Research exploring correlates of, precursors to, and consequences of psychological disorders has often relied on designs wherein both predictor and outcome are measured by self-reports. In this article, coauthored by a clinical psychologist (C. E. Fairbairn) and a data scientist (N. Bosch), we offer information surrounding an evolving class of machine-learning models as these inform an expanding measurement tool kit in clinical-psychological science. Specifically, we note the development of deep-learning applications for image analysis, language analysis, and the analysis of physiological time-series data, reviewing implications of these advances for measurement in behavioral research. We weigh strengths and limitations of these automated methods in comparison with self-reports, including the specific form of error likely yielded via each (random vs. systematic), with the aim of fostering a replicable, sustainable, and reputationally strong field of clinical-psychological science.
The ability to make valid conclusions in psychological science rests upon rigorous measure development. People with lived experience of psychological disorders can make invaluable contributions to the measure development process, but they are often excluded from this process by researchers. When people with lived experience are included, their contributions are limited to consultation early in the process. This review advocates for shared decision-making with people with lived experience throughout the measure development process. We provide an overview of the phases and steps involved in the development of self-report measures, highlighting the critical contributions of people with lived experience at each step. Next, guided by the continuum of community engagement in research, we review studies from the psychological science literature that embrace community-engaged measure development approaches inclusive of people with lived experience of psychological disorders. We conclude with a discussion of opportunities and challenges to community-engaged measure development in psychological science.
Clinical psychological research stands to benefit greatly from collaborations that incorporate perspectives from other disciplines. However, the challenges of such collaborative efforts are immense. This commentary provides the perspectives of five frequent collaborators from distinct disciplines (clinical psychology, linguistics, affective and developmental science, vision science, and cognitive neuroscience). We outline three overarching challenges we have encountered during our collaborations: disciplinary bias (i.e., implicit and explicit beliefs about the best ways to gain knowledge), lack of multidisciplinary fluency (i.e., difficulty effectively communicating across disciplines), and inherent risk (i.e., the speculative nature and uncertain career prospects of multidisciplinary work). We then discuss potential solutions to these challenges. We hope that by sharing our experiences and insights, we can promote more productive and impactful clinical science.
Anxiety and related disorders are a significant public health burden with rising prevalence in the wake of the COVID-19 pandemic. As demand for effective anxiety treatment increases, so too does the need for strategies to bolster treatment outcomes. Research on the mechanisms of exposure therapy, the frontline behavioral treatment, will be critically important for optimizing clinical outcomes. We outline an initial agenda for future research on the mechanisms of change of exposure therapy, developed in collaboration with a large international team of researchers through the Exposure Therapy Consortium (ETC). Key questions and recommendations for future research focus on five priority areas: conceptualization, measurement, study design/analysis, and individual/contextual differences. Rising to the challenge of addressing these questions will require coordinated action and availability of centralized tools that can be used across trials, settings, and research groups.
Air pollution is a leading threat to human health (WHO, 2021) but has been largely overlooked in the study of psychopathology. As the burden of poor mental health grows, a consideration of new contributors to psychopathology is needed to identify novel prevention and intervention approaches. Consequently, collaboration between clinical psychological scientists and experts in atmospheric research, pollution, and built environments holds great potential for advancing knowledge and addressing these threats. The current project brings together a cross-disciplinary team to summarize the state of existing research linking air quality to the development and maintenance of psychopathology. We then identify some traditional challenges to collaboration across our disciplines before identifying promising areas for future research and providing concrete advice to psychological scientists interested in similar collaborations, including recommendations for the measurement and application of outdoor and indoor air quality, ways to strengthen causal inference, and considerations for environmental justice.
