ABCT 2017

*Presentations authored/co-authored by student mentees.

Depression and Anxiety (Internalizing)
Disorders

*Bolla, P., Oravec, K., Petrochic, K., & Yaroslavsky, I. (2017, November). The effect of worrisome thinking on autonomic regulation. Poster presented at the 51st annual convention of the Association for Behavioral Cognitive Therapies, San Diego, CA.

• Introduction. Stress is a transdiagnostic risk factor for many disorders and negative health outcomes that affects emotional as well as physiological response systems. In particular, the autonomic nervous system (ANS) has been linked with the stress response, and quick recovery following the cessation of the stressor is associated with salubrious outcomes. Generalized Anxiety Disorder (GAD) is characterized by worry about potential stressors, and is associated with a dampened autonomic reactivity, although the literature is mixed as to whether these blunted reactions are a function of reduced parasympathetic and heighted sympathetic activity at baseline that constrains the magnitude of the ANS response. Relatively little is known about the relationship between worry and ANS activity following the termination of stressful events. Given that a prolonged stress response is associated with adverse health outcomes, the present study examined the relationship between worry and ANS reactivity before, during, and following an interpersonal stressor.
• Method. Forty (n=40) students who completed measures of worry (Penn State Worry Questionnaire), a free 3 minute breathing baseline, the Trier Social Stress Test (TSST), and two one-minute rest periods following the TSST. TSST involved participants preparing and presenting a speech, as well as counting backwards from a large number while they were ostensibly video and audio recorded in front of confederates. This was then followed by a 2 minute recovery period. ANS indices in the form of respiratory sinus arrhythmia (RSA) and left ventricular pre-ejection period (PEP) were derived from electrocardiogram and impedance cardiogram data, and reflected parasympathetic and sympathetic nervous system activity, respectively.
• Results. One-way repeated measures ANOVA was used to analyze the data. While the TSST evoked significant parasympathetic nervous system withdrawal and sympathetic activation, the effects of worry were only observed during the recovery phase that followed the TSST. Specifically, while RSA returned to near baseline levels after the TSST was terminated, elevated worry was associated with reduced parasympathetic activity during the second 60 second phase of the recovery period (F(1,35)=4.46, p < .05).
• Conclusion. Our results suggest that the worry impedes the ability for the ANS to recover from stress. Such failures are consistent with the sustained physiological arousal associated with GAD, and may place worriers at risk to experience associated adverse health effects in the long term.

*Napolitano, S. C., Scamaldo, K., Najjar, K., & Yaroslavsky, I. (2017, November). Blunted positive affectivity differentiates Borderline Personality Disorder and Depression. Poster presented at the 51st annual convention of the Association for Behavioral Cognitive Therapies, San Diego, CA.

• Introduction. Symptoms of depression and borderline personality disorder (BPD) feature a high degree of overlap, with as many as 38% of individuals with BPD reporting symptoms of depression or a depressive episode, and as many as 48% of people with depression reporting a diagnosis of BPD (Shea, Widiger, & Klein). These high rates of co-occurrence may reflect a shared dispositional vulnerability in form of high negative affectivity. However, the role of positive affectivity, which has traditionally been viewed as depression-specific risk factor, is not known. The present study aimed to test whether low positive affectivity reflects a specific risk factor for depression among individuals at low and elevated levels of BPD features. We examined the unique effects of depression and BPD across dispositional, state, and reactivity indices of positive (PA) and negative affect (NA) to accommodate the tendency for those with BPD to over-report their symptoms and distress levels on retrospective measures.
• Methods. Eighty-three (n=83) community dwelling adults (67% female, M_age=31.01, SD=12.99) completed measures of BPD (Personality Assessment Inventory-Borderline Subscale), depression (Center for Epidemiological Studies Depression Scale), dispositional PA and NA (Positive Affect and Negative Affect Schedule), and affect ratings of PA and NA at baseline and in response to two film clips that engendered sadness ("The Champ") and happiness ("Wall-E"). Reactivity in each affect domain reflects the difference between post-film and baseline levels.
• Results. Multivariate and repeated measures analyses revealed that depression symptoms, independent of BPD symptoms, were associated with higher levels of NA and lower levels of PA across dispositional (b_NA=.28, b_PA=-.41, ps_NA=.08, b_PA= -.06, p < .05), while BPD was solely linked to elevated dispositional NA (b= .30, p < .001). Interestingly, while both depression levels and BPD symptoms predicted attenuated affect reactivity to the sad film clip, these results fell below significance levels when symptoms of both disorders were examined simultaneously.
• Conclusion. Results suggest that positive affectivity may the key to differentiate depression from BPD. At trait levels, depressive symptoms are related to blunted positive affect and enhanced negative affect, where BPD symptoms are related to only elevated negative affect. Relatedly, state affect ratings remain stable when depressive symptoms are present, but not when BPD symptoms are present. These findings are clinically significant because they suggest that blunted positive affect is stable across trait and state measures and is likely domain-specific to depression.

