[Show abstract][Hide abstract] ABSTRACT: Objective
To assess the relationship between session-by-session mediators and treatment outcomes in traditional cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for social anxiety disorder.
Session-by-session changes in negative cognitions (a theorized mediator of CBT) and experiential avoidance (a theorized mediator of ACT) were assessed in 50 adult outpatients randomized to CBT (n = 25) or ACT (n = 25) for DSM-IV social anxiety disorder.
Multilevel modeling analyses revealed significant non-linear decreases in the proposed mediators in both treatments, with ACT showing steeper decline than CBT at the beginning of treatment and CBT showing steeper decline than ACT at the end of treatment. Curvature (or the non-linear effect) of experiential avoidance during treatment significantly mediated post-treatment social anxiety symptoms and anhedonic depression in ACT, but not in CBT, with steeper decline of AAQ at the beginning of treatment predicting fewer symptoms in ACT only. Curvature of negative cognitions during both treatments predicted outcome, with steeper decline of negative cognitions at the beginning of treatment predicting lower post-treatment social anxiety and depressive symptoms.
Rate of change in negative cognitions at the beginning of treatment is an important predictor of change across both ACT and CBT whereas rate of change in experiential avoidance at the beginning of treatment is a mechanism specific to ACT.
[Show abstract][Hide abstract] ABSTRACT: Objective: Cognitive behavioral therapy (CBT) is an empirically supported treatment for social phobia. However, not all individuals respond to treatment and many who show improvement do not maintain their gains over the long-term. Thus, alternative treatments are needed. Method: The current study (N = 87) was a 3-arm randomized clinical trial comparing CBT, acceptance and commitment therapy (ACT), and a wait-list control group (WL) in participants with a diagnosis of social phobia based on criteria of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). Participants completed 12 sessions of CBT or ACT or a 12-week waiting period. All participants completed assessments at baseline and posttreatment, and participants assigned to CBT and ACT also completed assessments 6 and 12 months following baseline. Assessments consisted of self-report measures, a public-speaking task, and clinician ratings. Results: Multilevel modeling was used to examine between-group differences on outcomes measures. Both treatment groups outperformed WL, with no differences observed between CBT and ACT on self-report, independent clinician, or public-speaking outcomes. Lower self-reported psychological flexibility at baseline was associated with greater improvement by the 12-month follow-up in CBT compared with ACT. Self-reported fear of negative evaluation significantly moderated outcomes as well, with trends for both extremes to be associated with superior outcomes from CBT and inferior outcomes from ACT. Across treatment groups, higher perceived control and extraversion were associated with greater improvement, whereas comorbid depression was associated with poorer outcomes. Conclusions: Implications for clinical practice and future research are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Journal of Consulting and Clinical Psychology 07/2014; · 4.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Conflict between parents and adolescents involves reciprocal exchanges in which family members influence and shape each other's behavior. This study uses multilevel path analysis to examine interrelations in observed behavior during 15-min conflict discussions conducted by 103 family triads, looking specifically at parent coercive and youth avoidant behaviors. We also explore the moderating roles of parents' past aggressive family conflict behavior on parents' responses to youth behavior. Discussions were coded in 3-min segments. Analyses used time-lagged codes so that a family member's behavior in 1 segment predicted another family member's behavior in the following segment. The fully saturated cross-lagged model tested all possible paths (parents' behavior predicting parents' and youths' subsequent behavior, and vice versa). Parents' coercive behavior was associated with more avoidant youth behavior in the following segment when controlling for youths' prior avoidant behavior. The opposite direction of effects also emerged: Mothers became more coercive when youth were more avoidant in a prior segment. Fathers' coercive behavior was not associated with youths' prior behavior and, with both parents in the same model, father and youth behavior were no longer associated; however, fathers' coercive behavior predicted more mother coercive behavior in the following segment. Mothers who had behaved more aggressively during family conflict over 2 waves of data collection became more coercive when youths were more avoidant, although parents' history of aggressive family conflict behavior did not moderate father-to-youth or youth-to-parent paths. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Journal of Family Psychology 05/2014; · 1.