Differences and similarities between intrusive thoughts typical of obsessive–compulsive disorder, generalized anxiety disorder, and hypochondriasis are relevant for their differential diagnosis, ...formulation, and psychological treatment. Previous research in non‐clinical samples pointed out the relevance of some process variables, such as responsibility, guilt, or neutralization strategies. This research is aimed to investigate the differences and similarities between clinical obsessions, worries, and illness intrusions in some of these process variables. A second aim is to identify models based on these variables that could reliably differentiate between them. Three groups of patients with obsessive–compulsive disorder (n = 35; 60% women, mean age 38.57), generalized anxiety disorder (n = 36; 61.1% women, mean age 41.50), and hypochondriasis (n = 34; 70.6% women, mean age 31.59) were evaluated using the Cognitive Intrusions Questionnaire—Transdiagnostic Version (Romero‐Sanchiz, Nogueira‐Arjona, Godoy‐Ávila, Gavino‐Lázaro, & Freeston, ). The results showed that some appraisals (e.g., responsibility or egodystonicity), emotions (e.g., guilt or insecurity), neutralization strategies, and other variables (e.g., verbal content or trigger from body sensation) are relevant for the discrimination between obsessions, worries, and illness intrusions. The results also showed 3 stable models based on these variables for the discrimination between these thoughts. The implication of these results in the diagnosis, formulation, and psychological treatment of obsessive–compulsive disorder, generalized anxiety disorder, and hypochondriasis is discussed.
Depression is one of the most common mental disorders and will become one of the leading causes of disability in the world. Internet-based CBT programs for depression have been classified as "well ...established" following the American Psychological Association criteria for empirically supported treatments. The aim of this study is to analyze the cost effectiveness at 12-month follow-up of the Internet-based CBT program "Smiling is fun" with (LITG) and without psychotherapist support (TSG) compared to usual care. The perspective used in our analysis is societal. A sample of 296 depressed patients (mean age of 43.04 years; 76% female; BDI-II mean score = 22.37) from primary care services in four Spanish regions were randomized in the RCT. The complete case and intention-to-treat (ITT) perspectives were used for the analyses. The results demonstrated that both Internet-based CBT interventions exhibited cost utility and cost effectiveness compared with a control group. The complete case analyses revealed an incremental cost-effectiveness ratio (ICER) of €-169.50 and an incremental cost-utility ratio (ICUR) of €-11389.66 for the TSG group and an ICER of €-104.63 and an ICUR of €-6380.86 for the LITG group. The ITT analyses found an ICER of €-98.37 and an ICUR of €-5160.40 for the TSG group and an ICER of €-9.91 and an ICUR of €496.72 for the LITG group. In summary, the results of this study indicate that the two Internet-based CBT interventions are appropriate from both economic and clinical perspectives for depressed patients in the Spanish primary care system. These interventions not only help patients to improve clinically but also generate societal savings.
clinicaltrials.gov NCT01611818.
In the context of psychological treatment, a sudden gain is a large and enduring improvement in symptom severity that occurs between two single therapy sessions. The influence of sudden gains on ...long‐term outcomes and functional impairment in anxiety disorders is not well understood, and little is known with regard to panic disorder in particular. In addition, previous research on patients with anxiety disorders has produced inconsistent results regarding the relationship between sudden gains and cognitive change. We examined the incidence of sudden gains in a large sample (n = 116) of panic disorder patients undergoing exposure‐focused cognitive‐behavioral group therapy, and compared panic severity, functional impairment, and cognitive change in patients with and without sudden gains at posttreatment and 6‐month follow‐up. Participants who experienced sudden gains displayed lower levels of panic severity and functional impairment at posttreatment and 6‐month follow‐up than those who did not experience sudden gains. However, we observed no difference in cognitive changes between groups, either at posttreatment or at follow‐up. Our results demonstrate that the beneficial effects of sudden gains on therapeutic outcomes not only extend to long‐term and functional outcome measures but are also evident in less cognitive (i.e., exposure‐focused) forms of psychological treatment.
Key Practitioner Message
Sudden gains are common in panic disorder patients undergoing exposure‐based cognitive‐behavioral group therapy.
Sudden gains during exposure‐focused therapy are linked to greater improvement in panic disorder severity and functional impairment.
The positive impact of sudden gains on panic disorder severity and functional impairment is maintained in the long term.
While individuals have many motives to gamble, one particularly risky motive for gambling is to cope with negative affect. Conflict with one's romantic partner is a strong predictor of negative ...affect, which may elicit coping motives for gambling and, in turn, gambling-related problems. Support for this mediational model was demonstrated in relation to drinking-related problems. We extended this model to gambling.
Using a cross-sectional design, we examined links between romantic conflict (Partner-Specific Rejecting Behaviors Scale), negative affect (Depression, Anxiety, and Stress Scales-21), coping gambling motives (Gambling Motives Questionnaire, coping subscale), and gambling-related problems Problem Gambling Severity Index (PGSI) in 206 regular gamblers (64% men; mean age = 44.7 years; mean PGSI = 8.7) who were in a romantic relationship and recruited through Qualtrics Panels in July 2021.
