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The most common symptom of obsessive-compulsive disorder (OCD) is contamination fear. Feelings of contamination can be provoked through contact with a physical contaminant, referred to as contact contamination (CC), as well as in the absence of one, referred to as mental contamination (MC). Prior research indicates that CC and MC are distinct, and MC may interfere with treatment for CC. However, no study to date has examined how MC may be associated with responses to physical contaminants and treatment response for CC. This study examined the relationships between CC and MC in a sample of individuals with elevated contamination symptoms (N = 88), half of whom met diagnostic criteria for OCD. Participants engaged in three sessions of exposure and response prevention (ERP) for CC and completed self-report measures and behavioral tasks assessing CC and MC at pretreatment, posttreatment, and follow-up. As hypothesized, at pretreatment, MC was positively associated with reactivity to physical contaminants, even after participants washed their hands. ERP for CC was associated with unique changes in CC and MC across self-report and behavioral measures, and greater pretreatment MC predicted greater posttreatment CC, though this effect was evident in only one of two CC measures. Additionally, specificity analyses indicated changes in MC were independent of changes in disgust propensity, a related construct. Pretreatment disgust propensity also predicted treatment outcome, though the addition of pretreatment disgust propensity as a covariate reduced the relationship between pretreatment MC and posttreatment CC to nonsignificance. Results suggest MC plays an important role in the manifestation and treatment of CC symptoms and may represent a manifestation of disgust proneness. Theoretical and clinical implications are discussed., (Copyright © 2018. Published by Elsevier Ltd.)

Cannabis use is prevalent but only a minority of regular users develop cannabis use disorder (CUD); thus, CUD risk identification among current cannabis users is vital for targeted intervention development. Existing data suggest that high distress intolerance (DI), an individual difference reflective of the ability to withstand negative affect, is linked to CUD, possibly via stress-elicited impairment of response inhibition but this has never been explicitly tested. Frequent cannabis users with high and low DI completed a go/no-go task during EEG recording before and after a laboratory stressor. Relations between DI, cannabis use-related problems, and behavioral as well as neurophysiological markers of response inhibition functioning were assessed. DI significantly moderated the effect of the stressor on the conflict-monitoring but not evaluative phase of response inhibition as measured by N2 and P3a amplitude, respectively. Unexpectedly, cannabis users with high DI demonstrated stressor-elicited enhancement rather than impairment of conflict-monitoring neural activity, which was related to faster reaction time (RT) and decreased past-month cannabis problems. Enhanced inhibition-related modulation of P3a amplitude was generally associated with increased cannabis problems regardless of acute stress. Results did not provide support for stress-elicited impairment in cognitive control as a mechanism linking high DI and CUD, though some support was found for the relevance of inhibition-related neural activity to CUD. Stress-elicited enhancement of conflict-monitoring neural activity during response inhibition may reflect an adaptive neural response among cannabis users with high DI that protects against CUD in this at-risk group. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Individuals with appearance concerns engage in "safety behaviors" (SBs) aimed at checking, hiding, fixing, and reducing threat associated with their perceived flaw in appearance. Appearance-related SBs are important in contemporary accounts of body dysmorphic disorder (BDD), though they are also relevant to social anxiety (SAD) and eating disorders. The present study examined the extent to which appearance-related SBs contribute to the development of disorder-specific symptoms and maladaptive cognitions. Female undergraduates without clinically elevated appearance concerns (N = 99) were randomly assigned to 1 week of (a) increasing the frequency and duration of appearance-related SBs (SB+), (b) decreasing these behaviors (SB-), or (c) a control in which they increased their academic studying behaviors. Generally, SB+ participants demonstrated greater BDD symptoms, SAD symptoms, body dissatisfaction, disorder-relevant threat interpretations, beliefs about the importance of appearance, and reactivity to an in vivo appearance-related task following the manipulation, relative to the other groups, with some exceptions. The SB- and control conditions largely did not differ from one another in these outcomes. SB+ participants also reported greater anxiety and depressive symptoms postmanipulation relative to other conditions. Groups no longer differed from one another at a follow-up assessment. Overall, these findings suggest that engagement in appearance-related SBs may play an instrumental role in symptoms and maladaptive cognitions across a range of disorders. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Disgust is a universal emotion that has received recent empirical attention for its potential role in various forms of psychopathology. We conducted two studies using varying methods to explore the relationship between disgust propensity, a construct related to obsessive-compulsive symptomatology, and symptoms of body dysmorphic disorder (BDD). Study 1 found a significant and unique (i.e., above and beyond co-occurring depression and anxiety) relationship between higher disgust propensity and more severe BDD symptoms, as measured by a standardized self-report and via an in-vivo task aimed at eliciting BDD-related concerns (N = 200). In Study 2, a clinical sample of individuals with BDD (N = 50) reported higher disgust propensity compared to mentally healthy controls (N = 36). This finding remained significant when controlling for depression and anxiety. Findings are the first to our knowledge to demonstrate a relationship between disgust propensity and BDD symptoms and provide directions for future research exploring the role of disgust in BDD., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Previous research suggests that computerized interpretation bias modification (IBM) techniques may be useful for modifying thoughts and behaviours relevant to eating pathology; however, little is known about the utility of IBM for decreasing specific eating disorder (ED) symptoms (e.g. bulimia, drive for thinness)., Aims: The current study sought to further examine the utility of IBM for ED symptoms via secondary analyses of an examination of IBM for individuals with elevated body dysmorphic disorder (BDD) symptoms (see Summers and Cougle, 2016), as these disorders are both characterized by threat interpretation biases of ambiguous appearance-related information., Method: We recruited 41 participants for a randomized trial comparing four sessions of IBM aimed at modifying problematic social and appearance-related threat interpretation biases with a placebo control training (PC)., Results: At 1-week post-treatment, and relative to the PC, the IBM group reported greater reductions in negative/threat interpretations of ambiguous information in favour of positive/benign biases. Furthermore, among individuals with high pre-treatment bulimia symptoms, IBM yielded greater reductions in bulimia symptoms compared with PC at post-treatment. No treatment effects were observed on drive for thinness symptoms., Conclusions: The current study suggests that cognitive interventions for individuals with primary BDD symptoms may improve co-occurring ED symptoms such as bulimia.

"Not just right" experiences (NJREs) are uncomfortable sensations of incompleteness linked to obsessive-compulsive disorder; however, NJREs may be transdiagnostic and play a role in eating pathology. The current study examined relations between NJREs and eating pathology in undergraduate students. Participants (n = 248) completed self-report and behavioral assessments. Controlling for obsessive-compulsive symptoms, negative affect, and perfectionism, NJRE frequency was associated with greater drive for thinness, body dissatisfaction, and bulimic symptoms. Discomfort in response to a visual in vivo NJRE task was positively associated with drive for thinness and body dissatisfaction. The present study provides initial evidence for NJREs in eating pathology. Theoretical implications are discussed.

