Top

Gepubliceerd in:

01-08-2015 | Original Article

Preliminary Evidence for the Enhancement of Self-Conducted Exposures for OCD Using Cognitive Bias Modification

Auteurs: Nader Amir, Jennie M. Kuckertz, Sadia Najmi, Sara L. Conley

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 4/2015

Abstract

Exposure and Response Prevention (ERP) is the most effective treatment for OCD but it is not accessible to most patients. Attempts to increase the accessibility of ERP via self-directed ERP (sERP) programs such as computerized delivery and bibliotherapy have met with noncompliance, presumably because patients find the exposure exercises unacceptable. Previous research suggests that Cognitive Bias Modification (CBM) interventions may help individuals approach feared situations. The goal of the current study was to test the efficacy of a treatment program for OCD that integrates sERP with CBM. Twenty-two individuals meeting diagnostic criteria for OCD enrolled in our 7-week treatment program. Results suggest that sERP with CBM led to significant reduction of OCD symptoms and functional impairment. Indeed, the magnitude of the effect of this novel treatment, that requires only an initial session with a clinician trained in ERP for OCD, was comparable to that of the gold standard clinician-administered ERP. Moreover, preliminary evidence suggests that CBM interventions targeting interpretation bias may be most effective, whereas those targeting attention and working memory bias may not be so.

vorige artikel Modeling the Neuroanatomical and Neurocognitive Mechanisms of Cognitive Insight in Non-clinical Subjects

volgende artikel Trait Anxiety, State Anxiety, and Attentional Bias to Threat: Assessing the Psychometric Properties of Response Time Measures

We calculated Reliable clinical change (RCI) as follows (Jacobson and Truax 1991): \(RCI = \frac{{x_{1} - x_{2} }}{{S_{diff} }},\;S_{diff} = \sqrt {2(S_{E} )^{2} } ,\;S_{E} = s_{1} \sqrt {1 - r_{xx} } ,\) x₁ = pre-assessment Y-BOCS mean, x₂ = post-assessment Y-BOCS mean, s₁ = standard deviation of current sample at pre-treatment, r_xx = test–retest reliability of the Y-BOCS. Test–retest reliability of .79 was obtained from Steketee et al. (1996b).

Change scores for the time corresponding to the psychoeducational video week were unavailable for four participants who failed to complete the OCI-R at the end of that week.

Abramowitz, J., Franklin, M., & Foa, E. (2002). Empirical status of cognitive-behavioral therapy for obsessive-compulsive disorder: A meta-analytic review. Romanian Journal of Cognitive & Behavioral Psychotherapies, 2(2), 89–104.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Amir, N., Elias, J., Klumpp, H., & Przeworski, A. (2003). Attentional bias to threat in social phobia: Facilitated processing of threat or difficulty disengaging attention from threat? Behaviour Research and Therapy, 41, 1325–1335.PubMedCrossRef

Amir, N., Freshman, M., & Foa, E. B. (2000). Family distress and involvement in relatives of obsessive-compulsive disorder patients. Journal of Anxiety Disorders, 14, 209–217.PubMedCrossRef

Amir, N., Kuckertz, J. M., & Najmi, S. (2013). The effect of modifying automatic action tendencies on overt avoidance behaviors. Emotion, 13, 478–484.PubMedCentralPubMedCrossRef

Amir, N., Najmi, S., & Morrison, A. M. (2009). Attenuation of attention bias in obsessive-compulsive disorder. Behaviour Research and Therapy, 47, 153–157.PubMedCentralPubMedCrossRef

Amir, N., & Taylor, C. T. (2012). Combining computerized home-based treatments for generalized anxiety disorder: An attention modification program and cognitive behavior therapy. Behavior Therapy, 43, 546–559.PubMedCentralPubMedCrossRef

Amir, N., Weber, G., Beard, C., Bomyea, J., & Taylor, C. (2008). The effect of a single session attention modification program on response to a public speaking challenge in socially anxious individuals. Journal of Abnormal Psychology, 117(4), 860–868. PMCID: PMC19025232.

