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Although clinical intuitions influence psychotherapeutic practice and are a rich source of novel hypotheses for research, many remain to be empirically tested. This study evaluates whether clinicians' beliefs about barriers to progress in cognitive-behavioral therapy (CBT) for panic disorder are supported by data. Data from a randomized-controlled trial comparing CBT to panic-focused psychodynamic psychotherapy (PFPP) for adults with primary panic disorder (N = 161) were used to evaluate 15 factors endorsed by clinicians as impediments to CBT in a recent survey. Panic severity was assessed before, during (at Weeks 1, 5, and 9), and at termination of treatment (Week 12) using the Panic Disorder Severity Scale. Hierarchical linear modeling revealed that none of the perceived barriers were predictive of poor outcome. Contrary to clinicians' intuitions, dissociation during panic attacks was associated with greater symptomatic improvement in both treatment arms (β = -0.69, p < .05), above the effect of established predictors. Moderation analyses revealed that when patients had PTSD diagnosed with the Anxiety Disorders Interview Schedule (β = 1.71, p < .05) or less severe panic disorder (β = 0.45, p = .04), they changed more rapidly in CBT than in PFPP. Overall, clinician agreement was inversely related to the strength of a predictor (r = -.24, p = .39). Although clinical intuitions can be useful as clinical and empirical signals, such beliefs should be critically examined before informing practice. Dialogue between academics and clinicians might be enhanced through research that incorporates input from front-line practitioners., (Copyright © 2021. Published by Elsevier Ltd.)

Individuals with social anxiety disorder (SAD) have difficulties in their romantic relationships, including decreased satisfaction and intimacy, but the reasons for these difficulties are poorly understood. Because fear of negative evaluation is a cardinal feature of SAD, perceived criticism from a romantic partner may play a central role in socially anxious individuals' relationships. In the present study, we compared levels of perceived, expressed, and observed criticism and reactions to criticism among individuals with SAD and their partners (n = 21), individuals with other anxiety disorders and their partners (n = 35), and couples free of psychopathology (n = 30). Participants rated both global criticism and criticism during a 10-minute problem-solving task, which was also coded for criticism by observers. Individuals with anxiety disorders showed elevated levels of interaction-specific perceived criticism, expressed criticism, and upset and stress due to criticism relative to normal controls; they also reported that the interaction was more stressful. However, there were no group differences on global measures of criticism, and the two anxious groups did not differ on any measures. Findings suggest that the high levels of criticism anxious individuals perceive and their corresponding negative reactions to criticism, though not specific to SAD, may account for some of the relationship difficulties that have been identified in SAD. Results also indicate that anxious individuals may contribute to their relationship difficulties by being highly critical themselves. Overall, our findings point to the need for a clinical focus on decreasing perceived criticism among individuals with anxiety disorders., (Copyright © 2018. Published by Elsevier Ltd.)

The primary aims of the current investigation were (a) to examine the relationships among attributions, perceived constructive and destructive criticism, and upset due to criticism and (b) to explore racial differences in mean levels of attributions, perceived criticism, upset due to criticism, and warmth in a community sample of Blacks and Whites (N = 272). The Attributions of Criticism Scale (ACS) was used to measure participants' attributions regarding criticism from their relatives. No racial differences were found in mean levels of attributions or type of perceived criticism. However, Blacks were significantly less upset by perceived criticism from their relatives than Whites. When the relationships between attributions, perceived criticism, and upset were explored, results showed that positive attributions were associated with greater perceived constructive criticism and less upset due to criticism, whereas negative attributions were associated with greater perceived destructive criticism and more upset. Perceptions of relatives' warmth were also associated with greater perceived constructive criticism and less perceived destructive criticism, but warmth was only related to less upset for Blacks and not Whites. Findings suggest that attributions and warmth play an important role in the perception of criticism and the extent to which individuals become upset in response to criticism from loved ones. Results also point to potential racial differences in mean levels of these variables and the associations among them., (Copyright © 2017. Published by Elsevier Ltd.)

