Nicholas Forand - Academia.edu (original) (raw)

Papers by Nicholas Forand

Research paper thumbnail of Personal psychiatric treatment among psychiatric residents in Manhattan: evidence of stigma

Journal of the American Psychoanalytic Association, 2004

Research paper thumbnail of The impact of graduation from analytic training

Journal of the American Psychoanalytic Association, 2004

Research paper thumbnail of Posttermination contact: a survey of prevalence, characteristics, and analyst attitudes

Journal of the American Psychoanalytic Association, 2004

Research paper thumbnail of Understanding processes of change: How some patients reveal more than others—and some groups of therapists less—about what matters in psychotherapy

Psychotherapy Research, 2014

We identify difficulties researchers encounter in psychotherapy process-outcome investigations, a... more We identify difficulties researchers encounter in psychotherapy process-outcome investigations, and we describe several limitations of the popular "variance accounted for" approach to understanding the effects of psychotherapy. Using data simulations, we show how the expected correlation between an excellent measure of therapy quality and outcome would be surprisingly small (approximately .25) under conditions likely to be common in psychotherapy research. Even when we modeled conditions designed to increase the likelihood that strong process-outcome relationships would be observed, we found that the expected correlations were still only in the modest range (.38-.51). We discuss the implications of our analysis for the interpretation of process-outcome findings as well as for design considerations in future investigations.

Research paper thumbnail of APPEARANCE INVESTMENT AND EVERYDAY INTERPERSONAL FUNCTIONING: AN EXPERIENCE SAMPLING STUDY

Psychology of Women Quarterly, 2010

Several studies have shown that body satisfaction affects interpersonal functioning. However, few... more Several studies have shown that body satisfaction affects interpersonal functioning. However, few have studied the specific interpersonal correlates of another important body image dimension, appearance investment-that is, the importance a woman places on appearance. We used an experience sampling design with PDA (personal digital assistant) devices to assess how 92 college women's appearance investment is related to perceptions of everyday social interactions and to investigate the association of these perceptions with mood and self-esteem. For 1 week, participants completed electronic diaries of their mood, self-esteem, and perceptions of one-on-one interactions. High appearance investment was associated with a stronger relationship between perceived communion of the interaction and negative mood and self-esteem. Notably, highly appearance-invested women did not report differences in average momentary levels of perceived communion or agency in interactions, negative mood, or self-esteem when compared to women with lower appearance investment. In contrast, women with low body satisfaction reported lower average perceptions of communion and self-esteem as well as higher average negative mood compared to women with higher body satisfaction, but no relationships among perceptions and self-esteem and mood were found. Thus, self-esteem and negative mood in women high in appearance investment might be contingent on perceptions of communion in interactions, even though they appear to have average levels of mood and self-esteem in general. This mood and self-esteem contingency could predispose appearance-invested women to psychological distress or eating pathology.

Research paper thumbnail of The Personalized Advantage Index: Translating Research on Prediction into Individualized Treatment Recommendations. A Demonstration

PLoS ONE, 2014

Background: Advances in personalized medicine require the identification of variables that predic... more Background: Advances in personalized medicine require the identification of variables that predict differential response to treatments as well as the development and refinement of methods to transform predictive information into actionable recommendations.

Research paper thumbnail of Psychoanalytic Practice in the Early Postgraduate Years

Journal of the American Psychoanalytic Association, 2004

As a pilot investigation for a longitudinal study of psychoanalytic careers, a survey was conduct... more As a pilot investigation for a longitudinal study of psychoanalytic careers, a survey was conducted of analysts who graduated during the last fifteen years from the Columbia University Center for Psychoanalytic Training and Research. Graduates were asked to describe both their analytic practice and their interest in pursuing appointment as training and supervising analysts. The 23-item questionnaire was completed by 67 of 102 potential respondents (66%). The study identified two subgroups of graduates: those who were not certified and were not training analysts (GAs), 78% of the sample, and certified and training analysts (CAs, TAs), 22% of the sample. GAs started a mean of 1.4 new analytic cases since graduation, as compared to CAs and TAs, who started a mean of 5.4 and 8.3 new cases, respectively. CAs and TAs also saw more twice-weekly therapy cases than did GAs. Once-weekly therapy was the most commonly practiced treatment for all subgroups. Interest in becoming a TA was highest during the first five postgraduate years and was lower among non-TAs five to fifteen years after graduation. Only one of the CA respondents met current APsaA immersion criteria for training analyst appointment.

