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Objectives Individuals with major depressive disorder (MDD) have problems with engaging in approach behaviour to potentially rewarding encounters, which contributes to the maintenance of depressive symptoms. Approach-avoidance training (AAT) retrains implicit approach tendencies, and behavioural activation (BA) promotes explicit approach behaviour in MDD. As a novel MDD treatment strategy, this study aimed to implement a brief, computerized version of BA integrated with implicit AAT. Design Adults with a principal diagnosis of MDD (N = 25) were randomly assigned to complete one of two versions of AAT - approach-positive faces (n = 12) or balanced approach of positive and neutral faces (n = 13) - concurrently with self-guided BA twice weekly for 2 weeks. Methods Outcomes included treatment completion rates; bias scores for automatic approach towards positive social cues; and symptom scales for depression, positive affect, social relationship functioning, anhedonia, and anxiety. Results Feasibility and acceptability of computerized BA + AAT were supported by moderate pre-treatment credibility and expectancy ratings and 80% treatment completion. Participants across both conditions displayed significant and large sized reductions in depression from pre- to post-assessment (Cohen's d = -1.23) that maintained three months later, as well as decreased anxiety and anhedonia and increased positive affect and social relationship functioning (medium to large effects). Conclusion Results support the feasibility and potential efficacy of brief, computerized BA + AAT. Research is needed to determine whether AAT is additive to BA, and what AAT parameters best enhance treatment outcomes. Practitioner points Brief, computerized behavioral activation plus approach/avoidance training (BA + AAT) may be acceptable and beneficial for some patients with moderate-to-severe major depression. Computer-delivered BA + AAT can be implemented as a largely self-guided program for MDD and could be administered remotely and/or with minimal clinician interaction. As this was a small proof of concept study, it cannot be determined which treatment components - AAT, BA, or both - contributed to positive clinical outcomes. Because BA + AAT was implemented in a research clinic, it remains unknown what treatment engagement and response would look like in community settings.

OBJECTIVES: Hoarding disorder (HD) is conceptualized as a fear-based disorder and exposure to sorting/discarding possessions is a core part of treatment. However, there has been no investigation of age-related differences in emotional reaction to sorting. The objective of this study was to explore the association between age and affective response during a sorting task. METHODS: Forty-nine adults with HD completed a standardized sorting task. Participants reported their current emotion before and after the sorting task and reported their subjective distress throughout the task. RESULTS: Older participants reported significantly lower distress ratings. Only 43% of participants reported fear prior to the task and 22% reported fear after the task. The probability of reporting fear before and after the task decreased significantly with age. CONCLUSIONS: Fear may not be the emotion experienced when discarding items, particularly for older adults with HD. Future work should focus on mechanisms of action in HD treatment. CLINICAL IMPLICATIONS: Clinicians should not assume fear or anxiety to be the primary emotional response in older adults with HD when engaged in an exposure to sorting/discarding. Older hoarding patients with a more fear-oriented aversion to sorting possessions may require a treatment emphasis on increasing the percentage of items discarded.

Background Suicide is a serious public health problem, including among U.S. Army personnel. There is great interest in discovering objective predictors of suicide and non-fatal suicidal behaviors. The current study examined the association between neurocognitive functioning and pre-military history of suicide attempts (SA) and post-enlistment onset of SA. Methods: New Soldiers reporting for Basic Combat Training (N = 38,507) completed a comprehensive computerized neurocognitive assessment battery and self-report questionnaires. A subset of Soldiers (n = 6216) completed a follow-up survey, including assessment of lifetime SA, 3–7 years later. Results Six hundred eighty-nine Soldiers indicated lifetime SA at baseline and 210 Soldiers indicated new-onset SA at follow-up. Regression analyses, adjusted for demographic variables, revealed significant bivariate associations between neurocognitive performance on measures of sustained attention, impulsivity, working memory, and emotion recognition and lifetime SA at baseline. In a multivariable model including each of these measures as predictors, poorer impulse control and quicker response times on an emotion recognition measure were significantly and independently associated with increased odds of lifetime SA. A second model predicted new-onset SA at follow-up for Soldiers who did not indicate a history of SA at baseline. Poorer impulse control on a measure of sustained attention was predictive of new-onset SA. Limitations: Effect sizes are small and of unlikely clinical predictive utility. Conclusions We simultaneously examined multiple neurocognitive domains as predictors of SA in a large, representative sample of new Army Soldiers. Impulsivity most strongly predicted past and future SA over and beyond other implicated cognitive-emotional domains.

OBJECTIVES: To establish whether positive affect (PA) is uniquely associated with loneliness and other social functioning variables beyond negative affect (NA) among older adults. METHODS: Four hundred and twenty-eight participants (aged 60+ years old, 82% White, and 48% female) were recruited using random digit-dialing and completed scales for loneliness (UCLA Loneliness Scale), companionship (PROMIS scale), satisfaction with discretionary social activities (PROMIS scale), PA (Center for Epidemiologic Studies [CES] Happiness Scale), and NA (CES-Depression scale and Brief Symptom Inventory-Anxiety Subscale). RESULTS: Multiple linear regression models found PA to be a significant predictor of lower loneliness where the effect of PA on loneliness is dependent on the level of NA; a large effect size at the mean level of NA, which becomes attenuated when NA increases. Although the direction of effect of PA on loneliness will change for NA > 5.10, which is 5 standard deviations away from 0, based on the model estimates, the percent of subjects with this large NA levels is practically 0. Thus, higher PA is associated with lower loneliness, however this effect is attenuated for larger NA. Similarly, multiple linear regression models found that companionship was associated with PA and NA where the effect of PA is dependent on the level of NA; a medium effect size at the mean level of NA, which becomes attenuated when NA increases. As in the case of loneliness, the direction of effect of PA on companionship will change for NA > 3.52, which is 3.5 standard deviation away from 0, based on the model estimates, but the percent of subjects with this large NA levels is practically 0. Thus, higher PA is associated with increased companionship, and this effect is attenuated with greater NA. Satisfaction with social activities was associated with PA only (medium effect size). CONCLUSIONS: Results suggest PA appears to be uniquely associated with social functioning among older adults. These findings support the potential for treatments that target PA to decrease loneliness among older adults, or vice versa.

Positive valence system dysregulation is a relatively unexplored transdiagnostic mechanism and potential treatment target underpinning alcohol use and anxiety and depression symptoms. The current study examined the feasibility and potential benefit of a behavioral intervention focused on amplification of positivity (AMP) with eight adults (five female) diagnosed with alcohol use disorder and clinically significant depression or anxiety (ClinicalTrials.gov: NCT04278365). AMP for alcohol use (AMP-A) was delivered in 11 individual sessions involving positive activity interventions integrated alongside psychoeducation and alcohol use monitoring. Case descriptions are provided to illustrate treatment implementation. Treatment credibility and acceptability, participant endorsement of the therapy, and homework compliance were rated moderate to high. Exploratory, intent-to-treat analyses suggested medium to large effect sizes for post-treatment improvements in alcohol use, depression, anxiety, and positive affect. Results provide initial evidence of feasibility and acceptability of AMP-A and will be useful for informing future randomized clinical trials to examine clinical efficacy.