Given the substantial symptom overlap between anxiety and depressive disorders, researchers have sought to develop approaches for better differentiating these subdimensions of internalizing psychopathology. Neurophysiological indices of biobehavioral processes specific to either subdimension may provide a means for doing so. Here, we report evidence for opposing associations of a well-established neural indicator of reward responsiveness - the reward positivity (RewP) - with trait indices of depressive and phobic fear pathology. We show that these relationships were strengthened when controlling for their shared variance via regression modeling. Additionally, structural equation modeling revealed that broad negative affectivity (NA) constituted the shared variance between the two trait indices. Our findings point to the potential use of reduced RewP to improve differential diagnosis of depressive versus phobic fear conditions. They also indicate that variance shared between conditions of these types may operate to obscure their observed associations with neural indicators of core processes unique to each.
Despite growing popularity, associations between dosage and outcomes in meditation app interventions have not been established. We examined this relationship using a range of operationalizations of dosage (e.g., minutes of use, days of use, number and type of activities completed) and strategies for modeling outcomes (e.g., ordinary least squares regression, multilevel modeling, latent class analysis). We used data from a recently completed randomized controlled trial testing a meditation app (n=662; 80.4% with elevated depression/anxiety) which included psychological distress as its preregistered primary outcome. Across 41 models, whether or not an association was detected as well as the shape and direction of this association varied. Although several models indicated that higher dosage was associated with larger decreases in psychological distress, many models failed to show this relationship and some even showed the opposite. These results may have implications for optimizing and studying dosage in meditation apps and for open science practices.
More comprehensive modelling of psychopathology in youth is needed to facilitate a developmentally informed expansion of the Hierarchical Taxonomy of Psychopathology (HiTOP) model. This study examined a symptom-level model of the structure of psychopathology in youth-most aged 11-17 years-bringing together data from large clinical, community, and representative samples (N = 18,290) and with coverage of nearly all major forms of mental disorders and related content domains (e.g., aggression). The resulting hierarchical and dimensional model was based on the points of convergence among three statistical approaches and included fifteen narrow dimensions nested under four broad dimensions of Internalizing; Externalizing; Eating Pathology; and Uncontrollable Worry, Obsessions, and Compulsions. We position these findings within the context of the existing literature, and articulate implications for future research. Ultimately, these findings add to the rapidly growing literature on the structure of psychopathology in youth and take us a step closer towards understanding (dis-)continuities in psychopathology's structure across the lifespan.
Understanding why interventions work is essential to optimizing them. Although mechanistic theories of meditation-based interventions (MBIs) exist, empirical evidence is limited. We randomly assigned 662 adults (79.9% reported clinical levels of anxiety or depressive symptoms) to a four-week smartphone-based MBI or wait-list control condition early in the COVID-19 pandemic. Psychological distress and four theory driven preregistered psychological mediators of well-being (mindful action, loneliness, cognitive defusion and purpose) were assessed five times during the intervention period and at three-month follow-up. In preregistered analyses, assignment to the intervention predicted significant gains on all mediators which in turn significantly mediated follow-up distress (21.9%-62.5% of intervention effect on distress). No significant mediation pathway was observed in an exploratory multiple mediator analysis, but reduced loneliness accounted for 61.7% of the combined indirect effect. Multiple psychological pathways may mediate reduced distress in a digital MBI.
While it is known that therapists vary in effectiveness, it is unclear what therapist-level characteristics predict this variation. We conducted a large-scale, preregistered study (n = 97 therapists from the United States and Canada, n = 6,152 patients) examining a multimodal set of 38 therapist-level predictors that have been empirically or theoretically linked with patient outcomes. We examined associations with pre-post change and rate of change in psychological distress, and likelihood of attending >1 treatment session. We largely did not find associations between therapist-level characteristics and patient outcomes. Most predictors failed to replicate across sensitivity analyses and/or were non-significant following p-value correction. The most robust evidence suggested that interpersonal capacities assessed via a performance task are associated with likelihood of attending >1 treatment session. A key limitation of the study is small therapist effects which may have reduced statistical power. Empirically, it remains uncertain what qualities characterize highly effective therapists.