Social anxiety is associated with difficulties in intimate relationships. Because fear of negative evaluation is a cardinal feature of social anxiety disorder, perceived criticism and upset due to criticism from partners may play a significant role in socially anxious individuals' intimate relationships. In the present study, we examine associations between social anxiety and perceived, observed, and expressed criticism in interactions with romantic partners. In Study 1, we collected self-report data from 343 undergraduates and their romantic partners on social anxiety symptoms, perceived and expressed criticism, and upset due to criticism. One year later couples reported whether they were still in this relationship. Results showed that social anxiety was associated with being more critical of one's partner, and among women, being more upset by criticism from a partner. Social anxiety was not related to perceived criticism, nor did criticism variables predict relationship status at Time 2. In Study 2, undergraduate couples with a partner high (n = 26) or low (n = 26) in social anxiety completed a 10-minute, video-recorded problem-solving task. Both partners rated their perceived and expressed criticism and upset due to criticism following the interaction, and observers coded interactions for criticism. Results indicated that social anxiety was not significantly related to any of the criticism variables, but post hoc analyses cast doubts upon the external validity of the problem-solving task. Results are discussed in light of known difficulties with intimacy among individuals with social anxiety., (Copyright © 2016. Published by Elsevier Ltd.)

Little is known about the quality of socially anxious individuals' romantic relationships. In the present study, we examine associations between social anxiety and social support in such relationships. In Study 1, we collected self-report data on social anxiety symptoms and received, provided, and perceived social support from 343 undergraduates and their romantic partners. One year later couples were contacted to determine whether they were still in this relationship. Results indicated that men's social anxiety at Time 1 predicted higher rates of breakup at Time 2. Men's and women's perceived support, as well as men's provided support, were also significantly predictive of breakup. Social anxiety did not interact with any of the support variables to predict breakup. In Study 2, a subset of undergraduate couples with a partner high (n=27) or low (n=27) in social anxiety completed two 10-minute, lab-based, video-recorded social support tasks. Both partners rated their received or provided social support following the interaction, and trained observers also coded for support behaviors. Results showed that socially anxious individuals received less support from their partners during the interaction according to participant but not observer report. High and lower social anxiety couples did not differ in terms of the target's provision of support. Taken together, results suggest that social anxiety is associated with difficulties even in the context of established romantic relationships. Clinical implications are discussed., (Copyright © 2016. Published by Elsevier Ltd.)

The current investigation had two principal goals: (a) to examine whether attributions regarding the intentions underlying criticism from one's relative predict perceived criticism from that relative and (b) to explore differences between African Americans and Whites in attributions and perceived criticism. A new measure, the Attributions of Criticism Scale, was employed in the present study to assess attributions of perceived criticism. Results showed that the attributions scale demonstrated good psychometric properties in a sample of African American (n=78) and White (n=165) community participants. As hypothesized, attributions were correlated with perceptions of criticism. When racial differences in attributions and perceived criticism were explored, results showed that African Americans made more positive attributions but also perceived more destructive criticism than Whites. No racial differences were observed on overall and constructive criticism, but there was some evidence to suggest that African Americans made more negative attributions than Whites. However, these results were inconsistent across recruitment method. Taken together, these findings suggest that positive and negative attributions are important factors in the perception of criticism and that mean levels of attributions and perceived criticism may differ by race. Possible explanations for effects as well as clinical implications and directions for future research are considered., (Copyright © 2014. Published by Elsevier Ltd.)

In response to three surveys of (mostly) cognitive-behavioral practitioners about barriers to treatment success with cognitive-behavioral therapy for patients with generalized anxiety disorder, panic disorder, and social phobia (McAleavey, Castonguay, & Goldfried, 2014-this issue; Szkodny, Newman, & Goldfried, 2014-this issue; Wolf & Goldfried, 2014-this issue), the author proposes several methods for tapping clinical expertise in the development and dissemination of psychological interventions. These include: following surveys with interviews of a subset of clinicians to obtain richer information, systematically incorporating answers to questions and problems trainees raise in supervision in efficacy or effectiveness trials, organizing clinical roundtables at meetings of the Association for Behavioral and Cognitive Therapies to discuss ways to address barriers identified in these surveys, and encouraging papers on these topics in Cognitive and Behavioral Practice. At the same time the author emphasizes that clinical observations are not facts and need to be verified in empirical research., (© 2013.)

