Jonathan D Huppert

• PhD
• Hebrew University of Jerusalem

Objective: Sudden gains in psychotherapy have been found to predict outcome, but the conditions under which this occurs remain understudied. In the present study, we experimentally examined the effects of processing sudden gains on treatment outcome. Method: As part of a large randomized controlled trial of internet-delivered cognitive behavior...

Anxiety and related disorders are a significant public-health burden with rising prevalence in the wake of the COVID-19 pandemic. As demand for effective anxiety treatment increases, so too does the need for strategies to bolster treatment outcomes. Research on the mechanisms of exposure therapy, the frontline behavioral treatment, will be critical...

Many individuals with social anxiety disorder (SAD) have depressive symptoms that meet criteria for major depressive disorder (MDD). In our study, we examined the temporal relationship between symptoms of social anxiety and symptoms of depression during the course of an 11-week internet-delivered cognitive behavioral treatment (ICBT) for SAD (n = 1...

The Exposure Therapy Consortium (ETC) was established to advance the science and practice of exposure therapy. To encourage participation from researchers and clinicians, we describe the organizational structure and activities of the ETC. Initial research working group experiences and a proof-of-principle study underscore the potential of team scie...

UNSTRUCTURED Recent breakthroughs in artificial intelligence (AI) language models have elevated the vision of using AI support for mental health, with a growing body of literature indicating varying degrees of efficacy. In this paper we ask when in therapy will it be easier to replace humans, and conversely, in what instances will human connection...

Recent breakthroughs in artificial intelligence (AI) language models have elevated the vision of using conversational AI support for mental health, with a growing body of literature indicating varying degrees of efficacy. In this paper, we ask when, in therapy, it will be easier to replace humans and, conversely, in what instances, human connection...

Social anxiety disorder (SAD) is a highly prevalent and disabling disorder characterized by intrapersonal (self-related) and interpersonal (interaction-related) difficulties. We use the biobehavioral systems of affiliation and status as linchpins connecting intrapersonal and interpersonal bodies of knowledge to frame such difficulties. We suggest t...

Individuals with Panic Disorder (PD) often have impaired insight, which can impede their willingness to seek treatment. Cognitive processes, including metacognitive beliefs, cognitive flexibility, and jumping to conclusions (JTC) may influence the degree of insight. By understanding the relationship between insight and these cognitive factors in PD...

Interoceptive exposure, or exposure to one's feared physical sensations, has been shown to be an important technique in cognitive behavioral therapies for anxiety disorders and related constructs, such as anxiety sensitivity (AS). The current study sought to further clarify the underlying cognitive-behavioral mechanisms of interoceptive exposure in...

Objective The therapeutic alliance is related to treatment outcome but less is known about the agreement on alliance between patients and therapists and its relationship to outcomes. We examined the association of patient-therapist congruence of alliance perceptions, early and late in cognitive behavioral therapy for panic disorder in relation to s...

Background and objectives Negative mental imagery appears to play a role in anxiety disorders and can involve aversive memories or anticipated future threats. Modulating aversive memories through imagery rescripting generally reduces negative memory appraisals and associated anxiety. This pre-registered two-day analog study investigated whether ima...

Background and objectives Rumination involves fixating on negative content, is associated with biases in inhibitory control, and typically worsens negative mood. In contrast, distraction attempts to engage attentional control and downregulate negative mood. To date studies have not dissociated the detrimental effects of rumination from beneficial e...

Background and objectives Obsessive-compulsive disorder (OCD) is often characterized by rigidity regarding rules and perfectionism, which suggests a formal reasoning style. However, other characterizations suggest an overreliance on internal cues for behavior termination, which suggests a more intuitive reasoning style. We examine reasoning styles...

Although vulnerable narcissism (VN) and avoidant personality (AP) share many characteristics, almost no research has been done to examine their differences. In this study, we examined the notion of VN and AP having similar overt presentations that stem from different underlying mechanisms. VN’s and AP’s relationships with explicit and implicit self...

Zilcha-Mano (2020) suggests that making a distinction between trait-like and state-like (TLSL) processes is the key to developing personalized treatments. In the current commentary, I question the novelty of the TLSL concept and emphasize the importance of having clearly defined, psychometrically sound concepts applied to psychotherapy research for...

Background Grandiose and vulnerable narcissism (GN/VN) are theorized to form two opposite coping strategies aimed at regulating self-esteem in face of a threat, especially negative feedback in social context. To test this, we examined the relationships of GN and VN with self-appraisals in social context, and hypothesized that GN would predict posit...

