Papers by Lauren Wadsworth
Alzheimers & Dementia, Jul 1, 2012
non-invasive screening variables that could predict which individuals have significant amyloid ac... more non-invasive screening variables that could predict which individuals have significant amyloid accumulation would reduce screening costs. Methods: 483 cognitively normal (CN) individuals, aged 70-92, from the population-based Mayo Clinic Study of Aging underwent PIB-PET imaging. Logistic regression was used to determine whether age, sex, APOE genotype, family history, or cognitive performance were associated with increased odds of a PIB retention ratio>1.4 and >1.5. Area under the receiver operating characteristic curve (AUROC) evaluated the discrimination between PIB positive and negative subjects. Positive (PPV) and negative (NPV) predictive value was defined based on an estimated probability >0.50 who were PIB-positive. The estimated sample size for each characteristic, by age group (70-79 and 80-89 years), needed to screen to enroll 100 participants into a clinical trial with PIB>1.4 or >1.5 was determined based on the desired sample size divided by sample proportions in the MCSA data. Results: Of 483 CN individuals, 151 (31%) had PIB>1.5 and 211 (44%)>1.4. In univariate and multivariate models, discrimination was modest (AUROCw0.6-0.7). Multivariately, age and APOE best predicted odds of PIB>1.4 and>1.5. For PIB>1.5, the addition of all factors resulted in a PPVof 60% and NPVof 74%, and reduced the number needed to screen from 320 to 166 to enroll 100 individuals into a pre-clinical AD trial requiring brain amyloidosis. The predictability of some factors varied with age. For example, based on PIB>1.5, information on APOE genotype alone reduced the number needed to screen by 48% in persons aged 70-79 and 33% in those aged 80-89. Conclusions: Age and APOE genotype are useful predictors of amyloid accumulation, but discrimination is modest. Nonetheless, these results suggest that inexpensive and non-invasive measures could significantly reduce the number of CN individuals needed to screen with amyloid PET imaging or a lumbar puncture for CSF to identify a given number of amyloid positive subjects.
The goal of the present study was to investigate perceived external control as a transdiagnostic ... more The goal of the present study was to investigate perceived external control as a transdiagnostic feature of anxiety, as well as the potential role of a brief acceptance intervention in reducing anxious response to a low control task. Study 1: we collected self-report data via a large online study to explore the relationship between level of anxiety symptomology and level of perceived external control, hypothesizing that greater anxiety would be correlated with lower perceived external control over and above perceived internal control. Results of study 1 showed significant negative correlations between perceived internal and external control and levels of transdiagnostic anxiety. However, contrary to hypotheses, level of perceived external control did not predict level of anxiety over and above perceived internal control. Study 2: next, we invited individuals who scored low and high (excluding middle range) on a transdiagnostic measure of trait anxiety to participate in an experimental study. During the experimental study participants were asked to perform a gambling computer task twice with a monetary reward based on performance as a simulation of a low control environment. Participants were asked to rate their subjective anxiety before and after each trial. We also measured skin conductance, heart rate, and heart rate variability at baseline and throughout each trial as an objective measure of anxious response. After the first trial, participants were randomized into control or a brief acceptance-based intervention condition aimed at accepting low levels of external control and associated emotions and physiological response, before repeating the gambling the task. We examined differences between the acceptance and control groups and between high and low anxiety groups to investigate the potential role of the acceptance intervention on anxious response to the task. Results of study 2 indicated that all participants found the task low on controllability and reported/experienced increases in anxiety/anxious response. The high anxiety group reported greater levels of anxiety throughout the visit on subjective measures of anxiety. There were no differences across groups (high/low or acceptance/control) on psychophysiological measures of anxiety. There was evidence of an effect of anxiety reduction via the acceptance intervention across all participants compared to the control group, but we did not see the hypothesized interaction between group and anxiety level, possibly due in part to sampling randomization failure. Results validate previous research linking low trait perceived control and high trait anxiety in a diverse sample, show a slight anxiety producing effect using a low-control gambling task, and provide some evidence that acceptance-based interventions may provide more adaptive strategies for navigating low control situations. Limitations and future directions are discussed
PsycEXTRA Dataset, 2016
Although research indicates that anxious arousal in response to feared stimuli is related to trea... more Although research indicates that anxious arousal in response to feared stimuli is related to treatment outcome (Heimberg et al., 1990), less is known about the patterns of anxious arousal. We identified patterns of anxious arousal in individuals with social anxiety disorder (SAD) at pre-(n= 61) and post-treatment (n= 40; 12-session CBGT, Heimberg & Becker, 2002), and in non-anxious controls (NACs; n= 31) using an assessment speech task administered at pretreatment (SAD) or the pre-treatment equivalent (NACs), as well as at post-treatment (SAD only). We identified nine patterns of anxious arousal across groups that we further clustered into three groups: fear habituation, fear plateau, and fear increase. Chi-Square and adjusted standardized residual analyses revealed that individuals in the pre-treatment SAD group displayed the fear habituation patterns significantly more than chance and the fear plateau patterns significantly less than chance. In contrast, NACs displayed the fear plateau patterns significantly more than chance and the fear habituation patterns significantly less than chance. At post-treatment, treatment non-responders displayed fear habituation patterns significantly more than chance, whereas treatment responders displayed the fear habituation patterns significantly less than chance. Findings indicate that fear habituation during an anxiety-provoking assessment task is not necessary for treatment response.
