New Research From Clinical Psychological Science

Change of Threat Expectancy as Mechanism of Exposure-Based Psychotherapy for Anxiety Disorders: Evidence From 8,484 Exposure Exercises of 605 Patients
Andre Pittig et al.  

Exposure therapy might be most successful for anxiety disorders when patients’ threat expectations are violated. Pittig and colleagues analyzed the exposure records of patients with different anxiety disorders. Throughout sessions, high threat expectancy coupled with low occurrence and adjusted expectancy led to changed threat beliefs. Expectancy violation, change, and learning rate substantially varied between patients, but greater learning and expectancy change predicted better treatment outcomes. Successful exposure thus appears to require expectancy violation to induce actual expectancy change. This supports learning from prediction error as the mechanism underlying successful exposure therapy. 

It Is Time to Flip the Script and Leverage the Point of Care to Discover Ways of Improving Treatment Outcomes for Posttraumatic Stress Disorder: Commentary on “A Sobering Look at Treatment Effectiveness of Military-Related Posttraumatic Stress Disorder” (Levi et al., 2021)
Brett T. Litz  

Levi and colleagues (2021) reported posttreatment outcomes of 709 Israeli veterans seeking treatment for service-related distress and concluded that treatments for posttraumatic stress disorder (PTSD) had “limited overall effectiveness.” In this commentary, Litz appraises the categorical/diagnostic, model-based methods Levi and colleagues used to examine effectiveness. Litz uses Levi and colleagues’ observational study to describe an approach that uses benchmarked, repeated assessments of individual and aggregated outcomes (measurement-based care) to leverage observational results to improve outcomes at the point of care as a way of advancing knowledge about how to best treat PTSD. 

Elevated Anxious and Depressed Mood Relates to Future Executive Dysfunction in Older Adults: A Longitudinal Network Analysis of Psychopathology and Cognitive Functioning
Nur Hani Zainal and Michelle G. Newman  

Vulnerability models posit that executive-functioning (EF) problems increase psychopathology symptoms, whereas scar theory postulates that depression/anxiety symptoms reduce EF. To assess these predictions, Zainal and Newman tested older adults across four time points, using cognitive tests and the caregiver-rated Neuropsychiatric Inventory. Results indicated that the older participants were, the worse their episodic memory was. Similarly, the more agitation they reported, the worse their global cognition was. In addition, EF tended to be affected by prior depressed and anxious moods rather than influencing any future symptoms. Heightened anxious and depressed mood predicted future decreased EF in older adults, supporting scar theory but not vulnerability models. 

Empirically Supported Principles of Change in Youth Psychotherapy: Exploring Codability, Frequency of Use, and Meta-Analytic Findings
Olivia M. Fitzpatrick et al.  

This review suggests that empirically supported principles of change (ESPCs) in youth psychotherapies are reliably identifiable, and treatments containing more ESPCs may produce greater therapeutic benefit. Fitzpatrick and colleagues focused on five candidate ESPCs—calming, increasing motivation, changing unhelpful thoughts, solving problems, and practicing positive opposites. They analyzed data from 263 randomized controlled trials spanning six decades, testing treatments for anxiety, depression, attention-deficit/hyperactivity disorder, and conduct problems. Results indicated that ESPCs could be distinguished by independent coders and that psychotherapies most often included fewer than three ESPCs. However, treatments with all five ESPCs showed effects about twice as large as treatments with fewer ESPCs.   

Allostatic Load in Clinical Practice
Patricia Romero Verdugo, Lieke L. F. van Lieshout, Floris P. de Lange, and Roshan Cools 

One way to characterize an individual’s psychosocial environment involves using clinical measurements (clinimetric criteria) to determine allostatic overload (an excessive cost of chronic exposure to fluctuating or heightened physiologic responses to repeated or chronic stress). This characterization can have major implications for identifying syndromes not included in traditional diagnostic classifications and factors that may modulate the vulnerabilities induced by allostatic overload, such as healthy lifestyle behavior and euthymia (absence of mood disturbances). Fava and colleagues present a clinimetric system for the longitudinal development of allostatic load, allowing clinicians to create individually tailored interventions to prevent or decrease the negative impact of environmental factors on health. 

