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Objective Although clients' hostile behavior directed at therapists ( hostile resistance ) predicts worse outcomes in cognitive-behavioral therapy (CBT) for panic disorder, the process by which this happens remains unknown. This study examines two putative mechanisms: working alliance and therapist adherence. Method: Seventy-one adults with primary panic disorder received CBT in a larger trial. Hostile resistance and adherence in Sessions 2 and 10 were reliably coded using observer-rated measures; client- and therapist-rated questionnaires assessed working alliance. Outcome measures were attrition and symptomatic improvement, assessed at multiple timepoints with the Panic Disorder Severity Scale. Results: Hostile resistance was significantly related to both preexisting ( r   = -.36, p   =  .04) and subsequent declines ( r   = -.58, p   <  .0001) in the working alliance. Nevertheless, hierarchical linear modeling revealed that neither a declining alliance nor therapist adherence (whether treated as linear or curvilinear) was independently predictive of symptom change, nor did these factors mediate hostile resistance's association with worse symptomatic improvement. Exploratory logistic regressions similarly indicated that neither adherence nor alliance moderated whether hostilely resistant clients dropped out. Conclusion: This is the first study to establish a bidirectional association between hostile resistance and a declining working alliance. Findings also add to a mixed literature on the adherence-outcome relationship.

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

Hostile resistance (clients' openly combative behavior directed at therapists) predicts poor outcomes in cognitive-behavioral therapy (CBT) for panic disorder, but its origins are poorly understood. It is important to have a holistic understanding of the etiology of hostile resistance that incorporates the therapeutic context if these behaviors-and their negative consequences-are to be prevented and effectively addressed. Of the 71 adults who received CBT for panic disorder as part of larger trial, 8 exhibited hostile resistance. Grounded theory methodology was used to develop a theoretical framework to understand why these patients became hostile in session. The 10 minutes of session preceding instances of hostile resistance and matched portions of sessions from five never hostile controls were coded. Two pathways to hostile resistance emerged-one in which patient characteristics were primary and one wherein therapist failures (particularly of empathy) were primary. Being a challenging patient (i.e., narcissistic, obsessive, angry, resistant) moderated which pathway was followed. However, even among challenging patients, rarely was hostile resistance attributable to patients' dispositions alone. Most often, patient factors interacted with therapist (e.g., displays of frustration) and treatment (e.g., directiveness, degree of structure) factors to produce such resistance. Contrary to the view of hostile resistance as simply a product of a hostile patient, the picture is more complex. Findings indicate that greater attention to common factors in CBT and more flexible applications of treatment protocols is warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Introduction: Panic disorder patients who drop out of treatment typically do not remit from their disorder. How patient-level moderators influence dropping out of one panic-focused treatment over another has never been examined, nor in non-CBT treatments. Method: 200 patients with panic disorder with or without agoraphobia were randomized to receive cognitive-behavioral therapy (CBT), panic-focused psychodynamic psychotherapy (PFPP), or applied relaxation training (ART) across two sites. Therapy was twice a week for 12 weeks. A two-step variable search method was applied to identify potential prognostic predictors and moderators of patient dropout. Survival models predicting hazard of session-by-session dropout tested the resulting variables. Results: Across treatments, unemployment and higher psychosocial disability on the Sheehan Disability Scale predicted increased risk of dropout, while patients with higher anxiety sensitivity were more likely to complete treatment. Patients who reported experiencing childhood abuse had heightened dropout in ART, but not CBT or PFPP. Men were especially likely to complete PFPP. Session 2 expectancies and patient-rated alliance predicted lower dropout only in CBT. Conclusions: Patient-level factors may influence both whether patients will complete any treatment, and whether they continue in a particular panic-focused therapy. Moderators of dropout (e.g., abuse history) may inform treatment decisions for specific patients. Trial registration: ClinicalTrials.gov identifier: NCT00353470.

To examine process of changes in two distinct psychotherapies-cognitive-behavioral therapy (CBT) and Panic-Focused Psychodynamic Psychotherapy (PFPP). Two hypothesized processes of change-misinterpretation of bodily sensations and Panic Specific Reflective Function (PSRF)-were tested in the CBT and PFPP arms of the Cornell-Penn Study of Psychotherapies for Panic Disorder. The Brief Bodily Sensations Interpretation Questionnaire (BBSIQ) measures misinterpretation of bodily sensations-a focus of CBT interventions. PSRF, a target of PFPP, assesses the capacity to reflect on the underlying meaning of panic symptoms. A sample of 138 patients (37.7% men, 72.56% Whites, and 16.7% Latinx) with primary Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) panic disorder were included in the present analyses. Mixed effects models tested the effects of early change in BBSIQ and PSRF (intake through Week 5) on subsequent change in the Panic Disorder Severity Scale (PDSS; Week 5 through termination). Early change on both PSRF and BBSIQ predicted subsequent change in panic severity across the two treatments. As predicted, PSRF changed more in PFPP than in CBT, but, contrary to expectation, BBSIQ showed comparable changes in both groups. Counterintuitively, CBT patients benefited more in terms of panic symptom improvement when their PSRF improved than did PFPP patients. This is the first demonstration of general processes of change (PSRF and BBSIQ) across psychotherapies for panic disorder, suggesting that to the extent patients change their beliefs about the meaning of panic, their panic symptoms improve in time-limited, panic-focused psychotherapies. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Background: The hippocampus plays an important role in psychopathology and treatment outcome. While posterior hippocampus (PH) may be crucial for the learning process that exposure-based treatments require, affect-focused treatments might preferentially engage anterior hippocampus (AH). Previous studies have distinguished the different functions of these hippocampal sub-regions in memory, learning, and emotional processes, but not in treatment outcome. Examining two independent clinical trials, we hypothesized that anterior hippocampal volume would predict outcome of affect-focused treatment outcome [Interpersonal Psychotherapy (IPT); Panic-Focused Psychodynamic Psychotherapy (PFPP)], whereas posterior hippocampal volume would predict exposure-based treatment outcome [Prolonged Exposure (PE); Cognitive Behavioral Therapy (CBT); Applied Relaxation Training (ART)]., Methods: Thirty-five patients with posttraumatic stress disorder (PTSD) and 24 with panic disorder (PD) underwent structural magnetic resonance imaging (MRI) before randomization to affect-focused (IPT for PTSD; PFPP for PD) or exposure-based treatments (PE for PTSD; CBT or ART for PD). AH and PH volume were regressed with clinical outcome changes., Results: Baseline whole hippocampal volume did not predict post-treatment clinical severity scores in any treatment. For affect-focused treatments, but not exposure-based treatments, anterior hippocampal volume predicted clinical improvement. Smaller AH correlated with greater affect-focused treatment improvement. Posterior hippocampal volume did not predict treatment outcome., Conclusions: This is the first study to explore associations between hippocampal volume sub-regions and treatment outcome in PTSD and PD. Convergent results suggest that affect-focused treatment may influence the clinical outcome through the 'limbic' AH, whereas exposure-based treatments do not. These preliminary, theory-congruent, therapeutic findings require replication in a larger clinical trial.