Research paper thumbnail of The Impact of Graduation From Psychoanalytic Training

Journal of the American Psychoanalytic Association, 2004

To examine candidates' experience of graduation from psyc... more To examine candidates' experience of graduation from psychoanalytic training, 1997-2001 graduates of the Columbia University Center for Psychoanalytic Training and Research were sent a confidential questionnaire about their first year after analytic training. Of this group, 72 percent (23/32) returned the survey. Questions focused on the impact of graduation on time availability, net income, professional advancement, and sense of personal and professional autonomy. Graduates from analytic training were found to have more income in their first postgraduate year, a mean increase of 30,000 dollars, and more available time, a mean increase of sixteen hours. Increased earnings came primarily from seeing more patients during the time made available with the end of classes. In addition, graduates did not terminate their control cases or stop supervision. Graduates most valued their sense of professional accomplishment and ability to spend more time with their families. Although graduates also experienced relief from evaluation pressure, they did not rank this high in importance. For candidates, graduation profoundly impacts the structure of professional and personal life, but does not mean an end to learning.

Research paper thumbnail of Conducting Analysis After September 11: Implications for Psychoanalytic Technique

Journal of the American Psychoanalytic Association, 2004

The September 11, 2001, terrorist attack on the World Trade Center profoundly affected the popula... more The September 11, 2001, terrorist attack on the World Trade Center profoundly affected the population of New York City, including analysts and analysands. To study the effect of this event on the technique of psychoanalysts conducting ongoing analysis during the weeks after 9/11, confidential questionnaires were sent to all candidates and faculty at the Columbia University Center for Psychoanalytic Training and Research. Respondents indicated that in the days and weeks following 9/11 they initiated phone calls to their analysands, asked about their analysands' families, gave advice when it was requested, offered reassurance, and answered personal questions. They did not initiate physical contact, discontinue use of the couch, or give unsolicited advice. These responses suggest that these analysts made decisions to alter their technique in certain ways in the wake of a catastrophic event shared by the community.

Research paper thumbnail of The Influence of Dysphoria on Reactivity to Naturalistic Fluctuations in Anger

Journal of Personality, 2009

We used an experience sampling methodology to explore the relationship between current symptoms o... more We used an experience sampling methodology to explore the relationship between current symptoms of dysphoria and momentary mood fluctuations following everyday experiences of anger. Using PDA devices, participants rated their mood, ruminative cognitions, feelings of dependency, and stressful events 4 times per day for 1 week. We hypothesized and found that those higher in dysphoria would demonstrate a stronger link between anger and depressed mood than those who were lower in dysphoria. Those participants who reported higher initial dysphoria indicated more anger over the course of the week, a stronger within-person association between anger and depressed mood, and a slower recovery from anger experiences. Multilevel moderated mediation analyses indicated that the link between anger and depressed mood for those high in dysphoria is largely explained by a stronger carryover of anger from one assessment to the next and partially explained by greater increases in ruminative cognitions and feelings of dependency. The change in depressed mood appears to occur with increases in anger, specifically, and not other negative mood states. Our results extend previous research on the anger-depression relationship by investigating the short-term relationships between anger and depressed mood among those with varying levels of dysphoria.

Research paper thumbnail of Anxiety and Depressive Symptoms and Anxiety Sensitivity in Youngsters With Noncardiac Chest Pain and Benign Heart Murmurs

Journal of Pediatric Psychology, 2004

Objective Chest pain in children and adolescents is rarely associated with cardiac disease. We so... more Objective Chest pain in children and adolescents is rarely associated with cardiac disease. We sought to examine psychological symptoms in youngsters with medically unexplained chest pain. We hypothesized that children and adolescents with medically unexplained chest pain would have high rates of anxiety and depressive symptoms. Methods We assessed 65 youngsters with noncardiac chest pain (NCCP) and 45 comparison youngsters with benign heart murmurs using self-report measures of anxiety and depressive symptoms and anxiety sensitivity. Results Compared with the asymptomatic benign-murmur group, youngsters with NCCP had higher levels of some anxiety symptoms and anxiety sensitivity. Differences on depressive symptoms were not significant. Conclusions Though preliminary, results suggest that youngsters with chest pain may experience increased levels of some psychological symptoms. Future studies of noncardiac chest pain in youngsters should include larger samples and comprehensive diagnostic assessments as well as long-term follow-up evaluations.