Personality Disorders

*Napolitano, S. C., Scamaldo, K., Najjar, K., & Yaroslavsky, I. (2017, November). Evaluating the effect of Borderline Personality Disorder symptoms on emotion regulation strategies. Poster presented at the 51^st annual convention of the Association for Behavioral Cognitive Therapies, San Diego, CA.

• Introduction. Research is mixed on what emotion regulation (ER) strategies individuals with Borderline Personality Disorder (BPD) or BPD features employ most and which of the strategies are most effective in this population. Further muddying the waters is the limited generalizability of findings offered in laboratory conditions that test these hypotheses. Experience sampling from individuals' daily life helps bridge the gap between highly controlled, artificial experiments and naturalistic observation. As ER strategies vary based upon several highly individualistic factors, ecological momentary assessment (EMA) is one way to capture snapshots of daily life that inform researchers on participants' state affect and measures they take to regulate those emotions.
• Methods. Community dwelling adults (N=79, 65% female, Mage= 30.78, SD = 1.44) completed a measure of BPD (Personality Assessment Inventory-Borderline Subscale) and a 7-day EMA protocol. During this protocol, current and hourly peak negative affect (NA) (sad, nervous, upset, angry, frustrated, stressed affects), and adaptive (reappraisal, problem-solving, and distraction) and maladaptive (rumination and suppression) ER strategies during current and peak NA were ascertained 5 times daily.
• Results. Multi-level models revealed that peak NA ratings were significantly affected by the presence of BPD symptoms, (b = .08, p< .001) compared to the overall sample. For adaptive strategies, distraction changed NA ratings (b= .35, p < .05), while problem solving and reappraisal were insignificant.For maladaptive strategies, rumination lowered NA (b = .66, p < .05) but suppression did not lower NA ratings. In contrast, when individuals with higher BPD symptoms used reappraisal after peak NA ratings, there was a trend effect (b = -.03, p = .07) but distraction was more robust (b = -.03, p < .05) for decreasing NA, while problem-solving was insignificant. Conversely, when rumination was employed, individuals with BPD symptoms rated that they felt significantly worse for longer than individuals without BPD symptoms, (b = .06, p < .05) while suppression remained insignificant.
• Conclusion. These findings indicate that individuals with BPD symptoms may fare best when deploying an ER strategy that refocuses their attention, like distraction. Additionally, the effect of rumination appears to be particularly potent in this population, which confirms findings of contemporary models of BPD. Results suggest anything that interferes with the ruminative process and disrupts the cycle, like distraction, may be beneficial. The implications are hopeful, as they suggest that current efforts that target maladaptive ER strategies and address skill deficits will increase the efficacy of interpersonal regulation efforts for people with BPD.