ABSTRACT Objective: To examine whether working alliance quality and use of techniques predict improvement in Panic-Specific Reflection Function (PSRF), and misinterpretation of bodily sensations in treatments for panic disorder. Method: A sample of 161 patients received either CBT or PFPP (Panic-focused Psychodynamic therapy) within a larger RCT. Data were collected on patient-reported working alliance, misinterpretations, PSRF, observer-coded use of techniques, and interviewer-rated panic severity. Random-Intercept Cross-Lagged Panel Models assessed bi-directional associations, disentangling within- and between-patient effects, and accounting for prior change. Results: Higher alliance predicted subsequent within-patient improvement in PSRF in PFPP, but worsening in CBT. In both treatments, focus on interpersonal relationships predicted PRSF improvement (with stronger effects in CBT), while focus on thoughts and behaviors predicted worsening in PSRF. In CBT only, early focus on affect and moment-to-moment experience predicted reduced misinterpretation, while high focus on thoughts and cognitions predicted subsequent increase in misinterpretation. Conclusion: The quality of the alliance has differential effects on PSRF in distinct treatments. Interpersonal, rather than cognitive or behavioral focus, even when delivered differently within distinct treatments with high adherence, could facilitate improvement in PSRF. Additionally, early focus on affect and moment-to-moment experiences in CBT could reduce misinterpretations.

In panic-focused psychodynamic psychotherapy (PFPP), exploration and interpretation of avoided and conflicted emotions and fantasies surrounding anxiety are thought to promote panic-specific reflective functioning (PSRF), which drives panic disorder improvements. Patient emotional expression within a session may be a marker of engaged processing and experiencing of affectively charged material. Degree of in-session expressed emotion, indicating both verbal and nonverbal emotions, was examined across three early therapy sessions for prediction of subsequent outcomes. We further investigated whether personality disorder traits, theorized to relate to constricted (obsessive-compulsive) or heightened (borderline) emotions, moderated this relationship. Emotional expression in Sessions 2, 5, and 10 of a 24-session PFPP protocol was assessed by blinded observers in 44 patients randomized to PFPP in a two-site randomized controlled trial of psychotherapies for panic disorder. Robust regressions were conducted to examine the relationship between average emotional expression across the measured sessions and symptom and PSRF changes subsequent to the sampled sessions, as well as moderation by personality disorder criteria, controlling for early outcomes. Higher levels of emotional expression across the early sessions predicted greater subsequent symptom and PSRF improvement. Elevations in expression of grief/sadness drove the symptomatic finding. Patients meeting more borderline criteria experienced a smaller and potentially negative relationship between emotional expression and symptom improvement. Emotional expression in PFPP may be an indicator of positive therapy process for patients without comorbid borderline personality traits, predicting prospective improvements in both a key mediator (PSRF) and symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objective: This study examines whether, in panic-focused psychodynamic psychotherapy (PFPP), interpretations of conflicts that underlie anxiety (panic-focused or PF-interpretations) are specifically associated with subsequent panic disorder (PD) symptom improvement, over and above the provision of non-symptom-focused interpretations. Method: Technique use in Sessions 2 and 10 of a 24-session PFPP protocol was assessed for the 65 patients with complete outcome data randomized to PFPP in a two-site trial of psychotherapies for PD. Sessions were rated in 15-min segments for therapists' use of PF-interpretations, non-PF-interpretations, and PF-clarifications. Robust regressions were conducted to examine the relationship between these interventions and symptom change subsequent to the sampled session. Interpersonal problems were examined as a moderator of the relationship of PF-interpretations to symptom change. Results: At Session 10, but not at Session 2, patients who received a higher degree of PF-interpretations experienced greater subsequent improvement in panic symptoms. Non-PF-interpretations were not predictive. Patients with more interpersonal distress benefitted particularly from the use of PF-interpretations at Session 10. Conclusions: By the middle phase of PFPP, panic-focused interpretations may drive subsequent improvements in panic symptoms, especially among patients with higher interpersonal distress. Interpretations of conflict absent a panic focus may not be especially helpful.

