The cognitive model of suicide proposes that biased cognitive processes contribute to suicidal thoughts and behaviors, and initial evidence suggests that attentional bias to suicide-congruent cues may predict suicidal behavior beyond established clinical risk factors. To date, much less work has explored the potential role of interpretation biases in the development and prediction of suicide risk. The present study assessed the psychometric properties, including reliability, concurrent validity, and predictive validity, of a novel adaptation of the Word Sentence Association Paradigm (WSAP) to assess suicide-suicide interpretation biases. In a sample of 239 psychiatric inpatients, including patients with no recent suicidal ideation or lifetime attempts (n = 35), those with recent suicide attempts (n = 29), and those with recent suicidal ideation (n = 174), participants completed the modified WSAP as well as self-reported suicidal ideation and attempts for the subsequent 6 months. Although the WSAP demonstrated good reliability, evidence of concurrent and prospective validity (in terms of self-reported suicidal ideation and attempts) was limited. Specifically, the clinical groups did not differ from one another on any measure of interpretation bias, nor did suicide-specific interpretation endorsements predict concurrent or future suicidal ideation when controlling for dysphoric interpretation bias. However, suicide-specific interpretation biases were uniquely associated with a history of a lifetime suicide attempt. Future work should further clarify the extent and specificity of the relationship between suicide-specific interpretation biases and clinical outcomes.

Individuals elevated in distress intolerance (DI) may engage in dysfunctional behavioral strategies to cope with their distress. One behavioral strategy that may be related to DI is appearance related safety behavior (ARSB; i.e., maladaptive behavior that seeks to mitigate the feared consequences of the negative evaluation of appearance). We examined the relationship between DI and ARSBs in two separate samples of women. In Study 1 (N = 91), we found in an unselected sample that ARSBs were robustly associated with DI cross-sectionally while accounting for symptoms of depression and body dysmorphia. Further, greater ARSBs predicted increases in DI longitudinally. In Study 2, among a clinical sample of women with elevated appearance concerns (N = 94), we examined the experimental effect of reducing ARSBs compared to a self-monitoring control. Relative to control, instructions to reduce ARSBs led to lower DI, but this effect was only found for individuals low in baseline DI. Overall, we found preliminary evidence that ARSBs may be a salient factor in contributing to and maintaining DI; and SB fading may be a helpful strategy for reducing DI. We discuss these findings in the context of existing literature and provide directions for future research.

Fear generalization undergoes marked changes during adolescence, which may relate to the high prevalence of anxiety disorders. While intolerance of uncertainty (IU) is a key factor that amplifies fear generalization, its impact and neural basis in adolescence remain unclear. Here, we investigated the effects of IU on perceptual-based (n = 72) and category-based (n = 68) fear generalization in adolescents aged 12-15 years. Specifically, Experiment 1 utilized two different size rings as conditioned stimuli, with middle-sized rings serving as the generalized stimuli; Experiment 2 employed pictures of sparrows and refrigerators as conditioned stimuli, with other animals categorically related to the sparrow as generalized stimuli. We collected self-reported threat expectancy, response times, and fear ratings in both experiments, and conducted functional near-infrared spectroscopy in Experiment 2. Results showed that high IU adolescents had higher threat expectancy in both experiments compare to low IU. Moreover, in category-based generalization, high IU adolescents had higher fear ratings, shorter response times and reduced engagement of the left dorsolateral prefrontal cortex (DLPFC). Results indicated that IU may enhance fear generalization by deficient left DLPFC recruitment. Together the present findings point to a behavioral and neural mechanism that can render adolescents vulnerable for mental disorders.

