New Research From Clinical Psychological Science

Boundaries on Parent Involvement in Their Child’s Anxiety Cognitive-Behavioral-Treatment Outcome: Parent Reinforcement and Relationship Behaviors Moderate Outcome
Wendy Silverman, Yasmin Rey, Carla Marin, Panagiotis Boutris, James Jaccard, and Jeremy Pettit  

Extending a recent parent-mediation efficacy trial, we identified parent reinforcement and relationship behaviors as setting boundary conditions, or moderators, of youths’ anxiety outcome in 254 youths and their parents, who were randomized to (a) cognitive-behavioral treatment (CBT) with parent reinforcement-behavior training (CBT + Reinf), (b) CBT with parent relationship-behavior training (CBT + Relat), or (c) individual-youth CBT—a comparator control arm. Findings revealed that parents with high baseline negative-reinforcement levels and acceptance levels (i.e., above the mean) report their children as having lower anxiety at outcome when assigned to CBT + Reinf and CBT + Relat, respectively, versus CBT. No moderation effects were found for either parent positive reinforcement or parent psychological control. Implications for treating anxiety disorders and moving toward precision-treatment approaches in youths and the importance of research replication and extension are discussed. 

A Study of Parent-Reported Internalizing Symptoms in Transgender Youths Before and After Childhood Social Transitions
Lily Durwood, Natalie Gallagher, Robin Sifre, and Kristina Olson  

Some children socially transition genders by changing their pronouns (and often names, hairstyles, and clothing) from those associated with their assigned sex at birth to those associated with their gender identity. We refer to children who have socially transitioned as transgender children. Using a prospective sample of children who socially transitioned during childhood (at or before the age of 12; age of transition: M = 6.82 years), we tested whether the parent-reported internalizing symptoms of transgender children were different before versus after they socially transitioned. The children were predominantly White (70.6% White) and girls (76.5% transgender girls, 23.5% transgender boys). Their parents tended to have high levels of education (74.5% bachelor’s degree or above) and lived in families with high household incomes (62.7% with household incomes of $75,000 or above). On average, youths showed lower levels of internalizing symptoms after socially transitioning versus before, suggesting a possible mental-health benefit of these transitions. 

Perceptual Thresholds for Threat Are Lowered in Anxiety: Evidence From Perceptual Psychophysics
Shannon Glasgow, Gabriella Imbriano, Sekine Ozturk, Jingwen Jin, and Aprajita Mohanty  

Anxiety is believed to be characterized by heightened sensitivity to threat. The behavioral-inhibition system (BIS), a risk factor for anxiety, is hypothesized to index this threat sensitivity. In the present study, we address a critical gap in the literature: Neither anxiety nor BIS have been clearly linked with behavioral measures of threat sensitivity indexed by lowered threat-related perceptual thresholds. We used psychophysical methods to precisely measure absolute perceptual thresholds for detection of threatening and neutral faces. We examined their relationships with self-reported BIS and anxious apprehension in individuals diagnosed with anxiety disorders and individuals not diagnosed with anxiety disorders. Irrespective of anxiety disorder diagnosis, higher self-reported BIS and anxious apprehension were associated with reduced perceptual thresholds for threatening versus neutral stimuli, but only BIS showed a specific association after controlling for anxious apprehension. Using adaptive psychometrics, in this study, we offer key empirical evidence linking specific temperamental dimensions with perceptual indices of threat sensitivity transdiagnostically across anxiety disorders. 

Global Well-Being and Mental Health in the Internet Age
Matti Vuorre and Andrew Przybylski

In the last 2 decades, the widespread adoption of Internet technologies has inspired concern that they have negatively affected mental health and psychological well-being. However, research on the topic is contested and hampered by methodological shortcomings, leaving the broader consequences of Internet adoption unknown. We show that the past 2 decades have seen only small and inconsistent changes in global well-being and mental health that are not suggestive of the idea that the adoption of Internet and mobile broadband is consistently linked to negative psychological outcomes. Further investigation of this topic requires transparent study of online behaviors where they occur (i.e., on online platforms). We call for increased collaborative efforts between independent scientists and the Internet-technology sector. 

