Showing papers by "Michelle G. Craske published in 2016"

Treatment for Anhedonia: A Neuroscience Driven Approach.

Abstract: Anhedonia, or loss of interest or pleasure in usual activities, is characteristic of depression, some types of anxiety, as well as substance abuse and schizophrenia. Anhedonia is a predictor of poor long-term outcomes, including suicide, and poor treatment response. Because extant psychological and pharmacological treatments are relatively ineffective for anhedonia, there is an unmet therapeutic need for this high-risk symptom. Current psychological and drug treatments for anxiety and depression focus largely on reducing excesses in negative affect rather than improving deficits in positive affect. Recent advances in affective neuroscience posit that anhedonia is associated with deficits in the appetitive reward system, specifically the anticipation, consumption, and learning of reward. In this paper, we review the evidence for positive affect as a symptom cluster, and its neural underpinnings, and introduce a novel psychological treatment for anxiety and depression that targets appetitive responding. First, we review anhedonia in relation to positive and negative valence systems and current treatment approaches. Second, we discuss the evidence linking anhedonia to biological, experiential, and behavioral deficits in the reward subsystems. Third, we describe the therapeutic approach for Positive Affect Treatment (PAT), an intervention designed to specifically target deficits in reward sensitivity.

Testing a Hierarchical Model of Neuroticism and Its Cognitive Facets: Latent Structure and Prospective Prediction of First Onsets of Anxiety and Unipolar Mood Disorders During 3 Years in Late Adolescence

Abstract: Neuroticism and several other traits have been proposed to confer vulnerability for unipolar mood disorders (UMDs) and anxiety disorders (ADs). However, it is unclear whether the associations of these vulnerabilities with these disorders are attributable to a latent variable common to all vulnerabilities, more narrow latent variables, or both. In addition, some researchers have suggested that neuroticism predicts UMDs, ADs, and substance use disorders (SUDs) with comparable strength, whereas other researchers have hypothesized that neuroticism is more strongly related to UMDs and ADs. We tested hypotheses about the factor structure of several vulnerabilities and the prospective associations of these latent variables with initial onsets of UMDs, ADs, and SUDs during a 3-year period in 547 participants recruited as high school juniors. Although a general neuroticism factor predicted SUDs, it predicted UMDs and ADs more strongly and especially predicted comorbid UMDs and ADs. There was also mixed support for...

Proceedings of the 3rd Biennial Conference of the Society for Implementation Research Collaboration (SIRC) 2015: advancing efficient methodologies through community partnerships and team science

Abstract: Introduction to the 3rd Biennial Conference of the Society for Implementation Research Collaboration: advancing efficient methodologies through team science and community partnerships

A Preliminary Evaluation of a Home-based, Computer-delivered Attention Training Treatment for Anxious Children Living in Regional Communities:

Abstract: Many children with anxiety disorders live in communities with limited access to treatment. Attention bias modification training, a promising computer-based treatment for anxiety disorders, may prov...

Interaction of CD38 Variant and Chronic Interpersonal Stress Prospectively Predicts Social Anxiety and Depression Symptoms Over 6 Years

Abstract: Variation in the CD38 gene, which regulates secretion of the neuropeptide oxytocin, has been associated with several social phenotypes. Specifically, rs3796863 A allele carriers have demonstrated increased social sensitivity. In 400 older adolescents, we used trait-state-occasion modeling to investigate how rs3796863 genotype, baseline ratings of chronic interpersonal stress, and their gene-environment (GxE) interaction predicted trait social anxiety and depression symptoms over six years. We found significant GxE effects for CD38 A-carrier genotypes and chronic interpersonal stress at baseline predicting greater social anxiety and depression symptoms. A significant GxE effect of smaller magnitude was also found for C/C genotype and chronic interpersonal stress predicting greater depression; however, this effect was small compared to the main effect of chronic interpersonal stress. Thus, in the context of chronic interpersonal stress, heightened social sensitivity associated with the rs3796863 A allele may prospectively predict risk for social anxiety and (to a lesser extent) depression.

Measuring Positive Emotion With the Mood and Anxiety Symptom Questionnaire: Psychometric Properties of the Anhedonic Depression Scale

Abstract: Low positive emotion distinguishes depression from most types of anxiety. Formative work in this area employed the Anhedonic Depression scale from the Mood and Anxiety Symptom Questionnaire (MASQ-AD), and the MASQ-AD has since become a popular measure of positive emotion, often used independently of the full MASQ. However, two key assumptions about the MASQ-AD-that it should be represented by a total scale score, and that it measures time-variant experiences-have not been adequately tested. The present study factor analyzed MASQ-AD data collected annually over 3 years (n = 618, mean age = 17 years at baseline), and then decomposed its stable and unstable components. The results suggested the data were best represented by a hierarchical structure, and that less than one quarter of the variance in the general factor fluctuated over time. The implications for interpreting past findings from the MASQ-AD, and for conducting future research with the scale, are discussed.

Pathological personality traits and the naturalistic course of internalizing disorders among high-risk young adults.

Abstract: Background A personality disorder diagnosis signals a negative prognosis for depressive and anxiety disorders, but the precise abnormal personality traits that determine the temporal course of internalizing psychopathology are unknown. In the present study, we examined prospective associations between abnormal personality traits and the onset and recurrence of internalizing disorders. Methods A sample of 371 young adults at high risk for internalizing problems completed the Schedule for Nonadaptive and Adaptive Personality-Second Edition—a measure of 12 abnormal personality traits and three temperament dimensions (i.e., Negative Temperament, Positive Temperament, Disinhibition vs. Control)—and underwent annual diagnostic interviews over 4 years of follow-up. Results In multivariate survival analyses, Negative Temperament was a robust predictor of both new onsets and recurrences of internalizing disorder. Further, the Dependency and Self-Harm abnormal personality dimensions emerged as independent predictors of new onsets and recurrences, respectively, of internalizing disorders after statistically adjusting for variation in temperament. Conclusions Our findings suggest that abnormal personality traits and temperament dimensions have complementary effects on the trajectory of internalizing pathology during young adulthood. In assessment and treatment settings, targeting the abnormal personality and temperament dimensions with the greatest prognostic value stands to improve the early detection of enduring internalizing psychopathology.

