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Patient treatment preference may moderate treatment effect in major depressive disorder (MDD) studies. Little research has addressed preference in posttraumatic stress disorder (PTSD); almost none has assessed actual... more
Patient treatment preference may moderate treatment effect in major depressive disorder (MDD) studies. Little research has addressed preference in posttraumatic stress disorder (PTSD); almost none has assessed actual patients' PTSD psychotherapy preferences. From a 14-week trial of chronic PTSD comparing prolonged exposure, relaxation therapy, and interpersonal psychotherapy, we report treatment preferences of the 110 randomized patients, explore preference correlates, and assess effects on treatment outcome. Patients recruited between 2008 and 2013 with chronic DSM-IV PTSD (Clinician-Administered PTSD Scale [CAPS] score ≥ 50) received balanced, scripted psychotherapy descriptions prerandomization and indicated their preferences. Analyses assessed relationships of treatment attitudes to demographic and clinical factors. We hypothesized that patients randomized to preferred treatments would have better outcomes, and to unwanted treatment worse outcomes. Eighty-seven patients (79%) voiced treatment preferences or disinclinations: 29 (26%) preferred prolonged exposure, 29 (26%) preferred relaxation therapy, and 56 (50%) preferred interpersonal psychotherapy (Cochran Q = 18.46, P < .001), whereas 29 (26%) were disinclined to prolonged exposure, 18 (16%) to relaxation therapy, and 3 (3%) to interpersonal psychotherapy (Cochran Q = 22.71, P < .001). Several baseline clinical variables correlated with treatment preferences. Overall, treatment preference/disinclination did not predict change in CAPS score, treatment response, or dropout. Comorbidly depressed patients receiving unwanted treatment had worse final CAPS scores. These exploratory findings are the first relating patients' PTSD psychotherapy preferences to outcome. Despite explanations emphasizing prolonged exposure's greater empirical support, patients significantly preferred interpersonal psychotherapy. Preference subtly affected psychotherapy outcome; depression appeared an important moderator of the effect of unwanted treatment on outcome. Potential biases to avoid in future research are discussed. ClinicalTrials.gov identifier: NCT00739765.
Research Interests: Psychology, Clinical Psychology, Psychotherapy, Treatment Outcome, Medicine, and 15 moreHumans, Chronic Disease, Female, Male, Young Adult, Patient Preference, Moderation, Adult, Randomized Controlled Trial, Clinical Psychiatry, Interpersonal Psychotherapy, Relaxation Therapy, Implosive therapy, Psychology and Cognitive Sciences, and Medical and Health Sciences
ABSTRACT Research has consistently found high rates of comorbidity between narcissistic personality disorder (NPD) and borderline personality disorder (BPD). Patients with this complex clinical presentation often present formidable... more
ABSTRACT Research has consistently found high rates of comorbidity between narcissistic personality disorder (NPD) and borderline personality disorder (BPD). Patients with this complex clinical presentation often present formidable challenges for clinicians, such as intense devaluation, entitlement, and exploitation. However, there is a significant gap in the literature in identifying the clinical characteristics of these NPD/BPD patients. In this article, we present recent research describing patients with comorbid NPD/BPD, as compared with patients with BPD without NPD (BPD), from two randomized clinical trials for the treatment of borderline personality disorder, with a particular emphasis on attachment status and mentalization. We anchor our discussion of these patients in object relations and attachment theory, and we describe our treatment approach, transference focused psychotherapy (TFP). We conclude by using case material to illustrate our research findings, highlighting the significant differences between patients with NPD/BPD and BPD/non-NPD in terms of their attachment classification.
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Despite robust findings identifying impairments in interpersonal functioning associated with rejection sensitivity (RS), the object representations (OR) of self in relation to others from which such rejection expectancies and anxieties... more
Despite robust findings identifying impairments in interpersonal functioning associated with rejection sensitivity (RS), the object representations (OR) of self in relation to others from which such rejection expectancies and anxieties arise have not been evaluated. Our study was the first effort to evaluate the structural aspects of object representations in RS, which may provide a crucial link in understanding why interpersonal distress may translate to rejection expectancies. Participants included 56 ethnically diverse undergraduate students who self-reported interpersonal distress and RS, and were assessed using the Social Cognition and Object Relation Scale. Results showed greater disparities in levels of integration in OR predicted greater RS. Furthermore, a moderation model was supported in which heightened interpersonal distress predicted higher levels of rejection sensitivity only for those with greater disparities in levels of OR integration. Thus, individuals with unstable OR integration may find it difficult to accurately attribute accepting or rejecting dispositions to others in distressing interpersonal contexts.