Bachofen, M., Nakagawa, A., Marks, I. M., Park, J. M., Greist, J. H., Baer, L., et al. (1999). Home self-assessment and self-treatment of obsessive–compulsive disorder using a manual and a computer conducted telephone interview: Replication of a UK–US study. Journal of Clinical Psychiatry, 60, 545–549.PubMedCrossRef

Baer, L., Greist, J., & Marks, I. M. (2007). Computer-aided cognitive behaviour therapy. Psychotherapy and Psychosomatics, 76(4), 193–195.PubMedCrossRef

Beadel, J., Smyth, F., & Teachman, B. (2014). Change processes during cognitive bias modification for obsessive compulsive beliefs. Cognitive Therapy and Research, 8, 103–119.CrossRef

Beard, C., & Amir, N. (2009). Interpretation in social anxiety: When meaning precedes ambiguity. Cognitive Therapy and Research, 33, 406–415.PubMedCentralPubMedCrossRef

Beard, C., Sawyer, A. T., & Hofmann, S. G. (2012). Efficacy of attention bias modification using threat appetitive stimuli: A meta-analytic review. Behavior Therapy, 43, 724–740.PubMedCentralPubMedCrossRef

Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for beck depression inventory-II. San Antonio, TX: Psychological Corporation.

Beck, A. T., Steer, R. A., & Garbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8(1), 77–100.CrossRef

Bomyea, J., & Amir, N. (2011). The effect of an executive functioning training program on working memory capacity and intrusive thoughts. Journal of Cognitive Therapy and Research, 35, 529–535. doi:10.1007/s10608-011-9369-8.CrossRef

Britton, J. C., Bar-Haim, Y., Clementi, M. A., Sankin, L. S., Chen, G., Shechner, T., & Pine, D. S. (2013). Training-associated changes and stability of attention bias in youth: Implications for attention bias modification treatment for pediatric anxiety. Developmental Cognitive Neuroscience, 4, 52–64. doi:10.1016/j.dcn.2012.11.001.PubMedCentralPubMedCrossRef

Bystritsky, A., Liberman, R. P., Hwang, S., Wallace, C. J., Vapnik, T., Maindment, K., & Saxena, S. (2001). Social functioning and quality of life comparisons between obsessive-compulsive and schizophrenic disorders. Depression and Anxiety, 14(4), 214–218.PubMedCrossRef

Clerkin, E. M., Magee, J. C., & Parsons, E. M. (2014). Evaluating change in beliefs about the importance/control of thoughts as a mediator of CBM-I and responses to an ICT stressor. Journal of Obsessive-Compulsive and Related Disorders, 3(4), 311–318. doi:10.1016/j.jocrd.2014.07.002.PubMedCrossRef

Clerkin, E. M., & Teachman, B. A. (2011). Training interpretation biases among individuals with symptoms of obsessive compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry, 42, 337–343.PubMedCentralPubMedCrossRef

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Lawrence Earlbaum Associates.

Cougle, J. R., Wolitzky-Taylor, K. B., Lee, H., & Telch, M. J. (2007). Mechanisms of change in ERP treatment of compulsive handwashing: Does primary threat make a difference? Behaviour Research and Therapy, 45, 1149–1459.CrossRef

Crits-Christoph, P., Chambless, D. L., Frank, E., Brody, C., & Karp, J. F. (1995). Training in empirically validated treatments: What are clinical psychology students learning? Professional Psychology: Research & Practice, 26(5), 514–522.CrossRef

Davidson, G. C. (1998). Being bolder with the Boulder model: The challenge of education and training in empirically supported treatments. Journal of Consulting and Clinical Psychology, 66(1), 163–167.CrossRef

Denys, D., van Megen, H., & Westenberg, H. (2002). The adequacy of pharmacotherapy in outpatients with obsessive-compulsive disorder. International Clinical Psychopharmacology, 17, 109–114.PubMedCrossRef

First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. (1994). Structured clinical interview for DSM-IV: Patient edition (SCID-I/P, version 2.0). New York: Biometric Research Department.