Importance: Serotonin reuptake inhibitors (SRIs) are the only medications approved for obsessive-compulsive disorder (OCD), yet most patients taking SRIs exhibit significant symptoms. Adding exposure/response prevention (EX/RP) therapy improves symptoms, but it is unknown whether patients maintain wellness after discontinuing SRIs. Objective: To...

An open trial of a therapist-guided internet cognitive-behavioral therapy (ICBT) for panic disorder with and without agoraphobia (PD/A) was conducted. Ninety adults diagnosed with PD/A were treated using ICBT adapted from a face to face (FTF) protocol. Results were benchmarked against two FTF samples, one at the same research site using the same pr...

Background and objectives This study examined whether ritualistic behaviors characteristic of obsessive-compulsive disorder (OCD) are a product of dysfunctional goal-directed behavior leading to habitual behavior (Gillan & Robbins, 2014). We used an explicit motor sequence learning task to investigate the repetition of chunked action sequences acro...

Depression is one of the most common emotional disorders, and it is even more common when one is suffering from an anxiety disorder. The goal of this chapter is to discuss how depression impacts anxiety and its treatment, with a particular focus on treatment via exposure therapy. First, we discuss the prevalence of depression in anxiety and related...

Background Imagery rescripting (IR) is an effective intervention for social anxiety disorder (SAD) that targets autobiographical memories of painful past events. IR is thought to promote needs fulfillment and memory updating by guiding patients to change unhelpful schema through addressing the needs of the younger self within the memory.Methods Qua...

Although insight is widely studied in some disorders, research on insight in anxiety is limited. This study investigates clinical and cognitive insight and their relationship to symptoms and cognitive factors. A total of 175 participants with high trait anxiety completed an online self-reported measures and a reasoning task. No significant correlat...

Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and S...

The purpose of this study was to examine whether anxious and avoidant attachment styles improve during guided internet-based cognitive behavioral treatment (ICBT) for panic disorder, and if so, to identify potential theoretically driven mechanisms related to the change. We examined changes in anxious and avoidant attachment and their time-lagged (1...

Rumination about negative experiences is widely viewed as a transdiagnostic process underlying various forms of psychopathology that involve emotion dysregulation. Cognitive models highlight the role of attentional control and emotional biases in the development and maintenance of rumination. We suggest that the temporality of the attentional blink...

Objective There is substantial research examining insight in psychotic disorders and in some nonpsychotic disorders. However, there has been little attention given to many nonpsychotic disorders. Research on insight in psychosis distinguishes between cognitive and clinical insight. In most studies examining insight in nonpsychotic disorders, defini...

Objectives We examined patterns in alliance development in cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) compared to attention bias modification (ABM). We focused on the occurrence of sawtooth patterns (increases within- and decreases between-sessions) and sudden gains and their association with outcome. Methods Clients rece...

Practice guidelines for adults with obsessive-compulsive disorder (OCD) recommend augmenting serotonin reuptake inhibitors (SRIs) with exposure and ritual prevention (EX/RP). However, fewer than half of patients remit after a standard 17-session EX/RP course. We studied whether extending the course increased overall remission rates and which patien...

Experiencing doubt in an uncertain situation has been theorized to be an antecedent of compulsive checking. However, whether and when obsessive compulsive (OC) symptoms are associated with experiencing doubt and increased checking is unclear. In this study, we investigated the relationship between OC symptoms, the experience of doubt, and checking...

Objective: This study examines relationships among different aspects of therapeutic alliance with treatment outcome, adherence and attrition in internet delivered cognitive behavioral therapy (ICBT) for panic disorder. Methods: We examined alliance-outcome relationships in ICBT (N = 74) using a newly developed self-report alliance measure that dis...

Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illnessfor as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Si...

Panic disorder is characterized by a fear of future panic attacks, or a “fear of fear,” which leads to avoidance and distress. Panic disorder is often comorbid with agoraphobia, or a fear of experiencing anxiety or panic attacks in different situations. Psychological theories of panic have made significant progress since the inception of the diagno...

Objective: The aim of the current study was to examine changes in the therapeutic alliance and its role as a mediator of treatment outcome in cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) compared to attention bias modification (ABM). Method: Patients were randomized to 16–20 sessions of CBT (n = 33) or 8 sessions of ABM (n =...

Background: Contemporary models of cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) emphasize emotion dysregulation as a core impairment whose reduction may play a causal role in psychotherapy. The current study examined changes in use of emotion regulation strategies as possible mechanisms of change in CBT for SAD. Specifically...

https://onlinelibrary.wiley.com/doi/full/10.1111/pcn.13152

Objective: Even though the early alliance has been shown to robustly predict posttreatment outcomes, the question whether alliance leads to symptom reduction or symptom reduction leads to a better alliance remains unresolved. To better understand the relation between alliance and symptoms early in therapy, we meta-analyzed the lagged session-by-se...