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Research Interests: Psychology, Clinical Psychology, Interpersonal Communication, Psychometrics, Depression, and 15 morePersonality Assessment, Medicine, Comorbidity, Humans, Major Depressive Disorder, New York City, Female, Male, Interpersonal Relations, Aged, Middle Aged, Adult, Psychiatric Status Rating Scales, Psychology and Cognitive Sciences, and dysthymic disorder
IntroductionEffortful control (EC) is the self‐regulatory aspect of temperament that is thought to reflect the efficiency of executive attention (EA). Findings on relationship between EC and performance on EA tasks among adults are still... more
IntroductionEffortful control (EC) is the self‐regulatory aspect of temperament that is thought to reflect the efficiency of executive attention (EA). Findings on relationship between EC and performance on EA tasks among adults are still contradictory. This study used a computational approach to clarify whether greater self‐reported EC reflects better EA.MethodsFour hundred twenty‐seven healthy subjects completed the Adult Temperament Questionnaires and the Attention Network Task‐revised, a conflict resolution task that gauges EA as the flanker effect (FE), that is, the difference in performances between incongruent and congruent trials. Here we also employed a drift‐diffusion model in which parameters reflecting the actual decisional process (drift rate) and the extra‐decisional time are extracted for congruent and incongruent trials.ResultsEC was not correlated with the FE computed with the classic approach, but correlated positively with drift rate for the incongruent trials, even when controlling for the drift rate in the congruent condition and the extra‐decisional time in the incongruent condition.ConclusionThis study demonstrates an association between self‐reported EC and EA among adults. Specifically, EC is not associated with overall response facilitation but specifically with a greater ability to make goal‐oriented decisions when facing conflicting information.
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Previous research has shown that narcissism is associated with interpersonal difficulties and maladaptive affective responses to social rejection. In the current studies, the authors examined two phenotypes of pathological narcissism,... more
Previous research has shown that narcissism is associated with interpersonal difficulties and maladaptive affective responses to social rejection. In the current studies, the authors examined two phenotypes of pathological narcissism, narcissistic grandiosity and narcissistic vulnerability, and their impact on individuals' affective responses in two distinctive social rejection paradigms. Participants from Study 1 (N = 239), recruited from a multicultural university and Amazon's Mechanical Turk, completed Cyberball, a computerized social rejection paradigm. Participants from Study 2 (N = 238) were recruited from a multicultural university and participated in an in vivo group rejection paradigm in a laboratory. Results indicated that following the rejection in both studies, narcissistic vulnerability positively predicted explicit negative affect and state anger. In addition, the positive relationship between narcissistic vulnerability and explicit negative affect was moderated by greater implicit negative affect in Study 2. The implications and limitations of these findings are discussed.
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The two polarities model (TPM) of personality organizes psychological assessment and psychotherapy and connects to personality disorder diagnosis using the DSM-5 Alternative Model for Personality Disorders (AMPD). The authors developed... more
The two polarities model (TPM) of personality organizes psychological assessment and psychotherapy and connects to personality disorder diagnosis using the DSM-5 Alternative Model for Personality Disorders (AMPD). The authors developed scales assessing the TPM from an existing self-report measure for level of personality functioning (LPF), a core component of the AMPD. Iterative content analyses of the LPF measure yielded scales for Autonomy and Communion corresponding to dimensions of the TPM. The scales were refined via internal consistency analyses using a measure of psychological attachment and studied in development and validation samples. Associations with relevant external criteria were explored in a series of multiple regressions. The new content-based LPF scales were illustrated with a case vignette. Although the new Autonomy/Communion scales await further validation prior to clinical use, initial evidence suggests that they may bridge the nomological nets of the TPM and AM...
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Research has shown differences in the characteristics of suicidal behavior in individuals with dependent (anaclitic) versus self-critical (introjective) personality styles. Questions remain, however, as to what factors distinguish... more
Research has shown differences in the characteristics of suicidal behavior in individuals with dependent (anaclitic) versus self-critical (introjective) personality styles. Questions remain, however, as to what factors distinguish suicidal from nonsuicidal individuals within each personality style. The current study examined clinical and interpersonal correlates of suicidality in 124 patients attending residential treatment for complex psychiatric disorders, with the aim of clarifying how social cognition and quality of internalized object representations relate to suicidality in individuals with anaclitic versus introjective personality organizations. Higher anaclitic and lower introjective traits each predicted higher frequency of prior attempts. Furthermore, higher anaclitic and lower introjective traits interacted with the affective-interpersonal quality of object representations to predict prior attempts, such that each trait was associated with more frequent past attempts in t...