Research paper thumbnail of An Open Pilot Study of Interpersonal Psychotherapy for Panic Disorder (IPT-PD)

The Journal of Nervous and Mental Disease, 2006

Interpersonal psychotherapy (IPT) is a time-limited psychotherapy initially developed to treat de... more Interpersonal psychotherapy (IPT) is a time-limited psychotherapy initially developed to treat depression. It has yet to be studied systematically for treatment of panic disorder. We modified IPT for the treatment of panic disorder and tested this treatment in an open clinical trial with 12 patients seeking treatment of DSM-IV panic disorder. Patients were assessed before during and after treatment. At completion of treatment, nine patients (75%) were independently categorized as responders (i.e., rated as much improved or very much improved on the Clinical Global Impression-Change Scale). Substantial improvement was found for panic symptoms, associated anxiety and depressive symptoms, and physical and emotional well-being. Degree of change in this sample approximated that obtained in studies using established treatments such as cognitive behavioral therapy. Results, though preliminary, suggest that IPT may have efficacy as a primary treatment of panic disorder. Further study is warranted.

Research paper thumbnail of Extreme Response Style and Symptom Return After Depression Treatment: The Role of Positive Extreme Responding

Journal of Consulting and Clinical Psychology, 2014

Research paper thumbnail of Pretreatment anxiety predicts patterns of change in cognitive behavioral therapy and medications for depression

Journal of Consulting and Clinical Psychology, 2013

Objective: Some studies report that initial anxiety is associated with equivocal or negative effe... more Objective: Some studies report that initial anxiety is associated with equivocal or negative effects in depression treatment. In contrast, at least 4 studies of cognitive behavioral therapy (CBT) report that anxiety predicts greater or more rapid change in depression. Further exploration is needed to clarify the relationship between initial anxiety and depression change. Questions include the relationship between anxiety and patterns of change and time to relapse, as well as the specificity effects to CBT. Method: The study assessed the relation of Beck Anxiety Inventory anxiety scores to early rapid change and overall change in Beck Depression Inventory-II depression scores during acute depression treatment. Participants were 178 individuals enrolled in a randomized controlled trial of CBT versus antidepressant medications (ADMs) for moderate to severe depression. They were 58% female and 83% Caucasian, with an average age of 40 (SD ϭ 11.5). Thirty-four percent (34%) were married or cohabitating. Hierarchical linear models, including quadratic growth parameters, were used to model change. The relation of anxiety to the probability of posttreatment relapse was also examined. Results: Findings indicate that higher levels of anxiety predict early rapid change, but not overall change, in both CBT and ADM. However, patients with higher levels of intake anxiety evidenced increased risk for relapse after CBT. Conclusions: Early rapid change predicted by anxiety occurs across different treatment conditions, but this early rapid response is not indicative of positive overall outcome in all cases. These findings might indicate that anxiety predicts a response to nonspecific "common factors" of treatment. served as the cognitive therapists. Jan Fawcett provided consultation on the implementation of clinical management pharmacotherapy.

Research paper thumbnail of Cognitive Reactivity in Everyday Life as a Prospective Predictor of Depressive Symptoms

Cognitive Therapy and Research, 2010

We used PDA devices and an experience sampling technique to assess participants' negative mood an... more We used PDA devices and an experience sampling technique to assess participants' negative mood and thoughts as they engaged in their normal daily routines over the course of a week. We then calculated each person's own unique relationship between mood and thoughts, and used this index of cognitive reactivity to predict depressive symptoms at 6-month follow-up. Participants who demonstrated a stronger link between their momentary negative mood and negative cognitions reported more depressive symptoms at follow-up than those who had a weaker relationship between mood and cognitions. Further, this cognitive reactivity index was a better predictor of follow-up depressive symptom scores than initial depressive symptoms, dysfunctional attitudes, average experienced negative mood or thoughts, or variability of negative mood or thoughts. These results are consistent with earlier findings and build on previous research by demonstrating that naturally occurring cognitive reactivity is predictive of future mood disruptions.