*Scamaldo, K., Bodenbender, B., Vebares, T., Scott, L., & Yaroslavsky, I. (2017, November). Parasympathetic nervous system deficits differentiate Borderline and Antisocial personality disorders. Poster presented at the 51st annual convention of the Association for Behavioral Cognitive Therapies, San Diego, CA.

• Introduction. Antisocial personality disorder (APD) is characterized by risky decision making.  However, the mechanism through which APD features relate to poor executive functioning remain unclear. Emerging evidence suggests that deficits in autonomic nervous system (ANS) functioning in the form of low resting parasympathetic nervous system (PNS) activity and hyper-reactivity in the sympathetic nervous system (SNS) to rewarding situations is associated with APD. While ostensibly important for APD, there is a surprising dearth of studies that examine the mechanistic role of ANS deficits in combination with executive functioning. The present study aims to test the relationship between ANS activity at rest, and its reactivity from receiving reward and punishing feedback, with executive functioning and APD symptoms.
• Methods. Participants were 24 undergraduate students  (75% male, M_age=20.08, SD=3.66) who completed the Personality Assessment Inventory–Antisocial Personality Disorder scale to measure APD symptoms. Participants engaged in a computerized gambling task, the Iowa Gambling Task (IGT), to illustrate real life decisions by replicating a gambling paradigm of reward and loss. The index of PNS activity (respiratory sinus arrhythmia, RSA) was derived from electrocardiogram data that was collected during a free-breathing resting baseline. The index of SNS activity was derived via electro-dermal activity (EDA), and was measured by skin conductance responses (SCR). SCR magnitudes were calculated following win and loss feedback during the protocol by calculating the difference from the onset of the response to the peak of the response.
• Results. Regression analyses showed that strong sympathetic arousal in the form of large SCR responses to wins and losses were associated with the selection of advantageous decks on the IGT (bs = -.32 - -.45, ps < .05). In turn, advantageous deck selection was associated with elevated APD symptoms at a trend level (bs = .32, p   < . 10). Contrary to expectation, RSA was unrelated to decision making or to APD symptoms.
• Conclusion. These results suggest that sympathetic arousal is linked to decision making, and that impoverished sympathetic reactivity is linked to risk taking behavior. Further, the selection of advantageous decks tended to predict elevated APD symptoms. These findings support the tendency for APD to be linked with an increased reward sensitivity. Clinical implications are discussed.

*Scamaldo, K., Bodenbender, B., Vebares, T., Scott, L., & Yaroslavsky, I. (2017, November). Parasympathetic nervous system deficits differentiate Borderline and Antisocial personality disorders. Poster presented at the 51st annual convention of the Association for Behavioral Cognitive Therapies, San Diego, CA.

• Introduction. Antisocial Personality Disorder (APD) and Borderline Personality Disorder (BPD) are two commonly observed personality disorders that share many diagnostic characteristics and evidence high rates of co-occurrence. The high degree of symptom overlap has led some to question whether APD and BPD reflect dissimilar disorders, or if they evidence different behavioral manifestation of the same disorder. Examining physiological reactivity in response to interpersonal events may clarify on the degree to which APD and BPD share a common etiology. Recent findings suggest that while both disorders evidence interpersonal deficits, BPD is believed to reflect deficits marked by over-identification of interpersonal cues, and APD is linked to insufficient reactivity to interpersonal emotional content. Surprisingly, although the parasympathetic nervous system (PNS) is closely linked to processes that support interpersonal behavior and perceptions, there is a dearth of studies that specifically examine PNS reactivity in response to interpersonal tasks among those with APD and BPD. Clarifying whether patterns of PNS activity during interpersonal rejection differentiate APD and BPD may provide an objective means of differentiating between the two disorders.
• Methods. Participants were 80 females (Mage=20.68, SD=1.52) who completed the Structured Interview for DSM-IV Personality Disorders from which dimensional scores of BPD and APD were derived, and also an experimental protocol that involved social exclusion via the Cyberball task (CB). The CB task is a virtual ball-toss game which participants play with two computer-generated confederates who progressively exclude the participant from the game. Indices of the PNS (respiratory sinus arrhythmia, RSA) were derived from electrocardiogram data that was collected during the protocol. Baseline RSA reflects a 1 minute portion of the CB task during which participants were included in the game, while RSA reactivity reflects the difference between baseline RSA and RSA measured during a 1 minute period CB exclusion period.
• Results.Regression analyses showed that, independent of APD symptoms, high baseline RSA predicted low BPD symptoms (b= -.87, p < .01), as did RSA reactivity in the form of reduced RSA levels in response to interpersonal rejection at a trend level (b= -.95, p = .054). Conversely, neither resting state nor RSA reactivity were predicted APD symptoms.
• Conclusion. These findings suggest that physiological substrates may differentiate BPD from APD. These results are consistent with contemporary models that postulate PNS dysregulation as an integral part of emotion dysregulation that is commonly observed among those with BPD. Our findings provide one promising approach to delineate unique features across two highly comorbid disorders.