Due to the complex and heterogeneous nature of obsessive-compulsive disorder (OCD), movement toward multimodal assessment has become necessary to more precisely understand the nature of the disorder and interrelations between symptom clusters. Thus, the present study utilized large undergraduate samples (total N = 800) to test the validity of six in vivo assessments of OC symptoms (i.e., one ordering/arranging task, two contamination fear/washing tasks, and three checking tasks). Associations between task-specific variables and self-reported symptom scores (as measured by the Obsessive-Compulsive Inventory-Revised [OCI-R]) were examined. The majority of the in vivo task variables (those presented in Studies 1-4) exhibited significant relationships with the corresponding OCI-R symptom subscale (i.e., ordering, washing, checking). However, many of the task variables demonstrated relationships with other OCI-R symptom subscales, as well. Some evidence for discriminant validity was found, as task variables were generally unrelated to past-week symptoms of depression or anxiety. While continued research is necessary to further establish the validity and utility of the tasks discussed in the current article, findings have implications for improving future empirical examination of OC symptoms.

Background: Pain interference is associated with substance use, but has yet to be considered as a potential indicator of SUDs among substance users. We sought to examine whether moderate and high pain interference would confer risk for SUDs in ever and weekly users., Methods: Using data from the National Epidemiologic Survey on Alcohol and Related Conditions, logistic regression analyses were conducted to examine the association between pain interference and concurrent and prospective alcohol and nicotine dependence, as well as concurrent cannabis use disorder. Those with no/low pain were used as the reference group. Gender was examined as a moderator., Results: Controlling for relevant covariates, moderate pain interference was associated with past year alcohol (odds ratio [OR] = 1.33, 95% CI, 1.16-1.52, p < .001) and nicotine (OR = 1.41, 95% CI 1.27-1.56, p < .001) dependence among ever users. In prospective analyses, moderate pain interference predicted the development of alcohol (Moderate: OR = 1.56, 95% CI, 1.39-1.75, p < .001) and nicotine (OR = 1.37, 95% CI, 1.14-1.65, p < .001) dependence. Similar results were found with high pain and for weekly users. Both moderate and high pain interference were associated with past-year occurrence of cannabis use disorder for women but not men. High pain predicted the development of nicotine dependence exclusively among males., Conclusion: Pain interference may confer risk for the occurrence of cannabis use disorder among female cannabis users and the occurrence and development of alcohol and nicotine dependence among users of both genders. Pain interference may be an important factor to monitor in these populations., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Interpretation Bias Modification (IBM) is gaining attention in the literature as an intervention that alters cognitive biases and reduces associated symptoms. Forty, primarily college-aged, non-treatment-seeking adults with major depressive disorder (MDD) were randomly assigned to receive either IBM targeting hostile interpretation bias (IBM-H) or a healthy video control (HVC) condition. Compared to those in HVC, participants in IBM-H reported more benign interpretations and fewer hostile interpretations at posttreatment. No difference in depressive interpretation bias was found between groups at posttreatment. IBM-H led to improved anger control at posttreatment and follow-up compared to HVC, though no effects of condition were found on trait anger or depressive symptoms. The IBM-H group perceived their treatment as less credible than the HVC group. For individuals with high expectancy of treatment success, IBM-H led to lower posttreatment depressive symptoms compared to HVC, while findings trended in the opposite direction for those with low expectancy of success. Overall, these preliminary findings point to boundary conditions for the efficacy of IBM protocols for anger and depression and potential improvements to be made to future IBM protocols., (Copyright © 2017. Published by Elsevier Ltd.)

Distress intolerance (DI), a trait-like individual difference reflective of the inability to endure aversive affective states, is relevant to multiple forms of psychopathology, but its relations to theoretically relevant neurobiological systems have received little attention. Altered cognitive control-related neurobiology has been theorized to underlie individual differences in DI, but little empirical work has been conducted. To test this hypothesis, baseline data from a large community sample with elevated high levels of emotional psychopathology and comorbidity was utilized (N = 256). Participants completed a complex go/no-go task while EEG was recorded, and P2, N2, and P3 amplitudes were measured. Based upon prior findings on the relations between these components and response inhibition, a core cognitive control function, we hypothesized that DI would predict reduced no-go N2 and P3 amplitude while controlling for current anxious/depressive symptom severity (i.e., negative affect). Peak amplitudes from the raw data and principal components analysis were used to quantify amplitude of ERP components. Partially consistent with predictions, high DI was independently associated with reduced no-go N2 peak amplitude in the raw ERP data, and was significantly related to a frontal positivity factor in the N2 time window across no-go and go trials. Contrary to predictions, no relations between DI and the P3 were found. Overall, results support the theorized relevance of cognitive control-linked neurobiology to individual differences in tolerance of distress over and above distress severity itself, and suggest specific relations between DI and alterations in early controlled attention/conflict-monitoring but not response inhibition or response inhibition-related sequelae. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Distress tolerance (DT) is a transdiagnostic construct linked to multiple psychiatric disorders. We conducted three studies using different methods to investigate the relationship between DT and body dysmorphic disorder (BDD). Study 1 found a significant relationship between low DT and more severe BDD symptoms in an adult community sample (N=81). In Study 2, we found a similar relationship between lower DT and greater BDD symptoms in a student sample (N=192). Furthermore, we found a unique relationship between greater BDD symptoms and lower self-reported tolerance of anger and sadness mood induction tasks. Greater BDD symptoms were not significantly associated with lower self-reported tolerance of a fear mood induction task. In Study 3, a clinical sample of individuals with BDD (N=40) reported lower DT than a sample of healthy controls (N=36). Findings suggest that low DT is a broad vulnerability factor related to BDD., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Research indicates that physical and sexual abuse are associated with increased suicide risk; however, these associations have not been investigated among firefighters-an occupational group that has been shown to be at elevated suicide risk. This study examined whether physical and sexual abuse histories are associated with (a) career suicide ideation, plans, and attempts; and (b) current suicide risk (controlling for theoretically relevant symptoms) in this occupational group. A sample of 929 U.S. firefighters completed self-report surveys that assessed lifetime history of physical and sexual abuse; career suicide ideation, plans, and attempts; current suicide risk; and theoretically relevant symptoms. Logistic regression analyses revealed that individuals who reported a history of physical abuse were significantly more likely to report career suicide ideation, adjusted odds ratio [AOR] = 6.12, plans, AOR = 13.05, and attempts, AOR = 23.81, than those who did not. A similar pattern of findings emerged for individuals who reported a sexual abuse history, AORs = 7.83, 18.35, and 29.58 respectively. Linear regression analyses revealed that physical and sexual abuse histories each significantly predicted current suicide risk, even after controlling for theoretically relevant symptoms and demographics, pr 2 = .07 and .06, respectively. Firefighters with a history of physical and/or sexual abuse may be at increased risk for suicidal thoughts and behaviors. A history of physical and sexual abuse were each significantly correlated with current suicide risk in this population, even after accounting for the effects of theoretically relevant symptoms. Thus, when conceptualizing suicide risk among firefighters, factors not necessarily related to one's firefighter career should be considered., (Copyright © 2017 International Society for Traumatic Stress Studies.)