Positive valence system (PVS) deficits are increasingly recognized as important treatment targets for depression and anxiety. Emerging behavioral treatments designed to upregulate the PVS show initial promise; however, neural mechanisms underlying these approaches remain unknown. This study investigated neural reward-processing-related changes following Amplification of Positivity (AMP)-a treatment designed to enhance positive thinking, emotions and behaviors through positive activity interventions (Clinicaltrials.gov: NCT02330627). Individuals with depression and/or anxiety (N=29) were randomized to 10 sessions of AMP (n=16) or waitlist (WL; n=13). Participants completed a monetary incentive delay task during fMRI at baseline and post-assessment. Hypothesis-driven region of interest (ventral striatum, insula, anterior cingulate) and exploratory whole-brain activation and connectivity analyses evaluated pre-to-post changes for AMP vs. WL when anticipating potential monetary gain or loss. No between-group brain activation changes emerged in regions of interest or whole-brain analyses. Increased neural connectivity from pre-to-post-treatment was observed in AMP vs. WL, including ventral striatum, anterior insula, and anterior cingulate connectivity with prefrontal, limbic, occipital and parietal regions-predominantly during loss anticipation. This preliminary study is the first to examine neural mechanisms of positive activity interventions in depression and anxiety and suggests that AMP may strengthen brain connectivity in reward processing, attention, and emotion regulation networks.

Background Intolerance of uncertainty (IU) has been proposed as a transdiagnostic risk and maintenance factor underlying various forms of psychopathology. Few studies, however, have examined IU in hoarding disorder (HD)—a condition characterized by excessive urges to acquire and difficulties discarding possessions—core symptoms that may be fueled by inflated IU. We examined cross-sectional relationships between IU and different symptom facets of HD, controlling for anxiety and depression severity, and explored whether pre-treatment levels of IU predicted response to exposure-based treatment for HD. Method Fifty-seven individuals seeking treatment for HD completed baseline measures of hoarding symptoms, IU, anxiety and depression. Participants then completed 26 sessions of group exposure-based treatment for HD with or without compensatory cognitive training. Hoarding symptoms were assessed following the final treatment session to index treatment response. Results IU was positively and significantly associated with greater urges to acquire and greater difficulties discarding possessions, beyond shared variance accounted for by anxiety and depression. IU was not significantly related to clutter symptom severity. Higher pre-treatment IU predicted increased odds of treatment non-response. Conclusions Elevated IU is associated with specific hoarding symptom clusters and may be an important target for HD treatment.

Social impairments are common across many psychiatric conditions. Standardized dyadic assessments intended to elicit social affiliation between unacquainted partners are used to elucidate mechanisms that disrupt relationship formation and inform possible treatment targets; however, the psychometric properties of such paradigms remain poorly understood. This study evaluated the psychometric properties of a controlled social affiliation paradigm intended to induce connectedness between a target participant and trained confederate. Individuals with an anxiety or depressive disorder diagnosis (clinical group; n = 132) and those without (control group; n = 35) interacted face-to-face with a trained confederate; partners took turns answering a series of increasingly intimate questions about themselves. Social connectedness, affect, and affiliative behavior measures were collected during the interaction. Participant symptom and social functioning measures were collected to examine validity. The paradigm elicited escalating social connectedness throughout the task for both participants and confederates. Parallel forms (i.e., different question sets) elicited similar affiliation outcomes. Self-reported (but not behavioral) affiliation differed across some demographic variables (e.g., participant gender, Hispanic ethnicity). Within-task affiliation measures were associated with one another and with global social connectedness and social anxiety symptom measures, but not with somatic anxiety measures. Clinical participants reported lower social affiliation and positive affect reactivity and higher negative affect reactivity than healthy participants. These findings provide initial psychometric support for a standardized and controlled dyadic affiliation paradigm that could be used to reliably probe social disconnection mechanisms across psychopathology. Keywords: social affiliation, psychometrics, reliability, validity, relationship formation, behavioral, social anxiety, anxiety, depression, reciprocal self-disclosure paradigm

Background The heterogeneous nature of mood and anxiety disorders highlights a need for dimensionally based descriptions of psychopathology that inform better classification and treatment approaches. Following the Research Domain Criteria approach, this investigation sought to derive constructs assessing positive and negative valence domains across multiple units of analysis. Methods Adults with clinically impairing mood and anxiety symptoms (N = 225) completed comprehensive assessments across several units of analysis. Self-report assessments included nine questionnaires that assess mood and anxiety symptoms and traits reflecting the negative and positive valence systems. Behavioral assessments included emotional reactivity and distress tolerance tasks, during which skin conductance and heart rate were measured. Neuroimaging assessments included fear conditioning and a reward processing task. The latent variable structure underlying these measures was explored using sparse Bayesian group factor analysis. Results Group factor analysis identified 11 latent variables explaining 31.2% of the variance across tasks, none of which loaded across units of analysis or tasks. Instead, variance was best explained by individual latent variables for each unit of analysis within each task. Post hoc analyses 1) showed associations with small effect sizes between latent variables that were derived separately from functional magnetic resonance imaging and self-report data and 2) showed that some latent variables are not directly related to individual valence system constructs. Conclusions The lack of latent structure across units of analysis highlights challenges of the Research Domain Criteria approach and suggests that while dimensional analyses work well to reveal within-task features, more targeted approaches are needed to reveal latent cross-modal relationships that could illuminate psychopathology.

BACKGROUND: Anxiety and depressive disorders are often characterized by perceived social disconnection, yet evidence-based treatments produce only modest improvements in this domain. The well-established link between positive affect (PA) and social connectedness suggests that directly targeting PA in treatment may be valuable. METHOD: A secondary analysis of a waitlist-controlled trial (N=29) was conducted to evaluate treatment response and process of change in social connectedness within a 10-session positive activity intervention protocol—Amplification of Positivity (AMP)—designed to increase PA in individuals seeking treatment for anxiety or depression (ClinicalTrials.gov Identifier: NCT02330627). Perceived social connectedness and PA/negative affect (NA) were assessed throughout treatment. Time-lagged multilevel mediation models examined the process of change in affect and connectedness throughout treatment. RESULTS: The AMP group displayed significantly larger improvements in social connectedness from pre- to post-treatment compared to waitlist; improvements were maintained through 6-month follow-up. Within the AMP group, increases in PA and decreases in NA both uniquely predicted subsequent increases in connectedness throughout treatment. However, experiencing heightened NA throughout treatment attenuated the effect of changes in PA on connectedness. Improvements in connectedness predicted subsequent increases in PA, but not changes in NA. CONCLUSIONS: These preliminary findings suggest that positive activity interventions may be valuable for enhancing social connectedness in individuals with clinically impairing anxiety or depression, possibly through both increasing positive emotions and decreasing negative emotions.

