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. Background: Concerns regarding the potential iatrogenic effects of suicide assessment have long impeded suicide research. Aims: We sought to examine the effects of an intensive, suicide-focused assessment protocol on mood, suicidality,... more
. Background: Concerns regarding the potential iatrogenic effects of suicide assessment have long impeded suicide research. Aims: We sought to examine the effects of an intensive, suicide-focused assessment protocol on mood, suicidality, and urges to harm oneself or others. Method: Participants were adults admitted to a psychiatric inpatient unit for recent suicidal ideation or behavior, or reasons unrelated to suicide. Our study protocol included clinical interviews evaluating suicide history and laboratory tasks with suicide-related stimuli. We modified an existing measure to create a brief, 6-item interview, the Assessment Session Check-In, which was administered before and after research procedures. Results: These indicated overall reductions in distress, suicidal intent, and urges to harm oneself or others from preassessment to postassessment. Postassessment reductions in stress predicted lower likelihood of a suicide attempt at follow-up. Limitations: Although beneficial to examine a high-risk sample, it is possible that an intensive suicide-focused protocol could prove more problematic for those with lower baseline levels of negative affect and suicidal thoughts. Conclusions: Results challenge the belief that assessing suicide elevates distress or suicidality, even among a high-risk sample of adults admitted to a psychiatric inpatient unit.
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As emotion is a dynamic construct, ecological momentary assessment (EMA) methods, which gather data at multiple time points in individuals’ real-world environments, in the moment, are particularly well suited to measure emotion... more
As emotion is a dynamic construct, ecological momentary assessment (EMA) methods, which gather data at multiple time points in individuals’ real-world environments, in the moment, are particularly well suited to measure emotion dysregulation and related constructs. EMA methods can identify contextual events that prompt or follow an emotional response. This chapter provides an overview of traditional methods of studying emotion dysregulation and how EMA can be used to capture emotion dysregulation in daily life, both within and independent of psychiatric diagnoses. It reviews the literature on emotion dysregulation and related constructs within specific diagnoses (e.g., depression, bipolar disorder, borderline personality disorder, and eating disorders) and behaviors (e.g., suicide, nonsuicidal self-injury, and alcohol use). Finally, it discusses future directions in EMA research, as well as its implications for psychological treatment.
Research Interests: Clinical Psychology, Emotion, Psychiatry, Mood Disorders (Psychology), Assessment, and 11 moreDepression, Bipolar Disorder, Borderline Personality Disorder, Psychopathology, Suicide, Emotion Regulation, Experience Sampling Methods, Affect/Emotion, Affect Regulation, NSSI (self injury), and Ecological momentary assessment
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We evaluated the feasibility and acceptability of a novel, 12-week, adjunctive, smartphone-assisted intervention to improve treatment adherence in bipolar disorder. Eight participants completed 4 in-person individual therapy sessions over... more
We evaluated the feasibility and acceptability of a novel, 12-week, adjunctive, smartphone-assisted intervention to improve treatment adherence in bipolar disorder. Eight participants completed 4 in-person individual therapy sessions over the course of a month, followed by 60 days of twice-daily ecological momentary intervention (EMI) sessions, with a fifth in-person session after 30 days and a sixth in-person session after 60 days. Perceived credibility of the intervention and expectancy for change were adequate at baseline, and satisfaction on completion of the intervention was very high. Participants demonstrated good adherence to the intervention overall, including excellent adherence to the in-person component and fair adherence to the smartphone-facilitated component. Qualitative feedback revealed very high satisfaction with the in-person sessions and suggested a broad range of ways in which the EMI sessions were helpful. Participants also provided suggestions for improving the intervention, which primarily related to the structure and administration of the EMI (smartphone-administered) sessions. Although this study was not designed to evaluate treatment efficacy, most key outcome variables changed in the expected directions from pretreatment to posttreatment, and several variables changed significantly over the course of the in-person sessions or during the EMI phase. These findings add to the small but growing body of literature suggesting that EMIs are feasible and acceptable for use in populations with bipolar disorder.
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Although the relationships between PTSD, abuse history, and suicidal behaviors are well-established in military and outpatient samples, little data is available on this relationship in inpatient samples. This study examines the... more
Although the relationships between PTSD, abuse history, and suicidal behaviors are well-established in military and outpatient samples, little data is available on this relationship in inpatient samples. This study examines the relationships between these variables and related demographic and clinical correlates in a sample of psychiatric inpatients with a diagnosis of major depressive disorder using electronic medical record (EMR) data. Controlling for relevant demographic and clinical variables, PTSD diagnosis and history of abuse were both significantly associated with history of suicide attempt, but in a combined model, only history of abuse remained as a significant predictor. Whereas history of abuse was associated with a history multiple suicide attempts, PTSD diagnosis was not. Both insurance status and gender acted as significant moderators of the relationship between history of abuse and history of suicide attempt, with males and those with public/no insurance having greater associations with history of suicide attempts when an abuse history was present. These data indicate the importance of documentation of PTSD, abuse history, and history of suicide attempts. The results also suggest that in the presence of an abuse history or PTSD diagnosis, additional time spent on safety and aftercare planning following hospital discharge may be indicated.