High trait anger is associated with more severe alcohol use problems, and alcohol has been found to facilitate aggressive behavior among individuals with high trait anger. Treatments focused on a sample with alcohol use disorder with elevated anger could reduce alcohol use problems, as well as violence and aggression. We sought to examine the efficacy of interpretation bias modification for hostility (IBM-H) in a sample with high trait anger and alcohol use disorder (AUD). Fifty-eight individuals with AUD and elevated trait anger were randomly assigned to eight web-based sessions (two per week) of IBM-H or a healthy video control condition (HVC). Measures of interpretation bias, anger, and alcohol use were administered at pre- and post-treatment and at one-month follow-up. IBM-H led to greater improvements in interpretation bias compared to HVC at post and follow-up. IBM-H also led to greater reductions in trait anger than HVC, though this was an indirect effect mediated by changes in interpretation bias. Further, IBM-H led to lower anger expression than HVC; this was a direct (non-mediated) effect. Lastly, both conditions reported decreases in alcohol use and consequences following treatment, though there were no significant differences between them. These findings provide initial support for the utility of IBM-H as a brief non-confrontational intervention for AUD with elevated trait anger. Limitations and future research directions are discussed., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

A number of studies have reported associations between pain and anger in samples with chronic pain, but research has mostly overlooked associations between pain and anger in those with problematic anger. The present study explored associations between pain severity and a variety of anger and hostility constructs in a sample seeking anger treatment (n =131). Zero-order correlations and partial correlations were used to examine associations between pain, anger, and hostility, controlling for depressive symptoms. Hierarchical regression models examined potential interaction effects of gender on associations between pain and these outcomes. Pain severity was positively associated with trait anger, outward anger expression, hostile interpretation bias, hostile ideation, and inability to forgive others. These associations were independent of co-occurring depressive symptoms, with some exceptions. Gender moderated the association between pain and hostile ideation such that pain was positively associated with hostile ideation in women but not men. Pain severity was uniquely associated with multiple outcomes of relevance to individuals undergoing treatment for problematic anger. Clinical implications will be discussed., (Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.)

Cognitive theories of anxiety psychopathology cite biased attention towards threat as a central vulnerability and maintaining factor. However, many studies have found threat bias indices to have poor reliability and have failed to observe the theorized relationship between threat bias and anxiety symptoms; this may be due to the non-unitary nature of threat bias and the influence of state-level variables on its expression. Accumulating data suggests that state anxious mood is important for the robust expression of threat bias and for relations to emerge between threat bias and symptoms, though this possibility has not been experimentally tested. Eye-tracking was used to assess multiple forms of threat bias (i.e., early vigilance, sustained attention, facilitated engagement, delayed disengagement) thought to be related to anxiety. A non-clinical sample (N = 165) was recruited to test the hypothesis that biased attention towards threat, but not dysphoric or positive emotional stimuli, during an anxious mood induction, but not at a pre-stress baseline, would prospectively predict greater worry symptoms on days in which more naturalistic stressors occurred. Results revealed the hypothesized moderation effect for sustained attention towards threat after the mood induction but not at baseline, though sustained attention towards dysphoric stimuli also moderated the effect of stressors on worry. Worry-relevant sustained attention towards negative emotional stimuli may be a partially mood-context dependent phenomenon., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Low resting heart rate variability (HRV) is associated with a broad array of negative psychosocial outcomes. Recent theoretical explications of HRV suggest it is an autonomic marker of emotion regulation capacity, but limited research has examined its relationship with emotional information processing indices. The present study utilized eye-tracking methodology to test HRV's theorized role as a marker of emotion regulation capacity in a non-clinical sample. Attentional biases towards threatening, dysphoric, and positive emotional information as well as affective modulation of pupil size were assessed before and after a stress induction. Low resting HRV marginally predicted larger increases in attentional bias towards positive emotional stimuli from pre to post-stress induction and significantly predicted decreased pupil dilation to positive stimuli after the stress induction only; exploratory analyses suggested that this pattern might reflect an unsuccessful attempt at anxious mood repair. HRV was unrelated to negative emotional information processing. Findings are consistent with existing theories of HRV's psychological significance and suggest a specific association with altered positive emotional processing under acute stress., (Copyright © 2016 Elsevier B.V. All rights reserved.)

The current studies examined the role of 'not just right' experiences (NJREs) and incompleteness (INC) in body dysmorphic disorder (BDD). In Study 1, a clinical BDD sample endorsed more severe NJREs than healthy controls, when controlling co-occurring symptoms of depression and anxiety. In Study 2, INC predicted reactivity to an in vivo task designed to evoke BDD-related concerns in an unselected sample. Study 3 demonstrated a positive relationship between INC and BDD symptom severity in a community sample. Study 4 examined in vivo sensory NJRE tasks and INC in a sample high and low in BDD symptoms. The high symptom group reported greater INC and reactivity to a visual NJRE task than their low symptom counterparts, when controlling for co-occurring symptoms of depression, anxiety, and OC symptoms. No group differences were observed for tasks assessing auditory and tactile NJREs. These studies demonstrate a unique relationship between INC/NJREs and BDD., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Hostile interpretation biases are central to the development and maintenance of anger, yet have been inconsistently assessed. The Word Sentence Association Paradigm (WSAP) was used to develop a new measure of hostile interpretation biases, the WSAP-Hostility. Study 1 examined the factor structure and internal consistency of the WSAP-Hostility, as well as its relationship with trait anger. Study 2 provided convergent and divergent validity data by examining its associations with trait anger, aggression, depression, and anxiety. Study 3 examined the relationship between WSAP-Hostility and another measure of hostile interpretation biases, as well as another word sentence association measure, in a sample of community participants. Study 4 also used a sample of community participants to offer further evidence of convergent validity. Across the studies, the WSAP-Hostility demonstrated convergent and divergent validity and internal consistency, supporting its use as a measure of hostile interpretation biases., (© The Author(s) 2015.)