Fisher, P. L., & Wells, A. (2008). Metacognitive therapy for obsessive–compulsive disorder: A case series. Journal of Behavior Therapy and Experimental Psychiatry, 39, 117–132.PubMedCrossRef

Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., & Salkovskis, P. M. (2002). The obsessive-compulsive inventory: Development and validation of a short version. Psychological Assessment, 14, 485–496.PubMedCrossRef

Foa, E. B., & Kozak, M. J. (1996). Psychological treatment for obsessive-compulsive disorder. In M. R. Mavissakalian & R. F. Prien (Eds.), Long-term treatments of anxiety disorders. Washington: American Psychiatric Association.

Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Franklin, M. E., et al. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry, 162, 151–161.PubMedCrossRef

Franklin, M. E. (2005). Combining serotonergic medication with cognitive-behavior therapy: Is it necessary for all OCD patients? In J. S. Ambramowitz & A. C. Houts (Eds.), Concepts and controversies in obsessive-compulsive disorder (pp. 377–389). New York: Springer.CrossRef

Franklin, M., & Foa, E. B. (1998). Cognitive-behavioral treatments for obsessive compulsive disorder: A guide to treatments that work (pp. 339–357). New York: Oxford University Press.

Goisman, R. M., Rogers, M. P., Steketee, G. S., Warshaw, M. G., Cuneo, P., & Keller, M. B. (1993). Utilization of behavioral methods in a multicenter anxiety disorders study. Journal of Clinical Psychiatry, 54, 213–218.PubMed

Goodman, W. K., Price, L. H., Rasmussen, S. A., & Mazure, C. (1989). The Yale-brown obsessive compulsive scale. II. Validity. Archives of General Psychiatry, 46, 1012–1016.PubMedCrossRef

Greist, J. H., Marks, I. M., Baer, L., Kobak, K. A., Wenzel, K. W., Hirsch, M. J., et al. (2002). Behavior therapy for obsessive-compulsive disorder guided by a computer or by a clinician compared with relaxation as a control. Journal of Clinical Psychiatry, 63, 138–145.PubMedCrossRef

Grisham, J. R., Becker, L., Williams, A. D., Whitton, A. E., & Makkar, S. R. (2014). Using cognitive bias modification to deflate responsibility in compulsive checkers. Cognitive Therapy and Research, 38, 505–517.CrossRef

Gunter, R. W., & Whittal, M. L. (2010). Dissemination of cognitive-behavioral treatment for anxiety disorders: Overcoming barriers and improving patient access. Clinical Psychology Review, 30, 194–202.PubMedCrossRef

Hakamata, Y., Lissek, S., Bar-Haim, Y., Britton, J. C., Fox, N., Leibenluft, E., et al. (2010). Attention bais modification treatment: A meta-analysis towards the establishment of novel treatment for anxiety. Biological Psychiatry, 68, 982–990.PubMedCentralPubMedCrossRef

Hallion, L. S., & Ruscio, A. M. (2011). A meta-analysis of the effect of cognitive bias modification on anxiety and depression. Psychological Bulletin, 137, 940–958.PubMedCrossRef

Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology, 32, 50–55.PubMedCrossRef

Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56–61.PubMedCentralPubMedCrossRef

Hedlund, J. L., & Vieweg, B. W. (1979). The Hamilton rating scale for depression: A comprehensive review. Journal of Operational Psychiatry, 10, 149–165.

Heeren, A., Reese, H. E., McNally, R. J., & Philippot, P. (2012). Attnetion training toward and away from threat in social phobia: Effects on subjective, behavioral and physiological measures of anxiety. Behaviour Research and Therapy, 50, 30–39.PubMedCrossRef

Hirsch, C. R., Clark, D. M., & Mathews, A. (2006). Imagery and interpretations in Social Phobia: Support for the combined cognitive biases hypothesis. Behavior Therapy, 37, 223–236.PubMedCrossRef

Hollander, E. (2005). Obsessive-compulsive disorder and spectrum across the life span. International Journal of Psychiatry in Clinical Practice, 9(2), 79–86.PubMedCrossRef

Hollander, E., Alterman, R., & Dell’Osso, B. (2006). Approaching treatment-resistant obsessive-compulsive disorder with brain stimulation interventions: The state of the art. Psychiatric Annals, 36(7), 480–488.

Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.PubMedCrossRef

Jelinek, L., Hottenrott, B., & Moritz, S. (2009). When cancer is associated with illness but no longer with animal or zodiac sign: Investigation of biased semantic networks in obsessive-compulsive disorder (OCD). Journal of Anxiety Disorders, 23, 1031–1036.PubMedCrossRef

Jhung, K., Namkoong, K., Kang, J. I., Ha, R. Y., An, S. K., Kim, C. H., & Kim, S. J. (2010). Perception bias of disgust in ambiguous facial expressions in obsessive-compulsive disorder. Psychiatry Research, 178, 126–131.PubMedCrossRef

Karno, M., & Golding, J. M. (1991). Obsessive-compulsive disorder. In L. N. Robins & D. A. Regier (Eds.), Psychiatric disorders in America: The epidemiological catchment area study (pp. 204–219). New York: Free Press.

Kohn, R., Saxena, S., Levav, I., & Saraceno, B. (2004). The treatment gap in mental health care. Bull World Health Organization, 82(11), 858–866.

Kozak, M. J., & Foa, E. B. (1997). Mastery of obsessive-compulsive disorder: A cognitive-behavioral approach. San Antonio: PsychologicalCorporation.

Kuckertz, J. M., Amir, N., Tobin, A. C., & Najmi, S. (2013). Interpretation of ambiguity in individuals with obsessive-compulsive symptoms. Cognitive Therapy and Research, 37, 232–241.CrossRef

Leon, A. C., Olfson, M., Portera, L., Farber, L., & Sheehan, D. V. (1997). Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. International Journal of Psychiatry in Medicine, 27, 93–105.PubMedCrossRef

Leonard, H., Swedo, S., & Lenane, M. C. (1993). A 2–7 year follow-up study of 54 obsessive–compulsive children and adolescents. Archives of General Psychiatry, 50, 429–439.PubMedCrossRef

Maier, W., Buller, R., Philipp, M., & Heuser, I. (1988). The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. Journal of Affective Disorders, 14, 61–68.PubMedCrossRef

Mancebo, M. C., Eisen, J. L., Pinto, A., Greenberg, B. D., Dyck, I. R., & Rasmussen, S. A. (2006). The brown longitudinal obsessive compulsive study: Treatments received and patient impressions of improvement. Journal of Clinical Psychiatry, 67(11), 1713–1720.PubMedCrossRef

March, J. S., Frances, A., Carpenter, D., & Kahn, D. A. (1997). The expert consensus guidelines series: Treatment of obsessive-compulsive disorder. Journal of Clinical Psychiatry, 58(4), 1–72.

Marques, L., LeBlanc, N. J., Weingarden, H. M., Timpano, K. R., Jenike, M., & Wilhelm, S. (2010). Barriers to treatment and service utilization in an internet sample of individuals with obsessive-compulsive symptoms. Depression and Anxiety, 27, 470–475.PubMedCrossRef

Mavissakalian, M. R., Jones, B., & Olson, S. (1990). Absence of placebo response in obsessive-compulsive disorder. The Journal of Nervous and Mental Disease, 178, 268–270.PubMedCrossRef

McLean, P., Whittal, M., Thordarson, D., Taylor, S., Söchting, I., Koch, W., et al. (2001). Cognitive versus behavior therapy in the group treatment of Obsessive-Compulsive disorder. Journal of Consulting and Clinical Psychology, 69(2), 205–214.PubMedCrossRef

Mogoaşe, C., David, D., & Koster, E. H. W. (2014). Clinical efficacy of attentional bias modification procedures: An updated meta-analysis. Journal of Clinical Psychology. doi:10.1002/jclp.22081

Najmi, S. & Amir, N. (2010). The effect of attention training on a behavioral test of contamination fears in individuals with obsessive-compulsive symptoms. Journal of Abnormal Psychology, 119(1), 136–142. PMCID: PMC2866445.

