Clinical Psychological Science

The order and timing of substance initiation have significant implications for later problematic patterns of use. Despite the need to study initiation from a multivariate framework, survival analytic methods typically cannot accommodate more than two substances in one model. The discrete-time multiple event process survival mixture (MEPSUM) model represents an advance by incorporating more than two outcomes and enabling establishment of latent classes within a multivariate hazard distribution. Employing a MEPSUM approach, we evaluated patterns of tobacco, alcohol, and cannabis initiation in the National Longitudinal Study of Adolescent to Adult Health (N = 18,923). We found four classes that differed in their ages and ordering of peak initiation risk. Demographics, externalizing psychopathology, and personality significantly predicted class membership. Sex differences in the association between delinquency and initiation patterns also emerged. Findings support the utility of the MEPSUM approach in elucidating developmental pathways underlying clinically relevant phenomena.

Research has documented important sex differences in associations between early stress, stress sensitization, and psychiatric outcomes. The current study investigated whether sex differences in stress sensitization extended to cigarette smoking cessation. Data were analyzed from the National Epidemiologic Survey on Alcohol and Related Conditions (Waves 1 and 2), selecting for current daily and nondaily smokers at Wave 1 (daily smokers: n = 3,499 women, 3,055 men; nondaily smokers: n = 451 women, 501 men). Three-way interactions among sex, childhood adversity, and past-year stressful life events were modeled in the prediction of smoking cessation. Among women, stressful life events were more strongly related to lower likelihood of smoking cessation for those with a history of childhood adversity than those without. This relationship was not found among men. The stress sensitization model may be applicable to women with regard to smoking cessation, supporting further exploration of stress sensitization as a prevention and clinical target for smoking cessation.

Massive open online interventions (MOOIs) have the potential to increase the reach, scalability, and affordability of psychological interventions. This article reports on an extension of a proof-of-concept participant-preference smoking-cessation trial conducted in the form of a MOOI. This resource was available in Spanish and English for 30 months, and a total of 292,978 individuals from 168 countries visited the site. This report presents data on the last 18 months of recruitment during which 27,163 participants were screened for eligibility, 8,881 signed consent, and 7,407 completed the baseline survey. Observed quit rates were 39.2%, 43.5%, 45.7%, and 50.3%, respectively, at 1, 3, 6, and 12 months; at the same time intervals, the missing=smoking quit rates were 7.6%, 5.7%, 4.8%, and 5.5%. Results suggest that MOOIs have the potential to provide people worldwide with evidence-based behavioral interventions. The authors conclude that MOOIs should become an integral part of global health efforts.

The current study examined selective attention toward emotional images as a risk factor for major depressive disorder (MDD). Using multiple indices of attention in a dot-probe task (i.e., reaction time [RT] and eye-tracking-based measures) in a retrospective, high-risk design, we found that women with remitted MDD, compared with controls, exhibited greater selective attention toward angry faces across RT and eye-tracking indices and greater attention toward sad faces for RT measures. Second, we followed women with remitted MDD prospectively to determine if the attentional biases retrospectively associated with MDD history would predict MDD recurrence across a 2-year follow-up. We found that women who spent a greater proportion of time looking at angry faces during the dot-probe task at the baseline assessment had a significantly shorter time to MDD onset. Taken together, these findings provide converging retrospective and prospective evidence that selective attention toward angry faces may increase risk for MDD recurrence.

Schizophrenia, bipolar disorder, and major depression share several clinical and etiological factors. Coping is a critical mediator of the relationship between stress and psychopathology and a point of clinical intervention for all three disorders; however, little is known about their degree of overlap in coping style or the influence of unique or shared genetic diathesis. In this study, we examined five factors of coping within and across disorder proband and co-twin groups, modeled heritability, and tested for endophenotypic pattern in a sample of twin pairs recruited from the Swedish Twin Registry (N = 420). Although there was substantial phenotypic overlap across disorders, including low levels of productive problem-focused coping and high levels of disengagement, each disorder was associated with a unique profile across other dimensions of coping. We also found evidence of heritability for three of five factors, yet we found little evidence of genotypic overlap among disorders contributing to similar strategy use.