Background: Distress intolerance (DI) is conceptualized as an individual difference reflective of the ability to tolerate aversive psychological states. Although high DI has demonstrated cross-sectional associations with multiple forms of psychopathology, few studies have tested key facets of its theoretical conceptualization. Specifically, little research has been conducted on DI's theorized role as an incrementally valid prospective moderator of the relationship between daily stressful events and affective symptoms reflective of preoccupation with aversive internal (e.g., depression, worry) rather than external stimuli (e.g., social anxiety)., Method: A non-clinical sample (N = 147; 77% female; M age = 19.32) in which high DI individuals were oversampled was recruited. Participants completed baseline measures of DI and trait negative affect followed by six diary entries over a two-week period in which participants reported on daily stressors, negative affect, worry, depressive, and social anxiety symptoms., Results: Hierarchical linear models revealed that DI positively predicted depressive and worry, but not social anxiety symptoms, independent of daily stressors and negative affect. Further, a significant interaction effect was found such that the positive association between daily stressor(s) occurrence and daily worry was significant at high, but not low DI, and a similar trend-level interaction effect was observed for depressive symptoms. The interaction for social anxiety symptoms was non-significant LIMITATIONS: Utilization of a non-clinical sample precludes generalization of results to clinical samples. Only self-reported DI was assessed, limiting conclusions to perceived as opposed to behaviorally-indexed DI., Conclusions: Results largely supported DI's theoretical conceptualization as an incrementally valid moderator of stress responding with relevance to particular affective symptoms., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Individuals meeting diagnostic criteria for body dysmorphic disorder (BDD; N = 40) were enrolled in a randomized, four-session trial comparing interpretation bias modification (IBM) training designed to target social evaluation- and appearance-related interpretation biases with a placebo control training condition (PC). Sessions took place over the course of two weeks (two sessions per week). Analyses indicated that, relative to the PC condition, IBM led to a significant increase in benign biases and reduction in threat biases at post-treatment. IBM also led to greater reductions in BDD symptoms compared to PC, though this effect was present at high but not low levels of pre-treatment BDD symptoms. Additionally, compared to PC, IBM led to lower urge to check and lower fear in response to an in vivo appearance-related stressor (having their picture taken from different angles), though the latter effect was present only among those reporting elevated fear at pre-treatment. The effects of treatment on interpretation biases and BDD symptoms were largely maintained at a one-month follow-up assessment. Moderated-mediation analyses showed that change in threat bias mediated the effect of condition on post-treatment symptoms for individuals high in pre-treatment BDD symptoms. The current study provides preliminary support for the efficacy of IBM for BDD., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Disgust is thought to play a prominent role in multiple anxiety disorders and fears, including spider phobia, though little attention has been given to specific treatment strategies that may be effective for multiple disgust-based fears., Aims: In the present study, we evaluated contamination-focused exposure as a potential transdiagnostic treatment strategy for disgust-based fears in a spider fearful sample., Method: Women with significant spider fear were randomized to three 30-minute sessions of exposure therapy involving repeated contact with a dirt mixture (n=17) or a waitlist control condition (n=17). Assessments of spider fear and disgust were administered at baseline and at one-week posttreatment., Results: At high (but not low) levels of pretreatment disgust propensity, exposure led to lower in vivo spider fear and perceived danger than waitlist, though exposure had no effects on spider-related disgust. Similar effects of exposure on spider fear were found at high levels of pretreatment spider-related disgust. Exposure also reduced fear and danger perceptions, but not disgust, related to a separate contamination assessment (touching a toilet). No effects of treatment were found on self-report measures of spider fear or disgust propensity., Conclusions: These findings suggest contamination-focused exposure therapy may be an effective transdiagnostic treatment strategy for individuals with elevated disgust propensity. Limitations and directions for future research are discussed.

Background: Research suggests an important relationship between interpretation bias, hostility and Major Depressive Disorder (MDD). Extant literature has yet to examine hostile interpretation bias in clinically depressed samples; the current studies sought to fill this gap., Method: Study 1 participants included undergraduates who met criteria for MDD (n=36) or no anxiety or mood diagnosis (n=35). Each participant completed a structured clinical interview along with measures of depression, hostile interpretation bias, and trait hostility. In Study 2, a sample of treatment-seeking individuals with elevated trait anger completed measures of depression, hostile interpretation bias, and trait anger., Results: Study 1 demonstrated that, relative to the non-depressed group, individuals with depression displayed greater hostile interpretation bias but comparable levels of trait hostility. In Study 2, greater hostile interpretation bias was associated with greater depressive symptoms, and this relationship was independent of co-occurring trait anger., Limitations: The correlational nature of these studies precludes interpretation of causal relationships between constructs. Additionally, replication of these results should be sought in a larger, more diverse sample., Conclusion: Overall, the findings suggest hostile interpretation bias may play a unique role in depression and could be a treatable feature of interpersonal mechanisms maintaining MDD., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objective: Research on the progression from substance use to dependence typically relies on lifetime retrospective reports of dependence among ever users. We sought to evaluate probability and correlates of dependence among recent (past-year) weekly users of alcohol, nicotine, cannabis, and cocaine through cross-sectional and prospective analyses., Methods: Data on substance use (assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV) and DSM-IV psychiatric disorders were assessed in 2 waves (Wave 1, N = 43,093; Wave 2, N = 34,653) through the National Epidemiologic Survey on Alcohol and Related Conditions., Results: Conditional risk of dependence varied by frequency of substance use, although it was relatively stable for nicotine use. Among weekly past-year substance users at Wave 1, rates of dependence when rates of past-year dependence at Wave 1 were combined with new cases of dependence reported at Wave 2 were 15.6% for alcohol, 25.0% for cannabis, and 67.3% for nicotine. For past-year weekly users of cocaine at Wave 1, 49.9% met criteria for past-year dependence. Multiple demographic characteristics and past-year psychiatric disorders were correlated with past-year dependence, even among daily users. Men were generally more likely than women to be dependent on alcohol, cannabis, and cocaine, although women were more likely to be dependent on nicotine. Prospective analyses indicated that depressive disorders at Wave 1 predicted subsequent development of alcohol dependence (odds ratio [OR] = 1.40; 95% CI, 1.19-1.65; P < .05). Further, 33.5% of weekly tobacco smokers who were nondependent at Wave 1 developed dependence later on., Conclusions: The present findings highlight the importance of frequency of use when determining the addictiveness of substances and suggest that certain demographic variables and psychiatric disorders are associated with substance dependence even among regular substance users., (© Copyright 2016 Physicians Postgraduate Press, Inc.)