Research paper thumbnail of Cognitive vulnerability to depression in never depressed subjects

Cognition & Emotion, 2005

ABSTRACT The purpose of this study was to investigate whether dysfunctional cognitions could be m... more ABSTRACT The purpose of this study was to investigate whether dysfunctional cognitions could be measured in never-depressed individuals after a sad mood prime, and if these dysfunctional cognitions would predict future depression. Subjects were first screened for current or past depression. Never-depressed subjects were randomly assigned to a prime or no-prime condition and completed the Dysfunctional Attitudes Scale. After one month, subjects completed the Beck Depression Inventory. The mood induction was successful in producing a sad mood, but had no effect on accessibility of dysfunctional cognition. Dysfunctional cognitions did predict depressive symptoms one month later, for the women in the sample, but not the men. These results were actually stronger for the unprimed subjects. The results provide some support for the cognitive diathesis-stress model, and suggest that cognitive vulnerability to depression may exist prior to a clinically significant depressive episode. However, mood priming does not appear to be a useful strategy with never-depressed subjects.

Research paper thumbnail of Influence of dysphoria on positive and negative cognitive reactivity to daily mood fluctuations

Behaviour Research and Therapy, 2007

We used an experience sampling design to investigate the influence of dysphoria on positive and n... more We used an experience sampling design to investigate the influence of dysphoria on positive and negative cognitive reactivity. Participants recorded their thoughts and mood four times per day on PDA devices for one week. We hypothesized that those higher in dysphoria would demonstrate a greater increase in negative thinking in response to negative mood, and a weaker increase in positive cognitions in response to positive mood. These hypotheses were largely supported. For those participants who reported higher initial dysphoria, there was a stronger association between negative mood and thinking and a weaker link between positive mood and thinking. Regression analyses indicated that positive and negative cognitive reactivity were independently related to dysphoria, suggesting that they represent distinct processes. Our results highlight the importance of understanding levels of both negative and positive cognitive reactivity and underscore the benefits of assessing mood and cognition with repeated measurements in "real-time," in order to better understand the antecedent effects of mood on thinking.

Research paper thumbnail of Personal psychiatric treatment among psychiatric residents in Manhattan: evidence of stigma

Journal of the American Psychoanalytic Association, 2004

Research paper thumbnail of The impact of graduation from analytic training

Journal of the American Psychoanalytic Association, 2004

Research paper thumbnail of Posttermination contact: a survey of prevalence, characteristics, and analyst attitudes

Journal of the American Psychoanalytic Association, 2004

Research paper thumbnail of Understanding processes of change: How some patients reveal more than others—and some groups of therapists less—about what matters in psychotherapy

Psychotherapy Research, 2014

We identify difficulties researchers encounter in psychotherapy process-outcome investigations, a... more We identify difficulties researchers encounter in psychotherapy process-outcome investigations, and we describe several limitations of the popular "variance accounted for" approach to understanding the effects of psychotherapy. Using data simulations, we show how the expected correlation between an excellent measure of therapy quality and outcome would be surprisingly small (approximately .25) under conditions likely to be common in psychotherapy research. Even when we modeled conditions designed to increase the likelihood that strong process-outcome relationships would be observed, we found that the expected correlations were still only in the modest range (.38-.51). We discuss the implications of our analysis for the interpretation of process-outcome findings as well as for design considerations in future investigations.

Research paper thumbnail of APPEARANCE INVESTMENT AND EVERYDAY INTERPERSONAL FUNCTIONING: AN EXPERIENCE SAMPLING STUDY

