Cognitive-Behavioral Therapy for Alcohol and Other Substance Use Disorders: the Beck Model in Action Abstract The Beckian model of cognitive-behavioral therapy (CBT) for alcohol and other substance use disorders is highly consistent with generic CBT in terms of its structure, emphasis on the therapeutic relationship and case conceptualization, and focusing on teaching patients psychological self-monitoring and self-change skills. The model is distinctive because it zeroes in on the substance use issue per se by identifying and managing high-risk situations, modifying maladaptive automatic thoughts and beliefs (about substances, cravings, “permission-giving,” etc.), learning ways to resist acting on cravings and urges, interfering with substance-related behavioral patterns, limiting the damage from lapses, and learning adaptive life habits. CBT practitioners are more effective with this population when they respond with empathic understanding, even when the patients are ambivalent about being in treatment, are at a lower “stage of change,” and therefore are not fully collaborative and/or are not optimally forthcoming or sincere in their self-report. The CBT method of guided discovery is highly congruent with the methods of motivational interviewing, and CBT can be compatible and complementary with 12-step facilitation and pharmacotherapy. The outcome research on CBT for alcohol and other substance use disorders is not as extensive as that for other disorders, and the data (while promising) indicate that more work needs to be done in terms of preventing early termination and maintaining improvement for the long term. A number of studies suggest that CBT is at its best when helping patients manage their alcohol and/or substance use problems in the context of also providing effective treatment for their comorbid depression.

Positive Self-Imagery May Not Always Be Positive: Examining the Impact of Positive and Negative Self-Imagery in Social Anxiety Abstract Socially anxious individuals often hold a negative self-image in mind during social situations. The effect of self-imagery on post-event processing has yielded conflicting results, and its effect on anticipatory processing has yet to be examined. The primary aim of this study was to compare negative and positive self-imagery on anticipatory and post-event processing, and the secondary aim was to examine the impact on state anxiety, safety behaviors, and focus of attention. Participants (N = 80 students) were randomly assigned to a positive or negative self-imagery induction and then delivered an impromptu speech. Among those low in social anxiety, outcomes were generally better for the positive self-imagery condition but among those high in social anxiety, positive self-imagery led to similar or worse outcomes than negative self-imagery. Taken together, encouraging positive self-imagery may be useful for those with lower social anxiety, but not for those with higher social anxiety.

Comparison Between Obsessive Compulsive Disorder and Panic Disorder on Metacognitive Beliefs, Emotional Schemas, and Cognitive Flexibility Abstract We aimed to investigate the similarities and differences between patients with OCD and PD, and healthy control subjects (NPC) on their metacognitive beliefs, emotional schemas, and cognitive flexibility. We hypothesized that the clinical groups would score higher than the NPC group on their dysfunctional metacognitive beliefs and negative beliefs about emotional schemas, and lower than the control subjects on their cognitive flexibility. Regarding the metacognitive beliefs, the clinical groups scored higher than the NPC group on the scores of the uncontrollability and danger, the need to control thoughts subscales, and on the total score of the MCQ-30. On the uncontrollability, comprehensibility, rumination, dissimilarity, dangerousness, and guilt dimensions, and on the total score of the LESS, the clinical groups scored significantly higher than the NPC group. The NPC group obtained higher scores than the clinical groups on the Cognitive Flexibility Inventory. Focusing on the psychological concepts that differentiate patients with OCD and PD from healthy controls might help identify potential targets for psychotherapy.

