[Show abstract][Hide abstract] ABSTRACT: The 62-item Multidimensional Experiential Avoidance Questionnaire (MEAQ) was recently developed to assess a broad range of experiential avoidance (EA) content. However, practical clinical and research considerations made a briefer measure of EA desirable. Using items from the original 62-item MEAQ, a 15-item scale was created that tapped content from each of the MEAQ's six dimensions. Items were selected on the basis of their performance in 3 samples: undergraduates (n = 363), psychiatric outpatients (n = 265), and community adults (n = 215). These items were then evaluated using 2 additional samples (314 undergraduates and 201 psychiatric outpatients) and cross-validated in 2 new, independent samples (283 undergraduates and 295 community adults). The resulting measure (Brief Experiential Avoidance Questionnaire; BEAQ) demonstrated good internal consistency. It also exhibited strong convergence with respect to each of the MEAQ's 6 dimensions. The BEAQ demonstrated expected associations with measures of avoidance, psychopathology, and quality of life and was distinguishable from negative affectivity and neuroticism. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
[Show abstract][Hide abstract] ABSTRACT: Increasing research is promoting the need for innovative, holistic, and sustainable ways to foster resiliency and recovery in war-affected children. The Shropshire Music Foundation seeks to promote a culture of peace and unity, as well as development and recovery for children living in postconflict Kosovo. The current study evaluated the effectiveness of this program, by independent investigators, in promoting resiliency and diminishing distress in program participants. The study evaluated groups of students with no program participation, new program participants, 12 months of participation, and program graduates (N = 74). Overall, children who participated in the program at least 1 year evidenced fewer affective and cognitive disturbances than children recently enrolled. Furthermore, the relationship between posttraumatic stress disorder (PTSD) symptomology and conduct problems was mediated by attention problems. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
Traumatology: An International Journal. 01/2014; 20(2):112.
[Show abstract][Hide abstract] ABSTRACT: Background
DSM-5 portrays mania as unitary despite evidence of distinct symptom clusters. Studies investigating the structure of mania have been inconsistent, in part because many relied on instruments not designed for this question. The present work used a clinical interview designed for structural analysis in order to identify and validate subdimensions specific to mania symptoms.
Psychiatric outpatients (N=422) and undergraduates with a history of mental health treatment (N=306) were interviewed with a comprehensive measure of mood and anxiety that included 24 manic symptoms. Patients completed additional measures of symptoms and functioning, and a semi-structured diagnostic interview.
A 4-factor model of mania replicated across independent samples and was superior in fit to competing models, including the unidimensional model implied whenever researchers or clinicians use only a total score for mania. The factors were only moderately correlated, and three of the four (“Irritability” was the exception) showed a strong criterion, convergent and discriminant validity, suggesting they are specific to mania. Subdimensions showed distinct and meaningful associations with functioning.
Symptoms of psychosis and depression are important features of manic episodes, but were not included in the present study since they lack specificity to mania.
Mania is multifaceted. At least three subdimensions specific to mania were identified (“Euphoric Activation,” “Hyperactive Cognition” and “Reckless Overconfidence”). Use of subdimensions, in addition to overall mania severity, may enhance the ability of studies to detect meaningful biological correlates of bipolar disorder. Moreover, their different associations with functioning suggest assessing subdimensions has clinical utility as well.
Journal of affective disorders 01/2014; 161:8–15. · 3.76 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Individuals with bipolar disorder often endorse dysfunctional beliefs consistent with cognitive models of bipolar disorder (Beck, 1976; Mansell, 2007). Aims: The present study sought to assess whether young adult offspring of those with bipolar disorder would also endorse these beliefs, independent of their own mood episode history. Method: Participants (N = 89) were young adult college students with a parent with bipolar disorder (n = 27), major depressive disorder (MDD; n = 30), or no mood disorder (n = 32). Semi-structured interviews of the offspring were used to assess diagnoses. Dysfunctional beliefs related to Beck and colleagues' (2006) and Mansell's (2007) cognitive models were assessed. Results: Unlike offspring of parents with MDD or no mood disorder, those with a parent with bipolar disorder endorsed significantly more dysfunctional cognitions associated with extreme appraisal of mood states, even after controlling for their own mood diagnosis. Once affected by a bipolar or depressive disorder, offspring endorsed dysfunctional cognitions across measures. Conclusions: Dysfunctional cognitions, particularly those related to appraisals of mood states and their potential consequences, are evident in young adults with a parent who has bipolar disorder and may represent targets for psychotherapeutic intervention.