Objective: Little is known about how therapy processes relate to outcome in cognitive-behavioral therapy (CBT) for panic disorder (PD). This study examined whether client resistance predicts CBT for PD outcomes beyond the effects of established pre-treatment predictors. A secondary aim was to assess the consistency of resistance over treatment. Method: Data were from 71 adults participating in up to 24 biweekly sessions of CBT in a randomized controlled trial. Panic severity was assessed before, during (at Weeks 1, 5, and 9), and at termination of treatment (Week 12) using the Panic Disorder Severity Scale. Trained coders reliably rated resistance in videos of Sessions 2 and 10 using the Client Resistance Code. Results: Resistance was found to be moderately consistent ( r  = .64). Although overall resistance was unrelated to outcomes, hierarchical linear modeling revealed that openly hostile resistance at Session 10 predicted significantly diminished symptom change ( r  = .28, CI 95%  = [.01, .51]), beyond the effects of pretreatment predictors. Hostile resistance at Session 2 predicted attrition ( r rb  = -.30, p  = .001), even after established predictors were controlled. Conclusions: Although some forms of resistance may be benign, openly hostile resistance is an important therapy marker that warrants increased clinical and research attention.

Background: It is not known whether common anxiety/mood comorbidities of panic disorder (PD) improve with panic-focused psychological treatment, nor whether there is differential efficacy between therapies in treating comorbidities., Methods: In a randomized controlled trial for PD with and without agoraphobia comparing Cognitive-Behavioral Therapy (CBT) and Panic-Focused Psychodynamic Psychotherapy (PFPP), symptomatic comorbidities of agoraphobia, MDD, GAD, and social anxiety disorder (SAD) were assessed pre-to-post treatment with the Anxiety Disorders Interview Schedule (ADIS). Comparative efficacy of CBT versus PFPP for treating comorbid disorders was tested at termination and 1 year's follow-up. Covariance between panic and comorbidity improvements was also analyzed., Results: Most treatment completers (n = 120) evidenced diagnostic remission of their comorbidity (range = 54-69%), which typically reflected a subclinical score on the ADIS (mean range = 1.3 to 1.8). These improvements were generally retained at follow-up. However, patients with MDD dropped out significantly more often (HR = 2.79). No significant symptom change or remission differences emerged between CBT and PFPP for any comorbidity at termination or at follow-up. Panic change was strongly related to improvements in agoraphobia (r = 0.70) and MDD (r = 0.53), moderately related for GAD (r = 0.31), and not significantly related for SAD (r = 0.20)., Discussion: Patients completing panic-focused psychotherapies often experience meaningful remission for diagnoses of agoraphobia, MDD, GAD, and SAD, with no detectable differences between treatments, although sample sizes for the MDD and SAD comparisons were small. In addition, additional efforts may be needed to keep MDD-comorbid patients in treatment., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The National Institute of Mental Health (NIMH) plays an enormous role in establishing the agenda for mental health research across the country (its 2016 appropriation was nearly $1.5 billion; NIMH, 2016a). As the primary funder of research that will lead to development of new assessments and interventions to identify and combat mental illness, the priorities set by NIMH have a major impact on the mental health of our nation and training of the next generation of clinical scientists. Joshua Gordon has recently begun his term as the new Director of NIMH and has been meeting with different organizations to understand how they can contribute to the grand challenge of reducing the burden of mental illness. As a group of clinical psychological scientists (most representing the Coalition for the Advancement and Application of Psychological Science), he asked what we saw as key gaps in our understanding of the burden of mental illnesses and psychological disorders that psychosocial research could help fill. In response, we first present data illustrating how funding trends have shifted toward biomedical research over the past 18 years and then consider the objectives NIMH has defined in its recent strategic plan (U.S. Department of Health and Human Services, National Institutes of Health, & National Institute of Mental Health, 2015). We then note ways that advances in psychosocial research can help achieve these objectives. Critically, this involves integrating psychosocial and biomedical approaches to efficiently relieve the suffering of millions of Americans who struggle with mental illnesses and psychological disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objective: To investigate whether (a) baseline levels of panic-specific reflection function (PSRF; i.e. patients' capacity to reflect on their panic symptoms) and improvement in this capacity over treatment; (b) baseline borderline personality disorder (BPD) traits and pre-post treatment improvement in BPD traits predict change in patients' quality of object relations., Method: A subsample of 102 patients diagnosed with panic disorder from a larger randomized controlled trial received either Cognitive-Behavioral Therapy or Panic-Focused Psychodynamic Psychotherapy. We investigated whether baseline levels and change in both PSRF and BPD traits (as measured by the SCID-II) predicted pre-post change in quality of object relations (QOR), while controlling for pre-post treatment change in panic symptoms assessed by the Panic Disorder Severity Scale., Results: In both treatments, higher baseline levels of PSRF and lower levels of BPD traits, as well as pre-post decrease in BPD traits, predicted improvement in QOR when controlling for symptomatic change., Conclusions: The findings suggest that reduction in comorbid BPD traits can facilitate improvement in patients' quality of object relations even in brief symptom-focused psychotherapies. Additionally, patients with higher baseline levels of symptom-focused reflective function and lower BPD traits are more likely to demonstrate interpersonal change over the course of psychotherapy for panic disorder. Finally, our study highlights the importance of examining therapeutic change beyond reduction in symptoms, particularly in domains of interpersonal functioning.