Metacognitive Beliefs and Emotional Dysregulation Have a Specific Contribution on Worry and the Emotional Symptoms of Generalized Anxiety Disorder Abstract Metacognitive beliefs and emotional dysregulation are theoretically relevant and empirically supported variables for explaining worry and emotional symptoms in generalized anxiety disorder (GAD). These variables are proposed in alternative models of GAD and tested in separate research. This study first examined the relationships between metacognitive beliefs and emotional dysregulation and, second, analyzed the specific contribution of these variables to worry and emotional GAD symptoms. Correlation analyses revealed participants (n = 768) who had dysfunctional beliefs about their cognitive functioning also tended to have more difficulties with emotional regulation. Structural equation analyses revealed metacognitive beliefs and emotional dysregulation have a specific contribution to worry and emotional symptoms in GAD. We found strong correlations between metacognitive beliefs and worry, and between emotional dysregulation and emotional GAD symptoms. Moreover, the associations of metacognitive beliefs with worry and emotional symptoms remain significant when the effect of emotional dysregulation was accounted for. However, the association between emotional dysregulation and worry become non-significant when the effect of metacognitive beliefs was controlled for. These results help clarify the unique contribution of metacognition and emotional dysregulation on GAD and suggest that both variables should be integrated into a more comprehensive model and therapy for this anxiety disorder.

Gaze Avoidance Explains the Association Between Anxiety Sensitivity Social Concerns and Social Anxiety Abstract Anxiety sensitivity (AS), the fear of fear, has been proposed as a transdiagnostic feature of anxiety disorders. AS social concerns is a dimension of AS that involves worry about the social consequences of anxiety symptoms. Although AS social concerns has been linked to social anxiety both theoretically and empirically, few studies have considered processes that may explain this association. AS social concerns may be associated with avoidance of eye contact (gaze avoidance), which in turn may be associated with greater social anxiety. This hypothesis was tested using a sample of 190 undergraduate students. Self-reported gaze avoidance partially explained the association between AS social concerns and social anxiety. The model remained significant when controlling for other AS dimensions, general anxiety, and depression symptoms. The model was not moderated by race (Black, White), a finding which partially addresses the need to test how well theories apply to diverse populations. The findings advance cognitive frameworks of social anxiety by suggesting that gaze avoidance may explain associations between risk factors and symptoms. Additional research is needed to examine whether interventions that increase eye contact may weaken the association between AS social concerns and social anxiety.

Early Maladaptive Schemas Are Associated with Increased Suicidal Risk among Individuals with Schizophrenia Abstract Early maladaptive schemas (EMSs) are a dysfunctional cognitive pattern that can result from maladaptive functioning during childhood. EMSs are broad patterns of memories, emotions, cognitions, and bodily sensations related to the self and others. The aims of this study were to evaluate EMSs among individuals with schizophrenia and to evaluate the relations of EMSs and clinical factors (e.g., depression, positive, and negative symptoms of psychosis) to suicidal risk (e.g., current suicidal ideation, lifetime suicide attempts). Eighty-two inpatients with schizophrenia completed the Young Schema Questionnaire-Short Form (YSQ-SF), the Beck Depression Inventory-II (BDI-II), the Beck Scale for Suicide Ideation (BSSI), and the Positive and Negative Syndrome Scale (PANSS). Individuals with schizophrenia who had attempted suicide (relative to those who had not attempted suicide) had significantly higher EMSs, current suicidal ideation, and a family history of suicide attempts. Logistic regression analysis revealed that the emotional deprivation schema, positive symptoms, and depression were significantly associated with current suicidal ideation. In addition, emotional deprivation was significantly associated with lifetime suicide attempts. These findings suggest that the emotional deprivation schema, positive symptoms, and depression may be related to suicide in individuals with schizophrenia.

CBT with an Adolescent with Hoarding Disorder—a Single-Case Experimental Design Abstract Hoarding disorder (HD) in young people is little understood yet research conducted in adult populations suggests that the onset of HD occurs in early adolescence. There are no empirically based guidelines for how to treat hoarding in young people. This is the first case study adopting a single-case experimental design and hoarding specific measures to treat an adolescent with hoarding disorder. After a baseline period, a 15-year-old female received 13 sessions of cognitive-behavioural therapy for hoarding disorder, focussing specifically on excessive acquisition. There were substantial changes in well-being, which reflected modest changes in hoarding symptoms. The work is discussed in relation to issues of assessment and the utility of the adult HD evidence base for understanding HD in children in addition to making suggestions for future research.