Behavioural and Cognitive Psychotherapy 12/2013; · 1.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Post-traumatic stress disorder (PTSD) symptoms are common among responders to the 9/11 attacks on the World Trade Center and can lead to impairment, yet it is unclear which symptom dimensions are responsible for poorer functioning. Moreover, how best to classify PTSD symptoms remains a topic of controversy. The present study tested competing models of PTSD dimensions and then assessed which were most strongly associated with social/occupational impairment, depression, and alcohol abuse. World Trade Center responders (n=954) enrolled in the Long Island site of the World Trade Center Health Program between 2005 and 2006 were administered standard self-report measures. Confirmatory factor analysis confirmed the superiority of four-factor models of PTSD over the DSM-IV three-factor model. In selecting between four-factor models, evidence was mixed, but some support emerged for a broad dysphoria dimension mapping closely onto depression and contributing strongly to functional impairment. This study confirmed in a new population the need to revise PTSD symptom classification to reflect four dimensions, but raises questions about how symptoms are categorized. Results suggest that targeted treatment of symptoms may provide the most benefit, and that treatment of dysphoria-related symptoms in disaster relief workers may have the most benefit for social and occupational functioning.
[Show abstract][Hide abstract] ABSTRACT: Abstract To determine whether or not different therapies have distinct patterns of change, it is useful to investigate not only the end result of psychotherapy (outcome) but also the processes by which outcomes are attained. The present study subjected data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program to survival analyses to examine whether the process of psychotherapy, as conceptualized by the phase model, differed between psychotherapy treatment approaches. Few differences in terms of progression through phases of psychotherapy were identified between cognitive behavior therapy and interpersonal therapy. Additionally, results indicate that phases of psychotherapy may not represent discrete, sequentially invariant processes.
Psychotherapy Research 08/2013; · 1.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th ed.) Section III will include an alternative hybrid system for the diagnosis of personality disorder (PD). This alternative system defines PD types partly through specific combinations of maladaptive traits, rather than by using a set of polythetic diagnostic criteria. The current report utilizes a large sample of undergraduates (n = 1,159) to examine three dimensional methods for comparing an individual's trait profile to each PD type. We found that the sum of an individual's scores on the assigned traits obtained large convergent correlations (Mdn r =.61) and best reproduced the patterns of PD discriminant correlations observed within the DSM-IV measure. We also tested the DSM-5 Section III model algorithms and compared them with different thresholds for assigning categorical diagnoses. Frequency rates using the algorithms were greatly reduced, whereas requiring half of the assigned traits produced rates that more closely approximated current prevalence estimates. Our research suggests that DSM-5 Section III trait model can reproduce the DSM-IV-TR PD constructs and identifies effective methods of doing so.
[Show abstract][Hide abstract] ABSTRACT: As a result of CoA-mandated program disclosure being initiated in 2006, there is now sufficient data available to allow for analyses that compare clinical psychology programs on a range of variables, including student outcomes. This standardized data, in concert with other sources of publically available data (i.e., APPIC and ASPPB), allows for programs to be compared empirically in new ways. Using SEM, in this study 80.6% of the variance in clinical psychology training programs’ outcomes (i.e., internship match and licensure exam performances) was accounted for by pre-doctoral characteristics (measured by GPA and GRE scores). Analyses then identified programs that produced exceptionally better outcomes than expected, given their pre-doctoral characteristics. The identified top programs were next compared on a range of department level training-relevant variables to similar programs, but whose outcomes were equal to or worse than expected. Findings are discussed and future directions for research and policy are suggested.