Results supported our hypothesis that the association between romantic conflict and gambling-related problems would be sequentially mediated through negative affect and coping gambling motives, β = 0.38, 95% CI 0.27, 0.39, and also showed a strong single mediation pathway through negative affect alone, β = 0.27, 95% CI 0.17, 0.38.
Negative affect and coping gambling motives partially explain the link between romantic conflict and gambling-related problems. Interventions should target both negative affect and coping gambling motives in response to romantic conflict to reduce gambling-related problems in partnered gamblers.
Abstract
Granulocyte colony–stimulating factor (G-CSF) has raised much interest because of its role in cocaine addiction in preclinical models. We explored the plasma concentrations of G-CSF in ...patients diagnosed with substance use disorder (SUD) and highly comorbid psychiatric disorders. In particular, we investigated the association between G-CSF concentrations and comorbid major depressive disorder (MDD) in patients with cocaine and alcohol use disorders (CUD and AUD, respectively). Additionally, patients with MDD but not SUD were included in the study. Three hundred and eleven participants were enrolled in this exploratory study: 136 control subjects, 125 patients with SUD (SUD group) from outpatient treatment programs for cocaine (N = 60, cocaine subgroup) and alcohol (N = 65, alcohol subgroup), and 50 patients with MDD but not SUD (MDD group) from primary-care settings. Participants were assessed based on DSM-IV-TR criteria, and a blood sample was collected to examine the plasma concentrations of G-CSF. G-CSF concentrations were negatively correlated with age in the entire sample (r = − 0.233,
p
< 0.001) but not in the patients with MDD. G-CSF concentrations were lower in patients with SUD than in controls (
p
< 0.05), specifically in the cocaine subgroup (
p
< 0.05). Patients with SUD and comorbid MDD had lower G-CSF concentrations than patients with SUD but not comorbid MDD or controls (
p
< 0.05). In contrast, patients with MDD but not SUD showed no differences compared with their controls. The negative association between G-CSF concentrations and age in the sample was not observed in patients with MDD. G-CSF concentrations were decreased in patients with SUD and comorbid MDD but not in patients with MDD. Therefore, G-CSF may be useful to improve the stratification of patients with dual diagnosis seeking treatment. Further investigation is needed to explore the impact of sex and type of drug on the expression of G-CSF.
Fifteen to 25-year-olds are the age group most likely to misuse prescription drugs. Few studies have tested theory-driven models of adolescent risk for prescription drug misuse. Moreover, rarely are ...distinct pathways to different forms of prescription drug misuse considered.
We tested mediational paths from personality to mental health symptoms to prescription drug misuse, informed by etiological models of addiction. We specified pathways from particular personality traits to unique forms of prescription drug misuse via specific mental health symptoms. We used semi-longitudinal data collected across two waves of the Co-Venture Trial. Our sample included students from 31 Canadian high schools tested in Grade 9 (
= 3,024) and again in Grade 10 (
= 2,869; 95% retention). Personality (hopelessness, anxiety sensitivity, impulsivity, sensation seeking) was assessed in Grade 9. Mental health symptoms (depression, anxiety, ADHD, conduct disorder) and prescription drug misuse (opioids, sedatives/tranquilizers, stimulants) were assessed at both time points.
Consistent with the negative affect regulation model, hopelessness was specifically associated with opioid misuse via depressive symptoms, and anxiety sensitivity was specifically associated with sedative/tranquilizer misuse via anxiety symptoms. Consistent with positive affect regulation, sensation seeking was directly associated with stimulant misuse. Consistent with the psychological dysregulation model, impulsivity was associated with stimulant misuse via ADHD symptoms. And consistent with the deviance proneness model, impulsivity was also associated with unconstrained (i.e., all three forms of) prescription drug misuse via conduct disorder symptoms.
Screening for adolescents high in hopelessness, anxiety sensitivity, sensation seeking, or impulsivity and providing them with personality-matched cognitive-behavioral interventions may be helpful in preventing or mitigating prescription drug misuse. Our results point to the specific mental health symptoms that are important to target in each of these personality-matched interventions.
Homeschooling due to COVID-19 school closures is likely to increase conflict between work and family demands, potentially leading to adverse substance-use effects. We conducted a survey with 758 ...couples focusing on homeschooling, work–family conflict, and alcohol use (April 2020). The 211 homeschooling couples reported more work–family conflict than the 547 non-homeschooling couples; there also were stronger effects on family interference with work in women. Among the homeschooling couples, homeschooling hours were associated with greater partner drinking. In distinguishable dyad analyses by gender, women’s hours homeschooling were associated with greater drinking frequency by both parents. Men’s hours homeschooling were associated with lower drinking frequency in their partners. Increased work–family conflict in homeschooling couples is particularly worrisome given its link to increased stress and poor mental health. Moreover, women’s increased drinking may impede their ability to support their families during the pandemic. Men’s increased drinking could put homeschooling mothers at risk for escalating conflict/domestic violence, given links of male drinking to intimate partner violence. Finally, the protective-partner effects of men’s homeschooling hours on women’s drinking frequency suggests that more egalitarian division of homeschooling labor may have protective cross-over effects.
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