Inflated Responsibility in Worry and Obsessive Thinking Abstract Utilizing two measures of inflated responsibility, the current study provides an examination of the relation between responsibility and both obsessive-compulsive disorder (OCD) symptoms and worry/generalized anxiety disorder (GAD) symptoms. More specifically, the goals of the study were twofold. The first goal was to provide an elucidation of the construct of inflated responsibility by conducting a joint factor analysis with two measures commonly utilized to assess responsibly, the Responsibility Attitudes Scale (RAS) and the Responsibility to Continue Thinking Scale (RESP). The second goal was to examine the degree to which the factors obtained from the joint factor analysis predict symptoms of OCD, GAD, and worry. Based on an exploratory factor analysis, a three-factor solution emerged, with factors labeled Harm/Danger Avoidance (HDA), Personal Responsibility/Blame (PRB), and Responsibility to Continue Thinking/Perseverate (RCTP). Based on the results of regression analyses, PRB and RCTP, but not HAD, were found to be significant and unique predictors of OCD symptoms and of worry/GAD symptoms. Overall, this study provides insight into the construct of responsibly and the relation of this construct to psychopathology.

Is Behavioral Activation (BA) More Effective than Cognitive Therapy (CT) in Severe Depression? A Reanalysis of a Landmark Trial Abstract A landmark study (Jacobson et al., JCCP, 64:295–304, 1996) suggested that behavioral activation (BA) is as effective as cognitive therapy (CT) in the treatment of major depression. A conceptual replication supported the efficacy of BA and suggested BA is more effective than CT for severe depression (Dimidjian et al., JCCP, 74:658–670, 2006), though these findings have never been replicated. Outcome data from the participants in the BA and CT condition of the Jacobson et al. (JCCP, 64:295–304, 1996) trial were analyzed with the same analytic approach used by Dimidjian et al. (JCCP, 74:658–670, 2006). The sample was stratified on the Hamilton Rating Scale for Depression (HRSD) as higher-severity (HRSD ≥ 20) and lower-severity (HRSD ≤ 19). Treatment differences in change over time on the HRSD, Beck Depression Inventory (BDI), as well as response (≥ 50% change) and remission on each scale, were examined. Tests of moderation with severity as a categorical or continuous variable were conducted, and we explored the effect of severity by treatment on relapse. The results of Dimidjian et al. (JCCP, 74:658–670, Dimidjian et al. 2006) were not replicated. Tests of moderation with severity as a continuously measured variable (with the BDI or HRSD) also failed to find that BA was more effective than CT for more severe depression. No differences by severity emerged over the follow-up period. BA and CT may be roughly equivalent in the treatment of mild, moderate, and severe depression.

Reciprocal Relationship Between Reduced Autobiographical Memory Specificity and Depressive Symptoms in Nonclinical Populations Abstract Previous studies have demonstrated that patients with major depression have reduced autobiographical memory specificity (AMS), and reduced AMS predicts a worse course of depression. However, in nonclinical populations, the relationship between depressive symptoms and reduced AMS is unclear, as well as whether reduced AMS predicts high levels of depressive symptoms. A 6-month prospective study of 150 undergraduate students was conducted. Participants completed the Autobiographical Memory Test Optional Instructions, which is suitable for detecting reduced AMS in nonclinical populations. A cross-lagged panel design showed a significant reciprocal relationship between depressive symptoms and reduced AMS. Additional analysis revealed that reduced AMS at time 1 predicted depressive symptoms at time 2 for individuals with high levels of depressive symptoms at time 1. These results suggest that reduced AMS in nonclinical populations with some degree of depressive symptoms is a potential target for interventions to prevent the onset of depression.