Behavior Therapy, Nov 1, 2017
Although research indicates that anxious arousal in response to feared stimuli is related to trea... more Although research indicates that anxious arousal in response to feared stimuli is related to treatment outcome (Heimberg et al., 1990), less is known about the patterns of anxious arousal. We identified patterns of anxious arousal in individuals with social anxiety disorder (SAD) at pre-(n= 61) and post-treatment (n= 40; 12-session CBGT, Heimberg & Becker, 2002), and in non-anxious controls (NACs; n= 31) using an assessment speech task administered at pretreatment (SAD) or the pre-treatment equivalent (NACs), as well as at post-treatment (SAD only). We identified nine patterns of anxious arousal across groups that we further clustered into three groups: fear habituation, fear plateau, and fear increase. Chi-Square and adjusted standardized residual analyses revealed that individuals in the pre-treatment SAD group displayed the fear habituation patterns significantly more than chance and the fear plateau patterns significantly less than chance. In contrast, NACs displayed the fear plateau patterns significantly more than chance and the fear habituation patterns significantly less than chance. At post-treatment, treatment non-responders displayed fear habituation patterns significantly more than chance, whereas treatment responders displayed the fear habituation patterns significantly less than chance. Findings indicate that fear habituation during an anxiety-provoking assessment task is not necessary for treatment response.
Neurology Psychiatry and Brain Research, Dec 1, 2019
Background: Perceived internal and external control have long been theorized to relate to develop... more Background: Perceived internal and external control have long been theorized to relate to development and maintenance of anxiety (Barlow, 2002) and depression (Seligman, 1975). Experimental research studies investigating perceived control have largely focused on anxiety within cross-sectional samples and have shown that low levels of perceived internal and external control are associated with higher levels of anxiety (Gallagher et al., 2014) and depression (Brown & Siegel, 1988; Wardle et al., 2004). The majority of previous research has looked at the combined effects of perceived internal and external control and has not investigated these constructs as potential treatment targets in intensive, short-term clinical settings. Methods: The current study examined the associations of perceived internal and external control as they relate to anxiety and depression symptom change in a partial hospital sample. Results: Both perceived internal and external control increased significantly over brief, intensive treatment. Further, greater gains in internal perceived control were related to greater reductions in anxiety and depression symptoms. Discussion: Our study was limited in that it did not include a control group or follow-up data. This study provides evidence that perceived internal control is related to change in symptoms in a diagnostically diverse and severe population, after very brief intensive treatment. Future studies should investigate if perceived internal control is a mechanism of change in treatment and explore how to maximize the development of perceived internal control in treatment, to maximize reduction in symptoms.