This study investigates the role of positive cognitive reappraisal (PCR) flexibility and variability in mental health in response to real-life stressors among college students. We employed ecological momentary assessment and intervention through ReApp, a mobile app designed to train and promote PCR. We analyzed data from the intervention group of a randomized controlled trial with a total of 100 participants who used ReApp for three weeks. Stressors due to health problems, uncomfortable environment (e.g., rainy weather, crowded buses, etc.), and lack of time were reported most frequently. Stressors related to the war in Ukraine, fear of the future, exams, and COVID-19 were reported as the most severe. To reappraise these stressors, the participants used mostly acceptance and problem-solving tactics. A key finding is the role of emotional demand-dependent PCR flexibility in mental health. Specifically, the flexible adaptation of PCR tactics in response to stressor severity was associated with a more substantial decline in perceived stress over the study period among participants reporting low tendency to use PCR at the study's baseline (β = - 0.963, p = .016, Cohen's f = 0.26). In contrast, stressor domain-dependent flexibility and contextually independent between-tactic variability had no moderating effect on stress, depression, and anxiety symptoms. This study contributes to the field of emotion regulation flexibility by highlighting the adaptive role of emotional demand-dependent PCR flexibility in mental well-being among young adults navigating real-life stressors and underscores the importance of tailoring interventions based on the emotional demands of stressors.

This study investigates the daily associations between sleep disturbances and emotional well-being, focusing on exercise and social interaction as potential moderating factors. Using a longitudinal daily diary approach, we analyzed data from 455 participants (mean age = 41.98 years, 382 females) who reported daily diaries over 20 days. Multilevel modeling was employed to analyze both within- and between-person relations between sleep variables (duration, efficiency, difficulty falling asleep) and next day positive/negative affect. The analysis also explored the moderating roles of exercise and socializing, adjusting for age, sex, and COVID-related variables. Our findings indicate that at both within- and between-person levels, higher sleep efficiency predicted increased positive affect and reduced negative affect; conversely, difficulty falling asleep predicted diminished positive affect and heightened negative affect. Sleep duration had a nonlinear relationship with positive and negative affect, with both longer and shorter than usual sleep duration predicting less positive and more negative affect. Exercise and socializing showed different moderating roles in the relationship between sleep and negative affect. Exercise was found to mitigate the negative impact of poor sleep on negative affect, whereas extended socializing amplified the salutary impact of good sleep on reducing negative affect. Our findings underscore the importance of sleep health in daily emotional well-being, suggesting associations between sleep efficiency, difficulty falling asleep, and next-day affect at both within- and between-person levels. Furthermore, the distinct moderation patterns of exercise and socializing provide unique insights into the interplay of sleep, exercise, and social interaction, allowing more targeted interventions.

External environmental factors and internal cognitive bias affect college students' anxiety while job hunting. The current study is an intervention study on alleviating employment anxiety among college students through an Interpretation Bias Modification (IBM) computer-based intervention. A total of 79 valid participants were recruited. The Interpretation Bias Modification (IBM) group participants were required to complete employment-related IBM Internet training twice a week for three weeks. The placebo control group participants were required to complete neutral Internet training at the same frequency. The waiting list control group did not undergo any training. The groups were tested at three time points: prior to the intervention (pre-test), immediately after (post-test), and one month after the intervention (one-month follow-up). The IBM intervention group [F(2, 72) = 31.68, p < 0.001] showed greater significance in reducing employment anxiety than participants in the placebo control group [F(2, 72) = 9.83, p < 0.001] from the pre-test to one-month follow-up. There was no significant difference in employment anxiety among the waiting-list control group over time. The IBM intervention for college students can effectively decrease employment anxiety and reduce interpretation bias, which can be maintained at the one-month follow-up.

Research is increasingly highlighting the role of negative trauma-related appraisals in child and adolescent post-traumatic stress disorder (PTSD). The cognitive model of PTSD claims that an essential mechanism of treatment is a reduction in these appraisals. The current systematic review with meta-analysis investigated the extent to which psychological treatments for PTSD reduce negative trauma-related appraisals in children and adolescents. Four databases (PsycINFO, Medline Complete, CINAHL Complete and PTSDpubs) were searched on the 11-12th December 2022. The Risk of Bias 2 (ROB-2) tool was used to assess for risk of bias. Thirteen studies were included in this review, comprising 937 child and adolescent participants. Using a random effects model to perform the meta-analysis, a medium pooled effect size for the effect of current treatments on trauma-related appraisals was found (g = -.67, 95% CI [-.86, -.48]). There was only a moderate level of heterogeneity between studies (I = 44.4%), increasing the confidence with which these findings can be interpreted. These results indicate that psychological treatments for child and adolescent PTSD significantly reduce negative trauma-related appraisals. However, it is important to note that no trial included in the review was categorised as having low risk of bias.

