A transdiagnostic model of low self-esteem: pathway analysis in a heterogeneous clinical sample

Background: Low self-esteem (LSE) has been associated with several psychiatric disorders, and is presumably influenced by transdiagnostic factors. Our study was based both on investigations of the relationship between depression and LSE (vulnerability, scar, reciprocal models) and on theories of cognitive factors contributing to the development and maintenance of LSE, such as Melanie Fennell’s model, the catalyst model and the Self-Regulatory Executive Function model. Aims: Based on the theories above, in our cross-sectional study we aimed at understanding more specifically the transdiagnostic factors that can maintain LSE in a heterogeneous clinical sample. Method: Six hundred and eleven out-patients were assessed by SCID-I and self-report questionnaires. The model was tested by structural equation modelling. Results: Based on the fit indices, the hypothesis model did not fit the data; therefore, a modified transdiagnostic model was emerged. This model made a good fit to the data [χ2 (12, n=611)=76.471, p<.001; RMSEA=.080, CFI=.950, TLI=.913] with a strong explanatory power (adj R2=.636). Severe stressful life events and depressive symptoms lead to LSE indirectly. Self-blame, perfectionism, seeking love and hopelessness have been identified as mediating factors in the relationship between depressive symptoms and LSE. Although there was a significant correlation between state-anxiety and LSE, as well as LSE and rumination, these two factors did not fit into the model. Conclusions: The new transdiagnostic model of LSE has great potential in the treatment of various mental conditions and may serve as a guide to developing more focused and more effective therapeutic interventions.

Bot to the Rescue? Effects of a Fully Automated Conversational Agent on Anxiety and Depression: A Randomized Controlled Trial

Web-based conversational agents powered by Artificial Intelligence (AI) and rooted in cognitive-behavioral therapy have been proven efficacious in alleviating the symptoms of anxiety and depression, when compared to passive controls. However, the benefits of a fully automated agent vs. active controls have not yet been examined. Furthermore, the potential impact of such interventions on the transdiagnostic factors underlying anxiety and depression is not known. To elucidate this, 95 adults were randomized to receive (1) a 2-week intervention with an AI-powered chatbot (Woebot) (n=39) or (2) regular psychoeducational materials (n=54). In completers’ analyses, significant main effects of time were obtained for one of the primary outcomes, anxiety, and for the secondary outcomes, transdiagnostic factors, with both groups showing decreased anxiety and intolerance of uncertainty and increased rumination, selfcompassion, guilt and shame. No group by time interaction effects were found for either of the primary outcomes, depression and anxiety, or for the secondary outcomes. Intent-to-Treat analyses also revealed no significant effects of group on the primary or secondary outcomes. Our findings point to the necessity of further research to better understand the areas where chatbots might bring benefits superior to those obtained through simple and inexpensive strategies.

Effects of Coronavirus Fears on Anxiety and Depressive Disorder Symptoms in Clinical and Subclinical Adolescents: The Role of Negative Affect, Intolerance of Uncertainty, and Emotion Regulation Strategies

Fears related to COVID-19 (“coronavirus fears”) have emerged as a new psychological effect of the current COVID-19 pandemic and have been associated with psychological distress and impairment. Other adverse effects include an increase in anxiety and depression symptoms and the respective disorders. The purpose of the current study was to examine the incremental validity of coronavirus fears and transdiagnostic factors in the prediction of the severity of anxiety and depressive disorder symptoms. A sample of 144 adolescents [aged 12–18 years, 55 boys (38.2%) and 89 girls (61.8%)] most of whom showed elevated levels of anxiety and depressive disorder symptoms completed several self-report measures online assessing coronavirus fears, transdiagnostic vulnerability and protective factors, and emotion regulation strategies. Results based on a series of hierarchical multiple regression analyses revealed that coronavirus fears, negative affect, intolerance of uncertainty, acceptance/tolerance, rumination and suppression explained unique variance in the severity of anxiety and depressive disorder symptoms. Path analysis demonstrated that acceptance/tolerance, rumination and suppression mediated the association between higher level transdiagnostic factors and the severity of major depressive disorder symptoms. Findings provide support for the hierarchical transdiagnostic model of emotional disorders and suggest that clinicians should be aware of coronavirus fears. Also, the results warrant the need to consider transdiagnostic vulnerability and protective processes in the new protocols for the treatment of emotional disorders.

Exploring the Optimal Factor Structure of the Five Facet Mindfulness Questionnaire: Associations Between Mindfulness Facets and Transdiagnostic Factors

Objectives: The Five Facet Mindfulness Questionnaire (FFMQ) assesses five components of mindfulness. Studies of the FFMQ among clinical samples, however, fail to replicate the proposed factor structure. Failure to adequately understand the dimensionality of common mindfulness measures within clinical samples, therefore, represents an important gap in the current literature. The increasing popularity of mindfulness-based interventions (MBIs) warrants further investigation of differential associations between facets of mindfulness and different forms of psychopathology. Methods: We examined (1) the underlying structure of the FFMQ and FFMQ-SF and (2) associations between mindfulness facets and transdiagnostic factors of psychopathology (i.e. internalizing and substance use disorders) in two large clinical samples (N = 2,779). Results: Though bass-ackwards analyses determined that 6-factor models provided the best fit to the data, the 5-factor model was optimal in terms of fit and parsimony. Exploratory structural equation modeling revealed that all FFMQ facets were associated with the internalizing factor. Associations with substance use disorders were more complex. Conclusions: Mindfulness covariance within the FFMQ and the FFMQ-SF is best explained by a 5-factor model, with facets of mindfulness defined correspondingly to the original scale. While deficits in all FFMQ facets with the exception of observe are typical of internalizing psychopathology, a more nuanced association may be observed with substance use disorders. These results also bear implications for psychopathology intervention; while general mindfulness-based interventions might be appropriate for internalizing disorders, more specialized focus for externalizing psychopathology might be beneficial.

Reductions in transdiagnostic factors as the potential mechanisms of change in treatment outcomes in the Unified Protocol: a randomized clinical trial

Transdiagnostic approaches emphasize on the share underlying features of emotional disorders. In their view, these transdiagnostic factors play an important role in the etiology, maintenance, and treatment of emotional disorders. This study aimed to investigate the transdiagnostic factors as the potential mechanisms of change in the Unified Protocol (UP) for the transdiagnostic treatment of emotional disorders outcomes. The present study is a randomized clinical trial. Twenty-six individuals were selected based on the Beck anxiety inventory and Beck depression inventory and randomly assigned into two groups of control and treatment (n=13). The treatment group received 20 one-hour individual UP sessions. Beck Depression Inventory, Beck Anxiety Inventory, Difficulty in emotion regulation scale, Intolerance of Uncertainty scale and Acceptance and Action questionnaire were carried out in all three phases. UP enhances the difficulty in emotion regulation (large effect size, SEsg=1.81), intolerance of uncertainty (SEsg=1.91), and experiential avoidance (SEsg=1.78). In addition, the results of linear regression show the association between changes in anxiety and depression with changes in transdiagnostic factors. The difficulty in emotion regulation, intolerance of uncertainty and experiential avoidance can be considered as the potential mechanism of change in improving UP outcomes.