Background Social disconnection is a common and pernicious feature of anxiety and depressive disorders, yet is insufficiently addressed by our best available treatments. To better understand why people with anxiety and depression feel socially disconnected, we tested a positive and negative valence systems framework informed by research on how normative social connections develop and flourish. Method Individuals seeking treatment for anxiety or depression (N = 150) completed measures of perceived social connectedness, positive and negative valence temperament, social goals, affect, symptoms, and life satisfaction. Results Feeling less socially connected was associated with diminished life satisfaction, beyond clinical symptom severity. Regression analyses revealed that both diminished positive valence and heightened negative valence temperament, and their corresponding motivational and affective outputs, were significantly and uniquely (with no significant interaction between them) associated with lower perceived connectedness. Limitations Data was cross-sectional and based on self-report—limiting conclusions about causality and social disconnection processes at different units of analysis. Conclusions Understanding social disconnection through the lens of a positive and negative valence systems framework may inform transdiagnostic models and treatment approaches.

Objective Increasing evidence supports the presence of an anhedonic endophenotype in major depressive disorder (MDD), characterized by impairments in various components of reward processing, particularly incentive motivation, effort-based decision making, and reward learning. In addition to its prominent role in MDD, reward processing dysregulation has been proposed as a transdiagnostic risk and/or maintenance factor for a range of other forms of psychopathology. Individuals with social anxiety disorder (SAD)-a condition that frequently co-occurs with MDD-demonstrate low trait positive affectivity and altered processing of rewards and positively valenced information. However, no studies to date have directly tested reward learning-the ability to modulate behavior in response to rewards-in this population. Materials and methods The current study evaluated reward learning in MDD, SAD, and healthy control subjects (N = 90) using a well-validated signal detection task. Given increasing data supporting transdiagnostic features of psychopathology, we also evaluated associations between anhedonia and task performance transdiagnostically in the patient sample. Results Contrary to expectations, results indicated no significant group differences in response bias in the full sample, suggesting no diagnostic differences in reward learning. However, dimensional analyses revealed that higher self-reported anhedonia (but not general distress or anxious arousal) was associated with worse reward learning in both the MDD and SAD groups explaining about 11% of the variance. Conclusion Deficits in implicit reward learning are associated with anhedonia but not necessarily with major depressive disorder as a diagnosis, which supports the use of transdiagnostic approaches to understanding psychopathology.

While cognitive-behavioral therapy for hoarding disorder (HD) has resulted in significant reductions in symptoms, most individuals continue to have significant hoarding symptoms following treatment. This investigation sought to extend the literature on the behavioral treatments for hoarding by examining (1) group cognitive rehabilitation and exposure/sorting therapy (CREST) and (2) group exposure therapy (ET) for hoarding. Participants in both studies reported significant decreases in hoarding symptom severity from baseline to post-treatment on all primary outcome measures using mixed-effects linear regression models with the intent to treat sample. Participants who received group CREST reported statistically significant reductions in anxiety, depression, and overall severity at post-treatment, while participants who received group ET did not. Results provide preliminary evidence for both group CREST and group ET as effective treatments for hoarding disorder.

A defining feature of hoarding disorder (HD) is excessive attachment to possessions. Several existing self-report measures assess emotional attachment to items but do not explicitly assess the level of interconnectedness between the individual and their items. The current study investigated a new self-report measure of object attachment based on a measure of interconnectedness among individuals. The visual nature of this measure may be especially useful in HD patients since hoarding is often characterized by low insight. Participants completed the Relationship between Self and Items (RSI) measure and measures of hoarding severity, clutter, anxiety, and depression. HD participants reported significantly higher scores on the RSI than did community controls. The RSI was positively associated with hoarding symptoms, but was not significantly correlated with symptoms of anxiety or depression. Results also suggested that the RSI is sensitive to change from pre to post-treatment. This brief, one-item measure may be useful as a screen for HD and to provide further clinical data on level of interconnectedness to possessions.

Author(s): Kryza-Lacombe, Maria; Pearson, Nana; Lyubomirsky, Sonja; Stein, Murray B; Wiggins, Jillian Lee; Taylor, Charles T

Background and objectives Social anxiety is characterized by biased attentional processing of social information. However, heterogeneity of extant findings suggests that it may be informative to elucidate individual difference factors that modulate the processing of emotional information. The current study examined whether individual differences in components of attentional control (AC – shifting and focusing) moderated the link between social anxiety and attentional engagement and disengagement biases for threat-relevant cues. Methods Seventy–five undergraduate students completed well-established measures of social anxiety symptoms, AC, and attentional bias for social threat information (modified probe detection task). Results Moderation analyses revealed that at low levels of AC-shifting, increased social anxiety was associated with slower disengagement from threat-relevant compared to neutral social cues. In contrast, at high levels of AC-shifting, social anxiety was associated with faster disengagement from threat-relevant compared to neutral stimuli. Individual differences in AC-focusing did not moderate the social anxiety-attentional bias link. Limitations Causal inferences cannot be made given the cross-sectional study design. The sample comprised individuals displaying a range of self-reported social anxiety symptoms; thus, generalizability to clinical samples remains to be established. The measurement of AC relied on subjective participant report. Conclusions The current findings underscore the importance of AC processes in understanding the nature of attentional bias mechanisms in anxiety.

Background Positive affect (PA) attenuates negative reactivity to stress; however, this adaptive function of PA is seldom studied in psychiatric conditions characterized by more extreme forms of affective responding. We tested distinct associations of PA and negative affect (NA) with anxiety reactivity in participants with social anxiety disorder (SAD)—a condition characterized by heightened NA and diminished PA—and non-SAD control subjects. Method Adults with a principal diagnosis of SAD (n = 71) and those without a psychiatric history (n = 36) rated their PA and NA during the past week, and were exposed to a laboratory stressor wherein they delivered a video-recorded speech on a controversial topic. Anxiety reactivity was assessed in terms of anticipatory anxiety prior to the speech, and observer-rated anxiety-related behavior during the speech. Results Across all participants, higher PA significantly predicted lower anticipatory anxiety and less anxiety-related behavior, beyond level of NA; lower NA significantly predicted attenuated anticipatory anxiety, but not anxiety-related behavior, beyond level of PA. The association between PA and stress reactivity was diminished for individuals with especially elevated NA, as well as for individuals with SAD compared to those without. Conclusions PA may be protective against negative reactivity to social stress; however, theoretical models and clinical applications should consider possible interactive effects of PA and NA in modulating stress reactivity.