Aims of this study were (a) to summarize the psychometric literature on the Mobility Inventory for Agoraphobia (MIA), (b) to examine the convergent and discriminant validity of the MIA's Avoidance Alone and Avoidance Accompanied rating scales relative to clinical severity ratings of anxiety disorders from the Anxiety Disorders Interview Schedule (ADIS), and (c) to establish a cutoff score indicative of interviewers' diagnosis of agoraphobia for the Avoidance Alone scale. A meta-analytic synthesis of 10 published studies yielded positive evidence for internal consistency and convergent and discriminant validity of the scales. Participants in the present study were 129 people with a diagnosis of panic disorder. Internal consistency was excellent for this sample, α=.95 for AAC and .96 for AAL. When the MIA scales were correlated with interviewer ratings, evidence for convergent and discriminant validity for AAL was strong (convergent r with agoraphobia severity ratings=.63 vs. discriminant rs of .10-.29 for other anxiety disorders) and more modest but still positive for AAC (.54 vs. .01-.37). Receiver operating curve analysis indicated that the optimal operating point for AAL as an indicator of ADIS agoraphobia diagnosis was 1.61, which yielded sensitivity of .87 and specificity of .73., (Copyright © 2011. Published by Elsevier Ltd.)

Parents who are not overly protective and who encourage children to take on challenging experiences may help children develop an enhanced sense of control, thereby reducing the risk for subsequent anxiety. We developed the Parental Facilitation of Mastery Scale (PFMS) to assess parenting behaviors that may promote mastery experiences in childhood. Undergraduates and their biological siblings were recruited to complete the PFMS as well as other measures of parenting behaviors, perceived control, and anxiety. A factor analysis of the PFMS revealed two components representing parental overprotection and parental challenge. These two factors demonstrated adequate psychometric properties. We therefore used this measure to test a model in which perceived control mediated the relationship between parenting behaviors and anxiety. The hypothesized model demonstrated good fit, suggesting that the PFMS may be a useful tool for measuring parental behaviors that promote a sense of mastery and ultimately buffer against anxiety in adulthood., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Individuals with obsessive-compulsive disorder (OCD) seem to judge harm caused actively and passively as morally equivalent. In contrast, people generally choose harm by omission over harm by commission, a propensity known as omission bias. Two studies examined the hypothesis that OCD is associated with less omission bias. In Study 1, with a student population, symptoms of OCD and related cognitions were negatively associated with omission bias about washing and checking scenarios targeting common OCD fears. In contrast, neither symptoms nor cognitions related to OCD were associated with general omission bias. In Study 2, individuals with self-reported OCD evinced less omission bias about washing and checking scenarios than did individuals without OCD. Again, general omission bias was not related to OCD. These results support the idea that individuals with elevated OCD symptoms distinguish less than others between acts of omission and commission for harm relevant to general OCD concerns., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

The relationship between perceived criticism from one's relative and attributions about that relative's behavior was examined in two studies. In Study 1, 50 community couples volunteered to participate in a study of marital interaction. Participants rated their interaction-specific perceived criticism after a 10-min problem-solving interaction and their attributions for their spouses' behavior during a review of the videotaped interaction. In Study 2, 70 outpatients with obsessive-compulsive disorder (n=41) or panic disorder with agoraphobia (n=29) completed a measure of global perceived criticism in their relationship with their spouse or other family member and on another occasion participated in a 10-min problem-solving interaction with that relative. Using interaction transcripts, coders extracted and coded attributions from patients' speech and, using the videotapes themselves, rated relatives' observable criticism. In both studies higher scores on negative attributions were related to higher perceived criticism ratings. In Study 2, negative attributions contributed to the prediction of perceived criticism above and beyond the contribution of observed criticism. These findings suggest that targeting attributions about perceived criticism may be fruitful in reducing the negative impact of perceived criticism on treatment outcome for a variety of psychiatric disorders.