Anhedonia, a reduction in pleasure in previously enjoyed activities, is a hallmark feature of depression and is also of transdiagnostic relevance to many psychiatric disorders. Treatment and measurement of anhedonia are significant challenges. We examine anhedonia components, combining experimental training, with multimodal anhedonia assessment, comprising standard questionnaire instruments, a widely-used behavioural task, and daily reports of reward experience. Seventy-eight adults (74.4% female) completed both positive and negative cognitive bias modification training, a laboratory-based behavioural measure of reward anticipation and motivation, the Effort-Expenditure for Reward Task (EEfRT), and seven days of experience sampling via their smartphones. We found no evidence that cognitive bias modification training affected choices to engage in the high-effort trials on the EEfRT task, theorised to reflect reward anticipation. We also did not find the expected associations between baseline measures of anhedonia and reward sensitivity and response to training. Behavioural performance on the low probability EEfRT trials indicating higher reward anticipation was significantly associated with daily reports of anticipated reward. Daily reported reward anticipation and consumption were also associated with the questionnaire measure of anhedonia. Our findings demonstrate that traditional anhedonia questionnaire measures, and a laboratory-based measure of an anhedonia component, can translate to reported experiences of reward in real-world contexts. We demonstrate the specificity of associations between the laboratory measure, designed to measure reward anticipation and not consumption, and real-world reports.

Suicidal ideation (SI), a risk factor for suicide, is prevalent in internalizing psychopathologies, including depression and anxiety. Rumination and worry are well-studied repetitive negative thinking (RNT) constructs implicated in internalizing psychopathologies. These constructs have shared and distinct characteristics. However, the relationship between rumination and worry and their associations with SI are not fully understood in clinical samples. The present study used correlational and regression analysis to evaluate these relationships as a secondary data analysis in treatment-seeking participants with internalizing psychopathologies in two independent samples (Study 1:n = 143; Study 2:n = 133). Results showed about half of the participants endorsed SI (Study 1:n = 79; Study 2:n = 71). Correlations revealed a significant, positive relationship between rumination and worry. Regression results with SI as the dependent variable showed rumination significantly positively corresponded with SI in both studies. Post-hoc partial correlations controlling for symptom severity (depression, anxiety), worry, and age showed the rumination-SI relationship was maintained in both studies. Findings for worry and SI were inconsistent between studies. Findings indicate rumination, but not worry, could be a stable, unique contributor to SI in internalizing psychopathologies. It may be useful to incorporate RNT into suicide risk assessment for individuals with internalizing conditions.

Anhedonia, deficits in motivation and pleasure, is a transdiagnostic symptom of psychopathology and negative prognostic marker.

Decades of research have demonstrated the efficacy of cognitive behavioral therapies (CBTs) for a wide variety of psychiatric diagnoses, resulting in the inclusion of CBT as a first-line evidence-based practice (EBP) in treatment guidelines for mood and anxiety disorders. However, some research suggests that many providers do not implement EBPs as intended. Ongoing quality monitoring is needed to support EBP implementation and sustainability, but "gold standard" fidelity monitoring (e.g. observer ratings) is time-consuming, requires extensive training, and may feel intrusive to providers and clients. In the current study, we aimed to develop a scalable method of assessing CBT fidelity that leverages information generated in routine clinical care (e.g. session worksheets and clinician checklists). Ratings of adherence based on worksheets were not correlated with ratings of adherence based on observer ratings. However, ratings of competence based on worksheets were significantly correlated with observer ratings of competence. Ratings of adherence based on clinician checklist ratings were also significantly correlated with observer-rated adherence. Results did not indicate a strong relationship between adherence or competence measured by worksheet ratings or observer and symptom change. However, adherence as measured by clinician checklists were associated with subsequent depression symptom change. Findings have a strong potential to impact fidelity monitoring strategies for a variety of CBTs. Given the limited resources and time to do full audio review in routine care settings, findings suggest that using routine materials generated in session to assess therapist competence may be a feasible alternative to the "gold standard" audio review. The trial is registered at ClinicalTrials.gov, number NCT03479398.