RationaleAdvancing marijuana prevention and intervention efforts are important given the decreasing perception of harm among adolescents and increasing marijuana legalization.ObjectivesThis study evaluates how a monitored abstinence protocol may contribute to emotional functioning and changes in marijuana problems that can enhance successful outcomes for non-treatment-seeking adolescent marijuana users.MethodsAdolescent marijuana users (n=26) and demographically matched controls (n=30) completed 28days of monitored abstinence confirmed by biweekly urine toxicology. Participants were given measures of emotional functioning, marijuana use symptoms, and reward sensitivity during monitored abstinence.ResultsAll participants (n=56) completed the protocol, and 69% of marijuana users (n=18 of 26) were confirmed abstinent for 28days, with all users showing decreasing marijuana use. Reductions in subsyndromal depression, positive marijuana use expectancies, and poor sleep quality were observed by the end of the monitored abstinence period (n=26, p values

Objective Cognitive behavioral therapy (CBT) is empirically supported for the treatment of anxiety disorders; however, not all individuals achieve recovery following CBT. Positive emotions serve a number of functions that theoretically should facilitate response to CBT – they promote flexible patterns of information processing and assimilation of new information, encourage approach-oriented behavior, and speed physiological recovery from negative emotions. We conducted a secondary analysis of an existing clinical trial dataset to test the a priori hypothesis that individual differences in trait positive emotions would predict CBT response for anxiety. Method Participants meeting diagnostic criteria for panic disorder (n = 28) or generalized anxiety disorder (n = 31) completed 10 weekly individual CBT sessions. Trait positive emotionality was assessed at pre-treatment, and severity of anxiety symptoms and associated impairment was assessed throughout treatment. Results Participants who reported a greater propensity to experience positive emotions at pre-treatment displayed the largest reduction in anxiety symptoms as well as fewer symptoms following treatment. Positive emotions remained a robust predictor of change in symptoms when controlling for baseline depression severity. Conclusions Initial evidence supports the predictive value of trait positive emotions as a prognostic indicator for CBT outcome in a GAD and PD sample.

Individuals with social anxiety disorder (SAD) have difficulty forming social relationships. The prevailing clinical perspective is that negative emotions such as anxiety inhibit one’s capacity to develop satisfying social connections. However, empirical findings from social psychology and affective neuroscience suggest that positive emotional experiences are fundamental to establishing new social bonds. To reconcile these perspectives, we collected repeated measurements of anxiety, positive emotions (pleasantness), and connectedness over the course of a controlled relationship formation encounter in 56 participants diagnosed with SAD (64% female; Mage = 23.3, SD = 4.7). Participants experienced both increases in positive emotions and decreases in anxiety throughout the interaction. Change in positive emotions was the most robust predictor of subsequent increases in connectedness, as well as a greater desire to engage one’s partner in future social activities, above and beyond reductions in anxiety (medium to large sized effects). Those findings suggest that anxiety-based models alone may not fully explain difficulties in relationship formation in SAD, and underscore the potential value of considering positive emotional experiences in conceptual and treatment models of SAD.

Author(s): Taylor, Charles T; Lyubomirsky, Sonja; Stein, Murray B | Abstract: BackgroundResearch suggests that the positive affect system may be an important yet underexplored treatment target in anxiety and depression. Existing interventions primarily target the negative affect system, yielding modest effects on measures of positive emotions and associated outcomes (e.g., psychological well-being). The objective of the present pilot study was to evaluate the efficacy of a new transdiagnostic positive activity intervention (PAI) for anxiety and depression.MethodTwenty-nine treatment-seeking individuals presenting with clinically impairing symptoms of anxiety and/or depression were randomly allocated to a 10-session protocol comprised of PAIs previously shown in nonclinical samples to improve positive thinking, emotions, and behaviors (e.g., gratitude, acts of kindness, optimism; n = 16) or a waitlist (WL) condition (n = 13). Participants were assessed at pre- and posttreatment, as well as 3- and 6-month follow-up, on measures of positive and negative affect, symptoms, and psychological well-being. ClinicalTrials.gov Identifier: NCT02330627 RESULTS: The PAI group displayed significantly larger improvements in positive affect and psychological well-being from pre- to posttreatment compared to WL. Posttreatment and follow-up scores in the PAI group were comparable to general population norms. The PAI regimen also resulted in significantly larger reductions in negative affect, as well as anxiety and depression symptoms, compared to WL. Improvements across all outcomes were large in magnitude and maintained over a 6-month follow-up period.ConclusionsTargeting the positive affect system through a multicomponent PAI regimen may be beneficial for generating improvements in positive emotions and well-being, as well as reducing negative affect and symptoms, in individuals with clinically impairing anxiety or depression.

Mood and anxiety disorders are highly heterogeneous and their underlying pathology is complex. The Research Domain Criteria (RDoC) approach seeks to establish dimensionally and neuroscience-based descriptions of psychopathology that may inform better classification and treatment approaches. The current investigation sought to determine the latent variables underlying positive and negative valence processing in terms of symptoms and behavioral units of analysis.As part of an ongoing study, individuals with mood and anxiety problems were recruited largely from primary care clinics at UCLA (n=62) and UCSD (n=58). These participants underwent a comprehensive symptomatic and behavioral assessment. An implicit approach avoidance task and a modified dot probe detection task were used to measure positive and negative valence processing.Principal components analysis with varimax rotation identified four symptom components, three behavioral components for the dot probe task, and two behavioral components for the implicit approach avoidance task. These components yielded two meta-components consisting of: negative valence symptoms, negative approach bias, and high sustained, selective attention; and positive valence symptoms, positive approach bias, and slow selective or sustained attention. The components did not differ between males and females, nor by age or medication status.The limitations are: (1) relatively small sample, (2) exploratory analysis strategy, (3) no test/re-test data, (4) no neural circuit analysis, and (5) limited reliability of behavioral data.These preliminary data show that positive and negative valence processing domains load on independent dimensions. Taken together, multi-level assessment approaches combined with advanced statistical analyses may help to identify distinct positive and negative valence processes within a clinical population that cut across traditional diagnostic categories.

Clinical observations indicate that individuals with Social Anxiety Disorder (SAD) use a variety of safety behaviours; however, virtually no research has examined the functional effect of different safety-seeking strategies. Accordingly, we conducted two studies to address this issue. Study 1 measured global patterns of safety behaviour use in a large analogue sample. Factor analysis revealed two primary safety behaviour categories, avoidance and impression management. Study 2 assessed situational use of safety behaviours during a controlled social interaction in a clinical sample of 93 patients with Generalised SAD. Factor analysis again revealed support for avoidance and impression-management subtypes. Notably, the two types of safety behaviours were associated with different social outcomes. Avoidance safety behaviours were associated with higher state anxiety during the interaction and negative reactions from participants' interaction partners. Impression-management strategies appeared to impede corrections in negative predictions about subsequent interactions. These findings suggest that it may be beneficial to consider the unique effects of different safety-seeking strategies when assessing and treating SAD.