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ABSTRACT Research and theory related to nonsuicidal self-injury (NSSI) have highlighted the potential role for early traumatic experiences in subsequent enactment of NSSI behaviors. The present investigation explores the impact of trauma... more
ABSTRACT Research and theory related to nonsuicidal self-injury (NSSI) have highlighted the potential role for early traumatic experiences in subsequent enactment of NSSI behaviors. The present investigation explores the impact of trauma type and timing on both (a) reported NSSI as traditionally measured and (b) in vivo NSSI assessments. Findings supported an interaction between negative affect (NA) and cumulative trauma, such that individuals with high levels of cumulative life trauma evidenced greater in vivo NSSI severity following both high and low levels of in vivo NA. Nonlinear cusp models further supported the presence of an interaction of trauma, particularly trauma prior to 6 years of age, and pre-NSSI NA in the prediction of in vivo NSSI episode severity. The present findings extend a developing literature related to the effects of early life experiences on health behavior.
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Research suggests that individuals with a history of non-suicidal self-injury (NSSI) do not have difficulty generating alternatives to social problems but choose more negative solutions, suggesting a deficit in decision-making. However,... more
Research suggests that individuals with a history of non-suicidal self-injury (NSSI) do not have difficulty generating alternatives to social problems but choose more negative solutions, suggesting a deficit in decision-making. However, studies report no significant differences in risky decision-making on a performance-based task among individuals with and without NSSI histories. A limitation of these studies is that decision-making was only assessed at baseline. As individuals with a history of NSSI typically self-injure when experiencing negative emotions, decision-making ability may become impaired specifically in the presence of these emotions. The aim of the current study was to investigate decision-making ability among individuals with and without NSSI histories both at baseline and following a distressing social exclusion task. We compared individuals with (n=48) and without (n=72) NSSI histories on the Iowa Gambling Task, a behavioral measure of risky decision-making, before and after exclusion or inclusion on the Cyberball task. Results indicated no significant group differences in performance regardless of condition. When participants were grouped by racial/ethnic minority status, results indicated that non-Hispanic White individuals with a history of NSSI exhibited deterioration in risky decision-making ability following social exclusion. Potential explanations for these findings and clinical implications are discussed.
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Ecological momentary assessment (EMA) is one research method increasingly employed to better understand the processes that underpin depression and related phenomena. In particular, EMA is well suited to the study of affect (e.g., positive... more
Ecological momentary assessment (EMA) is one research method increasingly employed to better understand the processes that underpin depression and related phenomena. In particular, EMA is well suited to the study of affect (e.g., positive and negative affect), affective responses to stress (e.g., emotion reactivity), and behaviors (e.g., activity level, sleep) that are associated with depression. Additionally, EMA can provide insights into self-harm behavior (i.e. suicide and non-suicidal self-injury), and other mood disorders (e.g. bipolar disorder) commonly associated with depressive episodes. Given the increasing availability and affordability of handheld computing devices such as smartphones, EMA is likely to play an increasingly important role in the study of depression and related phenomena in the future.
This study investigated the point prevalence of probable cases of bulimia nervosa (BN), eating disorder not otherwise specified (EDNOS), and specific eating disorder symptomatology among 6,844 undergraduate women at a single site,... more
This study investigated the point prevalence of probable cases of bulimia nervosa (BN), eating disorder not otherwise specified (EDNOS), and specific eating disorder symptomatology among 6,844 undergraduate women at a single site, examining changes across five 3-year time periods and on a yearly basis from 1990 to 2004. Participants completed a self-report checklist that assessed the diagnostic criteria for BN (American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 1994) and the Bulimia Test (Smith and Thelen, J Consult Clin Psychol, 52, 863-872, 1984) (BULIT) or Bulimia Test-Revised (Thelen et al., Psychol Assess, 3, 119-124, 1991) (BULIT-R). Chi-square analyses comparing the percentages of probable cases of BN and EDNOS and the percentages of women who reported frequent binge eating and most compensatory weight control strategies were nonsignificant. Only the percentages of women who endorsed overconcern with weight and shape and diuretic use and excessive exercise as compensatory weight control strategies changed over time. Consistent with Keel et al.'s (Keel et al., Psychol Med, 36, 119-127, 2006) findings regarding the point prevalence rates of BN from 1992 to 2002, results indicated that probable cases of eating disorders remained relatively stable. Methodologically, this research illustrates the importance of examining multiple data points when investigating stability or change in behavior.
