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ABSTRACT: How do you judge when a client is getting better? How do clients know whether therapy is working? How can you respond to managed care organizations that require concrete evidence of progress? While psychotherapy has made great contributions, it offers only limited guidance for planning treatment for individual clients. Building a bridge between science and practice, this book provides clinicians of any theoretical orientation with a framework for evidence-based work. The treatment planning method presented is known as PACC (Planning and Assessment in Clinical Care). Applicable to a wide range of practice settings and situations, PACC tools and strategies are designed to enhance the accountability and efficiency of clinical work while making reporting tasks easier. The book begins by explicating the rationale and development of the approach. It then describes how PACC enables the clinician to set goals and track progress over the course of treatment, independent of the specific interventions used.
This book may serve as a resource for novice and experienced clinicians, as well as a text in graduate-level courses and practica in clinical and counseling psychology, social work, psychiatry, and related fields. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
10/2012;
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ABSTRACT: BACKGROUND AND OBJECTIVES: Cognitive-behavioral therapies are currently the gold standard for panic disorder treatment, with well-documented treatment response. However, following interventions, some individuals continue to improve, while others experience a return of symptoms. The field lacks reliable ways to predict follow-up symptomatology. In the current study, a cluster analysis with a repeated measures design was conducted to examine change patterns over 12 weeks of cognitive behavioral group therapy for panic disorder. The central aim of the study was to evaluate if change patterns predict level of panic symptom severity at a six month follow-up in this sample. METHODS: Individuals with panic disorder (N = 36) completed a measure of panic symptoms (Panic Disorder Severity Scale) at the outset of every therapy session and at a six month follow-up. RESULTS: Results revealed three patterns of change in this specific trial, which significantly predicted level of panic symptoms six months post-treatment, beyond initial or final level of panic symptoms, and beyond total symptom change. LIMITATIONS: Given the relatively small, lab-based sample, replications in other settings and samples will be important. CONCLUSIONS: Overall, results provide initial evidence that change patterns are meaningful predictors of panic symptom severity well after the final session of treatment.
Journal of behavior therapy and experimental psychiatry 09/2012; 44(2):150-157. · 2.48 Impact Factor
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ABSTRACT: Anxiety is characterised by a negative expectancy bias, such that anxious individuals report negatively distorted expectations about the future. Contrary to anxiety, ageing is characterised by a positivity effect, such that ageing is associated with a tendency to attend to and remember positive information, relative to negative information. The current study integrates these literatures to examine anxiety- and age-linked biases when thinking about the future. Participants (N=1,109) completed a procedure that involved reading valenced scenarios (positive, negative, or ambiguous) and then rating the likelihood of future valenced events occurring. Results suggest that ageing and anxiety have independent and opposing effects. Heightened anxiety was associated with a reduced expectancy for positive events, regardless of the scenarios' current emotional valence, whereas increased age was associated with an inflated expectancy for positive events, which was strongest when individuals were processing socially relevant or negative scenarios.
Cognition and Emotion 08/2012; · 2.52 Impact Factor
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ABSTRACT: Influences on the perception of affordances (i.e., opportunities for actions) have been primarily studied by manipulating the functional morphology of the body. However, affordances are not just determined by the functional morphology of the perceiver, but also by the physiological state of the perceiver. States of anxiety have been shown to lead to marked changes in individuals' physiological state and their behaviour. To assess the influence of emotional state on affordance perception, the perception of action capabilities in near space was examined after participants completed an anxiety-provoking task. Anxiety was induced immediately prior to tasks that assessed participants' perceived reaching ability in Experiment 1, grasping ability in Experiment 2, and the ability to pass their hands through apertures in Experiment 3. Results indicated that those participants who experienced changes in anxiety underestimated their reaching, grasping, and passing ability compared to non-anxious participants. In other words, anxious participants were more conservative in their estimations of their action capabilities. These results suggest that anxiety influences the perception for affordances in near space and are consistent with the notion that anxiety induces withdrawal behaviours.
