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Perfectionistic cognitions are thinking patterns that reflect excessive striving and are associated with emotional disorders in nonclinical samples. Despite literature connecting trait perfectionism with psychological disorders, much remains unknown about how perfectionistic cognitions relate to anxiety disorder symptoms in clinical populations. This is the first study to our knowledge that investigates how symptoms of anxiety and related symptoms are influenced by the frequency of perfectionistic cognitions when controlling for well documented correlates of anxiety. Perfectionistic cognitions, depressive symptoms, emotion regulation, anxiety sensitivity, and anxiety symptom severity were assessed prior to starting treatment in 356 treatment-seeking patients diagnosed with an anxiety or anxiety-related disorder at a specialty anxiety clinic. Perfectionistic cognitions were significantly correlated with all anxiety symptom measures as well as measures of depression, emotion regulation and anxiety sensitivity (range of rs =.22-.68). Hierarchical regression analyses revealed that when controlling for depressive symptoms, anxiety sensitivity, and emotion regulation, perfectionistic cognitions significantly and uniquely contribute to the variance of GAD (p .01) and PTSD (p .05) symptoms but not other anxiety-related symptoms (all ps.05). Regardless of specific diagnoses, treatment-seeking individuals reporting frequent perfectionistic thoughts are more likely to report more severe symptoms of PTSD and GAD.

OBJECTIVE/BACKGROUND: Few studies have examined the relationship between insomnia and anxiety treatment outcomes in naturalistic settings. Furthermore, prior studies typically examine insomnia within a single anxiety diagnosis without accounting for the high overlap between disorders. Here we investigate the association between insomnia and multiple anxiety disorders over a course of cognitive behavioral treatment (CBT) in a naturalistic treatment setting. PARTICIPANTS: Insomnia was assessed in 326 patients seeking treatment at a clinic specializing in CBT for anxiety. METHODS: Multilevel modeling was used to investigate whether insomnia moderated reductions in anxiety symptoms. A cross-lagged analysis tested for bidirectional effects between insomnia and anxiety. Multiple regression was used to investigate the relationship between insomnia and anxiety while controlling for the other anxiety disorders and depression. RESULTS: While there was a significant reduction in insomnia during treatment in all anxiety disorders, the majority of the most severe patients remained in the clinical range at post-treatment. Baseline insomnia did not significantly moderate anxiety outcomes, suggesting that patients with high or low levels of insomnia will do equally well in CBT for anxiety. The bidirectional effect between insomnia and anxiety did not reach significance. Additionally, posttraumatic stress disorder, generalized anxiety disorder, and panic disorder were associated with the greatest endorsement of insomnia, after controlling for the overlap between disorders. CONCLUSIONS: Sleep problems may persist after anxiety treatment, suggesting that CBT for insomnia may be warranted during or after a course of CBT for anxiety. Importantly, baseline insomnia does not impede anxiety reduction during CBT.

Negative cognitions about oneself, others, and the world are central to the development and maintenance of posttraumatic stress disorder (PTSD). We provide a comprehensive review of the literature examining the change in post-trauma negative cognitions in PTSD treatments. We explore the association between change in cognitions and change in PTSD symptoms and the mediational effect of negative cognitions on PTSD symptoms. A review of over 2000 manuscripts resulted in 65 PTSD treatment articles for review that included a measure of negative post-trauma cognitions and PTSD severity. Several studies found that PTSD treatments are associated with concurrent reductions in PTSD symptoms and negative post-trauma cognitions. Many studies suggest that the degree of reduction in negative post-trauma cognitions is both associated with the degree of reduction in PTSD symptoms and may mediate the change in PTSD symptoms in treatment. PTSD treatments are associated with significant improvements in negative post-trauma cognitions that often precede and predict reductions in PTSD symptoms.

OBJECTIVE: Adolescents with posttraumatic stress disorder (PTSD) are at higher risk for suicide compared to adolescents without PTSD. This study aimed to explore whether PTSD treatment reduces suicidal ideation in adolescents, and whether the degree of reduction in PTSD was associated with reduction in suicidal ideation. METHODS: Adolescent females with PTSD from a sexual assault (55% Black, 15.3 years, SD = 1.5) were randomized to either prolonged exposure therapy for adolescents (PE-A, n = 31) or client-centered therapy (CCT, n = 30). They reported on suicidal ideation, depression and PTSD at pre- and post-treatment, every therapy session, and follow-up, and about 40% endorsed suicidal ideation at baseline. RESULTS: There was a significant reduction in a single-item measure of suicidal ideation during treatment across all participants. The Time in Treatment × Condition interaction was significant (p < .05, d = 0.52), indicating a significantly steeper reduction in suicidal ideation in PE-A compared to in CCT. The degree of reduction in PTSD (ps < .05, d = 0.26 – 0.54) and depression symptoms (ps < .05, d = 0.54 – 0.81) in treatment and follow-up was associated with the speed of suicidal ideation reduction in treatment and follow-up. CONCLUSIONS: Adolescents randomized to PE-A had significantly faster reductions in suicidal ideation compared to those randomized to CCT. Greater reduction in PTSD and depression symptoms was associated with faster reduction in suicidal ideation. Clinically, this study demonstrates that adolescents who have suicidal ideation without current intent may benefit from PE-A.