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

Perceived criticism from relatives predicts poor clinical outcomes for patients with a variety of psychological disorders. Research indicates the attributions individuals make about motives for relatives' criticism are linked to perceived criticism from this relative. Accordingly, attributions may be an important target of intervention to reduce perceived criticism and improve clinical outcomes, but this association requires testing in a clinical sample. We examined relationships among attributions of criticism, perceived criticism, and upset due to criticism among individuals with anxiety disorders (n = 53) and with no psychopathology (n = 52). Participants completed measures of global attributions, perceived criticism, and upset due to criticism regarding criticism from a romantic partner/spouse or parent. After a 10-min problem-solving interaction with their relative, they completed measures of attributions, perceived criticism, and upset with regard to this relative's critical behavior during the interaction, and observers reliably coded interactions for relatives' criticism. Results showed that negative attributions were related to greater perceived criticism and upset for both global and interaction-specific measures. In analyses of interaction-specific measures, negative attributions added to prediction of perceived criticism and upset over and above the contribution of observed criticism. Positive attributions were not significantly related to global or interaction-specific upset in any analyses. Relationships were consistent across patients and normal controls. Our findings suggest that negative attributions of relatives' motives for their criticism are important predictors of perceived criticism and upset. Thus, interventions targeting these attributions may be helpful in mitigating the negative effect of perceived criticism for individuals with psychopathology. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Objective: Given the chronic, episodic nature of panic disorder, it is important to examine long-term outcomes of patients who respond well to various psychotherapies., Method: Out of 116 patients with DSM-IV panic disorder who evidenced a ≥ 40% reduction in panic and avoidance symptoms on the Panic Disorder Severity Scale (PDSS) after 12-14 weeks of panic-focused psychodynamic psychotherapy, cognitive-behavioral therapy, or applied relaxation training as part of a 2-site randomized controlled trial conducted between January 2007 and July 2012, 91 patients provided at least 1 PDSS datapoint during follow-up. Patients were assessed at each of the 12 following months using the PDSS, the Sheehan Disability Scale (SDS), and the Hamilton Depression Rating Scale (HDRS) and twice during the follow-up period with the Anxiety Disorders Interview Schedule., Results: Patients with panic disorder who responded to 1 of 3 treatments maintained their gains on the PDSS, SDS, and HDRS with no differences by condition in rates of change over the follow-up period (all P values ≥ .20). Similarly, 57% of improved patients did not have a panic disorder diagnosis by the end of 1 year, regardless of the treatment received. No differences in rates of panic disorder diagnosis were found across treatment conditions at either 6 months or 12 months (all P values ≥ .78). Results should be interpreted in light of the fact that patients giving data at follow-up experienced lower symptom levels at treatment termination than those not providing data., Conclusions: Improvement in any of the 3 treatments examined in this trial was largely maintained for a year following the end of therapy. Future treatment development could focus on factors to increase the level of response in the active phase of therapy., Trial Registration: ClinicalTrials.gov identifier: NCT00353470., (© Copyright 2018 Physicians Postgraduate Press, Inc.)

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

Background: No studies of psychotherapies for panic disorder (PD) have examined effects on comorbid personality disorders (PersD), yet half such patients have a PersD., Methods: In a randomized trial for PD with and without agoraphobia comparing Cognitive-Behavioral Therapy (CBT) and Panic-Focused Psychodynamic Psychotherapy (PFPP), PersD was assessed pre-to-post treatment with the Structured Clinical Interview for the Diagnosis of Axis-II Disorders (SCID-II). For patients completing therapy (n = 118, 54 with PersD), covariance between panic and SCID-II criteria improvements was analyzed. SCID-II diagnostic remission and recovery were evaluated. Comparative efficacy of PFPP versus CBT for improving PersD was analyzed both for the average patient, and as a function of PersD severity., Results: 37 and 17% of PersD patients experienced diagnostic PersD remission and recovery, respectively. Larger reductions in PersD were related to more panic improvement, with a modest effect size (r = 0.28). Although there was no difference between treatments in their ability to improve PersD for the average patient (d = 0.01), patients meeting more PersD criteria did better in PFPP compared to CBT (P = .007), with PFPP being significantly superior at 11 criteria and above (d = 0.66; 3 more criteria lost)., Conclusions: PersD presenting in the context of primary PD rarely resolves during psychotherapies focused on PD, and change in PersD only moderately tracks panic improvements, indicating non-overlap of the constructs. Patients receiving panic-focused psychotherapies may require additional treatment for their PersD. PFPP may be superior at improving severe PersD, but replication of this finding is required., (© 2017 Wiley Periodicals, Inc.)

Purpose: Aromatase inhibitors (AIs) are a potentially life-saving treatment for breast cancer survivors, yet poor adherence to treatment is a prevalent problem. A common adverse effect of AI treatment is arthralgia, which is identified by survivors as a major reason for treatment discontinuation. Women who experience arthralgia on AIs often report feeling they have aged rapidly while on the treatment. In the present study, we examined whether arthralgia-associated ageing perceptions predicted non-adherence., Patients and Methods: We conducted a prospective cohort study among women with stage I-III breast cancer, who were on an AI and completed the Penn Arthralgia Aging Scale within 2 years of AI initiation. Adherence data were abstracted from medical charts by trained raters. Cox proportional hazard analysis was used to determine the relationship between ageing perceptions and time to non-adherence. All analyses included adjustments for joint pain severity., Results: Among 509 participants, 144 (28.3%) were non-adherent. As hypothesised, women with high levels of ageing perceptions were at greater risk of non-adherence than women with low levels of ageing perceptions (adjusted hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.10-2.67; p = .02). High levels of depressive symptoms were also uniquely associated with increased risk of non-adherence (adjusted HR, 1.63; 95% CI, 1.03-2.59; p = .04)., Conclusion: Perceptions of ageing related to arthralgia and depressive symptoms predicted non-adherence to AIs. These findings suggest that interventions that address negative beliefs about ageing due to AI-related arthralgia and depressive mood can potentially improve rates of adherence to AIs., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

