Written exposure therapy (WET) is a brief, manualized trauma‐focused treatment typically delivered in five individual weekly sessions. Given the brevity and effectiveness of WET, researchers have ...begun to focus on its delivery in a massed format. However, only one case study examining massed delivery has been published to date. As such, the objective of the current study was to examine the acceptability, feasibility, and preliminary effectiveness of massed WET among veterans with a trauma‐ and stressor‐related disorder receiving care on an acute inpatient mental health unit. Veterans (N = 26) were assessed prior to, immediately after, and 1 month following massed WET. Most veterans found massed WET to be useful and acceptable. Recruitment and retention rates suggested that the treatment was feasible. Notably, the results revealed statistically significant reductions in overall posttraumatic stress symptoms, ηp2 = .81, p < .001; depressive symptoms, ηp2 = .71, p < .001; and functional impairment, ηp2 = .42, p = .002. These findings add to a growing body of literature highlighting the preliminary effectiveness of WET across various settings, populations, and delivery formats. Limitations include the small sample size and uncontrolled design.
Objective: Diagnosis is a cornerstone of clinical practice for mental health care providers, yet traditional diagnostic systems have well-known shortcomings, including inadequate reliability, high ...comorbidity, and marked within-diagnosis heterogeneity. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a data-driven, hierarchically based alternative to traditional classifications that conceptualizes psychopathology as a set of dimensions organized into increasingly broad, transdiagnostic spectra. Prior work has shown that using a dimensional approach improves reliability and validity, but translating a model like HiTOP into a workable system that is useful for health care providers remains a major challenge. Method: The present work outlines the HiTOP model and describes the core principles to guide its integration into clinical practice. Results: Potential advantages and limitations of the HiTOP model for clinical utility are reviewed, including with respect to case conceptualization and treatment planning. A HiTOP approach to practice is illustrated and contrasted with an approach based on traditional nosology. Common barriers to using HiTOP in real-world health care settings and solutions to these barriers are discussed. Conclusions: HiTOP represents a viable alternative to classifying mental illness that can be integrated into practice today, although research is needed to further establish its utility.
What is the public health significance of this article?
Redefining a taxonomy of psychopathology according to data results in dimensions, not categories, that can be organized hierarchically-with at least six higher level spectra near the top of the model and more specific lower level components and traits at the bottom. This approach may improve case conceptualizations and align more closely with transdiagnostic treatments, while also specifying more narrow targets for intervention. A case illustration shows how the HiTOP model can be used in clinical practice today, although additional research is needed to fully assess the utility of this approach for providers and patients.
Maternal depression predicts attachment insecurity in children, but parental bipolar disorder effects are less clear, particularly as children emerge into young adulthood. We assessed attachment in ...young adult children of parents with bipolar disorder (vs. depression and no mood disorder). Participants completed romantic attachment and retrospective parenting behavior self-reports, and semi-structured diagnostic interviews. Young adults with parental bipolar disorder endorsed more Avoidant and Anxious attachment, with father relationship quality partially mediating the effect. Results underscore the association of parental mood disorders with offspring attachment in emerging adulthood and highlight the importance of fathers in this dynamic.
The behavioral activation system (BAS), a putative neurobiological system guiding approach-related behavior and linked with increased risk for bipolar disorder, has long been associated with positive ...affect (PA). However, PA is multi-faceted, and little is known about BAS sensitivity's relationship to lower level PA facets, nor whether any such associations manifest prospectively in daily life or interact with environmental rewards. The present study mapped the relationship between BAS sensitivity and distinct facets of PA both cross-sectionally and across 7 days. Young adults (N = 265) completed measures of BAS sensitivity and affect at baseline, followed by one week of thrice daily surveys of daily affect and reward engagement. Exploratory factory analysis confirmed the multidimensional nature of PA (i.e., Serenity, Joviality, Attentiveness, Self-Assurance). Heightened BAS sensitivity predicted greater daily levels of Joviality and Self-Assurance, but not Serenity. BAS did not significantly moderate daily reactions to rewarding events, although there were trends in this direction. Findings support a multi-faceted structure of PA and suggest that only certain facets of PA may be related to BAS hypersensitivity. Findings point to potential clinical implications for discriminating among different types of positive affect.
Positive affect, which has been broken down into four lower-level facets (i.e., joviality, attentiveness, self-assurance, serenity), has demonstrated numerous ties to physical and mental health. The ...experience of positive affect can be regulated by emotion regulation strategies. However, few studies have assessed their relationship, and no studies have examined the relationship using the lower level facets of positive affect. The link between positive affect and emotion regulation may be of particular importance for individuals at increased risk for bipolar disorder, as both are disrupted in individuals with the condition. The aim of the present study was to examine the relationship between positive affect and emotion regulation while also exploring whether risk for bipolar disorder moderated their relationship. Undergraduates (N = 155) completed measures of emotion regulation, affect, and bipolar disorder risk at baseline. Using ecological momentary assessment (EMA), participants completed surveys 3 times a day for 7 days. Hierarchical linear models were estimated and revealed significant effects between certain baseline emotion regulation tendencies (experiential avoidance/ psychological inflexibility, rumination, behavioral social avoidance) and daily positive affect facets as well as between daily emotion regulation use (i.e., reappraisal, acceptance, reflection, savoring, mindfulness social support, suppression, rumination, procrastination) and daily positive affect facets. Bipolar disorder risk was not found to moderate the relationship. Findings support the use of strategies emphasized in evidence-based treatments and highlight the importance of daily practice of emotion regulation skills.