Najmi, S., Tobin, A., & Amir, N. (2012). Psychometric properties of a behavioral test of contamination-related obsessive-compulsive symptoms. Cognitive Therapy and Research, 36, 228–233.CrossRef

Obsessive Compulsive Cognitions Working Group. (2001). Development and initial validation of the obsessive beliefs questionnaire and the interpretation of intrusions inventory. Behaviour Research and Therapy, 39, 987–1006.CrossRef

Obsessive Compulsive Cognitions Working Group. (2003). Psychometric validation of the obsessive belief questionnaire and interpretation of intrusions inventory: Part 1. Behaviour Research and Therapy, 41, 836–878.

Pigott, T. A. (1998). Obsessive–compulsive disorder: Symptom overview and epidemiology. Bulletin of the Menninger Clinic, 62, A4–A32.PubMed

Posner, M. I. (1980). Orienting of attention. Quarterly of Journal of Experimental Psychology, 32A, 3–25.CrossRef

Rabkin, J. G., & Klein, D. F. (1987). The clinical measurement of depressive disorders. In A. Marsella, R. Hirschfeld, & M. Katz (Eds.), The measurement of depression (pp. 30–83). New York City: Guilford Press.

Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35, 793–802.PubMedCrossRef

Rachman, S. J. (2003). The treatment of obsessions. Oxford: Oxford University Press.

Ramanaiah, N. V., Franzen, M., & Schill, T. (1983). A psychometiric study of the State-Trait Anxiety Inventory. Journal of Personality Assessment, 47, 531–535.PubMedCrossRef

Rapee, R. M., MacLeod, C., Carpenter, L., Gaston, J. E., Frei, J., Peters, L., & Baillie, A. J. (2013). Integrating cognitive bias modification into a standard cognitive behavioural treatment package for social phobia: A randomized controlled trial. Behaviour Research and Therapy, 51(4–5), 207–215. doi:10.1016/j.brat.2013.01.005.PubMedCrossRef

Rickels, K., Rynn, M., Iyengar, M., & Duff, D. (2006). Remission of generalized anxiety disorder: A review of the paroxetine clinical trials database. Journal of Clinical Psychiatry, 67, 41–47.PubMedCrossRef

Riemann, B. C., Kuckertz, J. M., Rozenman, M., Weersing, V. R., & Amir, N. (2013). Augmentation of youth cognitive behavioral and pharmacological intervention with attention modification: A preliminary investigation. Depression and Anxiety, 30, 822–828.PubMedCentralPubMedCrossRef

Rinck, M., & Becker, E. S. (2007). Approach and avoidance in fear of spiders. Journal of Behavior Therapy and Experimental Psychiatry, 38, 105–120.PubMedCrossRef

Salkovskis, P. M. (1985). Obsessional–compulsive problems: a cognitive-behavioural analysis. Behaviour Research and Therapy, 23, 571–583.PubMedCrossRef

Salkovskis, P. M. (1989). Cognitive behavioural factors and the persistence of intrusive thoughts in obsessional problems. Behaviour Research and Therapy, 27, 677–682.PubMedCrossRef

Smithson, M. J. (2003). Confidence intervals. Quantitative applications in the social sciences series, No. 140. Thousand Oaks, CA: Sage.

Spielberger, C. D., Gorsuch, R. L., Lushene, R. E., Vagg, R. E., & Jacobs, G. A. (1983). Manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press.

Steketee, G. (1993). Treatment of obsessive-compulsive disorder. New York: Guilford.

Steketee, G., Chambless, D. L., Tran, G. Q., Worden, H., & Gillis, M. M. (1996a). Behavioral avoidance test for obsessive compulsive disorder. Behaviour Research and Therapy, 34, 73–83.PubMedCrossRef

Steketee, G., Frost, R., & Bogart, K. (1996b). The Yale-brown obsessive compulsive scale: Interview versus self-report. BehaviourResearchs and Therapy, 34, 675–684.