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: Within-family concordance in physiology may have implications for family system functioning and for individual health outcomes. Here, we examine patterns of association in cortisol within family triads. Methods: A total of 103 adolescents and their parents sampled saliva at multiple timepoints before and after a conflict discussion task. We explored whether within-family associations existed and were moderated by stepparent presence and youth gender, and whether within-family patterns of influence correlated with individuals' aggregate cortisol. Results: Across the laboratory visit, the cortisol levels of fathers, mothers, and youth were positively associated. In time-lagged models, mothers' cortisol predicted fathers' cortisol levels sampled at the following timepoint, whereas fathers' predicted youths' and youths' predicted mothers' cortisol. These patterns appeared stronger in families not including stepparents. Youth gender moderated some associations: in the aggregate, youth were more strongly linked with their same-gender parent. In time-lagged models, girls were more closely linked to their mothers than boys, and both parents were more linked to girls. Youth showed higher aggregate cortisol output if they were more linked with their mothers, and lower output if more linked with their fathers; parents had higher output if they were more linked with their spouses and lower output if more linked with their children. Conclusions: These results suggest that family members' physiological activation may be linked during shared interaction, and that these patterns may be affected by family role and by youth gender. Our findings identify specific patterns of physiological influence within families that may inform family systems theories. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
[Show abstract][Hide abstract] ABSTRACT: Complex social emotions involve both abstract cognitions and bodily sensations, and individuals may differ on their relative reliance on these. We hypothesized that individuals' descriptions of their feelings during a semi-structured emotion induction interview would reveal two distinct psychological styles-a more abstract, cognitive style and a more body-based, affective style-and that these would be associated with somatosensory neural activity. We examined 28 participants' open-ended verbal responses to admiration- and compassion-provoking narratives in an interview and BOLD activity to the same narratives during subsequent functional magnetic resonance imaging scanning. Consistent with hypotheses, individuals' affective and cognitive word use were stable across emotion conditions, negatively correlated and unrelated to reported emotion strength in the scanner. Greater use of affective relative to cognitive words predicted more activation in SI, SII, middle anterior cingulate cortex and insula during emotion trials. The results suggest that individuals' verbal descriptions of their feelings reflect differential recruitment of neural regions supporting physical body awareness. Although somatosensation has long been recognized as an important component of emotion processing, these results offer 'proof of concept' that individual differences in open-ended speech reflect different processing styles at the neurobiological level. This study also demonstrates SI involvement during social emotional experience.
Social Cognitive and Affective Neuroscience 07/2012; · 5.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Associations between adolescents' range of fundamental frequency, cortisol output, and self-reported emotional experience were examined during problem discussions with parents. Participants are a community-based sample of 56 boys and girls in a longitudinal study on conflict exposure. Results reveal that higher aggregate levels of range of fundamental frequency are associated with higher cortisol output and higher levels of self-reported negative emotions for boys and girls. Additionally, greater cortisol output is significantly associated with a slower time-to-peak of range of fundamental frequency for girls and with significantly less variability in range of fundamental frequency for boys. Implications of results for emotional development in adolescents, measurement, and modeling are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
[Show abstract][Hide abstract] ABSTRACT: Is an attenuated physiological response to family conflict, seen in some youth exposed to early adversity, protective or problematic? A longitudinal study including 54 youth (average age 15.2 years) found that those with higher cumulative family aggression exposure showed lower cortisol output during a laboratory-based conflict discussion with their parents, and were less likely to show the normative pattern of increased cortisol reactivity to a discussion they rated as more conflictual. Family aggression interacted with cortisol reactivity in predicting youth adjustment: Adolescents from more aggressive homes who were also more reactive to the discussion reported more posttraumatic stress symptoms and more antisocial behavior. These results suggest that attenuated reactivity may protect youth from the negative consequences associated with aggressive family environments.