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Abstract The goal of this commentary is to highlight clinical applications of personality assessment research via two recent studies that are distinguished by their use of innovative experimental, multimethod designs. These studies... more
Abstract The goal of this commentary is to highlight clinical applications of personality assessment research via two recent studies that are distinguished by their use of innovative experimental, multimethod designs. These studies evaluate implicit behaviors as predicted by clinically relevant facets of personality functioning. Parallels to implicit behaviors evoked in the context of psychotherapy are discussed, as is the value of assessing and intervening on the subtle manifestations of personality dysfunction observed by clinicians, especially when they do not comport to the patient’s self-assessment.
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The right of the editors to be identified as the authors of the e ditorial material, and of t he authors for their individual chapters , has been-asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act... more
The right of the editors to be identified as the authors of the e ditorial material, and of t he authors for their individual chapters , has been-asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights r e served. No pa rt of t his book may be reprinted o r r eprodu ced or utilised in any form or by any elect ronic, mechanical, or other m eans, now known or hereafter invented, includi ng phot ocopying and recording. or in any information storage or r etrieval system, without permission in writing from t he publishers. Trodemork notice: Produ ct or corpora te names may be. t rademarks or regis te re d t rademarks. and a re used only fo r identification and explanation wi thout intent to infr inge. A cata logue record for this book is available from t he Br itish Library Attachment theory in adult mental health : a guide to clinical practice I e dited
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INTRODUCTION Effortful control (EC) is the self-regulatory aspect of temperament that is thought to reflect the efficiency of executive attention (EA). Findings on relationship between EC and performance on EA tasks among adults are still... more
INTRODUCTION Effortful control (EC) is the self-regulatory aspect of temperament that is thought to reflect the efficiency of executive attention (EA). Findings on relationship between EC and performance on EA tasks among adults are still contradictory. This study used a computational approach to clarify whether greater self-reported EC reflects better EA. METHODS Four-hundred-twenty-seven healthy subjects completed the Adult Temperament Questionnaires and the Attention Network Task-revised (ANT-R), a conflict resolution task that gauges EA as the Flanker Effect (FE), i.e., the difference in performances between incongruent and congruent trials. Here we also employed a drift-diffusion model in which parameters reflecting the actual decisional process (drift rate) and the extra-decisional time are extracted for congruent and incongruent trials. RESULTS EC was not correlated with the FE computed with the classic approach, but correlated positively with drift rate for the incongruent trials, even when controlling for the drift rate in the congruent condition and the extra-decisional time in the incongruent condition. CONCLUSION This study demonstrates an association between self-reported EC and EA among adults. Specifically, EC is not associated with overall response facilitation but specifically with a greater ability to make goal-oriented decisions when facing conflicting information.
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Despite robust findings identifying impairments in interpersonal functioning associated with rejection sensitivity (RS), the object representations (OR) of self in relation to others from which such rejection expectancies and anxieties... more
Despite robust findings identifying impairments in interpersonal functioning associated with rejection sensitivity (RS), the object representations (OR) of self in relation to others from which such rejection expectancies and anxieties arise have not been evaluated. Our study was the first effort to evaluate the structural aspects of object representations in RS, which may provide a crucial link in understanding why interpersonal distress may translate to rejection expectancies. Participants included 56 ethnically diverse undergraduate students who self-reported interpersonal distress and RS, and were assessed using the Social Cognition and Object Relation Scale. Results showed greater disparities in levels of integration in OR predicted greater RS. Furthermore, a moderation model was supported in which heightened interpersonal distress predicted higher levels of rejection sensitivity only for those with greater disparities in levels of OR integration. Thus, individuals with unstable OR integration may find it difficult to accurately attribute accepting or rejecting dispositions to others in distressing interpersonal contexts.