Augmented Depression Therapy (ADepT) is an individual psychotherapy for depression, which has been shown to be effective in the general adult population. A randomised multiple baseline case series evaluated the feasibility, acceptability, and effectiveness of ADepT in young adults (aged 20-24). Eleven depressed young adults were recruited from a UK university wellbeing service to receive ADepT during the COVID-19 pandemic, with outcomes evaluated relative to pre-specified continuation targets. All participants received a minimum adequate treatment dose (>60% target); 89% judged ADepT as acceptable and satisfactory and would recommend it to others (>60% target); only 9% showed reliable deterioration for depression or wellbeing (meeting <30% target); and there were no trial- or treatment-related serious adverse events. Qualitative interviews revealed most participants were satisfied with and experienced benefits from ADepT. At post-treatment, reliable improvement was shown by 33% of participants for depression and 67% of participants for wellbeing (not meeting target of both >60%), with medium effect size improvements for depression (g = 0.78) and large effect size improvement for wellbeing (g = 0.93; not meeting target of both >0.80). ADepT is feasible, acceptable, and safe in young adults but may require modification to maximise effectiveness. Further research outside of the COVID-19 pandemic is warranted.

Human touch is a powerful means of social and affective regulation, promoting safety behaviors. Yet, despite its importance across human contexts, it remains unknown how touch can promote the learning of new safety memories and what neural processes underlie such effects. The current study used measures of peripheral physiology and brain activity to examine the effects of interpersonal touch during safety learning (extinction) on the recovery of previously learned threat. We observed that handholding during extinction significantly reduced threat recovery, which was reflected in enhanced prefrontal hemodynamic responses. This effect was absent when learners were instructed to hold a rubber ball, independent of the presence of their partners. Our findings indicate that social touch contributes to safety learning, potentially influencing threat memories via prefrontal circuitry.

In this study we aimed to investigate gender differences in fear generalization tendencies in humans and, inspired by recent findings in animal research, examine whether any such differences could stem from differences in memory precision. Forty men and forty women underwent a differential fear conditioning procedure using geometric shapes as cues. Subsequently, generalized fear responses were assessed across a spectrum of perceptually similar shapes. Throughout generalization testing, perceptual memory accuracy was repeatedly probed using a stimulus recreation task. Using statistical and computational modeling, we found strong evidence for the absence of gender differences in fear learning and generalization behavior. The evidence for gender differences in related processes such as perception and memory was inconclusive. Although some of our findings hinted at the possibility that women may be more perceptive of physical differences between stimuli and have more accurate memory than men, those observations were not consistently replicated across experimental conditions and analytical approaches. Our results contribute to the emerging literature on gender differences in perceptual fear generalization in humans and underscore the need for further systematic research to explore the interplay between gender and mechanisms associated with fear generalization across different experimental contexts.

The dynamic view of emotion regulation (ER) posits that ER is a temporally dynamic process unfolding over time. Cognitive reappraisal and rumination, two extensively investigated ER strategies, are implicated in depression. However, it remains unclear whether these two strategies exhibit reciprocal relations in real-world contexts, and whether such relations vary across baseline depressive symptoms. To address this, we conducted two experience sampling studies and applied residual dynamic structural equation modeling (RDSEM). Results of the RDSEM revealed significant bidirectional associations between cognitive reappraisal and rumination in the Chinese sample, whereas in the Belgian sample, only a unidirectional relationship was found where rumination predicts subsequent cognitive reappraisal. Additionally, both strategies demonstrated stable autoregressive effects. Interestingly, higher depressive symptoms predicted a lower autoregressive effect of cognitive reappraisal within the Chinese sample, while this was not the case in the Belgian sample. These findings highlight the importance of targeting factors such as dynamics in ER and its relationship with depression symptoms.

Traumatic memory intrusions, the involuntary retrieval of unwanted memories, significantly impact mental health. The dual representation theory proposes that the origin of intrusion lies in the overactivated sensory memory not being integrated with the corresponding contextual memory, highlighting the crucial associations between memory contextualization and intrusion. To test this, our study investigated whether enhancing memory contextualization could effectively reduce intrusion. After experiencing analogue trauma with the trauma film paradigm, 96 healthy participants were randomly allocated to three intervention groups: active contextualization (AC) in which participants actively retrieve and restructure film content, passive contextualization (PC) in which participants passively restudy content-matched pre-contextualized information, and working memory taxation (WM) in which participants performed a working memory dual-task. Diary recordings over the subsequent week revealed a significant reduction in intrusion frequency in the AC group compared to both the PC group and a no-intervention control group. Furthermore, comparing AC with WM, a well-established laboratory intervention on intrusion, established a superior efficacy of the AC intervention in reducing intrusions. Finally, analyses of the explicitly recollected film memories identified the critical element of active contextualization to be memory integration induced by active memory retrieval. Together, our findings suggest that active contextualization causally diminishes intrusions, providing novel insights into the regulation of the contextual memory system in intrusion intervention.