Substance Use Disorders

*Ghose, S. & Yaroslavsky, I. (2017, November). Risk factors for smoking behavior: Negative trait Affect and diminished response to hedonic stimuli. Poster presented at the 51^st annual convention of the Association for Behavioral Cognitive Therapies, San Diego, CA.

• Introduction. Smoking is associated with both positive and negative affective states (PA & NA). With respect to NA, smoking is one self-regulatory response aimed at reducing distress. With respect to PA, smoking behaviors often occur in the context of hedonic interpersonal situations. Over time, however, smoking is linked to reduced PA and increased NA. A growing literature links parasympathetic nervous activity (PNS) to the experience of NA and PA states. However, while some studies show that smoking is associated with reduced PNS activity, it remains uncertain whether this association is a function of NA and PA. Recent literature also supports a link between smoking and marked anhedonia in the processing of such hedonic stimuli as "happy" faces (Leventhal, Munafo, Tidey, Sussman, Monterosso, Sun & Kahler, 2012). The relationship between PNS changes in response to PA and NA related states, emotional stimuli (such as the aforementioned "happy faces"), and smoking is unclear.  Current studies linking PNS activity to smoking behavior measure PNS during resting states. The present study investigates the relationships between PNS activity at rest and in response to hedonic and dysphoric stimuli, trait affect, and smoking behavior in an adult community sample.
• Methods. Participants were 85 adults (64% female, M_age  = 31, SD = 12.89) who completed measures of smoking behavior, Trait Affectivity (Positive and Negative Affect Schedule), and a psychophysiology protocol during which PNS was measured via Respiratory Sinus Arrhythmia (RSA) at rest (free breathing resting baseline) and while viewing emotional film clips ("The Champ" and "Wall-E"). RSA reactivity was quantified as the difference between the free breathing condition film conditions. Age and sex were covaried in all analyses.
• Results. While trait PA, resting RSA, and RSA reactivity to the sad film clip were unrelated to smoking behavior, trait NA and RSA reactivity to the hedonic film clip robustly predicted smoking status. Specifically, those who smoked evidenced  higher NA levels (OR = 1.08, p < .05), and a robust RSA withdrawal to the hedonic film clip (OR = 1.92,  p<.05).
• Conclusion. These findings support NA as a correlate of smoking, and provide novel evidence on the role of the parasympathetic nervous system. It is particularly notable that PNS reactivity to hedonic stimuli, rather than to the dysphoric mood induction, emerged as a predictor of smoking status. This specificity may point to subtle deficits in hedonic capacity, and may suggest that physiological processes could be helpful in detecting risk factors for smoking behavior.  Clarifying such risk factors would allow for more effective detection and intervention strategies to be developed. 

*Ghose, S., Kovacs, M. & Yaroslavsky, I. (2017, November). The adolescent profile of the adult smoker. Poster presented at the 51st annual convention of the Association for Behavioral Cognitive Therapies, San Diego, CA.

