Treatment Of Psychopathology Research Articles

Active Inference in Psychology and Psychiatry: Progress to Date?

The free energy principle is a formal theory of adaptive self-organising systems that emerged from statistical thermodynamics, machine learning and theoretical neuroscience and has since been translated into biologically plausible 'process theories' of cognition and behaviour, which fall under the banner of 'active inference'. Despite the promise this theory holds for theorising, research and practical applications in psychology and psychiatry, its impact on these disciplines has only now begun to bear fruit. The aim of this treatment is to consider the extent to which active inference has informed theoretical progress in psychology, before exploring its contributions to our understanding and treatment of psychopathology. Despite facing persistent translational obstacles, progress suggests that active inference has the potential to become a new paradigm that promises to unite psychology's subdisciplines, while readily incorporating the traditionally competing paradigms of evolutionary and developmental psychology. To date, however, progress towards this end has been slow. Meanwhile, the main outstanding question is whether this theory will make a positive difference through applications in clinical psychology, and its sister discipline of psychiatry.

A Transdiagnostic, Hierarchical Taxonomy of Psychopathology Following Traumatic Brain Injury (HiTOP-TBI).

Psychopathology, including depression, anxiety, and post-traumatic stress, is a significant yet inadequately addressed feature of moderate-severe traumatic brain injury (TBI). Progress in understanding and treating post-TBI psychopathology may be hindered by limitations associated with conventional diagnostic approaches, specifically the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). The Hierarchical Taxonomy of Psychopathology (HiTOP) offers a promising, transdiagnostic alternative to psychiatric classification that may more effectively capture the experiences of individuals with TBI. However, HiTOP lacks validation in the TBI population. To address this gap, we administered a comprehensive questionnaire battery, including 56 scales assessing homogeneous symptom components and maladaptive traits within HiTOP, to 410 individuals with moderate-severe TBI. We evaluated the reliability and unidimensionality of each scale and revised those with psychometric problems. Using a top-down, exploratory latent variable approach (bass-ackwards modeling), we subsequently constructed a hierarchical model of psychopathological dimensions tailored to TBI. The results showed that, relative to norms, participants with moderate-severe TBI experienced greater problems in the established HiTOP internalizing and detachment spectra, but fewer problems with thought disorder and antagonism. Fourteen of the 56 scales demonstrated psychometric problems, which often appeared reflective of the TBI experience and associated disability. The Hierarchical Taxonomy of Psychopathology Following Traumatic Brain Injury (HiTOP-TBI) model encompassed broad internalizing and externalizing spectra, splitting into seven narrower dimensions: Detachment, Dysregulated Negative Emotionality, Somatic Symptoms, Compensatory and Phobic Reactions, Self-Harm and Psychoticism, Rigid Constraint, and Harmful Substance Use. This study presents the most comprehensive empirical classification of psychopathology after TBI to date. It introduces a novel, TBI-specific transdiagnostic questionnaire battery and model, which addresses the limitations of conventional DSM and ICD diagnoses. The empirical structure of psychopathology after TBI largely aligned with the established HiTOP model (e.g., a detachment spectrum). However, these constructs need to be interpreted in relation to the unique experiences associated with TBI (e.g., considering the injury's impact on the person's social functioning). By overcoming the limitations of conventional diagnostic approaches, the HiTOP-TBI model has the potential to accelerate our understanding of the causes, correlates, consequences, and treatment of psychopathology after TBI.

Defining distress tolerance in a structural model of Big Five personality domains.

Distress tolerance (DT)-willingness to face internal discomforts-has a fuzzy boundary with neuroticism (low emotional stability), raising questions about its independent role in models of personality and mental health. We investigated DT's overlap with neuroticism and other Big Five factors in a structural model of personality and personality disorder features in samples of university students (N = 1025), emotional disorder patients (N = 225), and substance-use patients (N = 210). In exploratory factor analyses, we found that DT indicators clustered with neuroticism and were essentially unrelated to other Big Five domains. Big Five personality dimensions collectively explained approximately 40%-70% of variation in DT, across different samples and methods of quantifying shared variance. We conclude that DT and neuroticism are near neighbors in empirical space and speculate that much of the observed correlation between DT and mental health outcomes in the literature may be carried by shared neuroticism variance. We suggest that clearer distinctions between the two constructs in empirical research could improve our understanding of DT's unique role in the development and treatment of psychopathology.