Improving outcomes for patients with medication-resistant anxiety: effects of collaborative care with cognitive behavioral therapy.

Abstract: Background Many patients with anxiety disorders remain symptomatic after receiving evidence-based treatment, yet research on treatment-resistant anxiety is limited We evaluated effects of cognitive behavioral therapy (CBT) on outcomes of patients with medication-resistant anxiety disorders using data from the Coordinated Anxiety Learning and Management (CALM) trial Methods Primary care patients who met study entry criteria (including DSM-IV diagnosis of generalized anxiety disorder, panic disorder, posttraumatic stress disorder, or social anxiety disorder) despite ongoing pharmacotherapy of appropriate type, dose, and duration were classified as medication resistant (n = 227) Logistic regression was used to estimate effects of CALM's CBT program (CALM-CBT; chosen by 104 of 117 medication-resistant patients randomized to CALM) versus usual care (UC; n = 110) on response [≥ 50% reduction of 12-item Brief Symptom Inventory (BSI-12) anxiety and somatic symptom score] and remission (BSI-12 < 6) at 6, 12, and 18 months Within-group analyses examined outcomes by treatment choice (CBT vs CBT plus medication management) and CBT dose Results Approximately 58% of medication-resistant CALM-CBT patients responded and 46% remitted during the study Relative to UC, CALM-CBT was associated with greater response at 6 months (AOR = 378, 95% CI 202-707) and 12 months (AOR = 249, 95% CI 136-458) and remission at 6, 12, and 18 months (AORs = 244 to 318) Patients in CBT plus medication management fared no better than those in CBT only Some evidence suggested higher CBT dose produced better outcomes Conclusions CBT can improve outcomes for patients whose anxiety symptoms are resistant to standard pharmacotherapy

A comparison of the nature and correlates of panic attacks in the context of Panic Disorder and Social Anxiety Disorder

Abstract: Panic attacks occurring outside of Panic Disorder are not well-understood despite their inclusion as a diagnostic specifier in the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). This study compares panic attacks in the context of Panic Disorder compared to social anxiety in terms of their symptom frequency, severity, and clinical correlates. Method: Participants ( n =404) were interviewed using the Anxiety Disorders Interview Schedule (ADIS-IV-L; Brown et al., 1994), from which we analyzed interviewer ratings of panic attacks and panic attack symptoms, as well as other demographic and clinical characteristics. Results: Panic attacks in the context of Panic Disorder were characterized by a greater number and severity of symptoms compared to panic attacks in the context of Social Anxiety Disorder, and were associated with a history of traumatization, inpatient psychiatric treatment, and benzodiazepine use. Social anxiety panic attacks were associated with reduced physical health concerns. Cognitive panic attack symptoms were more prevalent in Panic Disorder and were associated with a variety of poor clinical correlates. Conclusions: Panic attacks in the context of Panic Disorder are more severe than those in social anxiety, and this may be driven by cognitive disturbances during those attacks.

The DSM-5 social anxiety disorder severity scale: Evidence of validity and reliability in a clinical sample.

Abstract: With DSM-5, the APA began providing guidelines for anxiety disorder severity assessment that incorporates newly developed self-report scales. The scales share a common template, are brief, and are free of copyright restrictions. Initial validation studies have been promising, but the English-language versions of the scales have not been formally validated in clinical samples. Forty-seven individuals with a principal diagnosis of Social Anxiety Disorder (SAD) completed a diagnostic assessment, as well as the DSM-5 SAD severity scale and several previously validated measures. The scale demonstrated internal consistency, convergent validity, and discriminant validity. The next steps in the validation process are outlined.

Dysfunctional attitudes and anxiety sensitivity in the manifestation and first onset of social anxiety disorder versus specific phobia and healthy: A prospective longitudinal study

Abstract: This study evaluated the role of two cognitive vulnerability factors, anxiety sensitivity and dysfunctional attitudes, in the prediction of the manifestation and onset of social anxiety disorder relative to specific phobia and relative to healthy controls. Women, aged between 18 and 24 years, were studied at baseline and 18 months later using the Anxiety Disorders Interview Schedule-Lifetime-ADIS-IV-L and the Anxiety Sensitivity Index-ASI and the Dysfunctional Attitude Scale-DAS. First, 52 women with current social anxiety disorder were compared to 97 women with current specific phobia and 1124 healthy controls (cross-sectional analysis). Second, 24 women with a first incidence of social anxiety disorder were compared to 55 women with a first incidence of specific phobia and 684 healthy controls (longitudinal analysis). Multiple logistic regression analyses, adjusted for baseline anxiety and depressive severity, revealed that a) dysfunctional attitudes were elevated in women with current social anxiety disorder versus healthy controls as well as women with current specific phobia in the cross-sectional analysis and b) dysfunctional attitudes were elevated in women who subsequently developed social anxiety disorder versus healthy controls in the longitudinal analysis. However, dysfunctional attitudes were not predictive for women who developed social anxiety disorder during the study relative to women who developed specific phobia. The results suggest that dysfunctional attitudes are a marker of severity for social anxiety disorder relative to other phobias and a risk factor for phobias more generally. Anxiety sensitivity seems not to contribute to the manifestation and onset of social anxiety disorders.