Intolerance of uncertainty (IU) is a transdiagnostic construct associated with several anxiety and related disorders. Three studies were conducted to explore the potential relationship between IU and body dysmorphic disorder (BDD). Study 1 revealed a positive relationship between IU and BDD symptoms above symptoms of anxiety and depression in an unselected student sample (N=88). Study 2 demonstrated a similar relationship between IU and BDD symptoms above negative affectivity and intolerance of ambiguity in a community sample (N=116). Study 3 found that a clinical BDD sample (N=23) reported greater IU than healthy controls (N=20), though this relationship was accounted for by symptoms of anxiety and depression. Greater IU predicted functional impairment in the clinical sample above BDD symptoms and past-week anxiety and depression. The observed relationship between IU and BDD symptoms provides preliminary support for the relevance of IU to this population., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Posttraumatic stress disorder (PTSD) is generally assessed with reference to a "worst-event" (index) trauma, though little research has examined whether symptom presentation and comorbidity differ across worst-events. Data from individuals meeting lifetime PTSD criteria in the National Comorbidity Survey-Replication (N=398) were used to examine relations between PTSD presentation and comorbidity with the three most commonly reported "worst-event" trauma types: sexual trauma, non-sexual physical violence, and unexpected death of a loved one. Sexual trauma and non-sexual physical violence were associated with more symptomatic presentation of PTSD and lifetime trauma types compared to other worst-events. Non-sexual physical violence was associated with comorbid substance use disorder, and unexpected death of a loved one was associated with comorbid depression. Inclusion of number of lifetime trauma types as a covariate rendered most, but not all associations non-significant. These findings suggest worst-event trauma type is related to some important differences in PTSD presentation., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Generalized anxiety disorder and obsessive-compulsive disorder are defined by chronic intrusive thoughts. The aim of the present study was to evaluate the relationship between cognitive (attentional control) and motivational (negative urgency) mechanisms potentially underlying worry and obsessions. Participants ( N = 526) completed an online questionnaire battery consisting of self-report measures of worry, OCD symptoms, attentional control (AC), negative urgency (NU), and trait negative affect. After controlling for trait negative affect, self-reported AC was negatively related to worry, repugnant obsessions, and ordering symptoms. Greater NU was associated with increased worry and repugnant obsessions. Further, self-reported AC and NU interacted such that greater NU was associated with greater worry at high but not low levels of AC. AC and NU were independently associated with repugnant obsessions. Perceived executive functioning impairments may confer risk for intrusive thoughts, particularly worries, whereas distress-driven impulsivity may contribute to the involuntary, ego-dystonic features of intrusions.

Purpose of the Study: Combat is a risk factor for posttraumatic stress disorder (PTSD); however, less is known about how exposure to combat in early adulthood may contribute to the development of PTSD as the individual ages. Prior exposure to trauma may "sensitize" people to respond more intensely to subsequent stressors. Further, aging initiates new challenges that may undermine previous coping strategies. Over the life course combat veterans may be more reactive to new stressors and thus be more vulnerable to PTSD., Design and Methods: This study draws on the two waves of the National Comorbidity Survey (NCS-1) and NCS-2 (10-year follow-up). Participants were male (noncombat N = 620 and combat N = 107) and 50-65 years of age at Wave-2. At baseline, participants were assessed for exposure to wartime combat, number of Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses in the past year, and life-time PTSD. At follow-up, PTSD occurring between waves was determined. A measure of recent life stressors was also obtained., Results: Using logistic regression analyses, combat predicted PTSD at follow-up (controlling for baseline demographics, number of DSM diagnoses in the past year, life-time PTSD). Recent life stressors were also associated with PTSD. Importantly, the effect of combat on PTSD was significant at high levels, but not low levels, of recent life stress., Implications: Veterans who have experienced combat may be more reactive to new stressors, and in turn be more vulnerable to PTSD. Combat veterans should be regularly assessed for current stressors and PTSD., (© The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background and Objectives: A growing body of research has linked high distress intolerance (DI) to obsessions, but not other OCD symptom domains. However, existing research is correlational. Experimental studies are needed, but brief methods for reducing DI are lacking. To address these gaps in the literature, a brief, computerized intervention aimed at reducing DI was developed to determine if changing DI affected obsessional phenomena., Methods: Individuals reporting high DI were randomized to a treatment or waitlist control group (N = 53). Individuals in the treatment group received the DI treatment (i.e., a 2 h computerized intervention) over two weeks, and then underwent a post-assessment in which DI and obsession-relevant phenomena were measured. Individuals in the control group only received the post-assessment., Results: Analyses revealed a greater reduction in self-reported DI on one measure and smaller decreases in behavioral DI in the intervention condition relative to the waitlist condition, as well as lower in-vivo urges to neutralize an intrusive thought; however, anxious reactivity to the intrusion and neutralization behavior were not affected. Further, bootstrapping analyses revealed that reductions in DI mediated the effect of the intervention on neutralization urges., Limitations: A clinical sample and placebo control condition were not used., Conclusions: These results provide experimental evidence for the role of DI in obsessional phenomena, specifically in affecting urges to neutralize intrusions, findings consistent with negative reinforcement models of DI. Further, results revealed that DI can be reduced with a brief, computerized intervention, which has important implications for future experimental research and treatment development., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Pathological worry and generalized anxiety disorder (GAD) have been linked with low distress tolerance (DT), although questions remain including whether this association exists independent of depression and comorbidity, the directionality of the relationship between worry and DT, and DT's nonredundancy with other worry-relevant variables (i.e., emotional reactivity, stressful life events). Further, it is unclear whether DT is merely a correlate of excessive worry or acts as a risk factor for its development. Two independent studies were completed to evaluate these questions. In Study 1, DT was examined in patients with GAD and healthy controls. In Study 2, a nonclinical sample completed baseline measures of DT, negative affect, and worry, as well as daily assessments of these constructs and stressors for 1month. In Study 1, lower DT was associated with GAD diagnosis and greater worry symptoms independent of extent of comorbidity and depressive symptoms. In Study 2, lower baseline DT predicted unique variance in daily worry and increases in worry over time, whereas baseline worry did not predict daily DT or decreases in DT 1month later. Findings suggest that low DT plays a role in excessive worry independent of relevant covariates (i.e., comorbidity, emotional reactivity, stressful life events) and that this relationship is unidirectional. Further, preliminary evidence indicates that low DT may be an overall risk factor for the development of worry, particularly during periods of romantic stress, although further research and replication is required., (Copyright © 2015. Published by Elsevier Ltd.)