This article presents the results of a qualitative analysis of interviews with 25 psychologists in independent practice, with a focus on decision making with a selected patient. We endeavored to examine how clinical decision making intersected with the principles of evidence based practice (EBP) as laid out by Spring (2007). Clinicians reported that diagnostic impressions were generally formulated through unstructured assessment rather than validated instruments, and that treatment selection was based on therapists' perceptions of a treatment's match with client characteristics. Therapists viewed CBTs as appropriate for addressing symptoms but believed they needed to depart from CBT strategies to address underlying issues. Nonetheless, they often defined successes and failures in treatment in terms of symptoms. Overall, clinicians rarely mentioned utilization of research evidence for assessment or treatment selection and practice. Results are discussed within the framework of EBP.

Objective: To develop a more reliable and comprehensive version of the Parental Facilitation of Mastery Scale (PFMS) METHOD: In Study 1, 387 undergraduates completed an expanded PFMS (PFMS-II) and measures of parenting, perceived control, responses to early life challenges, and psychopathology. In Study 2, 182 trauma-exposed community participants completed the PFMS-II and measures of perceived control, psychopathology, and well-being RESULTS: In Study 1, exploratory factor analysis of the PFMS-II revealed two factors. These factors replicated in Study 2; one item was removed to achieve measurement invariance across race. The final PFMS-II comprised a 10-item overprotection scale and a 7-item challenge scale. In both samples, this measure demonstrated good convergent and discriminant validity and was more reliable than the original PFMS. Parental challenge was a unique predictor of perceived control in both samples CONCLUSION: The PFMS-II is a valid measure of important parenting behaviors not fully captured in other measures., (© 2016 Wiley Periodicals, Inc.)

Although widely used, the Hamilton Rating Scale for Depression (HRSD) and Hamilton Anxiety Rating Scale (HARS) discriminate poorly between depression and anxiety. To address this problem, Riskind, Beck, Brown, and Steer (J Nerv Ment Dis. 175:474-479, 1987) created the Reconstructed Hamilton Scales by reconfiguring HRSD and HARS items into modified scales. To further analyze the reconstructed scales, we examined their factor structure and criterion-related validity in a sample of patients with major depressive disorder and no comorbid anxiety disorders (n = 215) or with panic disorder and no comorbid mood disorders (n = 149). Factor analysis results were largely consistent with those of Riskind et al. The correlation between the new reconstructed scales was small. Compared with the original scales, the new reconstructed scales correlated more strongly with diagnosis in the expected direction. The findings recommend the use of the reconstructed HRSD over the original HRSD but highlight problems with the criterion-related validity of the original and reconstructed HARS.

Objective: To identify variables predicting psychotherapy outcome for panic disorder or indicating which of 2 very different forms of psychotherapy-panic-focused psychodynamic psychotherapy (PFPP) or cognitive-behavioral therapy (CBT)-would be more effective for particular patients., Method: Data were from 161 adults participating in a randomized controlled trial (RCT) including these psychotherapies. Patients included 104 women; 118 patients were White, 33 were Black, and 10 were of other races; 24 were Latino(a). Predictors/moderators measured at baseline or by Session 2 of treatment were used to predict change on the Panic Disorder Severity Scale (PDSS)., Results: Higher expectancy for treatment gains (Credibility/Expectancy Questionnaire d = -1.05, CI 95% [-1.50, -0.60]), and later age of onset (d = -0.65, CI 95% [-0.98, -0.32]) were predictive of greater change. Both variables were also significant moderators: patients with low expectancy of improvement improved significantly less in PFPP than their counterparts in CBT, whereas this was not the case for patients with average or high levels of expectancy. When patients had an onset of panic disorder later in life (≥27.5 years old), they fared as well in PFPP as CBT. In contrast, at low and mean levels of onset age, CBT was the more effective treatment., Conclusions: Predictive variables suggest possibly fruitful foci for improvement of treatment outcome. In terms of moderation, CBT was the more consistently effective treatment, but moderators identified some patients who would do as well in PFPP as in CBT, thereby widening empirically supported options for treatment of this disorder. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

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

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

Relatives' criticism of, hostility toward, and emotional overinvolvement (EOI) with patients are predictive of treatment response and relapse. Although these constructs have been linked to relatives' attributions for patient problems, little research has yet evaluated attributions for specific types of problems. This study examined event-specific attributions (i.e., attributions specifically for either disorder-related [DR] or non-DR problems) in relatives of patients with anxiety disorders. Relatives made more illness attributions (attributing problems to a patient's disorder) than controllable attributions (attributing problems to factors controllable by patients) for DR events, with the reverse pattern for non-DR events. Criticism and hostility were associated primarily with controllability attributions for non-DR events. In contrast, the presence of EOI was associated with illness attributions for non-DR events. Family-based interventions for anxiety disorders might need to focus on relatives' controllability attributions for a broad range of patient behaviors and on reducing tendencies to attribute non-DR problems to patients' disorders.

