Emily Upton’s research while affiliated with UNSW Sydney and other places

Background Repetitive Negative Thinking (RNT) is a key transdiagnostic mechanism underlying anxiety and depressive disorders, and targeting RNT specifically leads to improved treatment outcomes. There is a lack of research however into mechanisms of change in RNT-focused interventions and factors that predict treatment response. The aim of this study was to examine the mediators and predictors of outcome (RNT, depression, anxiety, and distress) in a brief online intervention for RNT in adults. Methods This study used secondary data from a Randomised Controlled Trial of the Managing Rumination and Worry Program (Joubert et al. in Beh Res Therapy, 168:104378, 2023) in which N = 137 adults with elevated levels of RNT were randomly allocated to a 3-lesson clinician-guided or self-guided version of the program delivered over 6 weeks, or a treatment-as-usual (TAU) control condition. Self-report measures of depression, anxiety, distress, and RNT were administered at baseline, post-treatment, and 3-month follow-up; RNT and distress were also measured prior to each lesson. Results Intention-to-treat linear mixed models showed a gradual reduction in RNT and distress over treatment in both active conditions, with the largest reductions in RNT occurring after the lessons containing the active treatment strategies (2 and 3). Structural equation modelling mediation analyses showed that reductions in transdiagnostic RNT mediated reductions in distress between Lessons 2 and 3, and reductions in rumination specifically mediated reductions in distress and depression between post-treatment and follow-up, but there was no consistent pattern of mediation by RNT throughout treatment. Finally, higher baseline symptom severity (particularly rumination) significantly predicted poorer post-treatment outcomes, while higher treatment expectancy and clinician guidance significantly predicted better post-treatment outcomes. Conclusion This is one of the first studies to examine mediators and predictors of change in a brief, online RNT-focused intervention for adults with elevated RNT. Further research in larger samples is needed, examining additional possible mediating and predictor variables and across more time points, to better understand how and for whom this intervention reduces RNT, anxiety and depression. Australian and New Zealand Clinical Trials Registration number: ACTRN 12620000959976. Date of registration: 25/09/2020.

Objectives Intrusive thoughts and images in Health Anxiety are poorly understood. The current study aims to explore the rates and nature of health‐related intrusive thoughts and images in people with and without Health Anxiety. Design We used a cross‐sectional interview and survey design recruiting 82 participants (Health Anxiety: n = 37; control: n = 45). Methods Participants completed a diagnostic and clinical interview, and questionnaires to assess experiences and appraisals of intrusive thoughts and images about health. Results Experiencing an intrusive thought or image was common in both groups (Health Anxiety: 89.2%, control: 55.6%). However, the Health Anxiety group reported their intrusive thoughts as more frequent, more distressing, and associated them with more negative emotions than controls. Further, the Health Anxiety group had increased negative appraisals and specific maladaptive behaviours for both intrusive thoughts and intrusive images compared to controls. Conclusions We conclude that, relative to controls, individuals with Health Anxiety experience intrusive thoughts and images more intensely and negatively, have more dysfunctional appraisals of them, and are more likely to respond to them with specific maladaptive behaviours. As such, addressing intrusive thoughts and images as part of cognitive behavioural interventions for Health Anxiety is warranted.

Introduction: Sleep difficulties are common amongst university students and are associated with mental illness and reduced wellbeing. This paper reports a pilot study of Cognitive Behavior Therapy for Insomnia (CBT-I) tailored specifically for university students. It was hypothesized that the intervention would be feasible, acceptable, and improve sleep, anxiety, depression, and wellbeing. Method: Students aged 18-25 participated via videoconferencing small group sessions of CBT-I. Feasibility was assessed through sign-up, consent rates, and study attrition, while acceptability was assessed using intervention adherence and a measure of intervention acceptability. Outcome measures included sleep quality, insomnia, suicidal ideation, symptoms of depression, anxiety, and wellbeing, and were assessed at baseline and post-intervention. Results: Participants were 44 students (M = 21.8 years). Feasibility was confirmed by sign-up and consent rates (80% of the students who expressed interest agreed to participate); overall study attrition was 48%, comprised largely of participants not commencing treatment (27%). Participants perceived the program as effective and logical and made use of the skills suggested. In terms of adherence, 82% of the participants who engaged with treatment attended two or more sessions and 63% attended all four sessions; and 92% were either very satisfied or mostly satisfied. Sleep quality, insomnia, depression, anxiety, and wellbeing all significantly improved from pre- to post-intervention. Discussion: There was evidence that the CBT-I intervention tailored for university students was acceptable to participants and could be feasible to deliver. Sleep quality, depression, anxiety, and wellbeing improved significantly. These findings suggest that the intervention is suitable for evaluation in a fully powered randomized controlled trial.