Cognition and Emotion 06/2012; 26(7):1301-15. · 2.52 Impact Factor
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ABSTRACT: Recent theories of psychopathology have suggested that thought suppression intensifies the persistence of intrusive thoughts, and proposed that difficulty with thought suppression may differ between groups with and without psychopathology. The current meta-analytic review evaluates empirical evidence for difficulty with thought suppression as a function of the presence and specific type of psychopathology. Based on theoretical proposals from the psychopathology literature, diagnosed and analogue samples were expected to show greater recurrence of intrusive thoughts during thought suppression attempts than non-clinical samples. However, results showed no overall differences in the recurrence of thoughts due to thought suppression between groups with and without psychopathology. There was, nevertheless, variation in the recurrence of thoughts across different forms of psychopathology, including relatively less recurrence during thought suppression for samples with symptoms of Obsessive-Compulsive Disorder, compared to non-clinical samples. However, these differences were typically small and provided only mixed support for existing theories. Implications for cognitive theories of intrusive thoughts are discussed, including proposed mechanisms underlying thought suppression.
Clinical psychology review 01/2012; 32(3):189-201. · 4.90 Impact Factor
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ABSTRACT: Differences in the relative use of global and local information (seeing the forest vs. the trees) may explain why people with social anxiety often do not benefit from corrective feedback, even though they pay close attention to details in social situations. In the current study, participants high (n=43) or low (n=47) in social anxiety symptoms gave a series of brief speeches, and then self-rated their speaking performance on items reflecting global and local performance indicators (self-assessment) and also received standardized performance feedback from an experimenter. Participants then completed a questionnaire asking how they thought the experimenter would rate their performance based on the feedback provided (experimenter assessment). Participants completed the self- and experimenter assessments again after 3 days, in addition to a measure of postevent processing (repetitive negative thinking) about their speech performance. Results showed that, as hypothesized, the High SA group rated their performance more negatively than the Low SA group. Moreover, the High SA group's ratings of global aspects of their performance became relatively more negative over time, compared to their ratings of local aspects and the Low SA group's ratings. As expected, postevent processing mediated the relationship between social anxiety group status and worsening global performance evaluations. These findings point to a pattern of progressively more negative global evaluations over time for persons high in social anxiety.
Behavior therapy 12/2011; 42(4):601-11. · 2.85 Impact Factor
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ABSTRACT: The current study incorporated a life span perspective into existing theories of intrusive thoughts to examine age-related differences in the difficulty controlling intrusive thoughts, the distress following intrusive thought recurrences, and the meanings assigned to these recurrences. Younger (N = 51) and older (N = 49) community adults were randomly assigned to suppress (i.e., keep out of mind) or monitor an intrusive thought. Participants rated their positive and negative affect throughout engagement with the intrusive thought, and they also rated the meanings they gave to recurrences of their everyday intrusive thoughts. The results demonstrated that older adults tended to perceive greater difficulty with controlling the intrusive thought than younger adults despite the fact that they did not differ in the actual recurrence of the intrusive thought. With regard to distress, older adults experienced steadier levels of positive affect than younger adults throughout engagement with the intrusive thought. However, older adults also reported greater residual negative affect after engaging with the intrusive thought than younger adults. Finally, older and younger adults appeared to assign meanings to recurrences of intrusive thoughts in line with age-relevant concerns. Specifically, older adults were prone to interpret the recurrence of intrusive thoughts as a sign of cognitive decline, but they were less likely than younger adults to see intrusive thoughts as a sign of moral failure. Together, these results highlight a range of potential risk and protective factors in older adults for experiencing emotion dysregulation after intrusive thoughts.
Psychology and Aging 06/2011; 27(1):199-210. · 2.73 Impact Factor
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ABSTRACT: Three studies were conducted to examine the psychometric properties of a new scale: the Heights Interpretation Questionnaire (HIQ). This scale was designed to measure height fear-relevant interpretation bias to help assess the relationship between biased interpretations and acrophobia symptoms. Studies 1 (N=553) and 2 (N=308) established the scale's factor structure and convergent and discriminant validity among two large undergraduate samples. Study 3 (N=48) evaluated the predictive validity of the HIQ by examining how well the scale predicted subjective distress and avoidance on actual heights. Factor analysis resulted in four distinct factors, and results suggest that each of the factors, along with the full HIQ, have good reliability and validity. Additionally, the scale predicts subjective distress and avoidance on heights beyond self-reported acrophobia symptoms. Overall, the HIQ shows promise as a new tool to investigate cognitive processing biases in acrophobia.