The current study investigated the mechanism through which safety behaviors perpetuate perceived and actual negative social outcomes hypothesized to maintain social anxiety disorder (SAD). Eighty individuals diagnosed with generalized SAD took part in a "getting acquainted" conversation with a trained experimental confederate. Participants were then randomly assigned to either a safety behavior reduction plus exposure condition (SB + EXP) or a graduated exposure (EXP) control condition and completed a 2nd conversation with the same interaction partner. Mediation analyses revealed that participants instructed to reduce their idiosyncratic safety behaviors displayed significantly greater increases in both perceived and actual positive interpersonal outcomes relative to the EXP group. However, whereas the safety behavior manipulation influenced participants' appraisals of their partner's reaction to them through reducing self-judgments about the visibility of anxiety-related behaviors, in reality, the SB + EXP group elicited more positive partner reactions because they displayed a greater increase in social approach behavior. Thus, although both parties recognized positive changes in the social exchange following the safety behavior manipulation, different sources of social information accounted for participant versus partner interpersonal judgments. The current findings point to the potential value of considering both the intra and interpersonal consequences of safety behaviors in SAD.

Accumulating evidence suggests that social anxiety is associated with biased processing of positive social information. However, it remains to be determined whether those biases are simply correlates of, or play a role in maintaining social anxiety. The current study examined whether diminished attentional allocation for positive social cues mediates the link between social anxiety and anxiety reactivity to a social-evaluative task. Forty-three undergraduate students ranging in severity of social anxiety symptoms completed a baseline measure of attentional bias for positive social cues (i.e., modified probe detection task) and subsequently delivered an impromptu videotaped speech. Mediation analyses revealed that the tendency to allocate attention away from positive social stimuli mediated the effect of social anxiety on change in state anxiety in response to the stressor. The current findings add to a nascent empirical literature suggesting that aberrant processing of positive social information may contribute to the persistence of excessive social anxiety.

Two experiments were conducted to examine the link between safety behaviors and social judgments in social anxiety disorder (SAD). Safety behaviors were manipulated in the context of a controlled laboratory-based social interaction, and subsequent effects of the manipulation on the social judgments of socially anxious participants (N = 50, Study 1) and individuals meeting diagnostic criteria for generalized SAD (N = 80, Study 2) were examined. Participants were randomly assigned to either a safety behavior reduction plus exposure condition (SB + EXP) or a graduated exposure (EXP) control condition, and then took part in a conversation with a trained experimental confederate. Results revealed across both studies that participants in the SB + EXP group were less negative and more accurate in judgments of their performance following safety behavior reduction relative to EXP participants. Study 2 also demonstrated that participants in the SB + EXP group displayed lower judgments about the likelihood of negative outcomes in a subsequent social event compared to controls. Moreover, reduction in safety behaviors mediated change in participant self-judgments and future social predictions. The current findings are consistent with cognitive theories of anxiety, and support the causal role of safety behaviors in the persistence of negative social judgments in SAD.

Impulsivity and anxiety, common features of bipolar disorder (BD), are each associated with a number of negative outcomes in BD. The relationship between anxiety and impulsivity, however, has not been a focus of study in BD. In this paper, we present data regarding the association between anxiety and impulsivity as measured by the Barratt impulsiveness scale (BIS-11) in 114 outpatients with BD. Results revealed that patients with a comorbid anxiety disorder displayed significantly higher levels of impulsivity relative to patients without an anxiety disorder. Moreover, a broad range of anxiety-related symptom domains was associated with greater impulsivity. Exploratory analyses also revealed that baseline anxiety symptoms were associated with elevated impulsivity at 9-month follow-up, although these relationships were less robust after covariate adjustment. These data demonstrate that anxiety is positively associated with impulsivity in patients with BD. Further studies are needed to elucidate the implications of and reasons for this association.

Growing evidence suggests that intolerance of uncertainty (IU) is a cognitive vulnerability that is a central feature across diverse anxiety disorders, including generalized anxiety disorder (GAD). Although cognitive behavioral therapy (CBT) has been shown to reduce IU, it remains to be established whether or not reductions in IU mediate reductions in worry. This study examined the process of change in IU and worry in a sample of 28 individuals with GAD who completed CBT. Changes in IU and worry, assessed bi-weekly during treatment, were analyzed using multilevel mediation models. Results revealed that change in IU mediated change in worry (ab = -0.20; 95% CI [-.35, -.09]), but change in worry did not mediate change in IU (ab = -0.16; 95% CI [-.06, .12]). Findings indicated that reductions in IU accounted for 59% of the reductions in worry observed over the course of treatment, suggesting that changes in IU are not simply concomitants of changes in worry. Findings support the idea that IU is a critical construct underlying GAD.

Social phobia is a condition in which anxiety impairs the person's ability to relate to others. Here, we draw on concepts from interpersonal theory to examine the literature on the role of interpersonal processes in creating and maintaining this disorder. Studies that examine interpersonal interactions with significant others and strangers are reviewed. We next consider topics of particular relevance to relationship impairment, such as the effect of anxiety on cognitive processing of social information, and the social developmental pathways to social phobia. The impact of interpersonal factors on the process and outcome of cognitive-behavioral treatment is also discussed. Finally, we identify emerging themes in the research literature and consider directions for future work. Throughout the paper we highlight topics central to the interpersonal perspective, such as the self-perpetuating interpersonal cycle, interpersonal variability in social phobia, and the relational nature of self-related information.

Computerized attention modification is a relatively new and empirically validated treatment approach for different types of anxiety disorders. However, its neural basis and processes involved are poorly understood. This study examined the effect of a one-time application of an attention modification program (AMP) on neural substrates underlying emotion processing in individuals with high social anxiety. Fourteen individuals with elevated social anxiety symptoms completed an emotional face processing task during functional magnetic resonance imaging before and after AMP, and were subsequently exposed to a laboratory stressor. Results revealed the following: First, there was attenuated activation from pre- to post-AMP in the bilateral amygdala, bilateral insula and subgenual anterior cingulate cortex. Second, post-AMP, individuals exhibited increased activation in several regions of the prefrontal cortex (PFC). Third, those individuals with greater enhancement of ventromedial PFC activation after AMP showed diminished attentional allocation for threat and attenuated anxiety reactivity to the stressor. We conclude that AMP exerts effects that are similar to those previously reported for standard anxiolytics; however, it also appears to foster deployment of top–down brain processes aimed to regulate anxiety.