Objective: The ability to experience positive affect (PA) has clinical and quality of life implications, particularly in vulnerable populations such as trauma-exposed disaster responders. Low PA is ...included in the diagnostic criteria for posttraumatic stress disorder (PTSD), however evidence for PA reduction in PTSD has been mixed. In contrast, negative affect (NA) has consistently been found to be elevated among individuals with PTSD. Multiday, ecological momentary assessment (EMA) can provide more ecologically valid evidence about experiences of affect; however, no such studies have been conducted in traumatized individuals with PTSD to date. Method: World Trade Center (WTC) responders (N = 202) oversampled for the presence of PTSD were recruited from the WTC Health Program. Participants were administrated the Structured Clinical Interview for DSM-IV and the PTSD Checklist for DSM-5 at baseline, then completed EMA surveys of affect four times a day over seven consecutive days. Results: Participants with current PTSD (19.3% of the sample) showed significantly higher levels of daily NA compared with those without PTSD. However, there was no group difference in daily PA, nor was PA associated with a dimensional measure of PTSD. Conclusion: Results suggest that for chronic PTSD among disaster responders, positive emotions are not inhibited across daily living. Such findings add to evidence suggesting that PA reduction may not be diagnostically relevant to PTSD, whereas NA remains an important target for therapeutic interventions. Moreover, results show that WTC responders can experience and benefit from positive emotion, even if they continue to have PTSD symptoms.
Clinical Impact Statement
First responders with posttraumatic stress disorder (PTSD) experience daily levels of positive affect that are similar to those without the disorder. Given the numerous health benefits associated with the ability to experience positive affect, findings suggest that even after experiencing significant trauma, disaster responders with PTSD can nevertheless benefit from interventions that promote positive affect. Moreover, results underscore how circadian patterns of affect can be anticipated and addressed in treatment of PTSD.
Traditional categorization of emotional disorders suffers from within-disorder heterogeneity and excessive comorbidity. Quantitative nosology instead proposes grouping homogenous components of these ...disorders within a higher order internalizing dimension. However, the precise number, composition, and hierarchical structure of these components remains unclear and varies based on assessment tools.
The present study jointly examined two assessment systems with the broadest coverage of homogeneous emotional disorder components—the revised Interview for Mood and Anxiety Symptoms (IMAS-R) and the self-report-based expanded version of the Inventory of Depression and Anxiety Symptoms (IDAS-II)—to map their convergent and discriminant validity and joint structure in outpatient (N=426) and treated student (N=306) samples.
Results identified 33 non-redundant components of emotional disorders. Most demonstrated strong convergent and discriminant validity between these two instruments. However, the IMAS-R provided more detailed and differentiated characterization of the content subsumed within three IDAS-II scales, and seven of the 33 components were unique to one measure or the other. Joint analysis of scales from both measures supported a four factor (i.e., distress, fear, OCD, mania) mid-level structure of emotional disorders.
Using multiple measures, methods, and samples, the present study provided evidence for the validity of core lower order components of the internalizing dimension and suggested they cluster into as many as four distinct factors reflecting distress, fear, OCD, and mania.
•Hypomanic personality traits are associated with positive attention bias.•Attention bias exists only for early orientation, not prolonged gaze.•Initial orientation effects persist even after ...controlling for mania and depression.•.
Previous research has identified altered processing of emotional information associated with the bipolar spectrum, but results have been inconsistent. The current study assessed whether hypomanic personality traits, a potential indicator of bipolar risk, are associated with biases in attention to emotional facial stimuli, even after controlling for mood state.
Participants (N = 135) completed measures assessing current mood symptoms, positive and negative affect, and hypomanic personality traits. They then completed an eye-tracking task measuring two indices of attention (i.e., mean initial orientation latency, mean total gaze duration) for happy, sad, angry, and neutral facial expressions.
Even after controlling for mood state, hypomanic personality traits were associated with a bias for emotion faces as well as a trend towards faster orientation to happy facial expressions.
Due to relatively low levels of mania in this sample, further work is needed to assess the extent to which these effects exist at clinical levels of depression or mania. Additionally, further work is needed to determine if such a bias represents a risk factor for the development of bipolar disorder.
Hypomanic personality traits appear to be associated with differences in early attention for emotional information.
Bipolar disorder is characterized by disruptions in mood and affect that occur not only during mood episodes, but during euthymic periods as well. At the same time, sensitivity of the behavioral ...activation system (BAS) has been implicated in the disorder and is a risk marker for it. Less clear is the relationship between BAS sensitivity and positive affect, particularly lower level facets of positive affect. The aim of the present study was to examine the relationship between positive affect and vulnerability for mania as assessed using BAS sensitivity. Specifically, the link between daily levels and fluctuations of positive affect and baseline BAS sensitivity was examined. Following the hierarchical model of affect, this study also assessed the relationship between BAS sensitivity and the distinct facets of positive affect. Finally, this study examined whether BAS sensitivity moderates associations between daily rewards and positive affect. Undergraduates (N = 265) from a large university in the South were recruited to complete measures of BAS sensitivity, affect, and mood symptoms at baseline. Using ecological momentary assessment (EMA), participants completed daily surveys assessing affect and engagement with rewarding situations. An exploratory factory analysis revealed a four factor structure of positive affect, consisting of Serenity, Joviality, Attentiveness, and Self-Assurance. Greater daily levels of overall positive affect, as well as the lower order facets of Joviality, Self-Assurance, and Attentiveness, were predicted by heightened BAS sensitivity. In contrast, the facet of Serenity demonstrated minimal associations with BAS sensitivity. The study findings support a multi-faceted structure of positive affect and suggest that certain facets may be more closely related to risk for bipolar disorder. Specifically, Joviality and Self-Assurance may represent maladaptive forms of positive affect, whereas Serenity may function as a protective element against bipolar disorder.
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