Journal of anxiety disorders 05/2011; 25(7):896-902. · 2.68 Impact Factor
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ABSTRACT: The current study tested the causal premise underlying cognitive models of obsessive compulsive disorder (OCD) that negative interpretations of intrusive thoughts lead to the distress and impairment associated with symptoms of OCD. Specifically, we sought to determine: (a) whether it was possible to train healthier (defined as more benign/less threatening) interpretations regarding the significance of intrusive thoughts; and (b) whether there was a link between modifying negative interpretations and subsequent emotional vulnerability to an OC stressor. A nonclinical sample of students high in OC symptoms completed either a Positive (n = 50) or Neutral (n = 50) interpretation training procedure designed to alter OC-relevant interpretations and beliefs. As expected, participants in the Positive (versus Neutral) training condition endorsed healthier OC-relevant interpretations and beliefs following training. Additionally, when controlling for baseline affect, participants in the Positive (versus Neutral) training condition reported less negative affect during the OC-stressor task (at the level of a non-significant trend) and reported less desire to perform neutralizing activities. In general, results provide some support for cognitive models of obsessions and suggest that negative interpretations of intrusive thoughts may be causally related to symptoms of OCD.
Journal of behavior therapy and experimental psychiatry 01/2011; 42(3):337-43. · 2.48 Impact Factor
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ABSTRACT: Cognitive models of panic disorder suggest that change in catastrophic misinterpretations of bodily sensations will predict symptom reduction. To examine change processes, we used a repeated measures design to evaluate whether the trajectory of change in misinterpretations over the course of 12-week cognitive behavior therapy is related to the trajectory of change in a variety of panic-relevant outcomes.
Participants had a primary diagnosis of panic disorder (N = 43; 70% female; mean age = 40.14 years). Race or ethnicity was reported as 91% Caucasian, 5% African American, 2.3% biracial, and 2.3% "other." Change in catastrophic misinterpretations (assessed with the Brief Body Sensations Interpretation Questionnaire; Clark et al., 1997) was used to predict a variety of treatment outcomes, including overall panic symptom severity (assessed with the Panic Disorder Severity Scale [PDSS]; Shear et al., 1997), panic attack frequency (assessed with the relevant PDSS item), panic-related distress/apprehension (assessed by a latent factor, including peak anxiety in response to a panic-relevant stressor-a straw breathing task), and avoidance (assessed by a latent factor, which included the Fear Questionnaire-Agoraphobic Avoidance subscale; Marks & Mathews, 1979).
Bivariate latent difference score modeling indicated that, as expected, change in catastrophic misinterpretations predicted subsequent reductions in overall symptom severity, panic attack frequency, distress/apprehension, and avoidance behavior. However, change in the various symptom domains was not typically a significant predictor of later interpretation change (except for the distress/apprehension factor).
These results provide considerable support for the cognitive model of panic and speak to the temporal sequence of change processes during therapy.
Journal of Consulting and Clinical Psychology 10/2010; 78(6):964-73. · 4.85 Impact Factor
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ABSTRACT: Despite predictions following from cognitive theories of anxiety, evidence for memory biases in social anxiety has been mixed. This study extends previous research by using stimuli relevant to participants' concerns and allowing time for post-event processing. Participants high (n=42) or low (n=39) in social anxiety symptoms gave speeches and received standardized feedback on their and a confederate's performance. Participants then took recognition and recall tests for the feedback immediately after it was given and after a two-day delay. Results showed no recall biases. However, the hypothesized recognition biases were found: the high social anxiety group remembered the confederate's feedback more positively than their own, remembered their negative feedback as worse than the low group, and diminished positive feedback over time. Moreover, post-event processing mediated the relationship between social anxiety and memory for negative feedback. Results suggest that biased recognition of social feedback is linked to social anxiety.