Midlife diseases of despair and cardiometabolic risk: testing shared origins in adolescent psychopathology.

Rising midlife mortality in the United States is largely attributable to 'deaths of despair' (deaths from suicide, drug poisonings, and alcohol-related diseases) and deaths from cardiometabolic conditions. Although despair- and cardiometabolic-related mortality are increasing concurrently, it is unclear whether they share common developmental origins. We tested adolescent psychopathology as a potential common origin of midlife diseases of despair and cardiometabolic risk. Participants (N = 4578) were from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative cohort followed from adolescence to early midlife. Adolescent psychopathology included depression, anxiety, eating disorders, PTSD, conduct disorder, and ADHD at ages 11-18. Diseases of despair (suicidality, substance misuse, pain, and sleep problems) and cardiometabolic risk (hypertension, hyperlipidemia, high-risk waist circumference, diabetes, and cardiovascular conditions) were multi-modally measured at ages 33-43. At midlife, adolescents who experienced psychopathology exhibited more indicators of despair-related diseases and cardiometabolic risk (IRRs = 1.67 [1.46-1.87] and 1.13 [1.04-1.21], respectively), even after accounting for demographics, adolescent SES, and adolescent cognitive ability. Associations were evident for internalizing and externalizing conditions, and in a dose-response fashion. In mediation analyses, low education explained little of these associations, but early-adult substance use explained 21.5% of psychopathology's association with despair-related diseases. Midlife despair-related diseases and cardiometabolic risk co-occurred within individuals (IRR = 1.12 [1.08-1.16]). Adolescent psychopathology accounted for 8.3% of this co-occurrence, and 16.7% together with adolescent SES and cognitive ability. Adolescent psychopathology precedes both diseases of despair and cardiometabolic risk. Prevention and treatment of psychopathology may mitigate multiple causes of poor midlife health, reducing premature mortality.

Cognitive Reappraisal is Associated with Lower Dysphoria Symptoms During the COVID-19 Pandemic

The COVID-19 pandemic has created unprecedented mental health concerns generally, but particularly for young adults navigating an already fluctuating and uncertain period of their lives. While there are many factors related to mental health, it is well-documented that emotion regulation– the ability to modulate an emotion or set of emotions– and risk perception appear to be relevant to the development, maintenance, and treatment of psychopathology. The current study aimed to assess the relationship between emotion regulation processes, COVID-19 risk perception, and dysphoria symptoms during the early months of the pandemic. Between April - May 2020, 243 undergraduate participants completed the Emotion Regulation Questionnaire, the dysphoria subscale of the IDAS-II, and questions about their perceived risk of COVID-19. Two subfacets of emotion regulation known as cognitive reappraisal and expressive suppression were analyzed specifically. Results indicated, contrary to hypotheses, no significant interaction between cognitive reappraisal and risk perception on dysphoria, nor was there a significant interaction between expressive suppression and risk perception on dysphoria. However, there were significant main effects of cognitive reappraisal on dysphoria and expressive suppression on dysphoria indicating cognitive reappraisal may be a more beneficial emotion strategy for maintaining mental health.

Psychodynamic theory meets HiTOP: The nomological network between motivational conflicts and dimensions of the hierarchical taxonomy of psychopathology (HiTOP)

The Hierarchical Taxonomy of Psychopathology (HiTOP) provides a comprehensive description of psychopathology and maladaptive personality traits but does not include etiological theorizing. Psychodynamic theory offers such theorizing, describing motivational conflicts that can be processed either in active (progressive) or passive (regressive) modes. We related motivational conflicts to HiTOP dimensions for the first time. Two studies (four samples, N = 580) showed replicable associations: passive conflict processing displayed stronger and more distributed associations with psychopathology, whereas active processing was associated with lower, yet more specific psychopathology. Particular symptoms were associated with different conflicts, showing that different etiological factors may underlie similar psychopathological signs. Motivational dynamics offer guidance for diagnosis and treatment of psychopathology.