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Research Interests: Psychology, Nonlinear dynamics, Psychopathology, Adolescent, Comparative Study, and 15 moreLinear models, Emotions, Dissociation, Linear Model, Humans, Models, Evaluation methods, Female, Male, Defense Mechanisms, Comparative Analysis, Dissociative disorders, Awareness, Adult, and Cross Sectional Studies
ABSTRACT Research and theory related to nonsuicidal self-injury (NSSI) have highlighted the potential role for early traumatic experiences in subsequent enactment of NSSI behaviors. The present investigation explores the impact of trauma... more
ABSTRACT Research and theory related to nonsuicidal self-injury (NSSI) have highlighted the potential role for early traumatic experiences in subsequent enactment of NSSI behaviors. The present investigation explores the impact of trauma type and timing on both (a) reported NSSI as traditionally measured and (b) in vivo NSSI assessments. Findings supported an interaction between negative affect (NA) and cumulative trauma, such that individuals with high levels of cumulative life trauma evidenced greater in vivo NSSI severity following both high and low levels of in vivo NA. Nonlinear cusp models further supported the presence of an interaction of trauma, particularly trauma prior to 6 years of age, and pre-NSSI NA in the prediction of in vivo NSSI episode severity. The present findings extend a developing literature related to the effects of early life experiences on health behavior.
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We evaluated the feasibility and acceptability of a 2-week-long ecological momentary intervention (EMI), delivered via personal digital assistants (PDAs), to improve treatment adherence in bipolar disorder. EMIs use mobile technology to... more
We evaluated the feasibility and acceptability of a 2-week-long ecological momentary intervention (EMI), delivered via personal digital assistants (PDAs), to improve treatment adherence in bipolar disorder. EMIs use mobile technology to deliver treatment as clients engage in their typical daily routines, in their usual settings. Overall, participants ( N = 14) stated that EMI sessions were helpful, user-friendly, and engaging, and reported satisfaction with the timing and burden of sessions, as well as the method of delivery. All participants completed the study, and all PDAs were returned undamaged. On average, participants completed 92% of EMI sessions. Although this study was not designed to assess efficacy, depression scores decreased significantly over the study period and data suggest relatively high rates of treatment adherence; missed medication was reported 3% of the time and three participants reported missing a total of six mental health appointments. Negative feedback la...
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Depressive rumination, as assessed by Nolen-Hoeksema’s Response Styles Questionnaire (RSQ), predicts the onset, chronicity, and duration of depressed mood. However, some RSQ items contain depressive content and result in a heterogeneous... more
Depressive rumination, as assessed by Nolen-Hoeksema’s Response Styles Questionnaire (RSQ), predicts the onset, chronicity, and duration of depressed mood. However, some RSQ items contain depressive content and result in a heterogeneous factor structure. After the a priori elimination of items potentially confounded with depressed item content, Treynor, Gonzalez, and Nolen-Hoeksema identified two factors within the remaining RSQ rumination sub-scale that were differentially related to depression: brooding and pondering. However, Treynor et al. used a nonstandard form and administration of the RSQ. The present study sought to address these methodological idiosyncrasies and replicate the factor structure of Treynor et al. through exploratory factor analysis and structural equation modeling. Findings support the brooding and pondering solution and demonstrate that brooding relates more strongly to depression and anxiety than does pondering.
Research Interests: Psychology, Assessment, Depression, Anxiety, Affect, and 15 moreFactor analysis, Humans, Business and Management, Evaluation methods, Female, Male, Exploratory Factor Analysis, Cognitive processes, Structural Equation Model, Questionnaires, ANXIETY, Psychological Models, Active Ingredient, Emotional Response, and Factor structure
Depressive rumination, as assessed by Nolen-Hoeksema's Response Styles Questionnaire (RSQ), predicts the onset, chronicity, and duration of depressed mood. However, some RSQ items contain depressive content and result in a... more
Depressive rumination, as assessed by Nolen-Hoeksema's Response Styles Questionnaire (RSQ), predicts the onset, chronicity, and duration of depressed mood. However, some RSQ items contain depressive content and result in a heterogeneous factor structure. After the a priori elimination of items potentially confounded with depressed item content, Treynor, Gonzalez, and Nolen-Hoeksema identified two factors within the remaining RSQ rumination sub-scale that were differentially related to depression: brooding and ...