Community, Work & Family, Nov 10, 2016
Little research has explored linkages between workplace policies and mental health in workingclas... more Little research has explored linkages between workplace policies and mental health in workingclass, employed parents, creating a gap in our knowledge of work-family issues across social class levels. The current U.S. study addresses this gap by employing hierarchical linear modeling techniques to examine how workplace policies and parental leave benefits predicted parents' depressive symptoms and anxiety in a sample of 125, low-income, dual-earner couples interviewed across the transition to parenthood. Descriptive analyses revealed that, on average, parents had few workplace policies, such as schedule flexibility or child care supports, available to them. Results revealed, however, that, when available, schedule flexibility was related to fewer depressive symptoms and less anxiety for new mothers. Greater child care supports predicted fewer depressive symptoms for fathers. In terms of crossover effects, longer maternal leave predicted declines in fathers' anxiety across the first year. Results are discussed with attention to how certain workplace policies may serve to alleviate new parents' lack of time and resources (minimize scarcity of resources) and, in turn, predict better mental health during the sensitive period of new parenthood. Keywords anxiety; depressive symptoms; parental leave; transition to parenthood; workplace policies; working-class Despite the large and growing literature on work and family issues in the United States, the U.S. is primarily known for its lack of supportive, family-friendly policies for workers (Kossek & Distelberg, 2009). Heyman and Penrose (2006), in their assessment of how the United States "measures up" in comparison to 150 countries around the world, concluded that, "the United States lags far behind the rest of the industrialized and developing world in guaranteeing the right to decent fundamental work conditions" (p. 205). Moreover, although research has documented the work-life challenges of individuals across the entire social spectrum, the burdens facing low-income families are magnified due to the fact that they more often face greater strains with fewer resources
Journal of Consulting and Clinical Psychology, Dec 1, 2017
Objective: Despite a greater need for mental health treatment in individuals identifying as lesbi... more Objective: Despite a greater need for mental health treatment in individuals identifying as lesbian, gay, bisexual, queer, and other sexual minority identities (LGBQ+), no prior study has examined mental health treatment outcomes for LGBQ+ populations receiving standard care. We compared individuals identifying as LGBQ+ or heterosexual on treatment outcomes following a partial hospital program based on cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). Method: A total of 441 participants (19% LGBQ+; mean age = 34.42 years; 56% female, 42% male, 2% nonbinary) attending a partial hospital program completed measures at admission and discharge as part of standard care. We compared LGBQ+ and heterosexual individuals on symptom outcomes (24-item Behavior and Symptom Identification Scale, 7-item Generalized Anxiety Disorder Scale, 9-item Patient Health Questionnaire), program dropout due to inpatient hospitalization, clinical global improvement, and perceived quality of care, controlling for baseline characteristics using propensity score adjustment. Results: Controlling for baseline demographic and clinical variables and a 10% false discovery rate, LGBQ+ and heterosexual individuals did not differ on treatment outcomes. However, when examining sexual identity subgroups, bisexual individuals reported more self-injurious and suicidal thoughts and worse perceptions of care at posttreatment compared to all other sexual identities. Conclusions: Findings support the comparable effectiveness of CBT- and DBT-skills-based hospital treatment for LGBQ+ and heterosexual individuals overall but suggest specific treatment disparities for bisexual individuals. Future research is needed to establish the effectiveness of traditional evidence-based treatment in other settings and to determine whether LGBQ+ affirmative treatments for specific LGBQ+ subgroups are superior to traditional treatments.
Professional Psychology: Research and Practice, Aug 1, 2014
This study examined the extent to which parental acceptance of one's sexual orientation and more ... more This study examined the extent to which parental acceptance of one's sexual orientation and more general family support moderated the associations between 3 dimensions of minority stress (internalized homonegativity, rejection sensitivity, and discrimination) and depressive symptoms in a sample of 414 self-identified lesbians and gay men who participated in an online survey. Results indicated that internalized homonegativity and rejection sensitivity were positively associated with depressive symp toms for those reporting less accepting parental attitudes, but they were not associated for those reporting more accepting parental attitudes. In contrast, parental acceptance did not moderate the association between discrimination and depressive symptoms, and general family support did not moderate any associations. Findings suggest that more accepting parental attitudes toward one's sexual orientation may protect individuals from distress in the face of their own negative thoughts and feelings related to their sexual orientation, but not overt discrimination. Further, parents' attitudes toward their child's sexual orientation may be more important than the extent to which they provide more general support. Interventions for parents struggling with their child's sexual orientation are encouraged to focus on the importance of parents expressing acceptance and support, which may directly impact well-being and act as a buffer in the face of minority stress.
