The impact of experiential avoidance on the reduction of depression in treatment for borderline personality disorder

Background

Reducing symptoms of depression is an important target in the treatment of borderline personality disorder (BPD). Although current treatments for BPD are effective in reducing depression, the average post-treatment level of depression remains high.

Aim

To test whether experiential avoidance (EA) impedes the reduction of depression during treatment for BPD.

Method

EA and depression were assessed in 81 clients at baseline and 4-month intervals during 1 year of therapy. Simple correlations, hierarchical linear modeling, and latent difference score models were used to investigate the association between self-reports of EA and both self-reports and observer-based ratings of depression.

Results

EA was positively associated with greater severity of depression at all points of assessment, and changes in EA were positively associated with changes in depression. Moreover, EA significantly predicted less subsequent reduction in depression whereas no such effect was found for depression on subsequent EA.

Conclusion

The findings are consistent with the hypothesis that EA impedes the reduction of depression in the treatment of BPD and should thus be considered an important treatment target.     

Overvaluation of shape and weight in binge eating disorder, bulimia nervosa, and sub-threshold bulimia nervosa

Increasing empirical evidence supports the validity of binge eating disorder (BED), a research diagnosis in the appendix of DSM-IV, and its inclusion as a distinct and formal diagnosis in the DSM-V. A pressing question regarding the specific criteria for BED diagnosis is whether, like bulimia nervosa (BN), it should be characterized by overvaluation of shape and weight. This study compared features of eating disorders in 436 treatment-seeking women comprising four groups: 195 BED participants who overvalue their shape/weight, 129 BED participants with subclinical levels of overvaluation, 61 BN participants, and 51 participants with sub-threshold BN. The BED clinical overvaluation group had significantly higher levels of specific eating disorder psychopathology than the three other groups which did not differ significantly from each other. Findings suggest that overvaluation of shape and weight should not be considered as a required criterion for BED because this would exclude a substantial proportion of BED patients with clinically significant problems. Rather, overvaluation of shape and weight warrants consideration either as a diagnostic specifier or as a dimensional severity rating as it provides important information about severity within BED.     

Does prior exposure to interpersonal violence increase risk of PTSD following subsequent exposure?

Research has generally found a “dose relationship” between potentially traumatic events (PTEs) and the likelihood of developing PTSD, with greater number of events associated with greater likelihood. Most of these studies have been cross-sectional, however. A recent prospective study (Breslau, Peterson, & Schultz, 2008) found that PTSD response to prior potentially traumatic event (PTE) exposure, rather than prior exposure itself, acts as a risk factor for PTSD in response to subsequent PTE; however, this analysis combined many different types of events, and the unique contribution of specific events (e.g., assault) that may be associated with differential risk of PTSD was indeterminable. The present study examined the effects of cumulative PTE exposure prospectively using a two-wave design in the National Survey of Adolescents (N = 1703). History of assault and witnessing serious violence were the focal PTEs examined. Wave I assault without PTSD was found to predict PTSD at Wave II following exposure to new assault or witnessed violence; however, among those without prior PTSD, Wave I witnessed violence did not increase risk of subsequent PTSD following exposure.     

Understanding the relationship between posttraumatic stress disorder and trauma cognitions: The impact of thought control strategies

Several models of PTSD suggest that dysfunctional beliefs play an important role in the maintenance of PTSD. This study examined whether thought control strategies intermediated in the relationship between PTSD and dysfunctional cognitions. It was hypothesized that PTSD would be positively associated with dysfunctional cognitions and that negative thought control strategies (worry and self-punishment) would partially account for this relationship. These maladaptive strategies were predicted to be associated with increased levels of PTSD and more trauma-related beliefs. Additionally, it was predicted that positive thought control strategies (social control and reappraisal) would be associated with decreased levels of PTSD and fewer trauma-related beliefs. Finally, because the literature supports distraction as both an adaptive and a maladaptive thought control strategy, no a priori hypothesis was made. Results support worry and self-punishment as maladaptive intervening variables in the association between PTSD and dysfunctional cognitions, resulting in greater levels of PTSD and trauma cognitions. Social control and distraction emerged as adaptive strategies, resulting in lower levels of PTSD and trauma cognitions, while reappraisal showed no relationship with PTSD severity. Although the results are cross-sectional, continued focus on the effects of thought control strategies as meditational maintenance variables over time appears warranted.     