The structure of antagonism: A hierarchical model of self- and interview-rated psychopathology.

Recent initiatives in the empirically based classification of psychopathology, namely, the Hierarchical Taxonomy of Psychopathology (HiTOP), have made significant strides in addressing the limitations of traditional taxonomies (i.e., Diagnostic and Statistical Manual of Mental Disorders, International Classification of Diseases). The current study aimed to extend this work by helping to clarify the lower order structure of an understudied dimension of psychopathology-antagonism (i.e., HiTOP antagonistic externalizing spectrum)-a core feature of many externalizing disorders and related to important outcomes such as interpersonal problems, childhood conduct problems, and incarceration. We examined the hierarchical structure of several measures of antagonistic externalizing features across both self-report and clinical interview ratings for 2,279 community participants with a diverse range of personality pathology (~75% with a personality disorder) and antagonistic behaviors (~30% with intermittent explosive disorder). Exploratory structural equation modeling was used to account for the shared variance between variables within self-report and interview methods. Results revealed an optimal lower order structure consisting of six factors labeled Antisociality, Anger, Hostility, Narcissism, Mistrust, and Attention Seeking. Factor scores yielded expected relations with self-report and interview ratings of psychopathology, personality, and childhood trauma. Implications for future research in classification and treatment of psychopathology are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A cybernetic perspective on the nature of psychopathology: Transcending conceptions of mental illness as statistical deviance and brain disease.

Explicitly or implicitly, psychopathology is often defined in terms of statistical deviance, requiring that an affected individual be sufficiently distant from the norm in some dimension of psychological or neural function. In recent decades, the dominant paradigm in psychiatric research has focused primarily on deviance in neural function, treating psychopathology as disease of the brain. We argue that these conceptualizations are misguided. We recently proposed a novel theory of psychopathology, based in cybernetics and drawing additionally from neuroscience, psychometrics, and personality theory (DeYoung & Krueger, 2018a). In this theory, deviations from the norm in psychological and neural functioning serve as important risk factors for psychopathology but are not in themselves necessary or sufficient to identify psychopathology, which requires the presence of cybernetic dysfunction. Psychopathology is defined as persistent failure to move toward one's goals, due to failure to generate effective new goals, interpretations, or strategies when existing ones prove unsuccessful. We argue that adopting a cybernetic theory to replace conceptualizations of psychopathology as statistical deviance or brain disease would facilitate improvements in measurement, diagnosis, prevention, and treatment of psychopathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Object Relations–Informed Psychotherapy: Introduction to Festschrift Honoring Otto F. Kernberg, M.D.

Object Relations–Informed Psychotherapy: Introduction to Festschrift Honoring Otto F. Kernberg, M.D.

Neurobiological reduction: From cellular explanations of behavior to interventions.

Scientific reductionism, the view that higher level functions can be explained by properties at some lower-level or levels, has been an assumption of nervous system analyses since the acceptance of the neuron doctrine in the late 19th century, and became a dominant experimental approach with the development of intracellular recording techniques in the mid-20th century. Subsequent refinements of electrophysiological approaches and the continual development of molecular and genetic techniques have promoted a focus on molecular and cellular mechanisms in experimental analyses and explanations of sensory, motor, and cognitive functions. Reductionist assumptions have also influenced our views of the etiology and treatment of psychopathologies, and have more recently led to claims that we can, or even should, pharmacologically enhance the normal brain. Reductionism remains an area of active debate in the philosophy of science. In neuroscience and psychology, the debate typically focuses on the mind-brain question and the mechanisms of cognition, and how or if they can be explained in neurobiological terms. However, these debates are affected by the complexity of the phenomena being considered and the difficulty of obtaining the necessary neurobiological detail. We can instead ask whether features identified in neurobiological analyses of simpler aspects in simpler nervous systems support current molecular and cellular approaches to explaining systems or behaviors. While my view is that they do not, this does not invite the opposing view prevalent in dichotomous thinking that molecular and cellular detail is irrelevant and we should focus on computations or representations. We instead need to consider how to address the long-standing dilemma of how a nervous system that ostensibly functions through discrete cell to cell communication can generate population effects across multiple spatial and temporal scales to generate behavior.