Social Anxiety Disorder (SAD) is a common and disabling condition (e.g., Stein & Stein, 2008) with a lifetime prevalence of 12% (Kessler et al., 2005). Research supports the efficacy of a number of psychosocial (e.g., Hofmann & Smits, 2008) and pharmacological treatments for SAD (e.g., Stein & Stein, 2008). Despite their established efficacy, however, extant treatments leave room for improvement. For example, using conventional treatment strategies (i.e., cognitive behavioral or pharmacological regimens), only about 50% of patients diagnosed with SAD are classified as treatment responders (e.g., Heimberg et al., 1998; Davidson et al., 2004; see Stein & Stein, 2008 for a review). Moreover, many individuals diagnosed with SAD fail to access existing empirically supported treatments (Coles, Turk, Jindra, & Heimberg, 2004; Huppert, Franklin, Foa, & Davidson, 2003; Olfson et al., 2000). Considered together, these findings underscore the potential value of exploring novel treatment approaches that may augment existing interventions and/or increase accessibility to effective treatments for SAD. Cognitive Bias Modification (CBM) research represents one emerging area of translational clinical science that shows promise in the development of novel interventions for emotional disorders (see Beard, 2011; Koster, Fox, & MacLeod, 2009 for recent reviews). CBM involves the application of experimental procedures used in cognitive science to measure basic cognitive processes (e.g., attention, interpretation) to manipulate factors involved in the etiology and maintenance of emotional disorders (Mathews & MacLeod, 2005). Previous research supports the efficacy of CBM procedures in modifying selective information processing biases for emotionally salient stimuli (e.g., Grey & Mathews, 2000; MacLeod, Rutherford, Campbell, Ebsworthy, & Holker, 2002) and conferring differential emotional vulnerability under conditions of heightened stress (e.g., Amir, Beard, Weber, Bomyea, & Taylor, 2008). Although promising, the majority of previous studies have examined the effects of CBM procedures in non-clinical samples, on state measures of anxiety or depression (rather than symptoms), using brief (e.g., single-session) manipulations. Moreover, few studies have tested the clinical utility of CBM procedures in the remediation of clinical disorders and those that have done so, have been restricted to attentional manipulations (CBM-A; Amir, Beard, Burns, & Bomyea, 2009; Amir, Beard, Taylor et al., 2009; Schmidt, Richey, Buckner, & Timpano, 2009) or have combined attentional and interpretation manipulations (Beard, Weisberg, & Amir, in press; Brosan, Hoppitt, Shelfer, Sillence, & Mackintosh, 2011). Thus, our goal in the present study was to extend previous CBM research by testing the efficacy of a multi-session computerized procedure designed to modify interpretation bias alone in individuals meeting diagnostic criteria for generalized social anxiety disorder (GSAD). Interpretation bias towards threat refers to the tendency to construe ambiguous information in an overly threatening manner. Cognitive models of emotional disorders propose that interpretation bias may be particularly influential in individuals with SAD because social cues are often ambiguous and therefore open to a range of interpretations (Clark & Wells, 1995; Rapee & Heimberg, 1997). For example, during a social interaction a conversation partner’s laughter after a comment one makes may indicate ridicule (threat interpretation) or amusement (benign interpretation). In support of cognitive models, previous studies find that socially anxious individuals display greater endorsement of threat interpretations compared to non-anxious controls (e.g., Amir, Foa, & Coles, 1998; Stopa & Clark, 2000; Huppert, Foa, Furr, Filip, & Mathews, 2003). Moreover, negative interpretation bias has been found to mediate the relationship between social anxiety and state anxiety in response to social-evaluative threat (Beard & Amir, 2010). Research also suggests that socially anxious individuals lack the benign interpretation bias exhibited by non-anxious individuals (Constans, Penn, Ihen, & Hope, 1999; Hirsch & Mathews, 2000; Moser, Hajcak, Huppert, Foa, & Simons, 2008). Numerous studies support the efficacy of CBM procedures in modifying interpretation bias (CBM-I; see Beard, 2011 for a review). Although methodologies vary across studies, the basic premise underlying CBM-I procedures involves manipulating the frequency with which an ambiguous stimulus and a target stimulus that conveys one meaning of the ambiguous information are paired together. This manipulation is intended to encourage participants to think of the ambiguous information in either a negative or positive way. For example, in their seminal study, Grey and Mathews (2000) used homographs (i.e., words with multiple meanings, e.g., ‘mean’ can imply ‘average’ or ‘nasty’), to modify interpretations in non-anxious individuals. In one experiment, participants saw homographs followed by target words implying a threatening (‘nasty’) or benign (‘average’) meaning of the homograph (‘mean’). Participants decided whether or not the two words were related. When tested later with new homographs, participants in the threat condition were faster to respond to threat interpretations in a lexical decision task. Similarly, participants in the benign condition were faster to respond to benign interpretations. Subsequent extensions of this research in non-anxious (e.g., Mathews & Mackintosh, 2000; Wilson, MacLeod, Mathews, & Rutherford, 2006) and high anxious samples (e.g., Hayes, Hirsch, Krebs & Mathews, 2010) have demonstrated that experimentally manipulating interpretation of ambiguous information can causally influence anxiety and related outcomes (e.g., negative thought intrusions) in response to laboratory-induced stress (see, however, Salemink, E., van den Hout, M., & Kindt, 2007). More relevant to the current study, in a sample of individuals with elevated levels of social anxiety, participants who received a single-session benign interpretation induction procedure reported experiencing less anticipatory anxiety about a future social situation relative to the control group (Murphy, Hirsch, Mathews, Smith, & Clark, 2007). To our knowledge, four published studies have examined the effects of multi-session computerized interpretation training programs in reducing anxiety symptoms. First, in a sample of individuals with high levels of trait anxiety, Mathews, Ridgeway, Cook, and Yiend (2007) demonstrated that a four-session interpretation training procedure (administered over one week) that encouraged participants to resolve ambiguous scenarios in a positive manner resulted in significantly lower trait anxiety scores at post-assessment relative to a control group who did not receive the training procedure. Similarly, Salemink, van den Hout, and Kindt (2009) found that high trait anxious students who completed a positive interpretation training program online for eight consecutive days were less state and trait anxious, and scored lower on a measure of general psychopathology compared to the control group. However, no effects were observed on measures of social anxiety and stress vulnerability. Most relevant to the current study, Beard and Amir (2008) examined the effects of an eight-session interpretation training program in an analogue sample of 27 individuals with elevated levels of self-reported social anxiety. Using a modified word-sentence association paradigm (WSAP; Beard & Amir, 2009), participants in the two experimental conditions were differentially reinforced for rejecting threatening interpretations and endorsing benign interpretations of ambiguous social information. Results revealed that participants who were trained to repeatedly interpret ambiguous social information in a less threatening and more benign manner displayed a significant reduction in threat interpretations and increase in benign interpretations. Moreover, the actively trained group displayed a significantly larger reduction in social anxiety symptoms compared to the control condition. Change in benign interpretations mediated the relationship between interpretation training and change in social anxiety. The groups did not differ, however, on change in trait anxiety or depression. More recently, two studies have found that a combined regimen that included the interpretation procedure used by Beard and Amir (2008) and an attentional training procedure (Amir, Beard, Taylor et al., 2009; MacLeod et al., 2002) resulted in significant reductions in anxiety symptoms in individuals diagnosed with GSAD (Beard et al., in press) or either GSAD or GAD (Brosan et al., 2011). In summary, previous research supports the efficacy of CBM procedures in modifying interpretations of ambiguous information and reducing anxiety symptoms in analogue and clinical samples. However, previous CBM-I studies were conducted in small, analogue samples (Beard & Amir, 2008) or in combination with CBM-A procedures (Beard et al., in press; Brosan et al., 2011). Thus, the efficacy of interpretation training procedures alone in individuals presenting with greater severity of symptoms and functional interference remains to be established. Accordingly, the primary aim of the current study was to test the efficacy of a multi-session Interpretation Modification Program (IMP) in a sample of patients meeting diagnostic criteria for GSAD. We predicted that IMP would reduce threat interpretations, increase benign interpretations, as well as decrease social anxiety symptoms and associated functional impairment from pre- to post-assessment relative to the Interpretation Control Condition (ICC). We also explored the effects of IMP on symptoms of trait anxiety and depression.