Child Development 05/2012; 83(3):821-30. · 4.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cortisol is a stress-related hormone with a robust circadian rhythm where levels typically peak in the morning hours and decline across the day. Although acute cortisol increases resulting from stressors are adaptive, chronic elevated cortisol levels are associated with poor functioning. Studies have shown age-related changes in cortisol levels. The present study investigated the relationship between salivary diurnal cortisol and functional outcomes among older adults undergoing inpatient post-acute rehabilitation.
Thirty-two older adults (mean age 78 years; 84% men) in a Veterans Administration inpatient post-acute rehabilitation unit were studied. Functional outcomes were assessed with the motor component of the Functional Independence Measure (mFIM; where mFIM change = discharge - admission score). Saliva samples were collected on 1 day at wake time, 45 minutes later, 11:30 AM, 2 PM, 4:30 PM, and bedtime. We analyzed the relationship between cortisol measures and functional outcomes, demographics, and health measures.
The analyses consistently showed that greater functional improvement (mFIM change) from admission to discharge was associated with lower comorbidity scores and higher cortisol levels at 2 PM, 4:30 PM, and bedtime. A morning cortisol rise was also associated with greater mFIM change.
Measurement of cortisol in saliva may be a useful biological marker for identification of patients who are "at risk" of lower benefits from inpatient rehabilitation services and who may require additional assistance or intervention during their post-acute care stay.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences 01/2012; 67(6):677-82. · 4.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Characteristics of family life are linked both cross-sectionally and prospectively to adult mental and physical health.
This paper discusses social and biological processes that may explain how families influence the health of their members.
We review naturalistic studies of short-term biopsychosocial processes as they unfold within the family.
Day-to-day fluctuations in stressors, demands, and social and emotional experiences in the family are reflected in short-term changes in adult members' affect and in the activity of biological stress-response systems, particularly the hypothalamic-pituitary-adrenal axis.
To learn how family environments are linked to health, researchers should study the interlacing of different aspects of the everyday lives of family members, including their physiology, emotions, behavior, activities, and experiences.
Annals of Behavioral Medicine 08/2011; 42(3):285-93. · 4.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Spouses' balancing of housework and leisure activities at home may affect their recovery from work. This paper reports on a study of everyday family life in which 30 dual-earner couples were tracked around their homes by researchers who recorded their locations and activities every 10 min. For women, the most frequently pursued activities at home were housework, communication, and leisure; husbands spent the most time in leisure activities, followed by communication and housework. Spouses differed in their total time at home and their proportion of time devoted to leisure and housework activities, with wives observed more often in housework and husbands observed more often in leisure activities. Both wives and husbands who devoted more time to housework had higher levels of evening cortisol and weaker afternoon-to-evening recovery. For wives, husbands' increased housework time also predicted stronger evening cortisol recovery. When both spouses' activities were entered in the same model, leisure predicted husbands' evening cortisol, such that husbands who apportioned more time to leisure, and whose wives apportioned less time to leisure, showed stronger after-work recovery. These results suggest that the division of labor within couples may have implications for physical health.
Journal of Family Psychology 04/2011; 25(2):271-81. · 1.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Over four days, a researcher recorded the at-home activities of 30 families at 10-min intervals. Television viewing was the second most frequently observed activity for parents and the most frequently observed activity for children. Most television was watched in common areas of the home and in the presence of at least one other person, with the most common viewing configuration involving both parents and at least one child. When parents pursued another activity in conjunction with TV viewing, that activity was most likely to be in-person social interaction. In contrast, children were more likely to watch TV in bedroom spaces and were more likely to pair TV viewing with other leisure activities. In families with TVs in a child's bedroom (about ½ of the families), children were especially likely to watch TV alone and in non-common areas of the home. The results indicate that parents tend to engage in television viewing as a social activity, but that children may be more likely to be solo viewers.
Communication Research Reports 04/2011; 28(2):180-189.