• Introduction. Physiological and behavioral risk factors for such health problems as cardiovascular disease (CVD) begin in adolescence and continue on into adulthood. A substantial risk factor for CVD that follows this pattern of continuation is smoking behavior (Kelder, Perry, Klepp, & Lytle, 1994). Just as CVD risk has been shown to emerge in adolescence and not just adulthood (Rottenberg, Yaroslavsky, Carney, Freedland, George, Baji, Dochnal, Gadoros, Halas, Kapornai, Kiss, Osvath, Varga, Vetro, & Kovacs, 2014), smoking as an adolescent has been shown to significantly predicate smoking as an adult (Chassin, Presson, Sherman, & Edwards, 1990). Smoking is linked to both positive and negative affective states, and recent works suggest that PNS activity is related to both. Surprisingly little work has been done that examines the role of PNS reactivity in emotional states associated with smoking behavior. The present study investigates the relationships between PNS reactivity to emotional stimuli and affective states with smoking behavior.
• Methods. Participants were 566 Hungarian adolescents (42.4% female, M_age = 16, SD= 1.97) with depression histories (n=210), their never-depressed siblings (n = 195), and healthy controls (n= 161). Participants completed measures of smoking frequency as well as a psychophysiology protocol. Parasympathetic nervous system (PNS) activity was measured via Respiratory Sinus Arrhythmia (RSA) during a paced breathing baseline, while viewing hedonic and dysphoric film clips ("Mr. Bean" and "The Champ"), and in response to receiving a prize. Happy and sad affect ratings were collected via an 8-point Likert scale. Reactivity in RSA and affect reflects differences in each index between post-film and baseline levels.
• Results. While RSA reactivity to the sad and happy film clips was unrelated to smoking behavior, adolescent smoking behavior was significantly predicted by changes in affect. Those who smoked evidenced blunted affect reactivity across positive and negative stimuli, specifically they were less reactive in response to the happy film (OR=1.22, p < .03), receiving a prize (OR=1.25, p < .02), and in response to viewing a sad film (OR=1.41, p<.001).  These effects were independent of both demographic characteristics and depression history.
• Conclusion. These findings suggest that a blunted capacity to experience emotions, irrespective of their valence, is linked to smoking behavior in adolescence. While this relationship may reflect the consequences of smoking, it is also feasible that blunted emotional arousal may presage heavy cigarette use. If the latter is true, early detection of diminished affective reactivity could inform prevention efforts. 

Cultural Differences in Emotion Regulation and Internalizing Disorders

*Najjar, K., Gaynier, L., & Yaroslavsky, I. (2017, November). Explanatory styles and depression risk in Arab Americans: A replication and extension into daily life. Poster presented at the 51st annual convention of the Association for Behavioral Cognitive Therapies, San Diego, CA.