Psychology of Women Quarterly, 2010

Several studies have shown that body satisfaction affects interpersonal functioning. However, few... more Several studies have shown that body satisfaction affects interpersonal functioning. However, few have studied the specific interpersonal correlates of another important body image dimension, appearance investment-that is, the importance a woman places on appearance. We used an experience sampling design with PDA (personal digital assistant) devices to assess how 92 college women's appearance investment is related to perceptions of everyday social interactions and to investigate the association of these perceptions with mood and self-esteem. For 1 week, participants completed electronic diaries of their mood, self-esteem, and perceptions of one-on-one interactions. High appearance investment was associated with a stronger relationship between perceived communion of the interaction and negative mood and self-esteem. Notably, highly appearance-invested women did not report differences in average momentary levels of perceived communion or agency in interactions, negative mood, or self-esteem when compared to women with lower appearance investment. In contrast, women with low body satisfaction reported lower average perceptions of communion and self-esteem as well as higher average negative mood compared to women with higher body satisfaction, but no relationships among perceptions and self-esteem and mood were found. Thus, self-esteem and negative mood in women high in appearance investment might be contingent on perceptions of communion in interactions, even though they appear to have average levels of mood and self-esteem in general. This mood and self-esteem contingency could predispose appearance-invested women to psychological distress or eating pathology.

Research paper thumbnail of The Personalized Advantage Index: Translating Research on Prediction into Individualized Treatment Recommendations. A Demonstration

PLoS ONE, 2014

Background: Advances in personalized medicine require the identification of variables that predic... more Background: Advances in personalized medicine require the identification of variables that predict differential response to treatments as well as the development and refinement of methods to transform predictive information into actionable recommendations.

Research paper thumbnail of Psychoanalytic Practice in the Early Postgraduate Years

Journal of the American Psychoanalytic Association, 2004

As a pilot investigation for a longitudinal study of psychoanalytic careers, a survey was conduct... more As a pilot investigation for a longitudinal study of psychoanalytic careers, a survey was conducted of analysts who graduated during the last fifteen years from the Columbia University Center for Psychoanalytic Training and Research. Graduates were asked to describe both their analytic practice and their interest in pursuing appointment as training and supervising analysts. The 23-item questionnaire was completed by 67 of 102 potential respondents (66%). The study identified two subgroups of graduates: those who were not certified and were not training analysts (GAs), 78% of the sample, and certified and training analysts (CAs, TAs), 22% of the sample. GAs started a mean of 1.4 new analytic cases since graduation, as compared to CAs and TAs, who started a mean of 5.4 and 8.3 new cases, respectively. CAs and TAs also saw more twice-weekly therapy cases than did GAs. Once-weekly therapy was the most commonly practiced treatment for all subgroups. Interest in becoming a TA was highest during the first five postgraduate years and was lower among non-TAs five to fifteen years after graduation. Only one of the CA respondents met current APsaA immersion criteria for training analyst appointment.

Research paper thumbnail of The Impact of Graduation From Psychoanalytic Training

Journal of the American Psychoanalytic Association, 2004

To examine candidates' experience of graduation from psyc... more To examine candidates' experience of graduation from psychoanalytic training, 1997-2001 graduates of the Columbia University Center for Psychoanalytic Training and Research were sent a confidential questionnaire about their first year after analytic training. Of this group, 72 percent (23/32) returned the survey. Questions focused on the impact of graduation on time availability, net income, professional advancement, and sense of personal and professional autonomy. Graduates from analytic training were found to have more income in their first postgraduate year, a mean increase of 30,000 dollars, and more available time, a mean increase of sixteen hours. Increased earnings came primarily from seeing more patients during the time made available with the end of classes. In addition, graduates did not terminate their control cases or stop supervision. Graduates most valued their sense of professional accomplishment and ability to spend more time with their families. Although graduates also experienced relief from evaluation pressure, they did not rank this high in importance. For candidates, graduation profoundly impacts the structure of professional and personal life, but does not mean an end to learning.

Research paper thumbnail of Conducting Analysis After September 11: Implications for Psychoanalytic Technique

Journal of the American Psychoanalytic Association, 2004

The September 11, 2001, terrorist attack on the World Trade Center profoundly affected the popula... more The September 11, 2001, terrorist attack on the World Trade Center profoundly affected the population of New York City, including analysts and analysands. To study the effect of this event on the technique of psychoanalysts conducting ongoing analysis during the weeks after 9/11, confidential questionnaires were sent to all candidates and faculty at the Columbia University Center for Psychoanalytic Training and Research. Respondents indicated that in the days and weeks following 9/11 they initiated phone calls to their analysands, asked about their analysands' families, gave advice when it was requested, offered reassurance, and answered personal questions. They did not initiate physical contact, discontinue use of the couch, or give unsolicited advice. These responses suggest that these analysts made decisions to alter their technique in certain ways in the wake of a catastrophic event shared by the community.