Predicting Transdiagnostic Symptom Change Across Diverse Demographic Groups in Single-Session Interventions for Adolescent Depression
Riley McDanal, Jenny Shen, Kathryn Fox, Nicholas Eaton, and Jessica Schleider

Youths with marginalized identities experience minority stress, a construct linked to more severe transdiagnostic psychopathology. Financial, geographical, and temporal barriers limit access to psychological care for these individuals. Single-session interventions (SSIs), which mitigate many such barriers, are likely more accessible than traditional therapies. However, accessibility does not guarantee effectiveness across identity groups. In a preregistered study (N = 2,452), we assessed whether demographic identities moderated the relationship between SSI condition and transdiagnostic internalizing (emotional distress) change from before SSI to after SSI in a national U.S. sample of adolescents with elevated depressive symptoms. SSI-driven internalizing-symptom reductions were equivalent between youths with myriad marginalized identities (e.g., Black, asexual, gender minority) and their counterparts (e.g., non-Hispanic White, heterosexual, cisgender) and across age and subjective school social status. We discuss implications of the results for SSI dissemination. 

Interpersonal Linkage in Positive and Negative Emotional Behaviors, Emotional Well-Being, and Physical Functioning in Dementia Caregivers
Kuan-Hua Chen, Jennifer Merrilees, Casey Brown, Claire Yee, Anna Sapozhnikova, Jenna Wells, Emilio Ferrer, Peter Pressman, Barbara Fredrickson, and Robert Levenson  

Caring for a person with dementia (PWD) can produce declines in caregivers’ emotional well-being and physical functioning, which could result from disruptions in the emotional linkage between PWDs and caregivers. We examined the effects of interpersonal linkage in emotional behaviors on emotional well-being and physical functioning in caregivers and control partners. Forty-five PWD–caregiver dyads and 12 control dyads had a 10-min unrehearsed conflict conversation in the laboratory. We quantified positive and negative emotional linkage as the covariation between objectively coded positive and negative emotional behaviors during the conversation. Caregivers and one partner in the control dyads completed questionnaires concerning their emotional well-being and physical functioning. We found that lower positive emotional linkage was associated with lower emotional well-being in caregivers and control partners. We did not find similar effects with negative emotional linkage or for physical functioning. We offer possible explanations for these findings and implications for assessing caregiver risk. 

The Continuity of Adversity: Negative Emotionality Links Early Life Adversity With Adult Stressful Life Events
Grace Brennan, Terrie Moffitt, Kyle Bourassa, HonaLee Harrington, Sean Hogan, Renate Houts, Richie Poulton, Sandhya Ramrakha, and Avshalom Caspi  

Adversity that exhibits continuity across the life course has long-term detrimental effects on physical and mental health. Using 920 participants from the Dunedin Study, we tested the following hypotheses: (a) Children (ages 3–15) who experienced adversity would also tend to experience adversity in adulthood (ages 32–45), and (2) interim personality traits in young adulthood (ages 18–26) would help account for this longitudinal association. Children who experienced more adversity tended to also experience more stressful life events as adults, β = 0.11, 95% confidence interval [CI] = [0.04, 0.18], p = .002. Negative emotionality—particularly its subfacet alienation, characterized by mistrust of others—helped explain this childhood-to-midlife association (indirect effect: β = 0.06, 95% CI = [0.04, 0.09], p < .001). Results were robust to adjustment for sex, socioeconomic origins, childhood IQ, preschool temperament, and other young-adult personality traits. Prevention of early life adversity and treatment of young-adult negative emotionality may reduce vulnerability to later life stress and thereby promote the health of aging adults.  

Criminalizing Psychopathology in Black Americans: Racial and Gender Differences in the Relationship Between Psychopathology and Arrests
Briana Brownlow, Kassidie Harmon, Jolynn Pek, Jennifer Cheavens, James Moore, and Emil Coccaro  

Black Americans are arrested at disproportionate levels compared with White Americans. We sought to understand whether the association between psychopathology and arrest record is equally strong for Black Americans and White Americans, hypothesizing that the association would be stronger for Black Americans. In a sample of adults (age: M = 34.81 years), we found that at the same level of psychopathology severity, emotion dysregulation, and impulsivity, Black Americans (n = 585) exhibited higher rates of being arrested in adulthood than White Americans (n = 977). These findings held even when controlling for environmental (e.g., socioeconomic status) and individual (e.g., substance-use history) factors associated with arrests. This suggests that the risk conferred by more severe psychopathology on arrests is stronger for Black Americans than White Americans. Our results highlight how structural racism affects both psychopathology and the carceral system to contribute to the overrepresentation of Black Americans within the criminal justice system.  