Objective: Ruptures and repairs in alliance and their association with treatment outcome have been studied widely. Many of these studies have used indirect methods, focused on decreases in alliance across sessions while measuring alliance at postsession. However, this approach does not establish whether observed decreases occur within (as insinuat...

The Pathological Narcissism Inventory (PNI) is a popular measure and the first to attempt to tap into both grandiose and vulnerable narcissism (GN/VN). However, data have raised questions as to whether it appropriately formulates GN and differentiates it from VN. In this study, we examined the Brief-PNI’s structure and construct validity, by using...

Objective: Sudden gains during psychotherapy have been found to be predictive of positive treatment outcomes. Previous attempts at predicting occurrence of sudden gains have yielded equivocal findings. Recently, intraindividual variability in symptoms during treatment was suggested as a trans-therapeutic and trans-diagnostic predictor of sudden gai...

Emotion-regulation deficits characterize many psychiatric disorders. To understand such deficits, researchers have focused on emotion-regulation strategies. Building on a motivational approach to emotion regulation, we suggest that to understand emotion regulation in psychopathology, it is necessary to also focus on emotion goals (i.e., what people...

People with social anxiety disorder (SAD) lack non-socially anxious individuals' tendency to interpret ambiguous social information in a positively biased manner. To gain a better understanding of the specific in-vivo social consequences of positive interpretation bias, we recruited 38 individuals with SAD and 31 healthy controls (HC) to participat...

Psychological treatment of generalized anxiety disorder.

Although exposure is considered one of the most effective treatments for the anxiety disorders, theories underlying the efficacy of the treatments vary. This chapter examines various forms of exposure in terms of emotional processing theory, the inhibitory learning model, and cognitive theory. The authors discuss how each relates to current literat...

In this article, we develop a computational model of obsessive-compulsive disorder (OCD). We propose that OCD is characterized by a difficulty in relying on past events to predict the consequences of patients' own actions and the unfolding of possible events. Clinically, this corresponds both to patients' difficulty in trusting their own actions (a...

Obsessive compulsive (OC) symptoms involve excessive information gathering (e.g., checking, reassurance-seeking), and uncertainty about possible, often catastrophic, future events. Here we propose that these phenomena are the result of excessive uncertainty regarding state transitions (transition uncertainty): a computational impairment in Bayesian...

Compulsive checking is the most common ritual among individuals with obsessive-compulsive disorder (OCD). Yet, other than uncertainty, the variables prompting checking are not fully understood. Laboratory studies suggest that task conditions - whether threatening (anxiety-relevant) or neutral, and task type - whether requiring perceptual or reasoni...

Obsessive compulsive (OC) symptoms involve excessive information gathering (e.g., checking, reassurance-seeking), and uncertainty about possible, often catastrophic, future events. Here we propose that these phenomena are the result of excessive uncertainty regarding state transitions (i.e. transition uncertainty): a computational impairment in Bay...

Imagery rescripting (IR) is an effective intervention for social anxiety disorder (SAD) that targets negative autobiographical memories. IR has been theorized to work through various memory mechanisms, including modifying the content of negative memory representations, changing memory appraisals, and improving negative schema or core beliefs about...

Successful social problem solving requires both an adaptive orientation toward the problem and the necessary skills to generate relevant and effective solutions. Surprisingly few studies have examined social problem solving in the context of social anxiety. We examined social problem solving in 38 participants with social anxiety disorder (SAD) in...

Background Research has long investigated the cognitive processes in the treatment of depression, and more recently in panic disorder (PD). Meanwhile, other studies have examined patients’ cognitive therapy skills in depression to gain insight into the link between acquiring such skills and treatment outcome. Aims Given that no scale exists to exa...

Scrupulosity is a religiously themed sub-type of obsessive-compulsive disorder. Religious individuals with scrupulosity tend to first turn to clergy for assistance rather than to mental health professionals. This is particularly relevant for Ultra-Orthodox Jewish patients, whose rabbis arbitrate a wide variety of life issues. In the current qualita...

Difficulties with emotion regulation in depression may be linked not only to emotion regulation strategies but also to the motivation to experience certain emotions. We assessed the degree of motivation to experience happiness or sadness in major depressive disorders outside the laboratory and prospective links to clinical outcomes over time. Depre...