Since 2022, following the Dobbs decision by the United States Supreme Court, abortion restrictions have increased throughout the country. This represents the most recent phase of decades of political and legal restrictions on abortion access, including the 1976 Hyde Amendment restricting federal funds for abortion services. Limiting access to legal abortion and safe reproductive healthcare has serious implications for the mental health of people who can become pregnant, and thus for clinical psychology. However, there are gaps in competence around sexual and reproductive health (SRH) for clinical psychologists in research and practice. In this paper, we 1) review empirical evidence regarding abortion and mental health, 2) discuss barriers to SRH competence for clinical psychology, and 3) present guiding principles for psychologists and institutions/training programs to address these competence gaps across research, clinical practice, and advocacy. We focus on clinical psychology, but the content is applicable to behavioral health disciplines broadly.
The Hierarchical Taxonomy of Psychopathology (HiTOP) provides a dimensional framework for connecting psychological disorders to neural systems/processes. We examined how neurophysiological measures of cognitive-attentional (oddball P300) and perceptual-emotional processing (fear-face N170/P200) relate to dimensions of the HiTOP externalizing spectrum. Employing 666 community participants, we fit a model in which antagonistic externalizing and substance problems subfactors, defined via symptom and questionnaire-scale measures, loaded with a disinhibitory trait scale onto a higher-order externalizing factor. Hierarchical regression was used to evaluate how much observed relations of each neural measure with the two subfactors reflected their unique variance versus their covariance (reflected in the general factor). P300's relations were fully accounted for by the general factor, suggesting that impaired cognitive processing characterizes broad risk for externalizing problems. Neural indicators of sensitivity to others' distress (N170, P200) were uniquely related to antagonistic externalizing. Findings highlight the HiTOP framework's potential to advance biobehavioral understanding of psychopathology.
In this study, we reduced the DSM-5 to its constituent symptoms and reorganized them based on patterns of covariation in individuals' (n = 14,762) self-reported experiences of the symptoms to form an empirically derived hierarchical framework of clinical phenomena. Specifically, we used the points of agreement among hierarchical principal components analyses and hierarchical clustering, as well as between the randomly split primary (n = 11,762) and hold-out (n = 3,000) samples, to identify the robust constructs that emerged to form a hierarchy ranging from symptoms and syndromes up to very broad superspectra of psychopathology. The resulting model had noteworthy convergence with the upper levels of the Hierarchical Taxonomy of Psychopathology (HiTOP) framework and substantially expands on HiTOP's current coverage of dissociative, elimination, sleep-wake, trauma-related, neurodevelopmental, and neurocognitive disorder symptoms. We also mapped some exemplar DSM-5 disorders onto our hierarchy; some formed coherent syndromes, whereas others were notably heterogeneous.
We investigated associations of romantic partners' alcohol use, cigarette smoking, personality, and psychological distress with alcohol use and binge drinking within a sample of Finnish twins who have initiated alcohol use (N = 1620, 51% female, mean age = 33.6 years) and their romantic partners. We also used twin modeling to examine whether partner characteristics moderate genetic influences on drinking behavior. Having a romantic partner with more frequent alcohol use and smoking was consistently associated with greater alcohol consumption and binge drinking, and partner alcohol use and smoking also moderated genetic influences on alcohol consumption. Further, a range of partner characteristics moderated genetic influences on binge drinking, such that the heritability of binge drinking was higher when partners reported less frequent alcohol use, greater smoking, lower conscientiousness, and higher extraversion, neuroticism, and psychological distress. These findings highlight the important, but complex, ways in which romantic partners contribute to drinking behavior.
