ABCT 2023 Posters

The road to skill use: Do baseline measurements predict the use of DBT skills during treatment?
Ally M. Heiland, Dorian Hatch, & Jennifer S. Cheavens

Abstract: Dialectical Behavior Therapy (DBT; Linehan, 1993; Linehan, 2006) is an evidence-based psychotherapy treatment originally developed for chronic suicidality and borderline personality disorder focused on the dialectic of acceptance and change. A key aspect of DBT involves teaching behavioral skills across four main skill dimensions: emotion regulation, mindfulness, distress tolerance, and interpersonal effectiveness. Few DBT studies include direct assessment of skill use (Rudge et al., 2020; Valentine et al., 2015), and those that do often include skill use as a predictor of treatment outcomes (e.g., Barnicot et al., 2015). Limited research has been conducted specifically on antecedents of the use of specific skills within DBT treatment. The present research examines how skill use changes over the course of DBT and how baseline measurements of the four skill dimensions predict skill use over the course of DBT.  Participants (N = 45) were clients in a DBT graduate training clinic and completed baseline measures of emotion dysregulation (Difficulties in Emotion Regulation Scale; Gratz & Roemer, 2004), distress tolerance (Distress Tolerance Scale; Simons & Gaher, 2005), mindfulness (The Mindful Attention Awareness Scale; Brown & Ryan, 2003), and interpersonal problems (Inventory of Interpersonal Problems; Horowitz et al., 1988). Skill use during treatment was assessed using DBT diary card responses. Consistent with our hypothesis, using Bayesian multilevel modeling, we found a reliable decrease in distress tolerance skill use over treatment, β = -.17, 95% CI [-0.32, -0.02]. Contrary to our hypothesis, we also found a reliable decrease in mindfulness skill use over the course of treatment, β = -.14, 95% CI [-0.27, -0.01]. We did not find reliable effects for emotion regulation or interpersonal effectiveness skill use change over the course of DBT. Using extracted slopes from the multilevel model, we found that, consistent with our hypothesis, higher baseline emotion dysregulation predicted less emotion regulation skill use over the course of treatment, β = -.37, t = -2.26, p = .02. Inconsistent with our hypothesis, we found that baseline mindfulness did not predict mindfulness skill use, baseline distress tolerance did not predict distress tolerance skill use, and that more baseline interpersonal problems did not predict interpersonal skill use over the course of DBT.  Findings indicate that baseline difficulties or strengths relating to the DBT skills modules may not correspond to the use of those skills during treatment with the exception of emotion dysregulation. This study highlights the importance of addressing emotion dysregulation as a key target in DBT; prioritizing this area of treatment for individuals high in baseline emotion dysregulation may be important in promoting the use of emotion regulation skills.


Relationships between intrinsic religiosity, emotion regulation, psychopathology, and race.
Kassidie S. Harmon, Whitney M. Whitted, & Jennifer S. Cheavens