Journal of anxiety disorders 06/2010; 24(5):468-79. · 2.68 Impact Factor
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ABSTRACT: The current study investigates an experimental anxiety reduction intervention among a highly socially anxious sample (N=108; n=36 per Condition; 80 women). Using a conditioning paradigm, our goal was to modify implicit social anxiety associations to directly test the premise from cognitive models that biased cognitive processing may be causally related to anxious responding. Participants were trained to preferentially process non-threatening information through repeated pairings of self-relevant stimuli and faces indicating positive social feedback. As expected, participants in this positive training condition (relative to our two control conditions) displayed less negative implicit associations following training, and were more likely to complete an impromptu speech (though they did not report less anxiety during the speech). These findings offer partial support for cognitive models and indicate that implicit associations are not only correlated with social anxiety, they may be causally related to anxiety reduction as well.
Journal of anxiety disorders 04/2010; 24(3):300-8. · 2.68 Impact Factor
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ABSTRACT: There is a tendency to think of case formulation as an activity that occurs at the outset of therapy to guide initial clinical
decision-making, but which plays little role once therapy is underway. However, we believe that case formulation is most useful
when viewed as a dynamic, iterative process that invites frequent revisiting of hypotheses as new client data become available.
As Eells describes in her influential handbook, “A psychotherapy case formulation is a hypothesis about the causes, precipitants,
and maintaining influences of a person’s psychological, interpersonal, and behavioral problems. A case formulation helps organize
information about a person, particularly when that information contains contradictions or inconsistencies in behavior, emotion,
and thought content.
12/2009: pages 7-30;
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ABSTRACT: The current study tests cognitive-behavioral models of body dysmorphic disorder (BDD) by examining the relationship between cognitive biases and correlates of mirror gazing. To provide a more comprehensive picture, we investigated both relatively strategic (i.e., available for conscious introspection) and automatic (i.e., outside conscious control) measures of cognitive biases in a sample with either high (n = 32) or low (n = 31) BDD symptoms. Specifically, we examined the extent that (1) explicit interpretations tied to appearance, as well as (2) automatic associations and (3) strategic evaluations of the importance of attractiveness predict anxiety and avoidance associated with mirror gazing. Results indicated that interpretations tied to appearance uniquely predicted self-reported desire to avoid, whereas strategic evaluations of appearance uniquely predicted peak anxiety associated with mirror gazing, and automatic appearance associations uniquely predicted behavioral avoidance. These results offer considerable support for cognitive models of BDD, and suggest a dissociation between automatic and strategic measures.
The Journal of nervous and mental disease 09/2009; 197(8):589-98. · 1.77 Impact Factor
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ABSTRACT: To examine the causal relationship between cognitive biases and anxiety, a bias modification paradigm was used to reduce negative interpretation biases in participants with high anxiety sensitivity (AS). Participants (N=75) were assigned to a Positive training condition or to one of two Control conditions (Neutral or No training). During training, participants imagined themselves in ambiguous scenarios related to AS. Positive training required participants to resolve the scenarios' ambiguity positively and was hypothesized to result in more positive and less negative subsequent interpretations related to AS, fewer self-reported AS symptoms, and less emotional vulnerability on AS stressors (compared to the Control conditions). As expected, Positive training shifted interpretations of novel scenarios and self-reported AS symptoms in the anticipated direction. Evidence was mixed for the effect of Positive training on emotional vulnerability (small effect for less fear, but not for avoidance). Findings support the causal premise underlying cognitive models of anxiety.
Journal of anxiety disorders 08/2009; 24(1):71-8. · 2.68 Impact Factor
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ABSTRACT: The current study tested whether height overestimation is related to height fear and influenced by images of falling. To assess perceptual biases, participants high (n=65) versus low (n=64) in height fear estimated the vertical extents of two balconies using a visual matching task. On one of the balconies, participants engaged in an imagery exercise designed to enhance the subjective sense that they were acting in a dangerous environment by picturing themselves falling. As expected, we found that individuals overestimated the balcony's height more after they imagined themselves falling, particularly if they were already afraid of heights. These findings suggest that height fear may serve as a vulnerability factor that leads to perceptual biases when triggered by a stressor (in this case, images of falling).