Objective: We tested the relation of perceived criticism (PC) from a parent or spouse/romantic partner to outcome of psychotherapy for panic disorder (PD)., Method: Participants were 130 patients with PD (79% with agoraphobia) who received 24 twice-weekly sessions of panic-focused psychodynamic psychotherapy, cognitive-behavioral therapy, or applied relaxation therapy. Patients were predominantly White (75%), female (64%), and non-Hispanic (85%). At baseline, Week 5 of treatment, termination, and at 6- and 12-month follow-up, patients rated PC from the relative with whom they lived. Independent evaluators assessed the severity of PD at baseline, Weeks 1, 5, and 9 of treatment, termination, and the 2 follow-up points. Data were analyzed with piecewise (treatment phase, follow-up phase) latent growth curve modeling., Results: The latent intercept for PC at baseline predicted the latent slope for panic severity in the follow-up (p = .04) but not the active treatment phase (p = .50). In contrast, the latent intercept for PD severity at baseline did not predict the latent slope on PC in either phase (ps ≥ .29). Nor did the slopes of PC and PD severity covary across treatment (p = .31) or follow-up (p = .13). Indeed, PC did not change significantly across treatment (p = .45), showing the stability of this perception regardless of significant change in severity of patients' PD (p < .001)., Conclusions: Because PC predicts worse long-term treatment outcome for PD, study findings argue for interventions to address perceived criticism in treatment. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Background: Although poor adherence to hormonal therapies such as aromatase inhibitors (AIs) is widely documented, to the authors' knowledge less is known regarding whether health beliefs predict treatment nonadherence. The objective of the current study was to evaluate the relationship between health beliefs (perceived susceptibility to breast cancer, perceived benefits of AI treatment, and perceived barriers to AI treatment) and adherence to AIs., Methods: Postmenopausal women with early-stage, estrogen receptor-positive breast cancer who were currently receiving treatment with an AI completed the 3-factor Health Beliefs and Medication Adherence in Breast Cancer scale and questionnaires concerning their demographics and symptoms. Adherence data (treatment gaps and premature discontinuation) were abstracted from participants' medical charts. Logistic regression analyses were conducted to evaluate the relationship between health beliefs and adherence., Results: Among 437 participants, 93 (21.3%) were nonadherent. Those who perceived greater barriers to their AI treatment were more likely to demonstrate AI nonadherence behaviors by the end of their treatment period compared with those who reported fewer barriers to AI therapy (adjusted odds ratio, 1.71; 95% confidence interval, 1.03-2.86 [P = .04]). In contrast, perceived susceptibility to cancer recurrence and perceived benefits of AIs did not appear to predict AI adherence. Minority individuals were found to have lower perceived susceptibility to breast cancer recurrence and higher perceived barriers to AI treatment (P<.05 for both)., Conclusions: Greater perceived barriers appeared to predict nonadherence to AIs. Interventions addressing women's negative beliefs regarding the challenges of AI treatment are needed to help optimize adherence in survivors of breast cancer. Cancer 2017;169-176. © 2016 American Cancer Society., Competing Interests: The authors declare that they have no conflict of interest. Moriah Brier, Dianne Chambless, Robert Gross, Jinbo Chen, and Jun Mao do not have conflicts of interest to report., (© 2016 American Cancer Society.)

Objective: To compare cognitive-behavioral therapy (CBT), panic-focused psychodynamic psychotherapy (PFPP), and applied relaxation training (ART) for primary DSM-IV panic disorder with and without agoraphobia in a 2-site randomized controlled trial., Method: 201 patients were stratified for site and DSM-IV agoraphobia and depression and were randomized to CBT, PFPP, or ART (19-24 sessions) over 12 weeks in a 2:2:1 ratio at Weill Cornell Medical College (New York, New York) and University of Pennsylvania ("Penn"; Philadelphia, Pennsylvania). Any medication was held constant., Results: Attrition rates were ART, 41%; CBT, 25%; and PFPP, 22%. The most symptomatic patients were more likely to drop out of ART than CBT or PFPP (P = .013). Outcome analyses revealed site-by-treatment interactions in speed of Panic Disorder Severity Scale (PDSS) change over time (P = .013). At Cornell, no differences emerged on improvement on the primary outcome, estimated speed of change over time on the PDSS; at Penn, ART (P = .025) and CBT (P = .009) showed greater improvement at treatment termination than PFPP. A site-by-treatment interaction (P = .016) for a priori-defined response (40% PDSS reduction) showed significant differences at Cornell: ART 30%, CBT 65%, PFPP 71% (P = .007), but not at Penn: ART 63%, CBT 60%, PFPP 48% (P = .37). Penn patients were more symptomatic, differed demographically from Cornell patients, had a 7.2-fold greater likelihood of taking medication, and had a 28-fold greater likelihood of taking benzodiazepines. However, these differences did not explain site-by-treatment interactions., Conclusions: All treatments substantially improved panic disorder with or without agoraphobia, but patients, particularly the most severely ill, found ART less acceptable. CBT showed the most consistent performance across sites; however, the results for PFPP showed the promise of psychodynamic psychotherapy for this disorder., Trial Registration: ClinicalTrials.gov identifier: NCT00353470., (© Copyright 2016 Physicians Postgraduate Press, Inc.)

