnaire and daily diary data (over 10 days) on emotional and interpersonal functioning. The authors found stronger associations between environmental risk factors (having a single-mother household or a mother with high internalizing problems) and psychosocial outcomes (externalizing problems, daily negative affect, and daily interaction quality) among youths with specific patterns of tonic and stress-induced sympathetic and parasympathetic nervous system activity, but the pattern of moderating effects differed between boys and girls. The findings support the notion that individual differences in autonomic functioning index variation in youth's susceptibility to environmental risk factors.     

Unique sudden onsets capture attention even when observers are in feature-search mode

Two sources of attentional capture have been proposed: stimulus-driven (exogenous) and goal-oriented (endogenous). A resolution between these modes of capture has not been straightforward. Even such a clearly exogenous event as the sudden onset of a stimulus can be said to capture attention endogenously if observers operate in singleton-detection mode rather than feature-search mode. In four experiments we show that a unique sudden onset captures attention even when observers are in feature-search mode. The displays were rapid serial visual presentation (RSVP) streams of differently coloured letters with the target letter defined by a specific colour. Distractors were four #s, one of the target colour, surrounding one of the non-target letters. Capture was substantially reduced when the onset of the distractor array was not unique because it was preceded by other sets of four grey # arrays in the RSVP stream. This provides unambiguous evidence that attention can be captured both exogenously and endogenously within a single task.     

Gender differences in subjective well-being, self-esteem and psychosocial functioning in adolescents with symptoms of anxiety and depression: findings from the Nord-Trøndelag Health Study

Derdikman‐Eiron, R., Indredavik, M. S., Bratberg, G. H., Taraldsen, G., Bakken, I. J. & Colton, M. (2011). Gender differences in subjective well‐being, self‐esteem and psychosocial functioning in adolescents with symptoms of anxiety and depression: Findings from the Nord‐Trøndelag health study. Scandinavian Journal of Psychology52, 261–267. Gender differences in the prevalence of symptoms of anxiety and depression during adolescence are well documented. However, little attention has been given to differences in subjective well‐being, self‐esteem and psychosocial functioning between boys and girls with symptoms of anxiety and depression. The aim of this study was to investigate gender differences in the associations between such symptoms and subjective well‐being, self‐esteem, school functioning and social relations in adolescents. Data were taken from a major population‐based Norwegian study, the Nord‐Trøndelag Health study (HUNT), in which 8984 (91% of all invited) adolescents, aged 13–19 years, completed an extensive self‐report questionnaire. Although prevalence rates of symptoms of anxiety and depression were higher in girls than in boys, a significant interaction between gender and symptoms of anxiety and depression was found in respect of each of the following outcome variables: subjective well‐being, self‐esteem, academic problems, frequency of meeting friends and the feeling of not having enough friends. These interactions indicate that the associations between symptoms of anxiety and depression and lower subjective well‐being and self‐esteem, more academic problems in school and lower social functioning were stronger for boys than for girls. Our findings may contribute to an earlier assessment and more efficient treatment of male adolescent anxiety and depression.     

Some Metaethical Desiderata and the Conceptual Resources of Theism

In this paper, I argue that theists are extremely well-situated with respect to developing metaethical accounts that qualify as ‘robust’ versions of moral realism. In the first part of the essay, a number of metaethical desiderata are identified. In the second part, theistic strategies for accommodating those desiderata are explained and defended. The upshot is that, contrary to the received philosophical wisdom, there are good theoretical reasons for theistic philosophers to seek to develop metaethical accounts that ground moral facts in facts about God.