Abstract: Emotion regulation strategies are used to change the direction, duration, or intensity of an affective experience (Mauss et al., 2007). Putatively maladaptive strategies like avoidance are associated with several forms of psychopathology including generalized anxiety disorder (Roemer et al., 2005), obsessive-compulsive disorder (Abramowitz et al., 2009), and depression (Tull et al., 2004). However, much of the emotion regulation literature has only investigated the use and effectiveness of emotion regulation strategies among primarily White samples. Recent data indicate that contextual variables like racism-related stress are important in understanding relationships between emotion regulation and psychopathology features (Southward et al., 2019; Harmon & Cheavens, in preparation). Previous research also documents the importance of religiosity in managing racism-related stressors (Bierman, 2006). In the present research, we aimed to understand relationships between emotion regulation, psychopathology features, and religion in Black and White Americans. Data were collected from a combined university and community sample.  (N = 400, 42% Black, 57.50% White). All participants self-reported demographic characteristics, their use of the experiential avoidance emotion regulation strategy (Brief Experiential Avoidance Questionnaire, Gámez et al., 2014; BEAQ), and their intrinsic religious beliefs (Duke University Religion Index, Koenig et al., 1997; DUREL). Participants also completed self-report measures of depression (Patient Health Questionanaire-9, Kroenke & Spitzer, 2002; PHQ-9), anxiety (Generalized Anxiety Disorder Scale, Spitzer et al., 2006; GAD-7) and borderline personality disorder features (Personality Assessment Inventory-Borderline Scale, Morey, 1991; PAI-BOR). In order to reduce type 1 error inflation, we created a standardized composite psychopathology score derived from the PHQ-9, GAD-7, and PAI-BOR measures. Regression analyses revealed that the full model, assessing DUREL scores, BEAQ scores, race, and psychopathology features was significant, R2 = .49, F(7, 206) = 28.00, p < .001. Additionally, there were significant main effects of experiential avoidance (t(206) = 5.61, p > .001) and intrinsic religiosity (t(206) = 2.24, p = .026) scores on psychopathology features. There was a significant BEAQ by DUREL interaction, t(206) = -3.13, p = .002, such that the relationship between experiential avoidance scores and psychopathology features was weaker for participants who reported higher intrinsic religiosity. Results also revealed a significant race by DUREL by BEAQ interaction, t(206) = 2.44, p = .015. This suggests that for Black, but not White participants, the relationship between experiential avoidance and psychopathology features was moderated by intrinsic religiosity. That is, the relationship between experiential avoidance and psychopathology features was weaker for Black participants who endorsed high intrinsic religiosity compared to Black participants with lower intrinsic religiosity and White participants. These results provide researchers with critical information about how religion may be an important factor in the psychological experiences of Black Americans. Future research should examine the mechanisms of these relationships to understand how religiosity may buffer negative psychological effects of maladaptive emotion regulation strategies.  


Building a Model for the Relationship Between Failure and Depression: A Pilot Study
Whitney M. Whitted, Maria Sanchez-Boedo, Kassidie S. Harmon, Jennifer S. Cheavens

Abstract: The learned helplessness model of depression suggests that humans can be conditioned to believe that there is no way to escape pain and suffering and, therefore, will no longer work to avoid the pain and suffering (Seligman, 1972). Experiences of failure often result in negative emotions (Johnson et al., 2011; Johnson et al., 2008; Nummenmaa & Niemi, 2004); however, experiences of failure can also produce growth (Tao et al., 2021). Thus, it stands to reason that repeated experiences of failure are likely to be associated with depressive symptoms, but that the risk may be mitigated when the failures are appraised as learning or growth opportunities. The current study aimed to lay a groundwork for investigating the relationships between experiences of failure and depression symptoms, as well as how constructs such as hope (Snyder et al., 1996) and a fear of failure contribute to these associations. We hypothesized that more experiences of failure and a fear of failure would be associated with greater symptoms of depression, but that hope would moderate these relationships. Furthermore, we hypothesized that hope would be negatively correlated with a fear of failure. We collected data from 133 undergraduate students at a large midwestern university (50.4% female; 73.7% White; Mean age = 19.20 years). All participants completed self-report questionnaires for information regarding demographic characteristics, symptoms of depression (PHQ-9; Kroenke & Spitzer, 2002), experiences of failure, hope (Snyder et al., 1991), and grit (Duckworth & Quinn, 2009). Depression symptoms were positively associated with frequency of failure, r(126) = .45, p < .001, and fear of failure, r(126) = .70, p < .001. Depression symptoms were negatively correlated with hope, r(124) = -.356, p < .001. Contrary to our hypotheses, hope did not moderate the relationship between experiences of failure and depression symptoms. However, hope was significantly inversely associated with depression symptoms even after accounting for frequency of failure and fear of failure. The results of this pilot study reveal relationships between frequency of failure, fear of failure, hope, and depression. From these analyses, we propose a temporal model to be tested in future studies. Specifically, as frequency of failure increases, hope decreases, which then leads to an increase in fear of failure. The resulting increase in fear of failure serves as a risk factor for developing symptoms of depression. However, given that these are cross-sectional data, the correlations could work in the opposite direction where people who are depressed appraise more events as failures and report less hope. Using longitudinal and/or experimental designs to further investigate the direction and causal relationships between these variables is an important next step in delineating these associations. Finally, our exploratory qualitative analyses revealed that the majority of participants viewed failure as negative or detrimental, while a minority of participants viewed failure as an opportunity for learning, growth, and experience. Future studies examining the learning process of failure appraisals, specifically, looking at developmental timing in experiencing and learning from failure would help us understand these two trajectories following failure experiences.