Behavior Therapy, Sep 1, 2022
Journal of Cognitive Psychotherapy, Apr 25, 2022
Estimated rates of co-occurrence between obsessive and compulsive disorder (OCD) and panic disord... more Estimated rates of co-occurrence between obsessive and compulsive disorder (OCD) and panic disorder (PD) are notable, but vary considerably, with rates from epidemiological and clinical studies ranging from 1.8% to 22% (Rector et al., 2017). We reviewed the current empirical literature on the etiology, treatment, diagnostic assessment, and differential diagnosis of co-occurring OCD/PD. Best practices for cognitive-behavioral treatment, including identifying and addressing treatment barriers are also addressed. Although it is acknowledged in current literature that co-occurring OCD and PD levels may be clinically significant, there remains a need to thoroughly examine the possible consequences and future research directions of this overlap. Future research must continue to elucidate the biological and environmental causes of OCD/PD co-occurrence.
Cognitive Therapy and Research, Jan 11, 2018
Positive aspects of self-compassion (i.e., self-kindness and nonjudgmental acceptance of personal... more Positive aspects of self-compassion (i.e., self-kindness and nonjudgmental acceptance of personal experiences) as well as negative aspects (i.e., high self-criticism and self-coldness) are strong predictors of anxiety, depression, worry, and quality of life. To date, however, relatively little is known about (a) how both aspects of self-compassion change during naturalistic treatment, (b) whether and how such changes relate to symptom improvement, and (c) which processes might explain the potential benefits of self-compassion. To address these gaps, the present study examined whether relations between changes in both aspects of self-compassion and treatment outcomes in a brief partial hospital setting for acute psychology could be explained by associated changes in repetitive negative thinking (RNT), an established maladaptive cognitive process involved in anxiety and depressive disorders. In a sample of 582 people receiving cognitive-behavioral (CBT) and dialectical behavior therapy over the course of 1-2 weeks, increases in positive aspects of self-compassion and decreases in negative aspects related to improvements in depression and anxiety. RNT mediated the relationship between decreases in negative aspects of self-compassion and improvements in anxiety and depression. However, a reverse model also showed that decreases in negative aspects of self-compassion could also explain relations between RNT and depressive symptom improvement only. These findings suggest that negative aspects of self-compassion and RNT may constitute important targets for treatment in acute settings. Future studies should investigate the impact of greater focus on self-compassion on RNT and symptom improvement using longitudinal experimental designs with multiple assessment points, examining causality and directionality.
Journal of Clinical Psychology, Sep 13, 2019
Objectives: We examined types of discrimination encountered by transgender and gender diverse (TG... more Objectives: We examined types of discrimination encountered by transgender and gender diverse (TGD) individuals and the associations with symptoms of depression and anxiety, as well as the mediating and moderating effects of coping responses. Method: This online study included 695 TGD individuals ages 16 years and over (M = 25.52; SD = 9.68). Results: Most participants (76.1%) reported discrimination over the past year. Greater exposure to discrimination was associated with more symptoms of depression and anxiety. These associations were mediated by coping via detachment and via internalization, although a direct effect remained. Conclusions: Many TGD people will encounter discrimination and this is associated with greater psychological distress. Engagement in internalization of blame or detachment partially explains the association between discrimination and mental health issues. These findings elucidate
Dementia and Geriatric Cognitive Disorders, 2012
Background/Aims: Neuropsychiatric symptoms in Alzheimer's disease (AD) are highly prevalent. We s... more Background/Aims: Neuropsychiatric symptoms in Alzheimer's disease (AD) are highly prevalent. We sought to determine whether neuropsychiatric symptoms were related to global functional impairment at baseline and over a 3-year period in older normal control (NC), mild cognitive impairment (MCI) and mild AD dementia subjects. Methods: Eight hundred and twelve subjects (229 NC, 395 MCI, 188 AD) from the Alzheimer's Disease Neuroimaging Initiative study underwent cognitive and behavioral assessments over 3 years. Results: Greater hallucinations, anxiety and apathy were associated with greater global functional impairment at baseline, while the presence of hallucinations and apathy at baseline was associated with greater global functional impairment over time across all subjects. The following neuropsychiatric symptoms were not significantly associated with global functioning: delusions, agitation, depression, euphoria, disinhibition, irritability, aberrant motor behaviors, sleep and appetite. Conclusions: These results suggest that increased baseline hallucinations, apathy and anxiety are associated with current and future disease progression in AD.
