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Attachment Insecurity, Emotion Regulation Difficulties, and Mindfulness Deficits in Personality Pathology
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A growing body of research has documented associations between personality disorders (PDs) and attachment disturbance, and yet, attachment disturbance does not necessarily guarantee the development of PD pathology. Thus, understanding the mechanisms mediating the relationship between attachment disturbance and PD pathology remains an open area of research. One area with sound theoretical and empirical evidence has shown that attachment disturbances are associated with emotion regulation difficulties, as well as maladaptive interpersonal patterns of behavior. However, the research conducted thus far has predominately focused on borderline personality disorder, at the exclusion of other PD domains, and also has not broadened the scope of research to include other relevant psychological processes that may clarify how personality pathology and attachment disturbance are interrelated. Using a large independent sample of college (n = 946) and community-based individuals (n = 271), the current study aimed to (1) examine how the Personality Inventory for DSM-5 (PID-5) PD trait domains would be differentially associated with maladaptive attachment processes and emotion regulation problems, and (2) explore whether deficits in mindfulness and emotion regulation mediated the relationship between disturbed attachment and PD trait domains. Findings suggested that the PID-5 PD trait domains have general and specific relations to attachment insecurity, impairments in emotion regulation, and decreased mindfulness. Overall, the current study suggests that improving emotion regulation skills and increasing dispositional mindfulness may limit the expression of pathological personality traits. Implications of these findings and directions for future research are discussed.
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Attitudes about Caregiving: An Ethnicity by Generation Approach
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The goal of this project was to understand ethnic and generational differences in attitudes towards caregiving and expected burden while taking into consideration factors such as gender, generation, familism, and acculturation. One hundred and sixteen young adults (ages 18-25) and 93 middle-age adults (ages 38-62) were enrolled in the study. Participants included European Americans, African Americans, and Hispanics. Using moderation analysis, two hypotheses were investigated: 1) Ethnicity relates to attitudes towards caregiving, moderated by gender, generation, familism, and acculturation. 2) Ethnicity and expected burden relate to each other, moderated by gender, generation, familism, and acculturation. Familism emerged as a moderator in the relationship between ethnicity and expected burden. Results suggested that the strength of the relationship between being African American and expecting burden was less for those with moderate familism (R =.078), slightly higher for low familism (R = .176), and the highest for high familism (R= .261). Additional results indicated that the strength of the relationship between being Hispanic, as opposed to being European American, and expected burden, was higher for middle-aged adults (R =.23) when compared to young adults (R =.19). The current findings lend support to the recently established idea that familism is not protective against burden as it increases one's sense of obligation towards family (Knight & Sayegh, 2010).
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A Comparison of Treatments for Posttraumatic Stress Disorder Symptoms: Memory Specificity Training (MeST) and Cognitive Processing Therapy (CPT)
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The effectiveness of memory specificity training (MeST) was compared with standard cognitive processing therapy (CPT) in treatment of individuals with posttraumatic stress disorder. Eighteen adults aged 18-36 were randomly assigned to the MeST intervention (n = 9) or to the active control group (n = 9) of CPT. Both treatments were administered in group format across 6 weeks. MeST consisted of 6 weekly sessions, while CPT consisted of 12 biweekly sessions. The trial was undertaken in the Psychology Clinic of the University of North Texas, with randomization to conditions accomplished via computer random number generator. The primary outcome measure was change in PTSD symptoms post-treatment from baseline. Sixteen individuals (13 women and 3 men; MeST n = 8 and CPT n = 8) completed treatment and their data was analyzed. MeST significantly decreased PTSD symptomology at post-treatment and these results were maintained at 3 months post-treatment. MeST was found to be as effective as the established CPT intervention at reducing PTSD symptomology. Both MeST and CPT significantly increased participants' ability to specify memories upon retrieval at post-treatment, with results maintained at follow-up. There were no significant effects of MeST or CPT in ability to increase overall controlled cognitive processing at post-treatment or follow-up. No individual in either group reported any adverse effects during treatment or at 3 months follow-up. MeST appears to hold promise as an efficacious treatment option for PTSD. MeST was as effective as CPT in reducing symptoms of PTSD, but required only half the number of treatment sessions to accomplish these gains. Replication of these findings in larger samples is encouraged.