A number of randomized, double blind, placebo controlled studies support the efficacy of computerized Attention Modification Programs (AMP) in the treatment of anxiety (Amir, Beard, Taylor et al., 2009; Amir, Beard, Burns, & Bomyea, 2009; Schmidt, Richey, Buckner, & Timpano, 2009). AMP is based on cognitive theories of anxiety that propose a causal role for selective attention to threat-relevant information in the maintenance of anxiety (e.g., Mathews & MacLeod, 2005; Williams, Watts, MacLeod, & Mathews, 1997). Consistent with these theories, 25 years of research provides evidence demonstrating that patients meeting diagnostic criteria for an anxiety disorder preferentially attend to threat-relevant stimuli over neutral stimuli when the two compete for processing resources (for a review see Bar-Haim, Lamy, Pergamin, Bakermans-Kranenburg, & van IJzendoorn, 2007). More relevant to the causality hypothesis, recent studies have demonstrated that experimentally manipulating attentional allocation to threatening information confers differential susceptibility to anxiety under stress (e.g., Amir, Weber, Beard, Bomyea, & Taylor, 2008; Clarke, MacLeod, & Shirazee, 2008; MacLeod, Rutherford, Campbell, Ebsworthy, & Holker, 2002). To modify attention, previous studies have used a variant of the probe detection task (MacLeod, Mathews, & Tata, 1986) designed to induce selective processing of neutral cues when these cues compete for processing resources with threat-relevant cues. In the original probe detection task participants were presented with neutral and threat-relevant information and their response latency to detect a visual probe replacing these words was measured. In the AMP training version of the task, participants respond to a visual probe that consistently replaces stimuli of neutral valence, thereby directing attention away from threat. To our knowledge, three published studies have examined the efficacy of AMP in reducing symptoms in treatment-seeking individuals meeting diagnostic criteria for an anxiety disorder; two in generalized social phobia (GSP; Amir, Beard, Taylor et al., 2009; Schmidt et al., 2009) and one in generalized anxiety disorder (GAD; Amir, Beard et al., 2009). All three studies were randomized placebo-controlled double-blind trials. The placebo group (Attention Control Condition, ACC) was identical to AMP except that the location of the probe relative to the threatening or neutral stimuli was random (i.e., the probe replaced neutral stimuli on 50% of trials, and threatening stimuli on the other 50% of trials). Participants completed AMP or ACC twice weekly for four weeks. Each training session was approximately 20 minutes in duration. Across all three RCTs, participants in the AMP group showed significantly larger reductions in clinician- and self-rated symptoms of anxiety and functional impairment relative to the control group. A recent meta-analysis found a medium-to-large effect of AMP on anxiety symptoms (averaged across all anxiety measures) relative to the ACC group (d = .78 in patient samples; Hakamata et al., 2010). Moreover, a significantly larger proportion of participants in the AMP group compared to the ACC group no longer met diagnostic criteria for the principal anxiety disorder diagnosis at post-assessment (loss of diagnosis: AMP, range 50% to 72%; ACC, range 11% to 14%). Finally, two of the trials conducted a formal mediation analysis (Mackinnon, Lockwood, Hoffman, West, & Sheets, 2002), demonstrating that change in attentional bias for threat mediated the reduction in interviewer-rated anxiety from pre- to post-assessment (Amir, Beard, Taylor et al., 2009; Amir, Beard et al., 2009). Considered together, these studies suggest that AMP may be an efficacious treatment for at least GSP and GAD. Despite these initial promising findings, not all individuals who complete AMP show a reduction of symptoms. Therefore, it is important to examine patient characteristics that may account for variability in response to AMP. Doing so may ultimately inform treatment selection as well as methods for augmenting existing treatments. As Steketee and Chambless (1992, p. 387) pointed out, “If we can identify characteristics of clients that are associated with poor response to treatment, we may: (a) gain clues that lead to needed modifications to treatment procedures and (b) be able to match patients to treatments that work best for those with their particular characteristics”. As a first step in this direction, we examined predictors of response to AMP in a large randomized clinical trial of patients seeking treatment for GSP. There are at least two types of pre-treatment variables that can have predictive utility: Prognostic and Prescriptive (Kraemer, Wilson, Fairburn, & Agras, 2002, Fournier et al., 2009). A prognostic variable predicts outcome irrespective of treatment condition. Prognostic variables are either identified in single-treatment designs (i.e., when there is no comparison condition) or when a variable is associated with outcome across multiple treatments (i.e., a main effect of the pre-treatment variable on outcome). A prescriptive variable or moderator (Baron & Kenny, 1986) predicts differential treatment response between two or more treatment conditions (i.e. an interaction effect). Our selection of predictor variables was guided by previous recommendations in prediction research (e.g., Kazdin, 2008; Kraemer et al., 2002; Steketee & Chambless, 1992). We began by identifying baseline demographic and clinical characteristics in our sample that have been examined in previous research examining predictors of treatment response in SP (e.g., Hofmann, 2000; Rodebaugh, Holaway, & Heimberg, 2004) as well as the extant literature more broadly (e.g., Fournier et al., 2009). These variables were categorized into the following domains: (1) demographic characteristics (e.g., age, gender), and (2) clinical characteristics (e.g., severity of co-occurring depression, Axis I comorbidity). Next, we followed recommendations that the selection of predictor variables should be informed by theory about the mechanisms hypothesized to underlie to treatment effects (e.g., Kazdin, 2008; Kraemer et al., 2002). Accordingly, we selected potential predictor variables based on information processing theories of anxiety (e.g., Mathews & MacLeod, 2005) and prior research on the mechanisms of action in AMP (e.g., Amir, Beard, Taylor et al., 2009). These variables were categorized as cognitive disturbance factors. We identified two cognitive disturbance factors hypothesized to be central to the maintenance of SP, namely (1) attentional bias for threat (Mathews & MacLeod, 2005; Williams et al., 1997; see also Bogels & Mansell, 2004) and (2) social interpretation bias (e.g., Clark & Wells, 1995; Hofmann, 2007; Rapee & Heimberg, 1997). Previous research in analogue (Amir et al., 2008) and treatment-seeking samples (Amir, Beard, Taylor et al., 2009; Amir, Beard et al., 2009) suggest that anxiety reduction associated with AMP occurs through a change in attention bias for threatening cues. Thus, to the extent that the modification of attentional bias for threat is a key target of AMP, we expected that patients with GSP who displayed the greatest attentional bias at baseline would be the ones who would benefit most from this intervention; that is, attentional bias is hypothesized to have a prescriptive effect on response to AMP. We also chose to examine social interpretation bias as a predictor of response to AMP because this cognitive bias is a core feature of cognitive models of SP (e.g., Clark & Wells, 1995; Hofmann, 2007; Rapee & Heimberg, 1997) and has been shown to be associated with social anxiety reduction in CBT regimens (e.g., Foa, Franklin, Perry, & Herbert, 1996; Hofmann, 2004; Smits, Rosenfield, McDonald, & Telch, 2006; Taylor & Alden, 2008; Wilson & Rapee, 2005). In the current study, we explored the prognostic and prescriptive predictive value of pre-treatment variables assessed in the context of two RCTs testing the efficacy of AMP for GSP. We followed the data analytic approach adopted by Fournier et al. (2009), first employing a stepwise procedure within the three broad predictor domains (demographics, clinical characteristics, and cognitive disturbance factors) and then testing a final model wherein we examined whether each of the previously identified predictors remained a significant predictor of outcome when all of the predictors were tested simultaneously in the same statistical model.