[Show abstract][Hide abstract] ABSTRACT: Although a majority of adults live with a close relationship partner, little is known about whether and how partners' momentary affect and physiology covary, or "coregulate." This study used a dyadic multilevel modeling approach to explore the coregulation of spouses' mood states and cortisol levels in 30 married couples who sampled saliva and reported on mood states 4 times per day for 3 days. For both husbands and wives, own cortisol level was positively associated with partner's cortisol level, even after sampling time was controlled. For wives, marital satisfaction weakened the strength of this effect. Partner's negative mood was positively associated with own negative mood for both husbands and wives. Marital satisfaction fully moderated this effect, reducing the strength of the association between one's own and one's partner's negative mood states. Spouses' positive moods were not correlated. As expected, within-couple coregulation coefficients were stronger when mood and cortisol were sampled in the early morning and evening, when spouses were together at home, than during the workday. The results suggest that spouses' fluctuations in negative mood and cortisol levels are linked over several days and that marital satisfaction may buffer spouses from their partners' negative mood or stress state.
Journal of Personality and Social Psychology 01/2010; 98(1):92-103. · 5.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The way people describe their homes may reflect whether their time at home feels restorative or stressful. This article uses linguistic analysis software (Linguistic Inquiry and Word Count) to analyze 60 dual-income spouses' self-guided home tours by calculating the frequency of words describing clutter, a sense of the home as unfinished, restful words, and nature words. Based on a principal components analysis, the former two categories were combined into the variable stressful home and the latter two into restorative home. Over 3 weekdays following the home tours, wives with higher stressful home scores had flatter diurnal slopes of cortisol, a profile associated with adverse health outcomes, whereas women with higher restorative home scores had steeper cortisol slopes. These results held after controlling for marital satisfaction and neuroticism. Women with higher stressful home scores had increased depressed mood over the course of the day, whereas women with higher restorative home scores had decreased depressed mood over the day.
Personality and Social Psychology Bulletin 11/2009; 36(1):71-81. · 2.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Families are dynamic systems that are permeable to influences from the outside world, such as daily stressors at work and at school. Our research uses naturalistic methods to investigate how family interactions change in response to such experiences and how other family members contribute to that process. We argue that the short-term effects of daily stressors on family dynamics can have cumulative, long-term implications for family health and functioning. Naturalistic studies that incorporate daily diary, observational, and physiological measures can offer new insights into families' everyday stress responding and coping processes.
Current Directions in Psychological Science 01/2009; 18(2):106-111. · 3.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Parents of 50 4th grade girls reported on their marital relationships and then, two years later, rated their daughters' pubertal development. Fathers' ratings of marital dissatisfaction, mothers' ratings of less emotional support from husbands, and both parents' ratings of aversive marital conflict were correlated with more advanced pubertal development in daughters. Fathers' withdrawal behavior during marital conflict emerged as the strongest predictor. These results are consistent with evolutionary theories of pubertal development and suggest that parents' impressions of the marital relationship may be linked with girls' pubertal development, even in a middle-class sample with both parents present in the household. They also suggest several heretofore underexplored foci for researchers in this area, such as parents' behaviors during marital conflict and fathers' experiences of the marital relationship.
Journal of Adolescence 09/2008; 32(2):415-23. · 2.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Researchers have been incorporating ambulatory cortisol sampling into studies of everyday life for over a decade. Such work provides an important supplement to acute laboratory stress paradigms and provides a novel perspective on the interrelationships between stress, psychological resources, and health. However, the results of many field studies have been inconclusive and more studies have been undertaken than published. We describe some of the challenges facing naturalistic cortisol researchers, including lack of power, methodological and analytical problems, and patterns of confusing or conflictual results. We then summarize key findings of published naturalistic cortisol studies to date, grouped by type of cortisol outcome (morning awakening response, diurnal slope, area under the curve, and associations between momentary experiences and cortisol). We propose research questions relevant to everyday stress researchers and suggest next steps for researchers who are interested in incorporating naturalistic cortisol sampling into future studies.
Health Psychology Review 09/2008; 2(2):163-190. · 2.06 Impact Factor