Research is limited on the effects of regular substance use on mental health-related outcomes. We used a large nationally representative survey to examine current and future quality of life and risk of psychiatric disorders among past-year regular (weekly) users of alcohol, nicotine, and cannabis. Data on psychiatric disorders and quality of life from two waves (Wave 1 N = 43,093, Wave 2 N = 34,653) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) were used to test study aims. In cross-sectional analyses, regular nicotine and cannabis use were associated with higher rates of psychiatric disorder, though regular alcohol use was associated with lower rates of disorders. Prospective analyses found that regular nicotine use predicted onset of anxiety, depressive, and bipolar disorders. Regular alcohol use predicted lower risk of these disorders. Regular cannabis use uniquely predicted the development of bipolar disorder, panic disorder with agoraphobia, and social phobia. Lastly, regular alcohol use predicted improvements in physical and mental health-related quality of life, whereas nicotine predicted deterioration in these outcomes. Regular cannabis use predicted declines in mental, but not physical health. These data add to the literature on the relations between substance use and mental and physical health and suggest increased risk of mental health problems among regular nicotine and cannabis users and better mental and physical health among regular alcohol users. Examination of mechanisms underlying these relationships is needed., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

"Not just right" experiences (NJREs), or uncomfortable sensations associated with the immediate environment not feeling "right," are thought to contribute to obsessive-compulsive disorder (OCD) symptomatology. The literature suggests that NJREs are experienced across sensory modalities; however, existing in vivo measures have been restricted to visual inductions (e.g., viewing and/or rearranging a cluttered table). The present study used a large undergraduate sample (N=284) to examine 4 in vivo tasks designed to elicit and assess NJREs across separate sensory modalities (i.e., visual, tactile, and auditory). Task ratings (discomfort evoked, and urge to counteract task-specific stimuli) were uniquely associated with self-report measures of NJREs, OC symptoms (ordering/arranging, checking, and washing), and certain maladaptive domains of perfectionism (doubts about actions, and organization). Findings have implications for experimental research and clinical work targeting NJREs specific to particular senses., (Copyright © 2014. Published by Elsevier Ltd.)

Hostility has emerged as an important predictor of smoking cessation difficulties, though the mechanisms underlying the hostility and smoking relationship are poorly understood. Further, research has yet to explore relations between hostile interpretation biases and different aspects of smoking behavior. In the present study, current daily smokers (N = 106) were administered measures of smoking characteristics, smoking motivation, reasons for quitting, hostility, and hostile interpretation bias. Neither trait hostility nor hostile interpretation bias were uniquely associated with motivation to quit, reasons for quitting, nicotine dependence, or problematic symptoms following past cessation attempts. However, hostility and hostile interpretation biases were uniquely associated with different reasons for smoking. Additionally, greater hostile interpretation bias (but not hostility) was uniquely associated with early relapse following past cessation attempts. The current findings add uniquely to the growing, but still relatively small, literature on hostility and smoking and implicate hostile interpretation bias as a potential treatment target in smoking cessation interventions.

Hoarding is characterized by emotionally reinforced saving behaviors, which often combine with excessive acquisition to give rise to clutter, distress, and impairment. Despite the central role emotional processes are thought to play in hoarding, very little research has directly examined this topic. There is suggestive evidence linking hoarding with several facets of emotional intolerance and avoidance, though one key limitation of this past research has been the exclusive reliance on self-report questionnaires. The aim of the current study was to conduct a multimethod investigation of the relationship between hoarding and perceptions of, and cognitions about, negative emotional states. A large unselected sample of nonclinical young adults (N=213) completed questionnaires, behavioral tasks, and a series of negative mood inductions to assess distress tolerance (DT), appraisals of negative emotions, and emotional intensity and tolerance. Hoarding symptoms were associated with lowered tolerance of negative emotions, as well as perceiving negative emotions as more threatening. Individuals high in hoarding symptoms also experienced more intense emotions during the mood inductions than individuals low in hoarding symptoms, though there was no association with poorer performance on a behavioral index of DT. Across measures, hoarding was consistently associated with experiencing negative emotions more intensely and reporting lower tolerance of them. This relationship was particularly pronounced for the difficulty discarding and acquiring facets of hoarding. Our results offer initial support for the important role of emotional processes in the cognitive-behavioral model of hoarding. A better understanding of emotional dysfunction may play a crucial role in developing more effective treatments for hoarding., (Copyright © 2014. Published by Elsevier Ltd.)

Introduction: Research has implicated problematic anger in multiple smoking outcomes, including nicotine dependence and difficulties with cessation. However, the mechanisms underlying the role of anger in smoking behavior and cessation difficulties remain unclear. The current study examined associations between different facets of anger with smoking motives, problematic symptoms during past quit attempts, reasons for quitting, and perceived barriers to cessation., Methods: Current smokers (N = 93) were administered measures assessing the relevant constructs., Results: After controlling for gender and negative affectivity, greater trait anger was uniquely related to more severe symptoms during past cessation attempts, perceived internal and external barriers to cessation, social influence reasons for quitting, and negative affect reduction and sensorimotor smoking motivations., Conclusions: These findings add uniquely to the literature on anger and smoking and suggest anger plays a role in everyday smoking behavior. Smokers with problematic anger might benefit from treatment focused on reducing anger and improving interpersonal functioning. Reducing trait anger may help reduce problematic symptoms during quitting, making relapse less likely.

Research has implicated a relationship between anger and suicidality, though underlying mechanisms remain unclear. The current study examined this relationship through the lens of the interpersonal theory of suicide (ITS). According to the ITS, individuals who experience thwarted belongingness, perceived burdensomeness, and elevated acquired capability for suicide are at increased risk for death by suicide. The relationships between anger and these variables were examined and these variables were examined as potential mediators between anger and suicidal ideation and behavior. Additionally, exposure to painful and provocative events was examined as a potential mediator between anger and acquired capability. As part of intake at a community mental health clinic, 215 outpatients completed questionnaires assessing depression, suicidal ideation, anger, perceived burdensomeness, thwarted belongingness, and acquired capability. Regression analyses revealed unique relationships between anger and both thwarted belongingness and perceived burdensomeness, covarying for depression. The association between anger and acquired capability trended toward significance. The links between anger and suicidal ideation and behavior were fully mediated by thwarted belongingness and perceived burdensomeness, but this effect was driven by perceived burdensomeness. Additionally, the link between anger and acquired capability was fully mediated by experience with painful and provocative events. In conclusion, results suggest that anger is uniquely associated with perceived burdensomeness and thwarted belongingness. Anger is associated with suicidal ideation and behavior via perceived burdensomeness and with greater acquired capability for suicide via experiences with painful and provocative events. Treatment for problematic anger may be beneficial to decrease risk for suicide., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background and Objectives: Research suggests a relationship between intolerance of uncertainty (IU) and obsessive-compulsive disorder (OCD), though this has been limited to self-report measures of OCD symptoms. The current investigation examined the relationship between IU and multiple symptom domains of OCD using self-report and in vivo assessments of OC symptoms., Methods: Five separate studies are presented in which undergraduate students (N=603) were administered a self-report measure of IU and tasks related to either ordering and arranging, checking, washing, contamination avoidance, or neutralization., Results: Intolerance of uncertainty was found to be significantly related to each self-report measure of the OCD symptom domains (ps < .01). Further, IU was predictive of performance on all in vivo tasks (ps < .05) except one concerning neutralizing/harm-related obsessions., Limitations: This study relied on an unselected sample and was correlational in design., Conclusions: The current study demonstrates that IU is related to multiple OC symptom dimensions. Future experimental research is warranted to evaluate the causal role of IU in OCD., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Correlational research suggests that smoking increases risk of posttraumatic stress disorder (PTSD), though such research by nature cannot rule out third variable explanations for this relationship. The present study used an analogue trauma film design to experimentally test the effects of nicotine on the occurrence of intrusive memories. Fifty-four healthy nonsmokers were randomly assigned to ingest either a nicotine or placebo lozenge before viewing a film depicting motor vehicle accidents. Participants recorded intrusive memories immediately after the film and for a week via diary. Participants in the nicotine condition reported significantly more intrusive memories immediately after watching the film, yet no group differences emerged on intrusions or intrusion-related distress reported during the following week. Among participants low in dispositional rumination, those who had ingested a nicotine lozenge reported more intrusions in the subsequent week than those in the placebo condition. These findings provide novel experimental evidence for the role of nicotine in increasing risk of PTSD and suggest that nicotine may contribute to trauma-related rumination but not heightened reactivity to trauma cues.