The kindling hypothesis for depression predicts that with more recurrences, the interval between successive recurrences decreases. Findings from studies with samples of unipolar and bipolar individuals generally have been consistent with this premise. However, previous research is subject to a statistical artifact. Slater’s fallacy maintains that these intermorbid intervals appear to decrease because highly recurrent individuals with consistently shorter intervals become a larger proportion of the remaining sample with each recurrence. Correcting for this bias, research on bipolar disorder no longer evidences such an effect. We predicted similar results for unipolar depression when correcting for this bias and proposed an alternative model: Individuals who are highly recurrent have consistently shorter intermorbid periods, even after the very first lifetime episode. As predicted, correcting for Slater’s fallacy removed the appearance of decreasing intermorbid intervals. Furthermore, highly recurrent individuals exhibited shorter intermorbid intervals in general, and for the very first interval, thereby supporting the alternative model.

Accurate assessment of dysfunction is central to clinical psychological science, essential for valid conclusions about prevalence, risk, and appropriate intervention. Measures applied without adjustment across diverse racial/ethnic groups may risk errors if measurement equivalence has not been established. We tested this possibility in the domain of youth depression, applying item response theory (IRT) and differential item functioning (DIF) analyses to reports by White, Black, Latino, and Asian youths (N = 2,335) on the most widely used measure of symptoms, the Children’s Depression Inventory (CDI). Analyses revealed that 77% of CDI items were nonequivalent indicators of symptom severity across groups. CDI sum scores exhibited marked overestimations of group differences and inappropriate classification as “clinically elevated” for 29% of Latino, 23% of Black, and 10% of Asian youths. Applying DIF adjustment corrected these errors. The study demonstrates a useful strategy for ethnically sensitive assessment, applicable to other symptom domains and ethnic groups.

Recent work suggests that memory representations may guide basic perceptual functions, such as figure-ground perception. In three studies we assessed top-down contributions to figure-ground perception in typical development and in two developmental disorders: Down syndrome (DS) and autism (ASD). We investigated how figure-ground segregation is modulated by high-level cues (i.e., memory representations) and low-level cues (i.e., convexity and surface integration). Study 1 results showed that both high-level and low-level contributions to figure-ground perception are functional by the age of 4 years. In Study 2, individuals with DS exhibited intact figure-ground segregation based on low level cues when compared with mental age–matched participants, but they showed attenuated effects of high-level memory cues on figure-ground assignment. In Study 3, individuals with ASD showed intact effects of both high-level and low-level cues on figure-ground perception, counter to previous suggestions that high-level influences on perception are usually impaired in ASD.

Using data from a longitudinal study of community-dwelling older adults, we analyzed the most extensive set of known correlates of posttraumatic stress disorder (PTSD) symptoms obtained from a single sample to examine the measures’ independent and combined utility in accounting for PTSD symptom severity. Fifteen measures identified as PTSD risk factors in published meta-analyses as well as 12 theoretically and empirically supported individual difference and health-related measures were included in our analysis. Individual difference measures assessed after the trauma, including insecure attachment and factors related to the current trauma memory, such as self-rated severity, event centrality, frequency of involuntary recall, and physical reactions to the memory, accounted for symptom severity better than did measures of pretrauma factors. In an analysis restricted to prospective measures assessed before the trauma, the total variance explained decreased from 56% to 16%. Results support a model of PTSD in which characteristics of the current trauma memory promote the development and maintenance of PTSD symptoms.

Recent findings suggest biases of emotional attention (BEA) may be expressed dynamically, fluctuating from moment to moment between overengagement and avoidance of emotional stimuli. We attempted to modify these temporal dynamics of BEA to threat among trait-anxious adults (N = 61) using Attention Feedback Awareness and Control Training (A-FACT). A-FACT is a novel intervention methodology that delivers real-time feedback to a person concurrent with her/his dynamic BEA expression. We found that relative to a placebo control condition, A-FACT led to significantly reduced BEA dynamics toward and away from threat, temporal variability in BEA, and emotional reactivity to an anxiogenic stressor. Findings illustrate that BEA may be optimally conceptualized and quantified as a dynamic process in time and that intervention methods sensitive to and capable of targeting BEA process dynamics in real time—as in A-FACT—represent a promising new direction for cognitive bias modification research.