RF17 | PSAT126 Early Life Adversity and a Sex-Specific Polygenic Risk Score for Altered Fasting Insulin are Associated with Executive Functioning.

Abstract Insulin is an important homeostatic hormone with implications for childhood growth, development and adult psychopathology. Considering the high prevalence of co-morbidity between altered metabolism and executive function problems (e.g. obesity and ADHD), we hypothesized that 1) the genetic background associated with altered fasting insulin (FI) and ADHD could be shared; 2) if (1) is rejected, it suggests that interactive models between the genetic background associated with altered FI and childhood environment would better predict executive functions. Using conjunctional false discovery rate (FDR), we found no SNPs shared between the FI GWAS and ADHD GWAS. (2) We calculated polygenic risk scores (PRS) from the sex-specific FI GWAS and identified the threshold that best predicted insulin levels in male and female children in the ALSPAC cohort [Nmales = 245, Nfemales = 222; pt-intial-males = 0.35 (41,108 SNPs), pt-intial-females = 0.01 (2751 SNPs)], further refining it to only include SNPs significantly associated with insulin levels [pt-refined-males = 0.05 (32,520 SNPs), pt-refined-females = 0.05 (230 SNPs)]. We calculated the refined PRS (rPRS) at different ages in multiple cohorts and investigated its interaction effect with early adversity on attention deficit assessments, through CBCL Attention Problems Scale and DSM ADHD Scale, in males and females. In MAVAN, there was a significant interaction [N = 74, p = 0.039] in females at the age of 60 months where simple slope analysis informed us that within the low rPRS group, there is a significant [p = 0.005] positive association between postnatal adversity and attention problems. In GUSTO, there was a significant interaction [N = 208, p = 0.026] in males at the age of 4 years where simple slope analysis informed us that within the high rPRS group, there is a significant [p = 0.003] positive association between postnatal adversity and attention problems. In ABCD, there was a significant interaction in males [N = 4012, p = 0.05] at the age of 10 years and in females [N = 1689, p = 0.013] at the age of 11 years where simple slope analysis informed us that within the low and high rPRS groups, there is a significant [plow_PRS_male < 0.01, phigh_PRS_male< 0.01, plow_PRS_female < 0.01, phigh_PRS_female= 0.03] positive association between postnatal adversity and attention problems. The sex differences at different ages observed in these analyses agree with the differences in males’ and females’ growth trajectories, which are influenced by insulin during development. We conclude that since conjunctional FDR was not feasible and there were no main effects of fasting insulin PRS, the genetic background associated with FI levels is linked with executive function psychopathology, but this effect is sex and environment dependent. The findings reported have implications for age-dependent identification and treatment of psychopathology. Presentation: Sunday, June 12, 2022 12:54 p.m. - 12:59 p.m.

DIAGNOSIS AND CLASSIFICATION OF CHILD AND ADOLESCENT PSYCHOPATHOLOGY IN THE ICD-11: NEW DEVELOPMENTS AND NEW DATA

Diagnostic systems provide a common language for the assessment, diagnosis, and treatment of psychopathology across the life span. These systems must be revised to align with current evidence and promote clinical utility. Recently, the World Health Organization’s ICD, the international standard for diagnostic classification, has undergone a decade-long revision process involving global, multilingual, and multidisciplinary research to guide, evaluate, and refine revisions. Relative to ICD-10 and/or DSM-5, new developments in ICD-11 reflect important changes to conditions affecting youth (eg, disruptive behavior, mood, anxiety, and stress-related disorders).

The relationship between self-esteem, body dissatisfaction, and eating attitudes in bariatric surgery candidates.