Generalized anxiety disorder (GAD) is a common and disabling condition associated with significant personal and societal costs. Although efficacious treatments exist for GAD, the majority of these individuals fail to access our most effective treatments. In the current paper, we report the results of an open trial that examined the efficacy of a computer-delivered home-based treatment program for GAD. Twenty-one individuals seeking treatment for GAD received a self-administered program over 6 weeks that comprised two components: (1) an Attention Modification Program (AMP) designed to facilitate attentional disengagement from threat-relevant stimuli and (2) brief computer-delivered cognitive and behavioral treatment modules (CCBT). Fourteen of the 21 enrolled participants (67%) completed the treatment program. Intent-to-treat and completer analyses revealed that AMP+CCBT resulted in significant reductions in clinician- and self-rated symptoms of anxiety, worry, depression, and functional impairment. Moreover, treatment completers displayed significant reductions in attentional bias for threat from pre- to postassessment. Change in attentional bias for threat from pre- to postassessment was associated with change in worry symptoms. Finally, 79% of participants no longer met DSM-IV criteria for GAD at postassessment and 36% were classified as remitted (Hamilton Rating Scale for Anxiety ≤7; Rickels et al., 2006). These results suggest that computer-delivered AMP+CCBT may serve as an effective and easily accessible treatment option for individuals with GAD.

Recent research supports a causal link between attentional bias for negative emotional information and anxiety vulnerability (MacLeod, Rutherford, Campbell, Ebsworthy, & Holker, 2002). However, little is known about the role of positive emotional processing in modulating anxiety reactivity to stress. In the current study we used an attentional training paradigm designed to experimentally manipulate the processing of positive emotional cues. Participants were randomly assigned to complete a computerized probe detection task designed to induce selective processing of positive stimuli or to a sham condition. Following training, participants were exposed to a laboratory stressor (i.e., videotaped speech), and state anxiety and positive affect in response to the stressor were assessed. Results revealed that individual variability in the capacity to develop an attentional bias for positive information following training predicted subsequent emotional responses to the stressor. Moreover, individual differences in social anxiety, but not depression, moderated the effects of the attentional manipulation, such that, higher levels of social anxiety were associated with diminished attentional allocation toward positive cues. The current findings point to the potential value of considering the role of positive emotional processing in anxiety vulnerability.

The authors conducted a randomized, double-blind placebo-controlled trial to examine the efficacy of an attention training procedure in reducing symptoms of social anxiety in 44 individuals diagnosed with generalized social phobia (GSP). Attention training comprised a probe detection task in which pictures of faces with either a threatening or neutral emotional expression cued different locations on the computer screen. In the attention modification program (AMP), participants responded to a probe that always followed neutral faces when paired with a threatening face, thereby directing attention away from threat. In the attention control condition (ACC), the probe appeared with equal frequency in the position of the threatening and neutral faces. Results revealed that the AMP facilitated attention disengagement from threat from pre- to postassessment and reduced clinician- and self-reported symptoms of social anxiety relative to the ACC. The percentage of participants no longer meeting Diagnostic and Statistical Manual (4th ed.) criteria for GSP at postassessment was 50% in the AMP and 14% in the ACC. Symptom reduction in the AMP group was maintained during 4-month follow-up assessment. These results suggest that computerized attention training procedures may be beneficial for treating social phobia.

Research suggests that individuals with social anxiety show an attention bias for threat-relevant information However, few studies have directly manipulated attention to examine its effect on anxiety. In the current article, the authors tested the hypothesis that an attention modification program would be effective in reducing anxiety response and improving performance on a public-speaking challenge. Socially anxious participants completed a probe detection task by identifying letters (E or F) replacing one member of a pair of faces (neutral or disgust). The authors trained attention by including a contingency between the location of the neutral face and the probe in one group (Attention Modification Program; AMP). Participants in the AMP group showed significantly less attention bias to threat after training and lower levels of anxiety in response to a public-speaking challenge than did the participants in the Attention Control Condition (ACC) group. Moreover, blind raters judged the speeches of those in the AMP group as better than those in the ACC group. These results are consistent with the hypothesis that attention plays a causal role in the maintenance of social anxiety.

OBJECTIVE: To evaluate safety and efficacy of corticotropin for acute gout. DATA SOURCES: Clinical literature was accessed through MEDLINE (1966–August 2000). Key search terms included gout, ACTH, adrenocorticotropic hormone, and corticotropin. DATA SYNTHESIS: Joint pain and local signs of inflammation characterize gout. Acutely, colchicine and nonsteroidal antiinflammatory drugs (NSAIDs) are first-line therapy. Adverse effects or concomitant diseases limit therapy and necessitate alternative options. An evaluation of studies involving corticotropin was conducted. CONCLUSIONS: Corticotropin alone or in combination with colchicine was more rapidly effective and associated with fewer adverse effects than indomethacin. This regimen may be considered an alternative, especially for patients with medical problems in which other regimens are contraindicated.