Background Prevention and early intervention of alcohol use disorder (AUD) is a public health priority, yet there are gaps in our understanding of how AUD emerges, which symptoms of AUD come first, and whether there are modifiable risk factors that forecast the development of the disorder. This study investigated potential early‐warning‐sign symptoms for the development of AUD. Methods Data were from the RADAR study, a prospective cohort study of contemporary emerging adults across Australia (n = 565, mean age = 18.9, range = 18–21 at baseline, 48% female). Participants were interviewed five times across a 2.5‐year period. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5) AUD criteria and diagnoses were assessed by clinical psychologists using the Structured Clinical Interview for DSM‐IV (SCID‐IV), modified to cover DSM‐5 criteria. Hazard analyses modeled the time from first alcoholic drink to the emergence of any AUD criteria and determined which first‐emergent AUD criteria were associated with a faster transition to disorder. Results By the final time point, 54.8% of the sample had experienced at least one DSM‐5 AUD criterion and 26.1% met criteria for DSM‐5 AUD. The median time from first AUD criterion to a diagnosis of AUD was 4 years. Social problems from drinking (hazard ratio [HR] = 3.24, CI95 = 2.14, 4.92, p < 0.001), major role (HR = 2.53, CI95 = 1.58, 4.06, p < 0.001), and drinking larger amounts/for longer than intended (HR = 2.04, CI95 = 1.20, 3.46, p = 0.008) were first‐onset criteria associated with a faster transition to AUD. Conclusion In the context of a prospective general population cohort study of the temporal development of AUD, alcohol‐related social problems, major role problems, and using more or for longer than intended are key risk factors that may be targeted for early intervention.

Purpose of Review We review recent evidence on Illness Anxiety Disorder (IAD), including risk factors and precipitants, diagnostic classification, clinical characteristics of the disorder, and assessment and treatment in both children and adults. Recent Findings IAD places a substantial burden on both individuals and society. Despite its impact, understanding of the disorder is lacking and debates remain about whether IAD should be classified as an anxiety disorder and whether it is distinct from Somatic Symptom Disorder. Cognitive behavioural therapy (CBT) is an effective treatment for IAD and there are multiple validated measures of health anxiety available. However, research on health anxiety in children and youth is limited. Summary IAD is chronic, and debilitating, but when identified, it can be effectively treated with CBT. Research using DSM-5 IAD criteria is lacking, and more research is needed to better understand the disorder, particularly in children and youth.

Background Many university students have difficulties with sleep; therefore, effective psychological treatments are needed. Most research on psychological treatments to improve sleep has been conducted with middle-aged and older adults, which means it is unclear whether existing psychological treatments are helpful for young adult university students. Objective This study aimed to discover university student preferences for a psychological intervention to improve sleep quality. Methods Focus groups were conducted over 3 stages to examine students’ views regarding content, format, and session duration for a psychological intervention to improve sleep. A thematic analysis was conducted to analyze participant responses. ResultsIn total, 30 participants attended small focus group discussions. Three key themes were identified: (1) program development, (2) help-seeking, and (3) student sleep characteristics. Program development subthemes were program format, program content, and engagement facilitators. Help-seeking subthemes were when to seek help, where to access help, stigma, and barriers. Student sleep characteristics subthemes were factors disturbing sleep and consequences of poor sleep. Conclusions Students emphasized the need for a sleep intervention with an in-person and social component, individualized content, and ways to monitor their progress. Participants did not think there was a stigma associated with seeking help for sleep problems. Students identified the lack of routine in their lifestyle, academic workload, and the pressure of multiple demands as key contributors to sleep difficulties.