American Journal of Orthopsychiatry, 2020
Historically, intensive obsessive-compulsive and related disorder (OCRD) treatment settings have ... more Historically, intensive obsessive-compulsive and related disorder (OCRD) treatment settings have been underrepresentative in terms of patient race and ethnicity. The present study piloted a novel technique to measure multiple marginalized identities and assess their impact on obsessive-compulsive disorder (OCD) symptoms and treatment response across intensive residential treatment (IRT). Participants included 715 residents receiving IRT for OCRD. Measures included the Yale-Brown Obsessive-Compulsive Scale, Dimensional Obsessive-Compulsive Scale (DOCS), Obsessive Beliefs Questionnaire-44, and measures of depression and quality of life. In addition, we piloted a marginalized identity score, an additive measure of intersectionality. Most patients endorsed holding primarily privileged identities. Higher marginalized identity score was significantly correlated with higher depression symptom severity and lower quality of life throughout treatment. Both at baseline and discharge, higher marginalized identity score was significantly and positively correlated with greater OCD symptom severity. Higher marginalized identity score was significantly associated with greater severity of DOCS1, DOCS2, DOCS4, and obsessive beliefs across multiple domains. Consistent with previous literature, patients in our IRT setting were not demographically representative of the general population. Individuals with more marginalized identities endorsed higher symptoms of OCD, obsessive beliefs, OCD dimensions, and depression, as well as lower quality of life at admission and discharge. Results support increased consideration of the role marginalization plays in symptom severity, symptom presentation, and treatment response across treatment settings. Further investigation is warranted to better address the multiplicative effects of holding intersecting marginalized identities and how treatment may be adapted to ameliorate these inequities. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
The present study investigated differences between individuals with social anxiety disorder (SAD)... more The present study investigated differences between individuals with social anxiety disorder (SAD) and non-anxious controls (NAC) on measures of thought processes and anxiety responses surrounding an anxiety-provoking situation. Participants gave a spontaneous speech to an audience and reported their anxiety throughout. Measures of trait decentering and anxiety, situational anxiety, negative thoughts and believability, and willingness to repeat the task were administered. Compared to NAC, individuals with SAD reported a higher prevalence of negative thoughts, found the thoughts more believable, reported lower levels of trait decentering, and reported less willingness to repeat an anxiety-provoking task. Collapsing the groups, we found an inverse relationship between the amount of negative thoughts and willingness to repeat the task, and a positive correlation between decentering and willingness. We did not find evidence to support that decentering and believability moderate this relationship. The present study partially supports the proposed model of SAD, as the SAD and NAC groups differed at each step of the proposed model, however moderation analyses were not significant. v
Neurology Psychiatry and Brain Research, Feb 1, 2020
Background: Limited perceived control has been theorized and measured to be a cognitive aspect of... more Background: Limited perceived control has been theorized and measured to be a cognitive aspect of anxiety disorder development and maintenance. The goal of the present study was to investigate perceived internal and external control as transdiagnostic features of anxiety in a diverse urban sample. Methods: We explored the relations between anxiety, perceived control, and acceptance skills experimentally using a low control computer task and a brief acceptance intervention between task trials. Results: Data revealed significant negative correlations between perceived internal and external control and levels of transdiagnostic anxiety. The high anxiety group reported lower acceptance skills at baseline and greater levels of anxiety across trials of the low control task. There was evidence of an anxiety reduction effect via the acceptance intervention across all participants compared to the control group, but we did not see the hypothesized interaction between group and anxiety level (possibly due in part to sampling randomization failure, as acceptance group had significantly higher anxiety at baseline). Discussion: Our findings validate previous research linking low trait perceived control and high trait anxiety in a diverse sample and provide evidence that acceptance-based interventions may provide more adaptive strategies for navigating low control situations.
Harvard Review of Psychiatry
The synergistic epidemics of COVID-19, racial injustice, and health inequities sparked an unprece... more The synergistic epidemics of COVID-19, racial injustice, and health inequities sparked an unprecedented commitment from US hospital systems and treatment settings to address health disparities by increasing access to care for historically oppressed and underserved communities. However, the inability of hospital systems to actually provide multiculturally responsive care and, more broadly, to consistently practice cultural humility will only exacerbate patient distrust and the deleterious health and social outcomes we seek to mitigate. This perspective article describes the development of a multidisciplinary team of mental health providers committed to delivering culturally responsive mental health treatment while promoting inclusive workplace environments. We outline the Multicultural Psychology Consultation Team’s (MPCT) origin, design, process, and structure and discuss successes and challenges in maintaining the model in its first two years. We recommend that systemic infusion of...
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Papers by Lauren Wadsworth