Training and Education in Professional Psychology 01/2013; 7:278-284. · 1.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Trauma Outcome Process Assessment (TOPA) is a theoretical model, based on a large body of empirical research establishing key variables that consistently are associated with a range of outcomes following traumatic events. Although most who experience a traumatic event will initially experience symptoms of distress, most will subsequently recover without intervention. Those responding to the needs of trauma survivors are unable currently to predict at early stages who might benefit from assistance and where to devote resources. In this model, individual variables (e.g., personality) are considered within the context of ecological factors (e.g., family dynamics, social support) to explain mental health outcomes (e.g., recovery, various forms of distress) following traumatic stressor exposure. Analyses in this study revealed the expected relationships among study measures and found that the measures mapped well onto the hypothesized latent constructs of the TOPA model. Using structural equation modeling (SEM) the TOPA performed well, suggesting that the TOPA has utility as a theoretical basis for the identification and treatment of differential mental health outcomes following exposure to a traumatic stressor and lend support to key variables that might be considered to better understand trajectories of recovery and illness.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Deficits in cognitive functioning have been associated with bipolar disorder during episodes of depression and mania, as well as during periods of symptomatic remission. Separate evidence suggests that patients may lack awareness of these deficits and may even be overly confident with self-appraisals. The extent to which these separately or together represent prodromes of the disorder versus a consequence of the disorder remains unclear. The present study sought to test whether risk for bipolar disorder in a younger, college-aged cohort of individuals would be associated with lower performance in cognitive ability yet higher self-appraisal of cognitive functioning. METHOD: Participants (N=128) completed an objective measure of working memory, a self-report measure of everyday cognitive deficits, and a measure associated with risk for bipolar disorder. RESULTS: Contrary to expectation, risk for bipolar disorder did not significantly predict poorer working memory. However, a person's risk for bipolar disorder was associated with higher self-appraisal of cognitive functioning relative to those with lower risk despite there being no indication of a difference in ability on the working memory task. LIMITATIONS: Participant recruitment relied on an analog sample; moreover, assessment of cognitive functioning was limited to working memory. CONCLUSIONS: Results add to a growing body of evidence indicating that overconfidence may be part of the cognitive profile of individuals at risk for bipolar disorder.
Journal of affective disorders 08/2012; · 3.76 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The original Inventory of Depression and Anxiety Symptoms (IDAS) contains 11 nonoverlapping scales assessing specific depression and anxiety symptoms. In creating the expanded version of the IDAS (the IDAS-II), our goal was to create new scales assessing other important aspects of the anxiety disorders as well as key symptoms of bipolar disorder. Factor analyses of the IDAS-II item pool led to the creation of seven new scales (Traumatic Avoidance, Checking, Ordering, Cleaning, Claustrophobia, Mania, Euphoria) plus an expanded version of Social Anxiety. These scales are internally consistent and show strong convergent and significant discriminant validity in relation to other self-report and interview-based measures of anxiety, depression, and mania. Furthermore, the scales demonstrate substantial criterion and incremental validity in relation to interview-based measures of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) symptoms and disorders. Thus, the expanded IDAS-II now assesses a broad range of depression, anxiety, and bipolar symptoms.
[Show abstract][Hide abstract] ABSTRACT: Bipolar disorder with psychosis is common in inpatient settings and is associated with diverse outcomes after hospital discharge, which can range from a return to premorbid functioning with no recurrence, to a chronic or recurring illness. Less is known, however, about factors that can predict a better or worse clinical outcome. The present study sought to assess four-year clinical outcomes and their predictors in patients hospitalized for bipolar I disorder with psychosis.
Participants from the Suffolk County Mental Health Project (SCMHP) with a baseline diagnosis of bipolar I disorder with psychotic features (N=126) were reassessed using face-to-face interviews at six months, two years, and four years following their first hospitalization. At each time point, clinical status, role functioning, and treatment were assessed by highly trained interviewers using standardized instruments.
The majority of participants (73.2%) returned to their premorbid level of role functioning by the four-year follow-up and the median percentage of time ill during the interval was less than 20%. Nevertheless, almost half of the sample (46.9%) was rehospitalized at least once. Psychotic symptoms at baseline (particularly Schneiderian symptoms), depressive phenomenology, childhood psychopathology, and younger age at first hospitalization predicted worse outcome, whereas mood-incongruent psychotic features and age of mood disorder onset did not.
The four-year outcomes of a first-admission cohort with bipolar I disorder with psychosis were generally favorable. Poorer premorbid functioning, Schneiderian delusions, greater depressive symptoms, and a younger age of first hospitalization portend a worse course.
[Show abstract][Hide abstract] ABSTRACT: Patterns of comorbidity among mental disorders are thought to reflect the natural organization of mental illness. Factor analysis can be used to investigate this structure and construct a quantitative classification system. Prior studies identified 3 dimensions of psychopathology: internalizing, externalizing, and thought disorder. However, research has largely relied on common disorders and community samples. Consequently, it is unclear how well the identified organization applies to patients and how other major disorders fit into it.
To analyze comorbidity among a wide range of Axis I disorders and personality disorders (PDs) in the general outpatient population.
Clinical cohort study.
A general outpatient practice, the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project.
Outpatients (N = 2900) seeking psychiatric treatment.