New Insights in Psychological Processes: Introduction to the Special Issue on COVID-19 and Mental Health
Cindy H. Liu, Thomas L. Rodebaugh, and Darby E. Saxbe  

In this introduction to a special issue of Clinical Psychological Science on COVID-19, Liu and colleagues review articles with novel research approaches that speak to: (a) the variable effects of pandemic experiences across different groups of people, (b) the impact of the pandemic on social support and social infrastructures, and (c) the inequities and violations of justice that the pandemic has revealed. They conclude by highlighting future directions for psychological research. Specifically, the issue spotlights research on COVID-19, whose individual and societal effects provided opportunities for testing fundamental assumptions within biopsychosocial phenomena that would not have been otherwise possible.   

The Central Role of Lifelong Learning and Humility in Clinical Psychology
Jason J. Washburn et al.  

Washburn and colleagues encourage clinical psychologists to approach lifelong learning as a clinical, ethical, and scientific imperative in the myriad dimensions of their professional life. They suggest that experience alone is not sufficient, attitude is also important in lifelong learning, and clinical psychologists must maintain and refresh their critical-thinking skills and seek to minimize their biases, especially as they relate to lifelong learning. 

A Theory of Momentary Distress Tolerance: Toward Understanding Contextually Situated Choices to Engage With or Avoid Distress
Jennifer C. Veilleux  

Low distress tolerance predicts a wide variety of psychopathology. But, rather than focusing on individual differences distress tolerance, Veilleux proposes a social-cognitive theory. This theory separates actions to remain engaged with distress (i.e., tolerance) from avoidance/escape actions associated with intolerance, and highlights willingness to experience distress as central to tolerance. It also emphasizes that an individual’s self-efficacy for tolerating distress predicts their tolerance/intolerance but this process is influenced by momentary factors such as distress intensity and the individual’s psychological resources in the moment (e.g., hunger, tiredness, social support). Finally, the theory explains how repeated experiences of distress tolerance and/or intolerance coalesce into a global self-perception indicative of individual differences in distress tolerance.

Characterizing Sex Differences in Clinical and Functional Outcomes Among Military Veterans With a Comprehensive Traumatic Brain Injury Evaluation: A Million Veteran Program Study
Victoria C. Merritt et al.  

Males and females appear to experience differential clinical and functional outcomes after military traumatic brain injury (TBI), this research suggests. Merritt and colleagues examined sex differences in responses to a structured TBI interview routinely administered in Veteran Affairs (VA) health centers. Testing a sample of previously deployed military veterans enrolled in the VA Million Veteran Program, they found that males were more likely than females to have confirmed TBI diagnoses. Compared with females, males with TBI diagnoses and histories more frequently experienced blast-related injuries and were employed. In contrast, more females reported experiencing falls, sustaining a TBI since deployment, and having more severe neurobehavioral symptoms (particularly affective-related symptoms).   

Linking Sleep and Aggression: Examining the Role of Response Inhibition and Emotional Processing
Melanie L. Bozzay and Edelyn Verona  

Naturally occurring sleep loss predicts increases in aggression, at least in the laboratory, and people who sleep less might be more vulnerable to acting rashly in negative and neutral contexts, this research suggests. Participants wore Fitbit Flex devices and kept a sleep diary for 3 days. Bozzay and Verona measured event-related potentials during an emotional-linguistic task, followed by a laboratory aggression paradigm. Results linked shorter sleep duration with greater aggression and reduced motor inhibition processing when presented with negative and neutral words. However, neurocognitive indices did not explain the sleep–aggression link.   

Where to Look? Alcohol, Affect, and Gaze Behavior During a Virtual Social Interaction
Talia Ariss et al.  

In virtual social contexts, alcohol might negatively affect interactions. Before an online video call, participants drank either an alcoholic beverage or a soda. During the video call, researchers tracked participants’ gaze and assessed their affect. Results indicated that participants who drank alcohol spent more time gazing at themselves than at their interaction partners, a habit that predicted significantly higher negative affect after the call. Thus, instead of acting as a social-affective enhancer, alcohol appeared to impair social interaction in this virtual context.

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