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Eight-Year Course of Cognitive Functioning in Bipolar Disorder with Psychotic Features
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The purpose of the current study was to examine neuropsychological functioning in patients with bipolar disorder (BD) with psychotic features. Data from a large, epidemiological study of patients with first-episode psychosis was used to examine verbal learning and working memory 10 years after onset of psychosis in patients with BD relative to patients with schizophrenia (SZ) and patients with psychotic major depressive disorder (MDD). Cross-sectional comparisons of verbal learning and working memory at the 10-year follow-up mirrored findings of relative performance at the 2-year follow-up (Mojtabai, 2000), as patients with SZ performed significantly worse than patients with psychotic affective disorders. When FEP patients' cognitive performance was examined longitudinally, all groups showed non-significant decline over time, with no significant diagnostic group differences after accounting for current symptoms. More frequent hospitalizations and longer treatment with antipsychotics were associated with poorer performance on cognitive testing 10 years after illness onset, but these associations disappeared when controlling baseline cognitive performance. Within the BD sample, current positive and negative psychotic symptoms were associated with poorer performance on cognitive testing. After controlling for baseline cognitive performance, markers of clinical course were unrelated to cognitive performance, consistent with existing literature on longitudinal cognitive functioning in patients with BD. The current findings support a neurodevelopmental model of verbal learning and working memory deficits in patients with bipolar disorder.
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Feigning ADHD: Effectiveness of Selected Assessment Tools in Distinguishing Genuine from Simulated ADHD
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Research indicates that some college students may be strongly motivated to feign AHDD symptoms for desired external incentives, such as stimulant medication or academic accommodations. To date, literature examining feigned ADHD has been primarily focused on ADHD specific self-report measures (e.g., CAARS) and continuous performance tests (e.g., CPTs); however, little attention has been devoted to the use of multi-scale inventories in detecting feigned ADHD. For CPT measures, virtually no literature exists on the effectiveness of the TOVA to identify feigned ADHD, despite its frequent clinical use for establishing this diagnosis. The current study utilized a between-subjects simulation design to validate feigning cut scores on ADHD-specific measures using 66 feigners and 51 confirmed ADHD cases. As prior literature suggested, the results convincingly demonstrated that face-valid ADHD assessment measures were easily faked. Across both TOVA modalities (e.g., Auditory and Visual), the ADHD simulators performed significantly poorer than those diagnosed with ADHD. As an innovative approach, a Dissimulation-ADHD (Ds-ADHD) scale was developed and initially validated. The Ds-ADHD is composed of ten MMPI-2-RF items mistakenly believed to be clinical characteristics associated with ADHD. Requiring cross-validation, Ds-ADHD optimized cut scores and classification of ADHD feigners appears promising. They were clearly distinguishable from ADHD client, as well as those feigning general psychopathology. Recommendations for the utilization of the Ds-ADHD scale, and future directions for research are discussed.
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Phases of Change in Psychotherapy Across Levels of Clinician Training
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Given the alarmingly high rates of premature termination in training clinics, research aimed at understanding the course of change and treatment outcomes in training clinics deserves considerable attention. Additionally, more research is needed to understand the effectiveness of psychotherapy training and whether more training is actually associated with better client outcomes. Thus, this study sought to investigate whether clinicians' level of training and experience were related to a variety of clients' outcomes (e.g., well-being, symptom reduction, and life functioning) based on the phase model of psychotherapy. Unfortunately, confirmatory factor analysis of the OQ45.2 did not support the three-factor conceptual model paralleling the phase model. Rather, a two-factor model of best fit was identified. Neither clinicians' level of clinical training nor therapeutic orientation were found to be related to client improvements. However, this finding may have been attenuated by limited variance in client outcomes. Implications for clinical training and future outcome research methodologies are discussed.
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Using Pre-Session Mindfulness to Improve Session Presence and Effectiveness: A Randomized-Controlled Trial
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While a significant amount of research illustrates the overall positive effects of therapists' general use of mindfulness, very few studies have addressed whether therapists' use of mindfulness translates to improved psychotherapy outcomes. The present study utilized a randomized-controlled design to test whether a brief mindfulness training program and pre-session mindfulness practice could have a positive impact on therapy; in particular, we hypothesized that mindfulness training and practice would improve ratings on therapeutic presence as rated by clients and therapists and session effectiveness as rated by clients. The present study also examined whether clients' subjective ratings of therapy outcome and therapists' theoretical orientation impacted outcome measures after therapists completed mindfulness training. The 20 participating therapists were randomly assigned to either the mindfulness training (MT) group or control group according to a computer generated randomization list. Results indicated that clients did not significantly improve on outcome measures after completing the mindfulness training. Clients' subjective ratings on a psychotherapy outcome measure did predict changes in their ratings of therapeutic presence. This finding may have important implications for future research examining client characteristics that may moderate the relationship between therapeutic presence and session outcomes. Limitations of the present study and future directions are discussed.