Tallis, F. (1997). The neuropsychology of obsessive-compulsive disorder: A review and consideration of clinical implications. British Journal of Clinical Psychology, 36, 3–20.PubMedCrossRef

Tata, P. R., Liebowitz, J. A., Prunty, M. J., Cameron, M., & Pickering, A. D. (1996). Attentional bias in obsessional compulsive disorder. Behaviour Research and Therapy, 34, 53–60.PubMedCrossRef

Tenney, N. H., Denys, D., van Megen, H., Glas, G., & Westenberg, H. (2003). Effect of pharmacological intervention on quality of life in patients with obsessive–compulsive disorder. International Clinical Psychopharmacology, 18(1), 29–33.PubMedCrossRef

Tolin, D. F., Hannan, S., Maltby, N., Diefenbach, G. J., Worhunsky, P., & Brady, R. E. (2007). A randomized controlled trial of self-directed versus therapist-directed CBT for OCD patients with prior medication trials. Behavior Therapy, 38, 179–191.PubMedCrossRef

Torres, A., Prince, M. J., Bebbington, P. E., Bhugra, D., Brugha, T. S., Farrell, M., et al. (2006). Obsessive-compulsive disorder: prevalence, comorbidity, impact, and help-seeking in the British National Psychiatric Morbidity Survey of 2000. The American Journal of Psychiatry, 163, 1978–1985.PubMedCrossRef

Turner, S. M., Beidel, D. C., Spaulding, S. A., & Brown, J. M. (1995). The practice of behavior therapy: A national survey of costs and methods. The Behavior Therapist, 18, 1–4.

Unsworth, N., Heitz, R., Schrock, J., & Engle, R. (2005). An automated version of the operation span task. Behavior Research Methods, 37, 498–505.PubMedCrossRef

Wilhelm, S., Steketee, G., Fama, J. M., Buhlmann, U., Teachman, B. A., & Golan, E. (2009). Modular cognitive therapy for obsessive-compulsive disorder: A wait-list controlled trial. Journal of Cognitive Psychotherapy: An International Quarterly, 23(4), 294–305.CrossRef

Wilhelm, S., Steketee, G., Reily-Harrington, N., Deckersbach, T., Buhlmann, U., & Baer, L. (2005). Effectiveness of cognitive therapy for obsessive-compulsive disorder: An open trial. Journal of Cognitive Psychotherapy, 19, 173–179.CrossRef

Williams, A. D., & Grisham, J. R. (2013). Cognitive Bias Modification (CBM) of obsessive compulsive beliefs. BMC Psychiatry, 13, 256. doi:10.1186/1471-244X-13-256.PubMedCentralPubMedCrossRef

Titel: Preliminary Evidence for the Enhancement of Self-Conducted Exposures for OCD Using Cognitive Bias Modification
Auteurs: Nader Amir
Jennie M. Kuckertz
Sadia Najmi
Sara L. Conley
Publicatiedatum: 01-08-2015
Uitgeverij: Springer US
Gepubliceerd in: Cognitive Therapy and Research / Uitgave 4/2015
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-015-9675-7

Bohn Stafleu van Loghum

Deel dit onderdeel of sectie (kopieer de link)

Abstract

Log in om toegang te krijgen

Andere artikelen Uitgave 4/2015

Validation of a Self-Report Measure of Self-Efficacy in Contamination Fear: The Contamination Self-Efficacy Scale (CSES)

Modeling the Neuroanatomical and Neurocognitive Mechanisms of Cognitive Insight in Non-clinical Subjects

Perceived Emotion Control Moderates the Relationship Between Neuroticism and Generalized Anxiety Disorder

Feeling Good and Taking a Chance? Associations of Hypomania Risk with Cognitive and Behavioral Risk Taking

Contextual Influences on Distress Intolerance: Priming Effects on Behavioral Persistence

The Use of Motivation Enhancement Therapy to Increase Utilization of a Preventative Intervention for Anxiety Sensitivity