Internet-delivered cognitive behavioural therapy (ICBT) is an effective treatment for obsessive-compulsive disorder (OCD). Currently there is limited research examining the predictors and moderators of outcome in ICBT for OCD. This study examined moderators of treatment outcome in a sample of 216 individuals who commenced a self-guided ICBT intervention for OCD (Mage = 34.00; SD = 12.57; 72.7% female). The results indicated that those with higher baseline OCD severity, depression severity, and neuroticism had less improvement at post-treatment and follow up (resulting in 40%, 24% and 12% higher symptom severity for every standard deviation increase on the measure at post-treatment and 33%, 17% and 20% higher symptoms at follow up respectively). However, participants with higher baseline treatment expectancy and readiness to reduce rituals and compulsions had better outcomes at post-treatment and three-month follow up (resulting in a 5% and 7% lower symptom severity for every standard deviation increase on the measure at post-treatment and 12% and 12% lower symptoms at follow up respectively). The results have important implications for who may respond best to self-guided ICBT.

Eating disorders are serious psychiatric illnesses associated with large amounts of suffering, high morbidity, and high mortality rates, signifying a clear need for rapid advancements in the underlying science. Relative to other fields of clinical psychological science, the eating disorder field is new. However, despite the fields' late beginnings, there is growing science in several important areas. The current paper discusses the current literature in three primary areas of importance: (a) diversity and inclusion, (b) systemic and social factors, and (c) treatment personalization. We discuss how these areas have huge potential to push both eating disorder and clinical psychological science in general forward, to improve our underlying understanding of psychological illness, and to enhance treatment access and effectiveness. We call for more research in these areas and end with our vision for the field for the next decade, including areas in need of significant future research.

Working memory training for Attention-Deficit/Hyperactivity Disorder (ADHD) has focused on increasing working memory capacity, with inconclusive evidence for its effectiveness. Alternative training targets are executive working memory (EWM) processes that promote flexibility or bolster stability of working memory contents to guide behavior via selective attention. This randomized, placebo-controlled study was designed to assess feasibility, tolerability, and behavioral target engagement of a novel EWM training for ADHD.

Occasionally presenting the unconditioned stimulus (US) during extinction training (occasional reinforced extinction, ORE) either unpaired or paired with the conditioned stimulus (CS) provides initial evidence for a less pronounced return of fear. However, translating this approach into clinical practice is challenging due to ethical and practical concerns of exposing patients to the original USs. The present study investigated extinction of fear responses in a novel approach employing ORE using vivid fear imagery of the US instead of actually exposing to it. Three experimental groups underwent differential fear conditioning. Subsequently, participants either received a non-reinforced (standard extinction, N = 25), occasional paired (N = 26), or occasional unpaired (N = 25) reinforced extinction training, followed by assessments for spontaneous recovery, reinstatement, and reacquisition of fear responses. Response patterns during spontaneous recovery, reinstatement and reacquisition showed no benefit from either paired or unpaired imaginative ORE. The current findings suggest that incorporating fear imagery of the US in ORE so far does not result in reducing the return of fear. Further investigation is needed to determine whether imaginal ORE with adjustments could still be a readily applicable strategy for translating the ORE approach into clinical practice.