In recent years, tremendous progress has been made in mapping the structure of comorbidity between psychiatric disorders. In particular, empirical findings have suggested the existence of a general p factor of susceptibility to psychopathology. In the present study, simulation methods were used to test whether the observed structure of psychiatric disorders can be reproduced by the life history model of psychopathology, a recent classification model based on evolutionary theory. The assumptions of the life history model were used to generate virtual epidemiological samples, which were then analyzed with the methods used by earlier researchers. Analyses of simulated data successfully replicated the key findings by these researchers, including the emergence of the p factor and the switch from positive to negative correlation between internalizing and externalizing symptoms after inclusion of the p factor. These results offer initial support for the validity of the life history model.

We investigated the neural correlates of remote traumatic reexperiencing in survivors of a life-threatening incident: the near crash of Air Transat (AT) Flight 236. Survivors’ brain activity was monitored during video-cued recollection of the AT disaster, September 11, 2001 (9/11), and a comparatively nonemotional (neutral) event. Passengers showed a robust memory enhancement effect for the AT incident relative to the 9/11 and neutral events. This traumatic memory enhancement was associated with activation in the amygdala, medial temporal lobe, anterior and posterior midline, and visual cortex in passengers. This brain–behavior relationship also held in relation to 9/11, which had elevated significance for passengers given its temporal proximity to the AT disaster. This pattern was not observed in a comparison group of nontraumatized individuals who were also scanned. These findings suggest that remote traumatic memory is mediated by amygdalar activity, which likely enhances vividness via influences on hippocampal and ventral visual systems.

Generalized anxiety disorder (GAD) is characterized by cognitive biases toward threat-relevant information, but the underlying mechanisms are unclear. We translated a retrieval-practice paradigm from cognitive science to investigate impaired inhibition of threat information as one such mechanism. Participants diagnosed with GAD and never-disordered control participants learned a series of cue–target pairs; whereas some cues were associated only with neutral targets, others were associated with both neutral and threat targets. Next, participants practiced retrieving neutral targets, which typically suppresses the subsequent recall of unpracticed associated targets (retrieval-induced forgetting; RIF). Finally, participants were tested on their recall of all targets. Despite showing intact RIF of neutral targets, the GAD group failed to exhibit RIF of threat targets. Furthermore, within the GAD group, less RIF of threat targets correlated with greater pervasiveness of worry. Deficits in inhibitory control over threat-relevant information may underlie the cognitive pathology of GAD, which has important treatment implications.

This review investigates how recent neuroimaging findings on vulnerability for depression and the mechanisms of mindfulness may serve to inform and enhance the understanding that is guiding the use of mindfulness training in the prevention and treatment of recurrent and chronic depression. In particular, we review evidence suggesting that alterations in default-mode-network activity and connectivity represent a fundamental deficit underlying cognitive vulnerability for depression and explore the ways in which mindfulness meditation may reverse such alterations. Furthermore, we discuss findings from studies that have investigated the effects of mindfulness on emotion-regulatory capacities. These findings suggest mindful emotion regulation has a characteristic neural signature that is particularly conducive to therapeutic learning. We conclude that training in mindfulness has unique strengths for addressing neural mechanisms associated with cognitive vulnerabilities for recurrent and chronic depression and propose future lines of research to more effectively harness this potential.

Homesickness (HS) is associated with mental and physical health problems and is thus of clinical concern. In some highly influential theoretical models and widely used questionnaires, HS spans home-related losses and new-locality adjustments. A differentiated approach is needed: Evidence suggests that distinct manifestations are associated with these two domains. Collapsing home- and new-place-related phenomena has impeded understanding of separation-from-home-specific aspects. Thus, we propose a dual process model of coping with HS (DPM-HS). According to this framework, HS is fundamentally a separation phenomenon, a “mini-grief,” involving different (though possibly mutually exacerbating) stressors from new place ones. It follows that HS should be narrowly defined; separate examination of home–new place stressors, correlates, and consequences is mandatory; regulatory cognitive-emotional processes and incremental effects due to new place stressors need charting. Following DPM-HS principles, HS prevention and treatment should not only focus on distraction and adjustment, but also pay attention to missing home aspects and emotion-regulation strategies.