The Structured Clinical Interview for DSM-IV and the Structured Interview for DSM-IV Personality.
We tested several alternative groupings of the 25 target disorders. The DSM-IV organization fit the data poorly. The best-fitting model consisted of 5 factors: internalizing (anxiety and eating disorders, major depressive episode, and cluster C, borderline, and paranoid PDs), externalizing (substance use disorders and antisocial PD), thought disorder (psychosis, mania, and cluster A PDs), somatoform (somatoform disorders), and antagonism (cluster B and paranoid PDs).
We confirmed the validity of the 3 previously found spectra in an outpatient population. We also found novel somatoform and antagonism dimensions, which this investigation was able to detect because, to our knowledge, this is the first study to include a variety of somatoform and personality disorders. The findings suggest that many PDs can be placed in Axis I with related clinical disorders. They also suggest that unipolar depression may be better placed with anxiety disorders than with bipolar disorders. The emerging quantitative nosology promises to provide a more useful guide to clinicians and researchers.
Archives of general psychiatry 10/2011; 68(10):1003-11. · 12.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present study investigates how consistently DSM-IV major depressive disorder (MDD) with psychosis was diagnosed by research consensus across 10 years and the association of clinical characteristics with diagnostic consistency.
The sample included 146 participants, part of a larger first-admission cohort (N = 628) presenting to a psychiatric inpatient facility with psychosis, who were diagnosed with psychotic depression at least once across 4 assessments spanning 10 years (after first admission and at 6-month, 24-month, and 10-year follow-ups). The primary outcome of this prospective epidemiologic study was retention of the best-estimate consensus diagnosis at each assessment. Diagnoses at each assessment were determined from semistructured interviews, medical records, and informant reports. The participants were recruited from 1989 to 1995.
Fifty-five of the 146 participants (37.7%) were diagnosed with psychotic depression at each available assessment; 13 (8.9%) switched from MDD to bipolar disorder, 24 (16.4%) switched from MDD to schizophrenia or schizoaffective disorder, and the remaining 54 (37.0%) had other patterns of diagnostic change. Only 47 of 80 participants (58.8%) diagnosed with MDD at baseline retained a mood disorder diagnosis 10 years later (36 [45.0%] had MDD and 11 [13.8%] had bipolar disorder), while 16 of 52 participants (30.8%) who ended the study with MDD were initially misdiagnosed. Compared to participants who were consistently diagnosed with MDD, those switching from MDD to bipolar disorder had better premorbid adjustment, more first-degree relatives with MDD, better functioning, and fewer negative symptoms at baseline, whereas those shifting to the schizophrenia spectrum had a more insidious onset, longer initial hospital stays, worse functioning, and more negative symptoms (all P values < .05).
The diagnosis of MDD with psychosis among inpatients showed poor long-term consistency. For clinicians, results indicate that the diagnosis of MDD with psychosis based on a single assessment should be considered provisional.
The Journal of Clinical Psychiatry 08/2011; 72(9):1207-13. · 5.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Diagnostic shifts have been prospectively examined in the short term, but the long-term stability of diagnoses has rarely been evaluated. The authors examined diagnostic shifts over a 10-year follow-up period.
A cohort of 470 first-admission patients with psychotic disorders was systematically assessed at baseline and at 6-month, 2-year, and 10-year follow-ups. Longitudinal best-estimate consensus diagnoses were formulated after each assessment.
At baseline, the diagnostic distribution was 29.6% schizophrenia spectrum disorders, 21.1% bipolar disorder with psychotic features, 17.0% major depression with psychotic features, 2.4% substance-induced psychosis, and 27.9% other psychoses. At year 10, the distribution changed to 49.8%, 24.0%, 11.1%, 7.0%, and 8.1%, respectively. Overall, diagnoses were changed for 50.7% of study participants at some point during the study. Most participants who were initially diagnosed with schizophrenia or bipolar disorder retained the diagnosis at year 10 (89.2% and 77.8%, respectively). However, 32.0% of participants (N=98) originally given a non-schizophrenia diagnosis had gradually shifted to a schizophrenia diagnosis by year 10. The second largest shift was to bipolar disorder (10.7% of those not given this diagnosis at baseline). Changes in the clinical picture explained many diagnostic shifts. In particular, poorer functioning and greater negative and psychotic symptom ratings predicted a subsequent shift to schizophrenia. Better functioning and lower negative and depressive symptom ratings predicted the shift to bipolar disorder.