This study examined the unique and interactive roles of anger experience and expression in suicidality (suicidal ideation, plans, and attempts) in a large, nationally representative sample. Participants included 5692 adults from the National Comorbidity Survey-Replication, a nationally representative survey. Anger experience was assessed through a continuous measure, whereas anger expression problems were determined by the presence of an intermittent explosive disorder diagnosis. Tests of unique associations revealed that for the overall sample, anger experience and expression each predicted a unique variance in all outcomes of suicidality. Among the individuals reporting lifetime suicidal ideation, anger experience and expression were uniquely related to suicide attempts. Analyses also revealed anger experience and expression to interact in the prediction of suicidal ideation, suggesting that these have independent and additive effects on risk for suicide. The findings suggest that both anger experience and expression contribute to suicidality and the progression from suicidal ideation to plans and attempts.

A growing body of research has linked poor distress tolerance (DT) to obsessions, but not other OC symptom domains. However, limited research has been conducted with clinical samples. Further, there is a dearth of research regarding the moderating influence of DT on the contribution of stress to OC symptoms. In Study 1, we sought to test the specificity of the link between poor DT and greater obsessions relative to other OC symptom domains in a clinical sample. In Study 2, we conducted a longitudinal investigation with a non-clinical sample examining DT and daily stressors in the prediction of daily obsessions. For Study 1, 22 outpatients with an OCD diagnosis and 37 healthy controls completed measures of DT, depression, and OC symptoms. For Study 2, 102 undergraduates completed measures of DT at baseline and daily assessments of OC symptoms and stressors twice weekly for one-month. In Study 1, OCD diagnosis was not a significant predictor of DT, though greater obsessions, but not other OC symptoms, were uniquely associated with lower DT. In Study 2, lower baseline DT predicted greater daily obsessions among those experiencing greater daily negative life events, though this relationship was absent among those with elevated DT. The specific association between DT and obsessions was replicated in a clinical sample. Further, results suggest that low DT increases obsessions in the context of life stress., (© 2013 Published by Elsevier Ltd.)

Emerging evidence implicates important roles of poor distress tolerance and heightened emotional reactivity in obsessive-compulsive disorder. To date, investigations have relied mostly on self-report measures, and we sought to extend the literature by examining the relationship between OC symptoms and distress tolerance, as well as emotional reactivity, using three laboratory assessments. Nonclinical participants (N=167) viewed emotional films associated with four different negative emotions and also completed mirror tracing and handgrip persistence tasks. Greater obsessions scores were predictive of poorer emotional tolerance for a sad film and shorter persistence on the mirror tracing task. Among men only, obsessions were negatively correlated with persistence on the handgrip task. Associations between increased emotional reactivity and washing symptoms also emerged. These findings provide further evidence for the role of poor distress tolerance in obsessions and suggest heightened emotional reactivity may play a role in compulsive washing.

Research suggests that individuals high in anger have a bias for attributing hostile intentions to ambiguous situations. The current study tested whether this interpretation bias can be altered to influence anger reactivity to an interpersonal insult using a single-session cognitive bias modification program. One hundred thirty-five undergraduate students were randomized to receive positive training, negative training, or a control condition. Anger reactivity to insult was then assessed. Positive training led to significantly greater increases in positive interpretation bias relative to the negative group, though these increases were only marginally greater than the control group. Negative training led to increased negative interpretation bias relative to other groups. During the insult, participants in the positive condition reported less anger than those in the control condition. Observers rated participants in the positive condition as less irritated than those in the negative condition and more amused than the other two conditions. Though mediation of effects via bias modification was not demonstrated, among the positive condition posttraining interpretation bias was correlated with self-reported anger, suggesting that positive training reduced anger reactivity by influencing interpretation biases. Findings suggest that positive interpretation training may be a promising treatment for reducing anger. However, the current study was conducted with a non-treatment-seeking student sample; further research with a treatment-seeking sample with problematic anger is necessary., (Copyright © 2013. Published by Elsevier Ltd.)

Objective: Recently, researchers have called for therapeutic applications of behavioral primes (Shalev & Bargh, 2011). We evaluated whether courageous approach behavior might be facilitated through priming in a sample of spider fearful women., Method: Undergraduate student women reporting elevated spider fear (N = 33, Age mean = 18.88) were recruited for this study. Participants completed self-report measures of spider fear and dispositional courage. They then completed either a courage or neutral word search prime, which was followed by a behavioral approach task involving a tarantula., Results: Consistent with predictions, among those reporting lower dispositional courage, the courage prime led to reduced approach behavior relative to the neutral prime. However, no group differences were found among those high in dispositional courage., Conclusions: These findings point to the importance of self-perceptions in moderating the effects of behavioral primes and suggest limitations to the use of such interventions with individuals with psychological dysfunction., (© 2013 Wiley Periodicals, Inc.)