Considering the effects of self-esteem, eating attitudes and body satisfaction on obesity and bariatric surgery outcomes, psychiatric evaluation is important for the identification and treatment of psychopathology, improvement of self-esteem, eating attitudes and body satisfaction. In this study, it was aimed to determine the relation between eating behaviors, body dissatisfaction, self-esteem and psychological symptoms in patients seeking bariatric surgery. Our second aim was to determine whether depressive symptoms and anxiety had a mediating role in the relationship between body satisfaction and self-esteem and eating attitudes. The study included 200 patients. Patients' data were retrospectively evaluated. Psychometric evaluation performed during the preoperative period included psychiatric examination and administration of the Beck Depression Inventory, Beck Anxiety Inventory, Rosenberg SelfEsteem Scale, Body-Cathexis Scale, and Dutch Eating Behaviors Questionnaire. There was a positive correlation between self-esteem and body satisfaction and a negative correlation between self-esteem and emotional eating (r= 0.160, p= 0.024; r= -0.261, p <0.001 respectively). Body satisfaction had an effect on emotional eating mediated by depression and an effect on external and restrictive eating mediated by anxiety. Furthermore, anxiety mediated the relations between self-esteem and external and restrictive eating behaviors. Our finding indicating that depression and anxiety have mediator effects on the relation between self-esteem, body dissatisfaction, and eating attitudes is significant since screening for these entities and their treatment is relatively more practical in clinical settings.

Toward Precision Characterization and Treatment of Psychopathology: A Path Forward and Integrative Framework of the Hierarchical Taxonomy of Psychopathology and the Research Domain Criteria

A critical mission of psychological science is to conduct research that ultimately improves the lives of individuals who experience psychopathology. One important aspect of accomplishing this mission is increasing the likelihood that treatments will work for each person. I contend that treatment prognosis can be improved by moving toward a precision-medicine model. I advance a principle-driven framework for working toward these objectives. First, I synthesize the Hierarchical Taxonomy of Psychopathology and the Research Domain Criteria and demonstrate how integrating these models facilitates precision characterization of psychopathology. Second, I outline and demonstrate a systematic process for approaching treatment selection by leveraging precisely characterized representations of psychopathology. Finally, I advocate the research and clinical applications of this framework. Although clinical and psychological scientists are conducting exciting, multidisciplinary, and methodologically rigorous research in their respective domains, the impact of these pursuits will be maximized in the context of a unifying theoretical framework that supports a clear guiding mission.

Multivariate GWAS of psychiatric disorders and their cardinal symptoms reveal two dimensions of cross-cutting genetic liabilities

SUMMARYUnderstanding which biological pathways are specific versus general across diagnostic categories and levels of symptom severity is critical to improving nosology and treatment of psychopathology. Here, we combine transdiagnostic and dimensional approaches to genetic discovery for the first time, conducting a novel multivariate genome-wide association study of eight psychiatric symptoms and disorders broadly related to mood disturbance and psychosis. We identify two transdiagnostic genetic liabilities that distinguish between common forms of psychopathology versus rarer forms of serious mental illness. Biological annotation revealed divergent genetic architectures that differentially implicated prenatal neurodevelopment and neuronal function and regulation. These findings inform psychiatric nosology and biological models of psychopathology, as they suggest that the severity of mood and psychotic symptoms present in serious mental illness may reflect a difference in kind rather than merely in degree.

The importance of idiographic and functionally analytic strategies in the unified protocol for transdiagnostic treatment of emotional disorders

Methodology in the behavioral sciences is heterogeneous, and this is particularly true in the application of methodologies in the study of the nature and treatment of psychopathology and related areas of applied behavior change. For this reason, the very thoughtful and thorough report on strategies and tactics of contextual behavioral science (CBS) research to which this commentary is directed (The Report) is very welcome (Hayes et al., 2021). For our part we will focus comments on several key features and recommendations from The Report, with emphasis on intensive dynamic longitudinal and functionally analytic research strategies for studying behavior change with an idiographic focus. We will also underscore our strong agreement with the need for a multilevel focus and will illustrate many of these issues in the context of our ongoing research on developing a deeper understanding of, and new interventions for, the emotional disorders. To this end we will review some of our recent research on the unified protocol for transdiagnostic treatment of emotional disorders (UP), a cognitive behavioral intervention with increasing evidence for efficacy across a wide range of disorders characterized by emotion dysregulation, among other things.