Obsessions are commonly described as intrusive, ego-dystonic, and ‘coming out-of-nowhere’. This might reflect an experience of low sense of agency (SoA), with SoA referring to the experience of being the source of our thoughts. The current study investigates the relationship between obsessive compulsive (OC) symptoms and the SoA over thoughts. Part...

Emotion regulation (ER) has been incorporated into many models of psychopathology, but it has not been examined directly in cognitive behavioral therapy (CBT) for panic disorder with agoraphobia (PD/A). In this study, a preliminary model of ER in CBT for PD/A is proposed based on existing theories, and several propositions of the model are tested....

Social anxiety is correlated with diminished global positive affect (PA). However, it is not clear from the data whether this relationship is due to global PA, or to specific emotions such as joy or pride. We hypothesized that pride will account for most of the relationship between social anxiety and PA after controlling for depression. Results of...

No studies have compared face-to-face cognitive-behavioral therapy (CBT) and attention bias modification (ABM) for social anxiety disorder (SAD) and their purported mechanisms. We asked: 1) Is CBT more effective than ABM? and 2) Are changes in attentional biases and cognitions temporally related to symptom change? Forty-three patients were randomly...

Reappraisal is a multifaceted construct associated with a wide range of proximal (e.g., affective responses) and distal (e.g., psychopathology) consequences. To date, our understanding of use of reappraisal is based either on self-reports of tendencies to use a specific strategy in general or in the last week or on performance on lab-based tasks. T...

Obsessions are often described as aversive thoughts that come out-of-nowhere. Indeed, several models of obsessive compulsive symptoms postulate that obsessions are characterized by being unrelated to several levels of context (e.g. self-concept, external stimuli). In the current study we aim to broaden this notion by presenting a multidimensional c...

CBT for obsessive-compulsive disorder (OCD) is a strong challenge to the contention that common factors explain most of the variance in outcomes in all therapies and all disorders, given that the treatment is focused and placebo response is low. In this study, the relative contributions of expectancy and therapeutic alliance as predictors of outcom...

Several recent models of obsessive compulsive disorder (OCD) consider it to be a neurocognitive disorder involving inflexibility and disinhibition. Indeed, previous reviews of neuropsychological functioning in OCD suggested impaired performance in flexibility tasks. The current meta-analysis examines whether the reported differences in flexibility...

Recent models of social anxiety disorder emphasise the role of emotion dysregulation; however, the nature of the proposed impairment needs clarification. In a replication and extension framework, four studies (N = 193) examined whether individuals with social anxiety (HSAs) are impaired in using cognitive reappraisal and expressive suppression. Sel...

Background Models of social anxiety emphasize the role of emotion dysregulation, but the nature of these impairments needs clarification. Methods We utilized a mixed-method approach to examine impairments in cognitive reappraisal and expressive suppression in social anxiety disorder. Forty nine treatment-seeking individuals diagnosed with social a...

Background and objectives: Attention bias modification treatment (ABMT) and cognitive bias modification of interpretation (CBM-I) both have demonstrated efficacy in alleviating social anxiety, but how they compare with each other, their combination, and with a combined control condition has not been studied. We examined their relative and combined...

Objective: This study examined attachment within the framework of cognitive behavioral therapy (CBT) for panic disorder with agoraphobia (PDA) by measuring the changes in avoidant and anxious attachment in a session-by-session analysis. Method: Thirty-one patients with PDA were treated using CBT. Pre-session data on attachment style (ECR), avoid...

The field of psychology began to develop in the Middle East in the early twentieth century. In this chapter, we present a broad view of the current state of clinical psychology in the Middle East. For each country we discuss the historical development of clinical psychology, academic and professional requirements and training, the number of employe...

Previous studies suggest that the link between obsessive–compulsive (OC) symptoms and moral thought–action fusion (TAF) depends on religion; however, no study has compared Muslim and Jewish samples. We examined the relationships between OC symptoms, scrupulosity, religiosity, and moral TAF in Israeli Muslims and Jews. Religiosity was not associated...

Individuals with scrupulosity prototypically have excessive religious fears or doubts about sin; however, individuals may have secular moral scrupulosity, fearing being immoral, bad, or evil without any religious component. It is worth acknowledging that others have argued that scrupulosity is distinct from obsessive-compulsive disorder (OCD) and w...

Background: Previous studies have indicated that obsessive-compulsive disorder (OCD) might have a reduced placebo response compared to other anxiety-related disorders including generalized anxiety disorder, panic disorder, post-traumatic stress disorder, and social anxiety disorder. No previous analysis has directly compared antidepressant and pla...