Emerging evidence implicates an important relationship between feelings of incompleteness and compulsive checking. To date, this work has relied mostly on self-report measures and correlational research designs. We explored the relationship in three different studies using in vivo tasks. In Study 1, we found checking symptoms to be uniquely associated with negative affective response to a pile of clutter (an incompleteness induction). In Study 2, two different measures of incompleteness were predictive of urge to check following a stove checking task. In Study 3, following a stove checking task, participants were randomized to incompleteness induction or control conditions, and urge to check was assessed afterwards. Among those with elevated checking symptoms and dispositional incompleteness, the incompleteness induction led to greater urge to check than the control condition. No effect of condition was found among those low in checking symptoms and dispositional incompleteness. Together, these studies provide novel data in support of an important role for incompleteness in checking compulsions., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Emotion regulation difficulties have been implicated in the maintenance of many anxiety disorders. However, existing research has relied mostly on self-report measures of emotion regulation or one type of mood induction. The present study examined the relationships between anxiety symptoms and emotional reactivity and tolerance using multiple assessment methodologies. Participants (N=122) completed measures of generalized, social, and health anxiety symptoms and reported tolerance of and reactivity to negative emotions (sadness, fear, anger, disgust) elicited by 4 film clips. Participants also completed a mirror-tracing persistence task, a behavioral measure of distress tolerance. Social anxiety symptoms predicted unique variance in tolerance of film-elicited emotions, whereas generalized anxiety symptoms predicted unique variance in total peak reactivity to film-elicited emotions. Health anxiety was not related to tolerance or peak reactivity, but it was predictive of greater anxiety following the mirror-tracing task. The results of this study suggest heightened emotional reactivity is a salient feature of generalized anxiety symptoms, whereas emotional tolerance is more strongly related to social anxiety symptoms. The unique association between health anxiety and anxious response to the distress tolerance task represents a novel finding that warrants further investigation., (Copyright © 2012. Published by Elsevier Ltd.)

Existing evidence suggests that disgust is an important affective process related to health anxiety. The present study sought to determine the contribution of health anxiety symptoms in the prediction of disgust and behavioral avoidance in a large, nonclinical sample (N=156). Regression analyses showed that overall health anxiety symptoms predicted disgust on a behavioral approach task independent of gender, negative affect, and fear of contamination. Particularly, health anxiety-related reassurance seeking was found to be uniquely associated with disgust and behavioral avoidance after controlling for the aforementioned covariates. In addition, the interaction between health anxiety and contamination fear was tested, and remained significant when controlling for gender and negative affect. These results suggest that heightened contamination fear is associated with elevated disgust reactions such that high levels of health anxiety leads even those low in contamination fear to be disgusted during a behavioral task. These results are in line with previous research on the role of disgust in health anxiety.

Evaluations of psychotherapy have traditionally focused on symptom reduction as the primary standard by which their value is determined. This has contributed to the appearance of equivalence between many therapies that may differ considerably in complexity, feasibility, amount of homework and therapist contact required, expected cost, speed of symptom decline, and transdiagnostic utility. In the current paper, I make the case that these are fundamental features related to quality that should be considered in psychotherapy development, randomized controlled trials, and dissemination efforts. Empirically supported treatments for different disorders are evaluated based on these criteria, and special consideration is given to cognitive-behavioral treatments for anxiety disorders. Specific recommendations for a quality-oriented clinical research agenda are also provided., (Copyright © 2011. Published by Elsevier Ltd.)

Objective: Genetic and nonshared environmental factors are implicated in the etiology of binge eating behaviors (BEB), with genetic risk expressed as parental psychopathology. Traumatic experiences including child abuse predict onset of BEB. It is not clear if each separately contribute to BEB, or whether parental pathology leads to abuse which in turn influences BEB., Method: Data were obtained from the National Comorbidity Survey-Replication (N = 2960). Through structural equation modeling, we estimated unique and combined effects of mother's and father's internalizing (INT) and externalizing (EXT) disorders, and child abuse on BEB., Results: Parental INT and EXT psychopathology contributed to child abuse and BEB. Abuse predicted BEB and partially mediated associations between parental psychopathology and BEB., Discussion: Results emphasize the value of models that incorporate nature and nurture to understand risk for psychopathology in offspring, with childhood abuse being one mediator of how parental psychopathology may reflect genetic risk and influence environmental risk., (Copyright © 2011 Wiley Periodicals, Inc.)

Recent reports of increasing suicide rates among military personnel indicate a need for increased work in understanding processes relevant to suicide risk in the military. Anxiety, along with anxiety-related risk factors have been implicated in suicidality as well as posttraumatic stress disorder (PTSD). One such risk factor, anxiety sensitivity (AS), refers to fear of anxiety-related symptoms. Subfactors of AS, notably the physical and cognitive concerns factors, appear to be relevant to the construct of acquired capability for suicidal behavior, a risk factor for death by suicide postulated by the Interpersonal-Psychological Theory of Suicide (Joiner, 2005; Van Orden et al., 2010). Study 1 examined the interaction of AS-cognitive concerns and AS-physical concerns in an outpatient sample with PTSD symptomatology (N = 128). Analyses were consistent with our a priori model and indicated that the interaction of AS-cognitive concerns by AS-physical concerns predicted previous suicide attempt. Specifically, those with high AS-cognitive concerns and low AS-physical concerns were at increased risk for suicide attempt. Study 2 prospectively examined the associations between AS and suicidal ideation in a sample of military cadets undergoing basic training (N = 1081). A similar interaction emerged such that high AS-cognitive and low AS-physical scores at Time 1 significantly predicted suicidal ideation several months later, even after controlling for Time 1 suicidal ideation and psychopathology. These findings suggest that suicide potential may be related to interactions between cognitive risk factors for anxiety among individuals with PTSD symptomatology as well as individuals experiencing stressful life events., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Excessive reassurance-seeking (ERS) is hypothesized to play a key role in emotional disorders but has been studied mostly in relation to depression. Study 1 reports a new measure of reassurance seeking that assessed ERS related to general and evaluative threats in a non-clinical student sample, and its factor structure was further examined in Study 2. In Study 3, the scale, along with other symptom-related measures and an existing measure of depressive ERS, was administered to an undergraduate sample at two different time points, one month apart. Greater ERS was associated with greater symptoms of social anxiety, generalized anxiety disorder, and obsessive-compulsive disorder (OCD), even after controlling for trait anxiety, depression, and intolerance of uncertainty. Among OCD symptoms, only thoughts of harm were uniquely related to ERS, a finding consistent with emerging literature. ERS involving general threats also predicted changes in social anxiety and GAD symptoms one month later. Overall, the findings implicate an important role for ERS across anxiety disorders., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

This study sought to examine the relations between chronic pain and marijuana use in a large nationally representative survey of adults (n = 5,672; 53% female; M(age) = 45.05, SD = 17.9) conducted in the United States. After controlling for sociodemographic variables, lifetime history of depression, and alcohol abuse/dependence, there was a significant association between lifetime chronic pain and lifetime and current marijuana use. Moreover, current chronic pain was significantly associated with lifetime marijuana use. There was no significant association between current chronic pain and current marijuana use, possibly owing to limited statistical power. Results suggest that there are generally consistent statistically significant relations between chronic pain and marijuana use. Future work is needed to explicate the developmental patterning between chronic pain and marijuana use. This paper presents the potential linkage between chronic pain and marijuana use. Results from this study suggest that it may be beneficial for clinicians to assess for marijuana use among patients suffering from chronic pain. Such patients may be using marijuana as a maladaptive coping strategy., (Copyright © American Academy of Addiction Psychiatry.)