Journal of anxiety disorders 01/2009; 23(3):381-6. · 2.68 Impact Factor
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ABSTRACT: Cognitive models of anxiety and panic suggest that symptom reduction during treatment should be preceded by changes in cognitive processing, including modifying the anxious schema. The current study tested these hypotheses by using a repeated measures design to evaluate whether the trajectory of change in automatic panic associations over a 12-week course of cognitive behavior therapy (CBT) is related to the trajectory of change in panic symptoms. Individuals with panic disorder (N = 43) completed a measure of automatic panic associations--the Implicit Association Test (A. G. Greenwald, D. E. McGhee, & J. L. K. Schwartz, 1998), which reflects elements of the schema construct--every 3 weeks over the course of therapy and measures of panic symptoms each week. Dynamic bivariate latent difference score modeling not only indicated that automatic panic associations changed over the course of CBT for panic disorder but showed these changes were correlated with symptom reduction. Moreover, change in automatic panic associations was a significant predictor of change in panic symptom severity. These findings permit inferences about the temporality of change, suggesting that cognitive change does in fact precede and contribute to symptom change.
Journal of Consulting and Clinical Psychology 01/2009; 76(6):988-1002. · 4.85 Impact Factor
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ABSTRACT: The literatures examining disgust's role in information processing biases and evidence for memory biases in anxiety disorders are both mixed, suggesting small or fragile effects. Thus, to maximize power and reliability, a mega-analytic approach was used to examine data across two studies to determine whether a memory bias for spider-relevant information exists under conditions when disgust is elevated and if the bias is specific to highly fearful individuals. Disgust was manipulated by having a large tarantula present or absent (at encoding and/or at recall) when individuals high (N=158) or low (N=108) in spider fear completed a free recall task. Results indicated that, as expected, the spider's presence was related to enhanced recall of spider information. However, this bias was driven by the presence of the spider during encoding only (as opposed to during recall), and high trait spider fear was not necessary for the memory bias to be expressed. Finally, there was a small effect for individual differences in trait and state disgust to predict spider recall, but this effect disappeared when anxiety was also included as a predictor, suggesting only a limited role for disgust in memory biases related to specific fears.
International Journal of Cognitive Therapy 01/2009; 2(1):16-36. · 0.98 Impact Factor
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ABSTRACT: There is mounting evidence that disgust plays an important role in certain anxiety disorders, yet little is known about disgust's cognitive component. The current study introduces a measure of cognitions associated with disgust and contamination to assess the role of disgust-specific primary and secondary appraisals in phobic responding. A multi-modal assessment of blood-injury-injection (BII) and spider phobia was conducted using BII (N=29) and spider (N=30) fearful groups, and a non-fearful control group (N=30). The Disgust Cognitions scale showed good reliability and validity, and distinguished among the groups. For example, relative to the other groups, the spider fear group reported higher disgust cognitions following presentation of a live spider, whereas the BII Fear group reported higher disgust cognitions following a surgery video. Moreover, the scale was associated with multiple phobic indicators (behavioral avoidance, subjective distress, symptom endorsement), suggesting cognitions may be critical to understanding how disgust contributes to anxiety disorders.
Cognition and Emotion 01/2009; 23(2):399-414. · 2.52 Impact Factor
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ABSTRACT: This study examined implicit and explicit measures of bias toward mental illness among people with different levels of mental health training, and investigated the influence of stigma on clinically-relevant decision-making. Participants (N = 1539) comprised of (1) mental health professionals and clinical graduate students, (2) other health care/social services specialists, (3) undergraduate students, and (4) the general public self-reported their attitudes toward people with mental illness, and completed implicit measures to assess mental illness evaluations that exist outside of awareness or control. In addition, participants predicted patient prognoses and assigned diagnoses after clinical vignettes. Compared with people without mental health training, individuals with mental health training demonstrated more positive implicit and explicit evaluations of people with mental illness. Further, explicit (but not implicit) biases predicted more negative patient prognoses, but implicit (and not explicit) biases predicted over-diagnosis, underscoring the value of using both implicit and explicit measures.
The Journal of nervous and mental disease 11/2008; 196(10):752-60. · 1.77 Impact Factor