Background and aims: Tolerance to the effects of alcohol is an important element in the diagnosis of alcohol use disorders (AUD); however, there is ongoing debate about its utility in the diagnosis AUD in adolescents and young adults. This study aimed to refine the assessment of tolerance in young adults by testing different definitions of tolerance and their associations with longitudinal AUD outcomes. Design: Prospective cohort study. Settings: Australia. Participants: A contemporary cohort of emerging adults across Australia (N = 565, mean age = 18.9, range = 18 - 21 at baseline). Measurements: Clinician administered Structured Clinical Interview for DSM-IV Research Version (SCID-IV-RV) assessed for AUD criteria across 5 interviews, at 6-month intervals over 2.5 years. Tolerance definitions were operationalised using survey-type response (yes/no), clinician judgement (SCID-IV-RV), different initial drinking quantity and percentage increase thresholds, and average heavy consumption metrics. Outcomes: AUD persistence was operationalised by the number of times AUD was present across the 2.5-year study period (N = 491), and new onset AUD was operationalised as any new incidence of AUD over the follow-up period (N = 461). Findings: The (i) SCID-IV-RV clinician judgement (odds ratio [OR] = 2.50, p = .005), (ii) an initial drinking quantity threshold of 4-5 drinks and 50% minimum increase (OR = 2.48, p = .007), and (iii) 50% increase only (OR = 2.40, p = .005) were the tolerance definitions more strongly associated with any new onset of AUD across the 4 follow-up time points than other definitions. However, these definitions were not associated with persistent AUD (p's > .05). Average heavy consumption definitions of tolerance were most strongly associated with persistent AUD (OR = 6.66, p = .001; OR = 4.65, p = .004) but not associated with new onset AUD (p's > .05). Conclusions: Initial drink and percentage change thresholds appear to improve the efficacy of change-based tolerance as an indicator for new onset alcohol use disorder diagnosis in self-report surveys of young adults. When predicting persistent alcohol use disorder, average heavy consumption-based indicators appear to be a better way to measure tolerance than self-reported change-based definitions.

Background: Supply of alcohol to adolescents is associated with increased alcohol consumption and harms including alcohol use disorder (AUD). We aimed to identify: (1) trajectories of alcohol supply to adolescents; (2) sociodemographic characteristics associated with supply trajectory; (3) patterns of alcohol consumption by supply trajectory; and (4) supply trajectory associations with adverse alcohol outcomes. Methods: We used Australian longitudinal survey data (N = 1813) to model latent trajectories of parent and peer alcohol supply over five annual follow-ups (Waves 2-6; Mage 13.9-17.8 years). Regression models assessed associations between supply trajectories and Wave 1 (Mage=12.9 years) sociodemographic factors and associations between supply trajectories and Wave 7 (Mage=18.8 years) alcohol outcomes. Results: We identified five alcohol supply classes: (1) minimal supply (n = 739, 40.8%); (2) early parent sips, late peer/parent whole drinks (n = 254, 14.0%); (3) late peer/parent whole drinks (n = 419, 23.1%); (4) early parent sips, mid peer/parent whole drinks (n = 293, 16.2%); (5) early peer/parent whole drinks (n = 108, 6.0%). Compared to minimal supply, the other classes were 2.7-12.9 times as likely to binge drink, 1.6-3.0 times as likely to experience alcohol-related harms, and 2.1-8.6 times as likely to report AUD symptoms at age 19. Conclusion: Earlier supply of whole drinks, particularly from peers, was associated with increased risk of early adulthood adverse alcohol outcomes. While minimal supply represented the lowest risk, supplying sips only in early-mid adolescence and delaying supply of whole drinks until late adolescence is likely to be less risky than earlier supply of whole drinks.

Background Different forms of alcohol‐related harm (e.g., hangovers, fighting) may confer differential risk of clinically relevant alcohol problems. We examine: (i) patterns of transition in experiencing alcohol‐related harms across adolescence; (ii) whether factors in early adolescence predict transition patterns; and (iii) whether transition patterns predict later alcohol use disorder (AUD) symptoms. Methods We used a longitudinal Australian cohort (n = 1828) to model latent class transition patterns of alcohol‐related harms across three timepoints (Mage = 13.9, 16.8, 18.8 years). Regression models assessed whether child, peer, and parent factors in early adolescence (Mage = 12.9) predicted harms transition patterns and whether these patterns predicted AUD symptoms in early adulthood (Mage = 19.8). Results Five transition patterns characterized most of the cohort (n ≈ 1609, 88.0%): (i) minimal harms (n ≈ 381, 20.8%); (ii) late physiological harms (n ≈ 702, 38.4%); (iii) early physiological harms (n ≈ 226, 12.4%); (iv) late all harms (n ≈ 131, 7.2%); and (v) gradual all harms (n ≈ 169, 9.2%). With late physiological harms as the reference, females had increased risk of experiencing early physiological harms (relative risk [RR]: 2.15; 99.5% CI: 1.19, 3.90). Late all harms (RR: 1.71; CI: 1.19, 2.47) and gradual all harms (RR: 1.84; CI: 1.37, 2.47) were each associated with increased odds of meeting criteria for AUD, even when patterns of alcohol consumption are considered. Conclusions Adolescents display heterogeneous transition patterns across physiological and psychosocial alcohol‐related harms. Females are at greater risk of experiencing early physiological harms. Experience of both physiological and psychosocial harms in late adolescence is an important and potentially modifiable precursor to clinically relevant alcohol problems in early adulthood.