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Suicide is estimated to be 1 of the top 5 leading causes of death for individuals between the ages of 5 and 44. Although the majority of empirical research on suicide has focused on specific risk factors, this has not led to improvement... more
Suicide is estimated to be 1 of the top 5 leading causes of death for individuals between the ages of 5 and 44. Although the majority of empirical research on suicide has focused on specific risk factors, this has not led to improvement in the prediction of suicide in specific individuals. Contemporary theories such as the Interpersonal-Psychological or Escape theory of suicide have provided promising models of self-destructive behavior, improving on risk factor research by focusing on the connections between precipitating stressors and individual personality-based processes. However, these theories remain limited because of their assumption that all suicidal individuals experience similar vulnerabilities to the same sources of psychological trauma (e.g., interpersonal isolation or experiences of failure and shame). This review argues for an alternative personality-based conceptualization of suicide that contextualizes risk factors within broader models of personality, including considerations of personality-based cognitive and affective processes such as primary motivating psychological needs, attentional biases, and capacities for impulse control. The integration of contemporary personality theory with new and developing methodological approaches to suicide research will aim toward a more sensitive and comprehensive understanding of suicidal behavior in specific individuals, and greater accuracy in prediction of risk at the clinical assessment level. Language: en
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Previous research has shown that narcissism is associated with interpersonal difficulties and maladaptive affective responses to social rejection. In the current studies, the authors examined two phenotypes of pathological narcissism,... more
Previous research has shown that narcissism is associated with interpersonal difficulties and maladaptive affective responses to social rejection. In the current studies, the authors examined two phenotypes of pathological narcissism, narcissistic grandiosity and narcissistic vulnerability, and their impact on individuals' affective responses in two distinctive social rejection paradigms. Participants from Study 1 (N = 239), recruited from a multicultural university and Amazon's Mechanical Turk, completed Cyberball, a computerized social rejection paradigm. Participants from Study 2 (N = 238) were recruited from a multicultural university and participated in an in vivo group rejection paradigm in a laboratory. Results indicated that following the rejection in both studies, narcissistic vulnerability positively predicted explicit negative affect and state anger. In addition, the positive relationship between narcissistic vulnerability and explicit negative affect was moderate...
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The impact of borderline personality pathology on facial emotion recognition has been in dispute; with impaired, comparable, and enhanced accuracy found in high borderline personality groups. Discrepancies are likely driven by variations... more
The impact of borderline personality pathology on facial emotion recognition has been in dispute; with impaired, comparable, and enhanced accuracy found in high borderline personality groups. Discrepancies are likely driven by variations in facial emotion recognition tasks across studies (stimuli type/intensity) and heterogeneity in borderline personality pathology. This study evaluates facial emotion recognition for neutral and negative emotions (fear/sadness/disgust/anger) presented at varying intensities. Effortful control was evaluated as a moderator of facial emotion recognition in borderline personality. Non-clinical multicultural undergraduates (n = 132) completed a morphed facial emotion recognition task of neutral and negative emotional expressions across different intensities (100% Neutral; 25%/50%/75% Emotion) and self-reported borderline personality features and effortful control. Greater borderline personality features related to decreased accuracy in detecting neutral ...
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The context-free diagnoses outlined by the Diagnostic and Statistical Manual of Mental Disorders might not provide enough information to represent the heterogeneity observed in depressed patients. Interpersonal factors have been linked to... more
The context-free diagnoses outlined by the Diagnostic and Statistical Manual of Mental Disorders might not provide enough information to represent the heterogeneity observed in depressed patients. Interpersonal factors have been linked to depression in a mutually influencing pathoplastic relationship where certain problems, like submissiveness, are related to symptom chronicity. This study evaluated interpersonal pathoplasticity in a range of depressive presentations. We examined archival data collected from 407 participants who met criteria for major depressive disorder (MDD), dysthymic disorder (DD), or subthreshold depression (sD). Latent profile analysis (LPA) identified 5 interpersonal subtypes (vindictive, intrusive, socially avoidant, exploitable, and cold). Apart from gender, the subtypes did not differ significantly on demographic characteristics, psychiatric comorbidity, or self-report depression severity. Socially avoidant participants were more likely to meet criteria fo...