State Perceived Stress Is Concurrently, but Not Prospectively, Associated With State Impulsivity in Youths
Katherine Seldin, Natalie Upton, Madison Feil, Michele Smith, Morgan Bryson, Liliana Lengua, and Kevin King  

Stress is considered a transdiagnostic mechanism underlying psychopathology. Research has suggested that when people experience more stress, they also act more impulsively. Most prior work has focused on between-persons associations or tested broad conceptualizations of impulsivity. We tested associations of momentary reports of perceived stress and appraisal of coping difficulty with three dimensions of impulsivity (urgency, planning, and persistence). High school and college students (N = 146) self-reported momentary perceived stress, coping appraisals, affect, urgency, planning, and persistence three times per day for 10 days. Higher perceived stress was concurrently associated with higher urgency and lower persistence, even after controlling for negative affect. Higher coping appraisals were concurrently associated with higher planning and persistence. No prospective effects were observed. Perceived stress may relate to a time-limited decreased ability to regulate responses to negative affect and persist, whereas coping appraisals may be associated with changes in multiple types of self-regulation.  

Seeing the Invisible: A Photovoice Exploration of Living With and Managing the Invisible Symptoms of Multiple Sclerosis
Le-Sharn Parker, Gogem Topcu, Danielle De Boos, Clare Bale, and Roshan das Nair

In this photovoice study, we explored how people with multiple sclerosis (MS) experience living with and managing invisible symptoms in daily life. Twelve people with MS produced digital images over a 2-week period to capture their experiences of invisible symptoms. Participants then discussed their images in semistructured interviews. We thematically analyzed the interviews and developed three main themes that encompass the difficulties around conceptualizing invisible symptoms and the conflicts of legitimacy this presents for people with MS, in which the reality of their invisible symptoms is invalidated by others and sometimes for themselves. Participants navigated these issues in dynamic ways, choosing to fit their symptoms to their lives or make space for their symptoms depending on the context, often influenced by a desire to “stay invisible” or to “be seen.” We highlight clinical implications for supporting people with MS around the legitimacy conflicts they experience and how they negotiate living with invisible symptoms.  

Reinforcement-Learning-Informed Queries Guide Behavioral Change
Vanessa Brown, Jacob Lee, John Wang, Brooks Casas, and Pearl Chiu

Algorithmically defined aspects of reinforcement learning correlate with psychopathology symptoms and change with symptom improvement following cognitive-behavioral therapy (CBT). Separate work in nonclinical samples has shown that varying the structure and statistics of task environments can change learning. Here, we combine these literatures, drawing on CBT-based guided restructuring of thought processes and computationally defined mechanistic targets identified by reinforcement-learning models in depression, to test whether and how verbal queries affect learning processes. Using a parallel-arm design, we tested 1,299 online participants completing a probabilistic reward-learning task while receiving repeated queries about the task environment (11 learning-query arms and one active control arm). Querying participants about reinforcement-learning-related task components altered computational-model-defined learning parameters in directions specific to the target of the query. These effects on learning parameters were consistent across depression-symptom severity, suggesting new learning-based strategies and therapeutic targets for evoking symptom change in mood psychopathology.  

Paranoia: From Passive Social-Threat Perception to Misattunement in Social Interaction
Michal Hajdúk, Noah Sasson, Sohee Park, and Amy Pinkham  

Paranoia, defined as the unfounded belief that others intend to cause harm, negatively affects individuals across the continuum from healthy to pathological. Despite a definition that is explicitly social, paranoia is often studied as an isolated characteristic of the person who is experiencing it. In the current review, we propose that the study of paranoia could be advanced by adopting a perspective focused on its interactional nature. Specifically, we hypothesize that aberrant dynamic interaction and/or misattunement between social partners may be a critical component in the formation and maintenance of paranoia. We also speculate that the relationship between paranoia and social functioning is bidirectional in which poor interpersonal functioning is both a result of and a contributor to paranoia. This approach may identify novel mechanisms and potential treatment targets.   

Family Genetic-Risk Profiles Associated With Divorce
Jessica Salvatore, Henrik Ohlssson, Jan Sundquist, Kristina Sundquist, and Kenneth Kendler  

We used Swedish national-register data (N = 2,828,777) to examine divorce and its associated patterns of family genetic-risk scores (FGRSs; personalized measures of genetic risk inferred from diagnoses in relatives) across 10 psychiatric disorders: major depression, anxiety disorders, obsessive compulsive disorder, bipolar disorder, schizophrenia, anorexia nervosa, alcohol use disorder, drug use disorder, attention-deficit/hyperactive disorder, and autism spectrum disorder. Individuals who divorced had elevated FGRSs across all disorders compared with individuals who were stably married or never married. FGRSs for all disorders were higher among divorced females compared with divorced males and among individuals who did not go on to have a stable second marriage compared with individuals who had a stable second marriage and increased as the cumulative number of divorces increased. In summary, genetic predispositions for psychiatric disorders are associated with the propensity to divorce and with several differences as a function of sex, remarriage, and the cumulative number of divorce transitions.  

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