• Purpose. Explanatory styles influence the interpretation of stressful life events with respect to their cause. Negative explanatory styles (NES) place the cause of stressful events as self-generated, enduring, and pervasive. Such negative causal attributions worsen the adverse effects of stress and are a strong risk factor for depression. The few cross-cultural studies that examine this topic showed that NES are a more pernicious risk factor for depression among individuals hailing from a collectivistic culture as compared to those of individualistic cultures (Anderson, 1999). However, there is some evidence that NES serves as a protective role for Arab-Americans who hold more traditional values relative to their acculturated peers and non-Arabs (Najjar, Gaynier & Yaroslavsky, 2015). The present study sought to test whether cultural differences and effects acculturation can be replicated in an independent sample, and to evaluate the proximal associations between NES, stress, and negative mood in the daily lives of Arab and non-Arab participants. We hypothesized that 1) the protective effects of NES in the association between stress and depression symptoms will only be present for Arabs who hold traditional values, and 2) these effects will be reflected in the relationship between momentary stress and negative mood in the context of participants' daily lives.
• Methods. Arab (n= 38) and non-Arab (n= 58) participants (69% female, Mage= 23.53 years, SD = 8.01) completed self-report measures of NES, life event stress, depressive symptoms, and acculturation surveys, as well as a 7-day ecological momentary assessment protocol during which momentary ratings of stress and negative affect were measured 5 times daily via participants' cell phones.
• Results. We failed to replicate the results of Najjar et al., (2015). Contrary to expectation, Arabs and non-Arabs did not differ in their levels NES, Arab M = 4.44, SD = .69, Non-Arabs M = 4.37, SD = .90, NES, t(83) = 4.00, p = .08. Further, NES do not significantly influence the effects of self-reported life event stress to predict depression symptoms between individuals of Arab and non-Arab descent. While NES predicted higher negative affect during periods when momentary stress increased relative to participants' average stress levels (b=.42, p = .03), this effect did not vary across the two cultural groups.
• Conclusion. Contrary to expectation, our findings fail to show cultural differences in the relationship between stress, NES, and depression symptoms and negative affect. While these results may reflect cross-cultural parallels in risk associated with NES and stress, they may also reflect a high level of acculturation in the Arab sample. Future studies that examine these relationships among individuals within their native cultures would do much to clarify the universality of known depression risk factors.  

*Najjar, K., Gaynier, L. & Yaroslavsky, I. (2017, November). Cultural differences in coping and depression between Arab and Non-Arab Americans: A replication and extension into daily life. Poster presented at the 51^st annual convention of the Association for Behavioral Cognitive Therapies, San Diego, CA.

• Purpose. Emotion regulation (ER) responses include the mechanisms that influence the intensity or duration of an emotion. Broadly speaking, ER responses are categorized as antecedent or response focused, with response focused ER involving what happens once an emotion is underway (Gross & John, 2003). Response focused ER strategies, also known as coping strategies, can be either adaptive or maladaptive. Studies show that ineffective (maladaptive) coping, or insufficient use of effective (adaptive) coping responses are robust predictors of depression among US samples, as compared to those of a collectivistic background. Najjar, Gaynier, and Yaroslavsky (2015) found that relative to non-Arabs, Arab Americans use fewer adaptive coping responses and more maladaptive coping responses. Specifically, those of an Arab background reported less likely to seek emotional support and engage more frequently in denial and behavioral disengagement during times of stress. Specifically, behavioral disengagement was associated with depression and mediated the relationship between an Arab background and depressive symptoms. The present study sought to replicate the effects evidenced by Najjar et al. (2015) and to extend these findings to proximal associations between coping responses and depressive symptoms in the daily lives of Arab and non-Arab participants. We hypothesized that the protective effects of the use of behavioral disengagement will be evident among Arabs with a strong Arab identity, and 2) these effects will be reflected during times of momentary stress and negative mood in the context of participants' daily lives.
• Methods. Arab (n= 34) and non-Arab (n= 58) participants (71% female, Mage= 23.53 years, SD = 8.01) completed self-report measures of coping behaviors, life event stress, depressive symptoms, and acculturation surveys, as well as a 7-day ecological momentary assessment protocol during which momentary ratings of stress and negative affect were measured 5 times daily via participants' cell phones.
• Results. This study failed to replicate the results of Najjar et. al., (2015). Contrary to expectation, there are no significant differences between the use of coping responses between the Arab and non-Arab sample. Further, behavioral disengagement does not moderate the relationship between an Arab identity and depressive symptoms. With respect to daily, while the use of suppression was associated with prolonged distress (b=-30, p < .01), its effects were unrelated to cultural backgrounds.
• Conclusion. Contrary to expectation, our findings fail to show cultural differences in the relationship between coping responses, depressive symptoms and negative affect. Although the results illustrate a cross-cultural parallel in the depression risk associated with use of coping responses, the results may also reflect the high level of acculturation in this Arab sample. In the future, studies that examine the aforementioned relationship among individuals within a given non-US culture would do much to elucidate the universality of known depression risk factors.