Research Interests: Psychology, Psychotherapy, Psychometrics, Depression, Personality Assessment, and 15 moreMedicine, Comorbidity, Humans, Major Depressive Disorder, New York City, Female, Male, Interpersonal Relations, Aged, Middle Aged, Adult, Social Behavior, Psychiatric Status Rating Scales, Psychology and Cognitive Sciences, and dysthymic disorder
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The Cognitive-Affective Processing System (CAPS) was used to examine effortful control (EC) as a moderator of daily interpersonal behavior. Participants (N = 240) were nonclinical young adults who completed a 7-day event-contingent... more
The Cognitive-Affective Processing System (CAPS) was used to examine effortful control (EC) as a moderator of daily interpersonal behavior. Participants (N = 240) were nonclinical young adults who completed a 7-day event-contingent experience sampling study of interpersonal perception and affect. Multilevel linear models indicated that EC moderated within-person covariation of interpersonal warmth and affect activation; high EC individuals reported greater momentary warm behaviors when perceiving others as affectively activated. EC also amplified between-person covariation of interpersonal warmth between self and others; high EC individuals generally responded to perceptions of another's warmth with a greater degree of warm behavior. Varying levels of EC predict responses to interpersonal perceptions and affect in daily life, suggesting an important dimension for interpersonal functioning.
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With the introduction in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) of a hybrid system of personality disorder assessment, the ability to assess patients' traits, as well as their level of... more
With the introduction in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) of a hybrid system of personality disorder assessment, the ability to assess patients' traits, as well as their level of personality functioning, has become increasingly important. To assess this criterion, the DSM-5 Levels of Personality Functioning Questionnaire (DLOPFQ) was developed. The DLOPFQ assesses individuals' self-impairments and other impairments in several domains (self-direction, identity, empathy, and intimacy) and across 2 contexts (work/school and relationships). A sample of 140 psychiatric and medical outpatients was administered the DLOPFQ and several other measures to assess its reliability and construct, incremental, and discriminant validity. The internal consistency and convergence with validation measures yielded generally meaningful and expected results. Several DLOPFQ scales and subscales were significantly correlated with measures of DSM-5 trai...
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Background The development of mindfulness parenting programs in recent years offers a promising direction for targeting parental emotional dysregulation in families of children with attention deficit hyperactivity disorder (ADHD).... more
Background The development of mindfulness parenting programs in recent years offers a promising direction for targeting parental emotional dysregulation in families of children with attention deficit hyperactivity disorder (ADHD). Nevertheless, research on the effectiveness of mindfulness parenting programs is limited, and little is known about the contribution of mindfulness skills to parenting when integrated with parent training (PT). Objective The present study evaluated a mindfulness skills augmentation to PT for ADHD. We hypothesized that mindfulness-enhanced PT would improve parental emotion regulation and reduce hostile and coercive parenting. Method We developed a 90-min mindfulness skills protocol and integrated it with a nonviolent resistance (NVR) PT program addressing ADHD and behavior difficulties. A total of 79 families were randomly assigned to PT or mindfulness-enhanced PT. Forty-three families completed intervention. We used multilevel modeling to evaluate parental emotion regulation, hostile and coercive parenting, and child behavioral symptoms across treatments and over time. Results Across treatment conditions, mothers’ negative feelings, escalating behaviors, and capacity for emotion regulation improved significantly following treatment. Fathers in the mindfulness condition reported greater improvement in the capacity for emotion regulation, reduced negative feelings, and reduced parental submission compared with fathers in the PT condition. We found no differences in child externalizing symptoms, which decreased significantly in both groups. Conclusions Study results suggest that PT in NVR is effective in improving maternal capacity for emotion regulation and in reducing hostile and coercive parenting. For fathers, a mindfulness-based skills augmentation may be important for enhancing treatment benefits.
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Research Interests: Psychology, Adolescent, Shame, Psychoanalytic Theory, Humans, and 4 moreNarcissism, Young Adult, Guilt, and Adult
The authors review clinical and conceptual errors that contribute to false attributions of malingering in forensic evaluations. Unlike the mental disorders, malingering is not defined by a set of (relatively) enduring symptoms or traits;... more
The authors review clinical and conceptual errors that contribute to false attributions of malingering in forensic evaluations. Unlike the mental disorders, malingering is not defined by a set of (relatively) enduring symptoms or traits; rather, it is an intentional, externally motivated, and context-specific form of behavior. Despite this general knowledge, attributions of malingering are often made by using assessment tools that may detect feigning but cannot be relied upon to determine incentive and volition or consciousness (defining characteristics of malingering). In addition, forensic evaluators may overlook the possibility that feigning is a function of true pathology, as in Ganser syndrome or the factitious disorders, or that a seemingly malingered presentation is due to symptoms of an underlying disorder, such as dissociative identity disorder (DID). Other factors that set the stage for false positives, such as pressure on forensic specialists to identify malingering at al...