Lizabeth Roemer, Ph.D. - US grants

The proposed study will begin a program of research designed to explore factors that enhance or inhibit successful emotional processing of traumatic information, beginning with a focus on motivated suppression of traumatic material. Extant theories of post-traumatic stress propose that avoidance of traumatic reminders interferes with successful processing of the traumatic event, causing the emotionality and accessibility of the memory to remain unaltered. However, these theories do not address whether avoidance may also directly cause memories to become more accessible and emotionally distressing. Experimental research on the ironic process of mental control indicates that such a causal relationship may exist: suppression instructions result in increased accessibility and negative affect associated with the forbidden material. The present investigation will explore the clinical applicability of these findings by examining the impact of suppressing thoughts of a rape- related article among rape survivors. Sixty female rape survivors will read a news article describing several sexual assaults. Half will then be instructed to suppress thoughts of the story while the other half are given instructions that permit thoughts of the story. Accessibility of rape-related thoughts will be measured by comparing latencies to color-naming rape related versus neutral words in the modified Stroop task. Rape-related emotional distress will be assessed by comparing self-report and heart rate responses during the initial reading of the rape article to those responses while reading the rape article following the experimental manipulation. It is predicted that suppression instructions will increase accessibility and emotional distress associated with rape-related material. These findings will have implications for devising effective early intervention strategies for trauma-exposed individuals.

DESCRIPTION (provided by applicant): Generalized anxiety disorder (GAD) is a chronic disorder that has been associated with significant psychosocial impairment, as well as health-care utilization/cost. Further, it is a highly comorbid disorder, and has been posited to be the basic anxiety disorder, which increases vulnerability for other anxiety and mood disorders. Despite the significant health impact of this disorder, it is currently the anxiety disorder for which existing treatments have demonstrated the least effectiveness. Cognitive-behavioral treatments have demonstrated the most efficacy to date; yet studies commonly find that less than half those treated meet criteria for high end state functioning after a follow-up period, indicating that more work is needed in treatment development for this disorder. Current theory and research in the area of worry and GAD highlights the role of cognitive/experiential avoidance in this disorder, suggesting that an integrative treatment that combines elements of traditional cognitive-behavioral approaches with mindfulness/acceptance-based elements from other behavioral treatments may be particularly efficacious with this population. The current application aims to further develop and refine this integrative therapy (Behavioral Mindfulness and Action Therapy for GAD; BMAT-G), develop reliable adherence and competency ratings for the therapy, and pilot the intervention by comparing BMAT-G to a wait list control group. The first phase of the study will focus on treatment development. Thirty-two clients will be treated with this new treatment and the manual will be refined through client, therapist, investigator, and consultant feedback. At the same time, adherence and competency ratings will be developed and raters will be trained to reliably administer them. Finally, thirty-two clients with a principal diagnosis of GAD will be randomly assigned to receive the newly developed intervention, or to a 14-week waitlist condition. Therapeutic gains will be assessed in several domains: anxious and depressive symptomatology, associated features (e.g., cognitive avoidance), and quality of life. Data from this development grant will be used to prepare a large-scale treatment outcome study that explores whether the addition of acceptance-based elements incrementally improves outcomes in both symptom report and broader functioning.

[unreadable] DESCRIPTION (provided by applicant): Generalized anxiety disorder (GAD) is a chronic disorder that has been associated with significant psychosocial impairment, as well as health-care utilization/cost. Further, it is a highly comorbid disorder, and has been posited to be the basic anxiety disorder, which increases vulnerability for other anxiety and mood disorders. Despite the significant health impact of this disorder, it is currently the anxiety disorder for which existing treatments have demonstrated the least effectiveness. Cognitive-behavioral treatments have demonstrated the most efficacy to date; yet studies commonly find that less than half those treated meet criteria for high end state functioning after a follow-up period, indicating that more efficacious treatments are needed. In addition, very few studies have addressed the effect of treatment on quality of life and functioning or assessed gains over a long follow-up period. Current theory and research in the area of worry and GAD highlights the role of cognitive/experiential avoidance in this disorder, suggesting that an integrative treatment that combines elements of traditional cognitive-behavioral approaches with mindfulness/acceptance-based elements from other behavioral treatments may be beneficial with this population. Recent pilot work suggests that an acceptance-based behavior therapy specifically designed to target presenting problems in GAD results in significant reductions in symptomatology and increases in quality of life and that these changes are significantly greater than changes that occur over a waitlist period. The current application aims to further investigate the efficacy of this intervention by comparing it to Applied Relaxation, an intervention with demonstrated efficacy in treating GAD. We will randomly assign 126 individuals who meet criteria for GAD (as well as comorbid disorders, providing GAD is principal) to receive one of these two treatments. We will examine whether acceptance-based behavior therapy leads to significantly greater reductions in symptoms and increases in quality of life and functioning at post and across 24 months of follow up assessments. We will also determine the proportion of individuals who meet high end state functioning in each treatment, and we will explore whether treatment effects are comparable among ethnic minority individuals (who we will make considerable efforts to recruit) and non-minority individuals. Finally, we will explore whether treatment effects are due to proposed mechanisms of change (experiential acceptance, mindfulness) as well as potential predictors of response among either or both treatments. Findings will have important implications in terms of determining maximally efficacious interventions for GAD and guiding future research in this area. [unreadable] [unreadable] [unreadable] [unreadable]