Research paper thumbnail of The Influence of Dysphoria on Reactivity to Naturalistic Fluctuations in Anger

Journal of Personality, 2009

We used an experience sampling methodology to explore the relationship between current symptoms o... more We used an experience sampling methodology to explore the relationship between current symptoms of dysphoria and momentary mood fluctuations following everyday experiences of anger. Using PDA devices, participants rated their mood, ruminative cognitions, feelings of dependency, and stressful events 4 times per day for 1 week. We hypothesized and found that those higher in dysphoria would demonstrate a stronger link between anger and depressed mood than those who were lower in dysphoria. Those participants who reported higher initial dysphoria indicated more anger over the course of the week, a stronger within-person association between anger and depressed mood, and a slower recovery from anger experiences. Multilevel moderated mediation analyses indicated that the link between anger and depressed mood for those high in dysphoria is largely explained by a stronger carryover of anger from one assessment to the next and partially explained by greater increases in ruminative cognitions and feelings of dependency. The change in depressed mood appears to occur with increases in anger, specifically, and not other negative mood states. Our results extend previous research on the anger-depression relationship by investigating the short-term relationships between anger and depressed mood among those with varying levels of dysphoria.

Research paper thumbnail of Anxiety and Depressive Symptoms and Anxiety Sensitivity in Youngsters With Noncardiac Chest Pain and Benign Heart Murmurs

Journal of Pediatric Psychology, 2004

Objective Chest pain in children and adolescents is rarely associated with cardiac disease. We so... more Objective Chest pain in children and adolescents is rarely associated with cardiac disease. We sought to examine psychological symptoms in youngsters with medically unexplained chest pain. We hypothesized that children and adolescents with medically unexplained chest pain would have high rates of anxiety and depressive symptoms. Methods We assessed 65 youngsters with noncardiac chest pain (NCCP) and 45 comparison youngsters with benign heart murmurs using self-report measures of anxiety and depressive symptoms and anxiety sensitivity. Results Compared with the asymptomatic benign-murmur group, youngsters with NCCP had higher levels of some anxiety symptoms and anxiety sensitivity. Differences on depressive symptoms were not significant. Conclusions Though preliminary, results suggest that youngsters with chest pain may experience increased levels of some psychological symptoms. Future studies of noncardiac chest pain in youngsters should include larger samples and comprehensive diagnostic assessments as well as long-term follow-up evaluations.

Research paper thumbnail of An Open Pilot Study of Interpersonal Psychotherapy for Panic Disorder (IPT-PD)

The Journal of Nervous and Mental Disease, 2006

Interpersonal psychotherapy (IPT) is a time-limited psychotherapy initially developed to treat de... more Interpersonal psychotherapy (IPT) is a time-limited psychotherapy initially developed to treat depression. It has yet to be studied systematically for treatment of panic disorder. We modified IPT for the treatment of panic disorder and tested this treatment in an open clinical trial with 12 patients seeking treatment of DSM-IV panic disorder. Patients were assessed before during and after treatment. At completion of treatment, nine patients (75%) were independently categorized as responders (i.e., rated as much improved or very much improved on the Clinical Global Impression-Change Scale). Substantial improvement was found for panic symptoms, associated anxiety and depressive symptoms, and physical and emotional well-being. Degree of change in this sample approximated that obtained in studies using established treatments such as cognitive behavioral therapy. Results, though preliminary, suggest that IPT may have efficacy as a primary treatment of panic disorder. Further study is warranted.

Research paper thumbnail of Extreme Response Style and Symptom Return After Depression Treatment: The Role of Positive Extreme Responding

Journal of Consulting and Clinical Psychology, 2014

Research paper thumbnail of Pretreatment anxiety predicts patterns of change in cognitive behavioral therapy and medications for depression