First-admission patients with psychotic disorders run the risk of being misclassified at early stages in the illness course, including more than 2 years after first hospitalization. Diagnosis should be reassessed at all follow-up points.
American Journal of Psychiatry 06/2011; 168(11):1186-94. · 14.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Experiential avoidance (EA) has been conceptualized as the tendency to avoid negative internal experiences and is an important concept in numerous conceptualizations of psychopathology as well as theories of psychotherapy. Existing measures of EA have either been narrowly defined or demonstrated unsatisfactory internal consistency and/or evidence of poor discriminant validity vis-à-vis neuroticism. To help address these problems, we developed a reliable self-report questionnaire assessing a broad range of EA content that was distinguishable from higher order personality traits. An initial pool of 170 items was administered to a sample of undergraduates (N = 312) to help evaluate individual items and establish a structure via exploratory factor analyses. A revised set of items was then administered to another sample of undergraduates (N = 314) and a sample of psychiatric outpatients (N = 201). A 2nd round of item evaluation was performed, resulting in a final 62-item measure consisting of 6 subscales. Cross-validation data were gathered in 3 new, independent samples (students, N = 363; patients, N = 265; community adults, N = 215). The resulting measure (the Multidimensional Experiential Avoidance Questionnaire, or MEAQ) exhibited good internal consistency, was substantially associated with other measures of avoidance, and demonstrated greater discrimination vis-à-vis neuroticism relative to preexisting measures of EA. Furthermore, the MEAQ was broadly associated with psychopathology and quality of life, even after controlling for the effects of neuroticism.
[Show abstract][Hide abstract] ABSTRACT: Bipolar disorder is often underdiagnosed. Recommendations for improving the detection of bipolar disorder include the use of screening questionnaires. The most widely studied screening scale is the Mood Disorders Questionnaire (MDQ). Studies of the performance of the MDQ in heterogeneous samples of psychiatric outpatients presenting for treatment have raised concerns about the adequacy of the MDQ as a screening measure because of its relatively low sensitivity. The sensitivity of a scale is not an inherent property of the instrument but depends on the threshold used to identify positive cases. Prior studies used the scoring recommendations of the developers of the MDQ to examine its performance; none examined the performance of the scale across the range of cutoff scores to determine whether a lower threshold would be more appropriate for the purposes of screening. The goal of the present study was to examine the operating characteristics of the MDQ at all cutoff scores to determine the cutoff point that would be appropriate for the purpose of screening. Seven hundred fifty-two psychiatric outpatients were interviewed with the Structured Clinical Interview for DSM-IV, and completed the MDQ. When MDQ caseness was based only on symptom score without regard to level of impairment, the cutoff score associated with at least 90% sensitivity was 5. At this cutoff the specificity of the MDQ was 60.7%, and its positive predictive value was 22.1%. These findings indicate that when the cutoff to identify cases on the MDQ was set to achieve a desired level of sensitivity as a screening instrument most cases screening positive on the scale did not have bipolar disorder. Low positive predictive value does not support the use of the MDQ or any bipolar disorder screening scale in psychiatric clinical practice.
[Show abstract][Hide abstract] ABSTRACT: The negative impact of bipolar disorder on occupational functioning is well established. However, few studies have examined the persistence of unemployment, and no studies have examined the association between diagnostic comorbidity and sustained unemployment. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we described the amount of time unemployed in the five years before the evaluation in a large cohort of outpatients diagnosed with bipolar disorder, and determined the demographic and clinical correlates of sustained unemployment.
A total of 206 patients diagnosed with DSM-IV bipolar I or bipolar II disorder were interviewed with semi-structured interviews assessing comorbid Axis I and Axis II disorders, demographic and clinical variables. The interview included an assessment of the amount of time missed from work due to psychiatric reasons during the past five years. Persistent unemployment was defined as missing up to two years or more from work.
Less than 20% of the patients reported not missing any time from work due to psychiatric reasons, and more than one-third missed up to two years or more from work. Prolonged unemployment was associated with increased rates of current panic disorder and a lifetime history of alcohol abuse or dependence. Patients with prolonged unemployment were older and experienced more episodes of depression.
Most patients presenting for the treatment of bipolar disorder have missed some time from work due to psychiatric reasons, and the persistence of employment problems is considerable. Comorbid psychiatric disorders are a potentially treatable risk factor for sustained unemployment. It is therefore of public health significance to determine if current treatments are effective in bipolar disorder patients with current panic disorder, and if not, to attempt to develop treatments that are effective.