This study tested two versions of parent-led, Internet-delivered cognitive behavioral therapy for anxiety among autistic youth; one that provided weekly email support (iCBT-Email), and one that provided alternating bi-weekly emails and video calls (iCBT-Video) across 12 weeks. It was expected that those in the iCBT-Video condition would complete more treatment content, which in turn would lead to more anxiety improvement. Fifty-seven autistic youth (7-15 years-old) with anxiety disorders were randomized to iCBT-Email or iCBT-Video. There were no significant differences in improvement in clinician-rated, child-reported, or parent-reported anxiety severity or functional impairment. Posttreatment response rates were 55% in iCBT-Email and 67% in iCBT-Video. Module completion predicted improved treatment outcome, though there was no difference in module completion across groups. Therapists spent an average of 16.29 min/family/week (SD = 7.11) in the iCBT-Email condition and 24.13 min/family/week (SD = 6.84) in the iCBT-Video condition. Email and telehealth-supported, parent-led iCBT both appear to be effective treatments for autistic youth with anxiety disorders that require reduced therapist effort. Future research should seek novel methods to enhance engagement with iCBT content. CLINICALTRIALS.GOV IDENTIFIER: NCT05284435.

Paediatric social anxiety disorder (SoAD) responds poorly to treatment. Improved understanding of potential psychological maintaining processes may indicate fruitful directions to improve treatment outcomes. The current study compared self-reported psychological processes and state anxiety in response to two social tasks experienced by children and adolescents with SoAD against comparison samples.

Develop and evaluate a treatment matching algorithm to predict differential treatment response to Mindfulness-Based Cognitive Therapy for suicide prevention (MBCT-S) versus enhanced treatment-as-usual (eTAU).

Rumination and mindfulness are transdiagnostic risk and protective factors while their role in Premenstrual Dysphoric Disorder (PMDD) is unclear. Thus, we aimed to investigate the cycle-phase-specific effects of rumination and mindful self-focus on momentary mood and cognitions in women with and without PMDD. This study involved brief ambulatory inductions of ruminative and mindful self-focus along with ambulatory assessments of negative (NA) and positive affect (PA), and rumination, present-moment-awareness (PMA) and self-acceptance on two days during both the follicular and late luteal phase in women with and without PMDD (n = 60 each). Compared to healthy controls, women with PMDD showed stronger increases in PA in response to mindful self-focus inductions during the late luteal phase, whereas no such group differences were identified during the follicular phase. Independent of clinical status and cycle phase, induced ruminative self-focus immediately increased momentary NA and rumination and decreased PMA, whereas induced mindful self-focus inductions increased momentary self-acceptance. Overall, higher PA-reactivity toward mindful self-focusing during late luteal phase in women with PMDD points to the potential of cycle-phase-specific mindfulness interventions for PMDD. Irrespective of cycle phase, rumination and mindfulness appear to represent targets for brief prevention and intervention measures for both non-clinical and clinical groups.

Habituation to bodily sensations is highly relevant for the experience of chronic bodily symptoms, but the neural mechanisms behind diminished habituation are currently unclear. One potentially relevant mechanism is neural gating (NG), reflected as the short-term suppression of cortical responses to redundant stimuli. We investigated the effects of repeated exposure to aversive sensations on NG and subjective perception in 91 healthy adults, by measuring their NG of respiratory and electrocutaneous stimuli using electroencephalography during two sessions separated by one week, in addition to their self-report of intensity and unpleasantness of the sensations. To test for intra- and cross-modal effects, 1/2 participants returned three times in the intervening week to experience additional aversive respiratory stimulation, while the other 1/2 received aversive electrocutaneous stimulation. Participants reported lower unpleasantness of all sensations in the final session (intra- and cross-modal habituation). NG was improved for respiratory sensations only in the group receiving additional respiratory stimulation (intra-modal habituation). We found no relationships between NG and perceptual habituation, adding to the mixed results on the relevance of NG to perceptual changes in healthy adults. Future research with clinical populations and different methods is encouraged to further clarify the mechanisms behind neural gating and diminished symptom habituation.

A better understanding of the processes that maintain social anxiety disorder (SAD) in adolescents could improve treatment outcomes. This study aimed to establish whether cognitive and behavioural processes known to be important in the maintenance of adult SAD are observed in adolescent populations and whether they are specific to SAD.

This study aims to test the effectiveness of brief mindfulness for anxiety-provoked adverse events during ultrasound-guided fine needle aspiration biopsy (FNAB).

Emotion regulation therapy (ERT) promotes resilience in distress disorders by strengthening attentional and metacognitive capacities. Regulation skills are presented with the goal of ameliorating the perseverative negative thinking (PNT) that characterizes these disorders. This study tested ERT in a randomized controlled trial comparing the effectiveness of 16-session (ERT16) versus 8-session (ERT8) doses.