Journal of Consulting and Clinical Psychology, 2013

Objective: Some studies report that initial anxiety is associated with equivocal or negative effe... more Objective: Some studies report that initial anxiety is associated with equivocal or negative effects in depression treatment. In contrast, at least 4 studies of cognitive behavioral therapy (CBT) report that anxiety predicts greater or more rapid change in depression. Further exploration is needed to clarify the relationship between initial anxiety and depression change. Questions include the relationship between anxiety and patterns of change and time to relapse, as well as the specificity effects to CBT. Method: The study assessed the relation of Beck Anxiety Inventory anxiety scores to early rapid change and overall change in Beck Depression Inventory-II depression scores during acute depression treatment. Participants were 178 individuals enrolled in a randomized controlled trial of CBT versus antidepressant medications (ADMs) for moderate to severe depression. They were 58% female and 83% Caucasian, with an average age of 40 (SD ϭ 11.5). Thirty-four percent (34%) were married or cohabitating. Hierarchical linear models, including quadratic growth parameters, were used to model change. The relation of anxiety to the probability of posttreatment relapse was also examined. Results: Findings indicate that higher levels of anxiety predict early rapid change, but not overall change, in both CBT and ADM. However, patients with higher levels of intake anxiety evidenced increased risk for relapse after CBT. Conclusions: Early rapid change predicted by anxiety occurs across different treatment conditions, but this early rapid response is not indicative of positive overall outcome in all cases. These findings might indicate that anxiety predicts a response to nonspecific "common factors" of treatment. served as the cognitive therapists. Jan Fawcett provided consultation on the implementation of clinical management pharmacotherapy.

Research paper thumbnail of Cognitive Reactivity in Everyday Life as a Prospective Predictor of Depressive Symptoms

Cognitive Therapy and Research, 2010

We used PDA devices and an experience sampling technique to assess participants' negative mood an... more We used PDA devices and an experience sampling technique to assess participants' negative mood and thoughts as they engaged in their normal daily routines over the course of a week. We then calculated each person's own unique relationship between mood and thoughts, and used this index of cognitive reactivity to predict depressive symptoms at 6-month follow-up. Participants who demonstrated a stronger link between their momentary negative mood and negative cognitions reported more depressive symptoms at follow-up than those who had a weaker relationship between mood and cognitions. Further, this cognitive reactivity index was a better predictor of follow-up depressive symptom scores than initial depressive symptoms, dysfunctional attitudes, average experienced negative mood or thoughts, or variability of negative mood or thoughts. These results are consistent with earlier findings and build on previous research by demonstrating that naturally occurring cognitive reactivity is predictive of future mood disruptions.

Research paper thumbnail of Cognitive vulnerability to depression in never depressed subjects

Cognition & Emotion, 2005

ABSTRACT The purpose of this study was to investigate whether dysfunctional cognitions could be m... more ABSTRACT The purpose of this study was to investigate whether dysfunctional cognitions could be measured in never-depressed individuals after a sad mood prime, and if these dysfunctional cognitions would predict future depression. Subjects were first screened for current or past depression. Never-depressed subjects were randomly assigned to a prime or no-prime condition and completed the Dysfunctional Attitudes Scale. After one month, subjects completed the Beck Depression Inventory. The mood induction was successful in producing a sad mood, but had no effect on accessibility of dysfunctional cognition. Dysfunctional cognitions did predict depressive symptoms one month later, for the women in the sample, but not the men. These results were actually stronger for the unprimed subjects. The results provide some support for the cognitive diathesis-stress model, and suggest that cognitive vulnerability to depression may exist prior to a clinically significant depressive episode. However, mood priming does not appear to be a useful strategy with never-depressed subjects.

Research paper thumbnail of Influence of dysphoria on positive and negative cognitive reactivity to daily mood fluctuations

Behaviour Research and Therapy, 2007

We used an experience sampling design to investigate the influence of dysphoria on positive and n... more We used an experience sampling design to investigate the influence of dysphoria on positive and negative cognitive reactivity. Participants recorded their thoughts and mood four times per day on PDA devices for one week. We hypothesized that those higher in dysphoria would demonstrate a greater increase in negative thinking in response to negative mood, and a weaker increase in positive cognitions in response to positive mood. These hypotheses were largely supported. For those participants who reported higher initial dysphoria, there was a stronger association between negative mood and thinking and a weaker link between positive mood and thinking. Regression analyses indicated that positive and negative cognitive reactivity were independently related to dysphoria, suggesting that they represent distinct processes. Our results highlight the importance of understanding levels of both negative and positive cognitive reactivity and underscore the benefits of assessing mood and cognition with repeated measurements in "real-time," in order to better understand the antecedent effects of mood on thinking.