The Role of Positive Affect in CBT Skills Training
Daniel S. Brunette, Graham Bartels, Daniel R. Strunk, & Jennifer S. Cheavens)

Abstract: According to the broaden and build theory of positive emotions (Fredrickson, 2004), while negative emotions narrow one’s thought-action repertoires to navigate dangerous or uncomfortable situations, positive emotions broaden these thought-action repertoires, allowing for increased approach behaviors such as creativity, exploration, and building of skills. Positive emotion and the associated behavioral urges may be advantageous in psychotherapy, which asks clients to explore and develop new coping skills. As such, we would expect those with higher positive affect (PA) to have higher outcome expectancies and be more willing to engage with the intervention. Additionally, given the positive associations of client expectancy (Beasley et al., 2017; Constantino et al., 2012) and engagement (LeBeau et al., 2013) with treatment outcomes, we might anticipate those with higher PA to also achieve greater improvement on depressive and anxiety symptoms. In the current study, we examined how a client’s baseline PA related to several process and outcome variables of a CBT skills-based intervention, including treatment expectancy at baseline, homework completion, and outcomes of depression and anxiety. Participants (n = 291) were randomized to either a cognitive (n = 75), behavioral (n = 75), interpersonal (n = 68), or mindfulness (n = 73) module, which took place over the course of 3 weeks. Each module consisted of three 5-minute educational videos (one per week) on a specific coping skill. In addition, participants were expected to practice by completing 9 module-specific worksheets over the course of the 3 weeks. Assessments of client expectancy (CEQ; Devilly & Borkovec, 2000) and PA (PANAS; Watson et al., 1988) were taken as baseline. Homework completion was defined as worksheets completed by the end of the intervention (0 = no worksheets, 1 = at least 1 worksheet). Depression (QIDS-SR; Rush et al., 2003) and anxiety (GAD-7; Spitzer et al., 2006) symptoms were assessed weekly. Multiple regression analyses were conducted for tests of the association of PA with expectancy and homework completion. For each of these, baseline depression scores were included as a moderator to examine the role of baseline differences in depression on the relationship. Repeated measures linear regression models were conducted for depression and anxiety symptoms regressed on time (in weeks), PA, and their interaction. The results suggested that baseline PA is associated with greater expectations of treatment success, t(283) = 3.76, p < .001. However, this is qualified by its interaction with baseline depression scores, t = 2.30, p = .022. Analysis of simple slopes suggests that PA relates to expectations of treatment success only for those with moderate depressive symptoms or greater. However, the relationship between PA and homework completion was not statistically significant, z = 1.94, p = .052. In a planned analysis of simple slopes, PA tended to be related to homework completion only for those with higher depressive symptoms. Finally, despite significant or nearly significant effects of PA on treatment expectations and engagement, PA was not predictive of change in symptoms of depression, t(618) = 1.03, p = .303, nor anxiety, t(612) = 0.53, p = .596. 

Ray Travel Award for Service and Scholarship

Cameryn Cooley received the Ray Travel Award for Service and Scholarship! This award is to help graduate students across the university participate in conferences. The award focuses heavily on an applicant’s service to their department, the university and the surrounding community. Great work, Cameryn!