Objective: Substantial research has established exposure and response prevention (EX/RP) as an effective treatment for obsessive-compulsive disorder (OCD). Yet, the role of the therapeutic alliance as a factor in EX/RP remains a relatively understudied area. We sought to investigate this issue and explore which aspects of the alliance matter most...

Scrupulosity is a manifestation of obsessive-compulsive disorder in which obsessional fears or compulsive rituals are religious or moral. Clinicians often struggle working with scrupulous individuals. Clinicians must disentangle religious from compulsive ritual and help patients violate the latter but not the former, which often involves becoming a...

The use of unreliable measures constitutes a threat to our understanding of psychopathology, because advancement of science using both behavioral and biologically-oriented measures can only be certain if such measurements are reliable. Two pillars of NIMH’s portfolio – the Research Domain Criteria (RDoC) initiative for psychopathology and the targe...

Whereas some theories of cognitive behavioral therapies (CBT) propose that acceptance and reappraisal conflict with one another, we propose that one component of acceptance, self-acceptance of negative emotions (being nonjudgmental of oneself for experiencing negative emotions), and reappraisal may facilitate one another. We hypothesized that emoti...

Objective: To examine emotion regulation (ER) among individuals with high (HSA) and low social anxiety (LSA) and the effects of 1 week of practiced cognitive reappraisal using self-report, daily diary measures and lab tasks. Method: HSAs received reappraisal (HSA-R; n = 43) or monitoring (HSA-M; n = 40) instructions. LSAs received monitoring instru...

Intrusive thoughts constitute a key feature of OCD. While the DSM-5 characterizes obsessions as intrusive and unwanted thoughts, and studies show that OCD patients report on a lower sense of control over thoughts, to our knowledge the question of authorship over thoughts in OCD was never tested experimentally. In this study we found that that high...

Scrupulosity, or obsessive-compulsive symptoms related to religiosity or religion, is a common presentation of obsessive compulsive disorder (OCD), and it is important to elucidate its phenomenology and measurement. Today, the most widespread questionnaire for the assessment of scrupulosity is the Penn Inventory of Scrupulosity (PIOS). The current...

The current meta-analysis reviews 24 studies on self-reported emotional reactions to facial expressions (social rejection, social acceptance, and neutral) in socially anxious versus nonanxious individuals. We hypothesized that socially anxious individuals would perceive all face types as less approachable, more negative, and more arousing. After co...

Research on deficits in emotion regulation has devoted considerable attention to emotion-regulation strategies. We propose that deficits in emotion regulation may also be related to emotion-regulation goals. We tested this possibility by assessing the direction in which depressed people chose to regulate their emotions (i.e., toward happiness, towa...

The study aims to determine whether 60-minute sessions of prolonged exposure (PE) that include 20minutes of imaginal exposure (IE) are noninferior to the standard 90-minute sessions that include 40minutes of IE in treating posttraumatic stress disorder (PTSD) and to explore the relationship of treatment outcome to within- and between-session habitu...

The author comments on Nirel and Samuel's article showing that psychologists in Israel reported practicing inconsistently with the likely demands of an upcoming Israel mental health reform. Some of the reasons for the differences in preparedness between psychologists and psychiatrists are considered. In addition, incorporating the knowledge from ps...

Objective: To compare outcomes after 6-month maintenance treatment of adults diagnosed with obsessive-compulsive disorder (OCD) based on DSM-IV criteria who responded to acute treatment with serotonin reuptake inhibitors (SRIs) augmented by exposure and response prevention (EX/RP) or risperidone. Method: A randomized trial was conducted at 2 aca...

Objective: There has been little research on the development of the therapeutic alliance in cognitive behavioral therapy (CBT). This study aims to examine the development of therapeutic alliance in CBT for panic disorder. Method: Nineteen patients were treated with CBT for panic disorder. Pre- and post-session data of the therapeutic alliance an...

Although the alliance-outcome correlation is well established, no published studies to date have separated between therapists' and patients' contributions while controlling for early symptom change. In this study, we examined therapist effects in two trials of CBT for panic disorder with agoraphobia (PDA) and the impact of therapists' and patients'...

Importance: Obsessive-compulsive disorder (OCD) is one of the world's most disabling illnesses according to the World Health Organization. Serotonin reuptake inhibitors (SRIs) are the only medications approved by the Food and Drug Administration to treat OCD, but few patients achieve minimal symptoms from an SRI alone. In such cases, practice guid...

This article describes the long-term effects of augmenting serotonin reuptake inhibitors (SRIs) with exposure and ritual prevention or stress management training in patients with DSM-IV obsessive-compulsive disorder (OCD). Between November 2000 and November 2006, 111 OCD patients from 2 academic outpatient centers with partial SRI response were ran...