Objective: The contributions of disorder severity, comorbidity and interpersonal variables to therapists' adherence to a cognitive-behavioural treatment (CBT) manual were tested., Method: Thirty-eight patients received panic control therapy (PCT) for panic disorder. Trained observers watching videotapes of the sixth session of a 24-session protocol rated therapists' adherence to PCT and their use of interventions from outside the CBT model. Different observers rated patients' behavioural resistance to therapy in the same session using the client resistance code. Interview measures obtained before treatment included the Panic Disorder Severity Scale, the anxiety disorders interview schedule for Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV and the structured clinical interview for DSM-IV, Axis II. Questionnaire measures were the anxiety sensitivity index at intake, and, at session 2, the therapist and client versions of the working alliance inventory-short form., Results: The higher the patients' resistance and the more Axis II traits a patient had, the less adherent the therapist. Moreover, the more resistant the client, the more therapists resorted to interventions from outside the CBT model. Stronger therapist and patient alliance was also generally related to better adherence, but these results were somewhat inconsistent across therapists. Pretreatment disorder severity and comorbidity were not related to adherence., Conclusions: Interpersonal variables, particularly behavioural resistance to therapy, are related to therapists' ability to adhere to a treatment manual and to their use of interventions from outside of the CBT model. Copyright © 2015 John Wiley & Sons, Ltd., Key Practitioner Message: Patients' behavioural resistance to therapy may make it more difficult for cognitive-behavioural clinicians to adhere to a structured treatment protocol and more likely for them to borrow interventions from outside the CBT model. Patients' Axis II traits may make adherence to treatment CBT protocol more difficult, although whether this is true varies across therapists. Therapists' adherence to a structured protocol and borrowing from outside of the CBT model do not appear to be affected by disorder severity or Axis I comorbidity., (Copyright © 2015 John Wiley & Sons, Ltd.)

Background: Despite the considerable efficacy of cognitive-behavioral therapy (CBT) for panic disorder (PD) and agoraphobia, a substantial minority of patients fail to improve for reasons that are poorly understood., Objective: The aim of this study was to identify consistent predictors and moderators of improvement in CBT for PD and agoraphobia., Data Sources: A systematic review and meta-analysis of articles was conducted using PsycInfo and PubMed. Search terms included panic, agoraphobi*, cognitive behavio*, CBT, cognitive therapy, behavio* therapy, CT, BT, exposure, and cognitive restructuring., Study Selection: Studies were limited to those employing semi-structured diagnostic interviews and examining change on panic- or agoraphobia-specific measures., Data Extraction: The first author extracted data on study characteristics, prediction analyses, effect sizes, and indicators of study quality. Interrater reliability was confirmed., Synthesis: 52 papers met inclusion criteria. Agoraphobic avoidance was the most consistent predictor of decreased improvement, followed by low expectancy for change, high levels of functional impairment, and Cluster C personality pathology. Other variables were consistently unrelated to improvement in CBT, understudied, or inconsistently related to improvement., Limitations: Many studies were underpowered and failed to report effect sizes. Tests of moderation were rare., Conclusions: Apart from agoraphobic avoidance, few variables consistently predict improvement in CBT for PD and/or agoraphobia across studies., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: Panic disorder (PD) is associated with significant personal, social, and economic costs. However, little is known about specific interpersonal dysfunctions that characterize the PD population. The current study systematically examined these interpersonal dysfunctions., Method: The present analyses included 194 patients with PD out of a sample of 201 who were randomized to cognitive-behavioral therapy, panic-focused psychodynamic psychotherapy, or applied relaxation training. Interpersonal dysfunction was measured with the Inventory of Interpersonal Problems-Circumplex (Horowitz, Alden, Wiggins, & Pincus, 2000)., Results: Individuals with PD reported greater levels of interpersonal distress than that of a normative cohort (especially when PD was accompanied by agoraphobia), but lower than that of a cohort of patients with major depression. There was no single interpersonal profile that characterized PD patients. Symptom-based clusters (with vs. without agoraphobia) could not be discriminated on core or central interpersonal problems. Rather, as revealed by cluster analysis based on the pathoplasticity framework, there were 2 empirically derived interpersonal clusters among PD patients that were not accounted for by symptom severity and were opposite in nature: domineering-intrusive and nonassertive. The empirically derived interpersonal clusters appear to be of clinical utility in predicting alliance development throughout treatment: Although the domineering-intrusive cluster did not show any changes in the alliance throughout treatment, the nonassertive cluster showed a process of significant strengthening of the alliance., Conclusions: Empirically derived interpersonal clusters in PD provide clinically useful and nonredundant information about individuals with PD., ((c) 2015 APA, all rights reserved).)

Background: Breast cancer survivors on aromatase inhibitors often experience joint pain as a side effect of their treatment; qualitative investigations suggest that this arthralgia may cause women to feel that they are aging faster than they should be. To facilitate further study of this experience, the Penn Arthralgia Aging Scale (PAAS) was developed. This report describes the development and validation of the PAAS in a racially diverse sample of breast cancer survivors suffering from joint pain., Methods: The items of the scale were developed from a content analysis of interviews with patients. The scale was pilot-tested, and modifications were made on the basis of patient feedback. Subsequently, 596 breast cancer survivors who endorsed joint pain completed the 8-item PAAS. The factor structure (with exploratory factor analysis), the internal consistency, and the convergent, divergent, and incremental validity were examined., Results: The resulting scale had a 1-factor structure with strong internal consistency (Cronbach's α = .94) and demonstrated both convergent and divergent validity: the PAAS was significantly correlated with joint pain severity (rs = 0.55, P < .01) and had a small and nonsignificant correlation with actual age (rs  = -0.07, P = .10). The PAAS was also found to explain incremental variance in anxiety, depression, and pain interference outcomes., Conclusions: These findings suggest that the PAAS produces reliable and valid scores that capture perceptions of aging due to arthralgia among breast cancer survivors. With further research, the PAAS may advance our understanding of how perceptions of aging may affect breast cancer survivors' emotional, behavioral, and clinical outcomes., (© 2015 American Cancer Society.)