The role of emotion regulation in the characterization, development and treatment of psychopathology

The role of emotion regulation in the characterization, development and treatment of psychopathology

Comparative metabolic profiling of posterior parietal cortex, amygdala, and hippocampus in conditioned fear memory

Fear conditioning and retrieval are suitable models to investigate the biological basis of various mental disorders. Hippocampus and amygdala neurons consolidate conditioned stimulus (CS)-dependent fear memory. Posterior parietal cortex is considered important for the CS-dependent conditioning and retrieval of fear memory. Metabolomic screening among functionally related brain areas provides molecular signatures and biomarkers to improve the treatment of psychopathologies. Herein, we analyzed and compared changes of metabolites in the hippocampus, amygdala, and posterior parietal cortex under the fear retrieval condition. Metabolite profiles of posterior parietal cortex and amygdala were similarly changed after fear memory retrieval. While the retrieval of fear memory perturbed various metabolic pathways, most metabolic pathways that overlapped among the three brain regions had high ranks in the enrichment analysis of posterior parietal cortex. In posterior parietal cortex, the most perturbed pathways were pantothenate and CoA biosynthesis, purine metabolism, glutathione metabolism, and NAD+ dependent signaling. Metabolites of posterior parietal cortex including 4′-phosphopantetheine, xanthine, glutathione, ADP-ribose, ADP-ribose 2′-phosphate, and cyclic ADP-ribose were significantly regulated in these metabolic pathways. These results point to the importance of metabolites of posterior parietal cortex in conditioned fear memory retrieval and may provide potential biomarker candidates for traumatic memory-related mental disorders.

Spectral analysis of heart rate variability in human fear learning

Understanding transient dynamics of autonomic control during emotional learning is crucial to translate basic research into the treatment of psychopathology. Fear learning typically elicits short-latency bradycardia in humans. Yet, standard analyses of heart rate variability (HRV) fail to disentangle the contribution of parasympathetic and sympathetic activation, and to capture phasic changes of HRV during fear learning.

Persisting Effects of Ayahuasca on Empathy, Creative Thinking, Decentering, Personality, and Well-Being.

Background: Naturalistic and placebo-controlled studies have suggested that ayahuasca, a traditional Amazonian beverage, could be helpful in the treatment of psychopathologies like depression and anxiety disorders by changing otherwise disturbed cognitive and emotional processes. To better understand its full therapeutic potential, one way is to study the effects on processes like flexible thinking, empathy, and well-being, which are normally compromised in stress-related psychopathologies. Materials and Methods: Volunteers attending ayahuasca ceremonies were asked to complete a test battery at three separate occasions: baseline, the morning after, and 1 week after the ceremony. We included the constructs of creative thinking (measured by Picture Concept Test), empathy (Multifaceted Empathy Test), satisfaction with life (Satisfaction with Life Scale), decentering (Experiences Questionnaire), and personality (Big Five Inventory) into the test battery. Additionally, the psychedelic experience was quantified with the Persisting Effects Questionnaire, the Ego Dissolution Scale, and Visual Analogue Scales. Results: In total, 43 attendees (males = 22; females = 21) completed parts of the baseline assessment, 20 (males = 12; females = 8) completed assessments in the morning after the ceremony, and 19 (males = 14; females = 5) completed assessments at the 1-week follow-up. At one and 7 days post-ceremony, cognitive empathy, satisfaction with life, and decentering increased, while divergent thinking (Fluency corrected for Originality) decreased, when compared to baseline. Implicit emotional empathy increased at 1-week follow-up, whereas ratings of the trait neuroticism decreased. Conclusion: The study suggests that a single ingestion of ayahuasca in a social setting is associated with enhancement of subjective well-being, an enhanced ability to take an objective and non-judging stance towards the self (decentering), and the ability to correctly recognize emotions in others, compared to baseline, lasting up to 1 week post-ceremony. To understand the therapeutic potential related to these effects, further research with clinical populations is needed in which these effects can be assessed, including its link with therapeutic outcomes. Together, this will increase our understanding of the effectiveness and breadth of future therapeutic options.