Predicate Logical Extensions of some Subintuitionistic Logics

The paper presents predicate logical extensions of some subintuitionistic logics. Subintuitionistic logics result if conditions of the accessibility relation in Kripke models for intuitionistic logic are dropped. The accessibility relation which interprets implication in models for the propositional base subintuitionistic logic considered here is neither persistent on atoms, nor reflexive, nor transitive. Strongly complete predicate logical extensions are modeled with a second accessibility relation, which is a partial order, for the interpretation of the universal quantifier. Presented by Melvin Fitting     

Multi-Modal CTL: Completeness,Complexity, and an Application

We define a multi-modal version of Computation Tree Logic (ctl) by extending the language with path quantifiers E ^δ and A ^δ where δ denotes one of finitely many dimensions, interpreted over Kripke structures with one total relation for each dimension. As expected, the logic is axiomatised by taking a copy of a ctl axiomatisation for each dimension. Completeness is proved by employing the completeness result for ctl to obtain a model along each dimension in turn. We also show that the logic is decidable and that its satisfiability problem is no harder than the corresponding problem for ctl. We then demonstrate how Normative Systems can be conceived as a natural interpretation of such a multi-dimensional ctl logic. Presented by Jacek Malinowski     

EFFECT OF REINFORCER MAGNITUDE ON PERFORMANCE MAINTAINED BY PROGRESSIVE‐RATIO SCHEDULES

This experiment examined the relationship between reinforcer magnitude and quantitative measures of performance on progressive‐ratio schedules. Fifteen rats were trained under a progressive‐ratio schedule in seven phases of the experiment in which the volume of a 0.6‐M sucrose solution reinforcer was varied within the range 6–300 μl. Overall response rates in successive ratios conformed to a bitonic equation derived from Killeen's (1994) Mathematical Principles of Reinforcement. The “specific activation” parameter, a, which is presumed to reflect the incentive value of the reinforcer, was a monotonically increasing function of reinforcer volume; the “response time” parameter, δ, which defines the minimum response time, increased as a function of reinforcer volume; the “currency” parameter, b, which is presumed to reflect the coupling of responses to the reinforcer, declined as a function of volume. Running response rate (response rate calculated after exclusion of the postreinforcement pause) decayed monotonically as a function of ratio size; the index of curvature of this function increased as a function of reinforcer volume. Postreinforcement pause increased as a function of ratio size. Estimates of a derived from overall response rates and postreinforcement pauses showed a modest positive correlation across conditions and between animals. Implications of the results for the quantification of reinforcer value and for the use of progressive‐ratio schedules in behavioral neuroscience are discussed.     

How Do Trait Dimensions Map onto ADHD Symptom Domains?

Theories of Attention-Deficit/Hyperactivity Disorder (ADHD) implicate dysfunctional regulation mechanisms that have been conceptually grouped into “top-down” control and “bottom-up” affective/reactive processes. This dual-process account can be invoked in relation to temperament or personality traits and may clarify how traits relate to ADHD. Two samples were examined to illuminate developmental effects. The younger sample was 179 youngsters aged 7 to 12 years (113 boys; 107 with ADHD). The older sample was 184 adolescents (109 boys; 87 with ADHD) aged 13 to 18 years. Structural equation models included parent-rated traits, teacher-rated ADHD symptoms, and laboratory-obtained executive functions. A control or “top-down” factor included cognitive control and conscientiousness/effortful control. A second factor labeled affective or “bottom-up” included neuroticism/negative emotionality, agreeableness, and reactive control. In the younger sample, these two factors were differentially and specifically related to inattention and hyperactivity, respectively. However, in the older sample, the first factor was related to inattention and hyperactivity, whereas the second factor was related to hyperactivity. Personality traits appear to map onto ADHD symptoms in a meaningful manner consistent with a dual-process model of temperament and ADHD. This research was supported by NIH National Institute of Mental Health Grant R01-MH63146, MH59105, and MH70542 to Joel Nigg. Martel was supported by NIH F31 MH075533. We are indebted to the families and staff who made this study possible.     

Multiple Psychological Senses of Community in Afghan Context: Exploring Commitment and Sacrifice in an Underground Resistance Community

The study of positive outcomes associated with strong psychological sense of community (PSOC) has grown worldwide. Yet most research explores PSOC as a uni-dimensional (positive) variable operating in a single referent community. Theoretical and empirical literature has suggested, however, that PSOC can be positive, neutral or negative (Brodsky in J Commun Psychol 24(4):347–363, 1996; Brodsky et al. in Psychological sense of community: Research, applications and implications. Kluwer, New York 2002) and since people live in multiple physical and relational communities, there may be multiple PSOCs (M-PSOC) operating simultaneously and interactively (Brodsky and Marx in J Commun Psychol 29(2):1–18, 2001). This paper explores the operation of M-PSOC in the lives of Afghan women, and male supporters, who belonged to a resistance organization before, during and after the Taliban regime. Decisions to join and stay in this community can be explained, in part, through the differentiation of positive, organizational-level PSOC from negative, macro-community-level PSOC. In addition, M-PSOC suggests unique cultural meanings of the terms “community” and “choice.” Findings have implications for cross-cultural community work and for fostering resilient sub-communities in the face of macro and societal-level risks and oppression.