Laska, Gurman, and Wampold (2014, pp. 467-481) present their common factors (CF) model as an alternative/complement to existing empirically supported treatments. The CF model is largely based on nonrandomized studies and a post hoc interpretation of a lack of differences between psychotherapies in their outcomes. Our view is that the CF model would be advanced through randomized experiments that test the specific components that Laska et al. (2014) hypothesize as necessary and sufficient for change. With some notable exceptions, we agree with many of the points made by Laska et al. (2014) regarding the relevance of the CF perspective to the delivery of psychotherapy in general, but suggest that prospective studies that control for potential confounds are needed to successfully advance the CF model or any other model of psychotherapy.

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

Objectives: To determine whether social anxiety covaries with satisfaction, social support, and intimacy in romantic relationships., Method: Undergraduates and their romantic partners (N = 163) completed self-report questionnaires., Results: Higher social anxiety in women, but not men, was associated with wanting, receiving, and providing less support, based on self- but not partner-report measures. Women higher in social anxiety also reported being less satisfied in their romantic relationships and self-disclosing less to romantic partners than women lower in social anxiety. Further, self-reported received support mediated the relationship between social anxiety and romantic relationship satisfaction in women. In both sexes, higher social anxiety was related to perceiving intimacy as riskier and romantic relationships as less emotionally intimate., Conclusions: Together, results suggest that social anxiety is associated with interpersonal difficulty even in established romantic relationships., (© 2013 Wiley Periodicals, Inc.)

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

We introduce the Journal of Clinical Psychology: In Session issue on couple and family therapies for adult psychological problems and health-compromising behaviors. The 8 articles, each with an extensive case study, represent different theoretical orientations (cognitive-behavioral, psychoeducational, systemic-strategic, experiential) and address problems with depression, anxiety, severe mental illness, substance use disorders, and dysfunctional coping with chronic illness. We identify points of consensus and divergence among the different therapies and consider implications for training psychotherapists., (© 2012 Wiley Periodicals, Inc.)

Family-focused therapy for anxiety disorders (FFT-AD), a flexible couple/family treatment provided in conjunction with cognitive-behavioral therapy (CBT) for anxiety disorders, is described. The treatment is based upon research showing that anxious patients are more likely to drop out of or fare poorly in CBT when they live with a family member who is hostile toward or emotionally over-involved with the patient, accommodates excessively to the patient's anxiety, or is perceived by the patient to be destructively critical. An adaptation of FFT for bipolar disorder, the treatment is intended for patients with anxiety disorders, regardless of their specific disorder type. FFT-AD is illustrated with two cases., (© 2012 Wiley Periodicals, Inc.)

This article presents the results of a qualitative analysis of interviews with 25 psychologists in independent practice, investigating everyday treatment decisions and attitudes about treatment outcome research and empirically supported treatments (ESTs). Clinicians noted positive aspects about treatment outcome research, such as being interested in what works. However, they had misgivings about the application of controlled research findings to their practices, were skeptical about using manualized protocols, and expressed concern that nonpsychologists would use EST lists to dictate practice. Clinicians reported practicing in an eclectic framework, and many reported including cognitive-behavioral elements in their practice. To improve their practice, they reported valuing clinical experience, peer networks, practitioner-oriented books, and continuing education when it was not too basic. Time and financial barriers concerned nearly all participants. Clinicians suggested they might be interested in ESTs if they could integrate them into their current frameworks, and if resources for learning ESTs were improved.

To identify barriers to the dissemination of empirically supported treatments (ESTs), a random sample of psychologists in independent practice (N=1291) was asked to complete measures of attitudes towards ESTs and willingness to attend a 3-hour, 1-day, or 3-day workshop in an EST of their choice. The strongest predictor of unwillingness to obtain EST training was the amount of time and cost required for the workshop, followed by objections to the need for EST training. Psychodynamic (compared to cognitive-behavioral) and more experienced practitioners agreed more strongly with the objections to ESTs overall, as did those whose graduate schools had not emphasized psychotherapy research. Results suggest that both practical and theoretical barriers are significant obstacles to EST dissemination., (© 2011 Wiley Periodicals, Inc.)

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

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

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

Isolated sleep paralysis (ISP) has received scant attention in clinical populations, and there has been little empirical consideration of the role of fear in ISP episodes. To facilitate research and clinical work in this area, the authors developed a reliable semistructured interview (the Fearful Isolated Sleep Paralysis Interview) to assess ISP and their proposed fearful ISP (FISP) episode criteria in 133 patients presenting for panic disorder treatment. Of these, 29.3% met lifetime ISP episode criteria, 20.3% met the authors' lifetime FISP episode criteria, and 12.8% met their recurrent FISP criteria. Both ISP and FISP were associated with minority status and comorbidity. However, only FISP was significantly associated with posttraumatic stress disorder, body mass, anxiety sensitivity, and mood and anxiety disorder symptomatology., (© 2010 Wiley Periodicals, Inc.)

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

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

It has been repeatedly demonstrated that clinicians rely more on clinical judgment than on research findings. We hypothesized that psychologists in practice might be more open to adopting empirically supported treatments (ESTs) if outcome results were presented with a case study. Psychologists in private practice (N=742) were randomly assigned to receive a research review of data from randomized controlled trials of cognitive-behavioral treatment (CBT) and medication for bulimia, a case study of CBT for a fictional patient with bulimia, or both. Results indicated that the inclusion of case examples renders ESTs more compelling and interests clinicians in gaining training. Despite these participants' training in statistics, the inclusion of the statistical information had no influence on attitudes or training willingness beyond that of the anecdotal case information.