The empirical literature on the relationship between moral thought-action fusion (TAF) and obsessive-compulsive disorder (OCD) is characterized by mixed findings. Previous studies have reported religious group differences in moral TAF and the relationship between moral TAF and religiosity. In light of those studies and considering the apparent role of moral TAF in scrupulosity, the purpose of this investigation was to evaluate the possible role of religion as a moderator of the relationship between moral TAF and OCD symptoms. The results revealed that (a) Christians endorsed higher levels of moral TAF than did Jews independent of OCD symptoms; (b) religiosity was correlated with moral TAF in Christians but not in Jews, suggesting that Christian religious adherence is related to beliefs about the moral import of thoughts; and (c) moral TAF was related to OCD symptoms only in Jews. That is, for Christians, moral TAF was related to religiosity but not OCD symptoms, and for Jews, moral TAF was related to OCD symptoms but not religiosity. These results imply that moral TAF is only a marker of pathology when such beliefs are not culturally normative (e.g., as a function of religious teaching or doctrine)., ((c) 2010 Elsevier Ltd. All rights reserved.)

The construct validity of the Perceived Criticism Measure (PCM) was examined in 2 studies. In Study 1, 50 community couples participated in problem-solving interactions after which they rated interaction-specific perceived criticism and their criticism of their spouses. In addition, they provided ratings of perceived criticism for their relationship overall and completed measures of psychopathology and marital satisfaction. For both husbands and wives, convergent validity was demonstrated by moderate-to-large correlations between the PCM and spouses' own ratings of their criticism for both general and interaction-specific perceived criticism. In Study 2, 37 patients with obsessive-compulsive disorder and their spouses participated in problem-solving interactions and provided ratings of marital satisfaction and general perceived criticism. Five untrained coders rated the interactions according to their own definitions of the relatives' destructive criticism of the patient. Their aggregated ratings proved strongly related to patients' PCM scores. Higher PCM scores were related to lower marital satisfaction in both Studies 1 and 2. The results of these studies are supportive of the convergent validity of the Perceived Criticism Measure. Evidence of discriminant validity was mixed.

In a test of Hooley's (1987) attributional model of expressed emotion (EE), attributions for negative behaviors and events in patients' lives were examined in relatives of 74 outpatients with panic disorder with agoraphobia or obsessive-compulsive disorder. Attributions were extracted from 10-minute problem-solving interactions between relatives and patients, whereas EE was assessed during a separate interview with the relative. Consistent with prior findings in relatives of individuals with other disorders, relatives who made greater proportions of attributions of patient responsibility demonstrated significantly higher levels of EE-hostility. In addition, nonspousal relatives (mostly parents) who attributed any negative behaviors or events to a patient's disorder were significantly higher in emotional overinvolvement (EOI); no such relationship was found for spouses. Finally, patients with relatives who made attributions to the patient's disorder received less benefit from behavior therapy than did those whose relatives made no such attributions, even when EE variables were controlled.

African Americans with obessive-compulsive disorder are underrepresented in behavioral treatment outcome studies. This paper consists of a clinical discussion of issues arising during the treatment with exposure plus response prevention of two African-American women with obessive-compulsive disorder. Clinical issues, such as excessive shame, insanity fears, and a sense of uniqueness, complicated the treatment process. However, both clients made significant improvement as assessed by behavioral testing, target ratings and the Yale-Brown Obsessive-Compulsive Scale.

Response to cognitive-behavioral group therapy for social phobia was assessed at posttest and 6-month follow-up in a sample of 62 clients (41 generalized subtype, 21 nongeneralized). Predictors assessed were depression, expectancy, personality disorder traits, clinician-rated breadth and severity of impairment, and frequency of negative thoughts during social interactions. Outcome measures included self-report questionnaires and behavioral tests of dyadic interaction and a public speech. Although no predictor was related to outcome across all domains of measurement, higher depression, more avoidant personality traits, and lower treatment expectancy were each related to poorer treatment response on one or more outcome criteria. Cognitive change was consistently associated with change on self-report symptom measures, but, contrary to expectation, lower rates of negative thinking at posttest did not predict better maintenance of treatment gains at follow-up.