The pathoplasty model posits that personality influences the manifestation of psychopathology, but has rarely tested the influence on the symptomatic expression of depression. We tested pathoplastic effects of personality on depressive symptoms in five cross-sectional samples varying in age, specific measures of personality, and specific measures of depression. Tests of pathoplastic effects were conducted using moderated non-linear factor analysis. Across samples, we found little evidence for pathoplastic effects of personality on depressive symptoms. We found minimal evidence that personality is associated with the structure of the depression construct (i.e., loadings to indicators). Lower levels of positive emotionality were associated with greater likelihood of endorsing sleep problems, beyond the influence of overall depression severity, but was inconsistent across sleep items. Although we found minimal influence of personality on depression symptom manifestation, longitudinal work can examine similar issues in younger and older samples, as well as examining more dimensions of personality.
Irritability is a transdiagnostic clinical problem in youths and adults and can be parsed into tonic and phasic components. However, no prior work has related these components to the Hierarchical Taxonomy of Psychopathology. In the present study, we used diagnostic-interview and self-report data from a sample of 18-year-olds (N = 461) to model irritability components alongside a psychopathology structure specifying fear and distress (internalizing) and harmful substance use and antisocial behavior (externalizing). After regressing tonic and phasic irritability onto the psychopathology subfactors, chi-square difference tests indicated that tonic irritability showed significantly stronger associations with fear (Cohen's w = 0.31, 95% confidence interval [CI] = [0.25, 0.38]) and distress (Cohen's w = 0.37, 95% CI = [0.31, 0.44]) than phasic irritability. Phasic irritability showed a stronger association with antisocial behavior (Cohen's w = 0.10, 95% CI = [0.04, 0.17]) than tonic irritability. Neither component uniquely related to substance misuse. Results support the tonic-phasic-irritability distinction and clarify its placement within higher-order psychopathology.
Given robust support for internalizing psychopathology as a broad construct, the field has shifted focus from its specific subcomponents to studying internalizing overall, leaving it unclear whether its components provide additional information. We investigated whether internalizing syndromes have incremental validity beyond each other in their associations with 22 external criteria (e.g., health, functioning) using the National Epidemiological Survey on Alcohol and Related Conditions data, a representative adult sample (Wave 1, N=43,093). We extracted a five-factor model for 5 lower-order internalizing syndromes (generalized anxiety, major depression, social anxiety, specific phobia, panic). All were moderately correlated with each other and associated with external criteria. Adjusting for other internalizing syndromes, generalized anxiety, major depression, and panic syndromes demonstrated incremental validity, or unique associations with external criteria. Our findings suggest internalizing syndromes exhibit shared and unique features. Investigating both the internalizing spectrum and its more specific syndromes can offer deeper insights into psychopathology.
This research examined whether non-suicide-specific treatments effectively reduced suicidal ideation (SI) among a clinical sample of eating disorder (ED) patients (N=3,447 of whom 50.9% presented with SI). All participants met criteria for a current DSM-5 ED and were administered a combination of evidence-based treatments in inpatient, residential, partial hospitalization, and intensive outpatient ED treatment facilities. Mediation analyses tested whether SI at discharge decreased specifically through standardized residual change scores in ED symptoms. Both SI and ED symptoms decreased over the course of treatment without clinically meaningful differences by ED diagnosis. ED symptom improvement partially mediated the relationship between SI at admission and discharge, suggesting that treating ED symptoms with evidence-based treatments can be an effective way to reduce SI, at least partially, for many patients. These findings demonstrate the importance of facilitating evidence-based treatment referrals for specific disorders as a component of broad-based suicide outreach and prevention strategies.
Some studies suggest a rise in anxiety prevalence and severity over the past decade, particularly among emerging adults, while others report stable rates. This preregistered study examines trends in anxiety symptom severity and explicit (self-reported) and implicit (using the Brief Implicit Association Test) associations about the self as anxious vs. calm. Using continuous cross-sectional data from 99,973 U.S. adults who visited the Project Implicit Health website between 2011-2022, we compared trends in anxiety outcomes between emerging adults (age 18-25) and adults age 26+, including during the COVID-19 pandemic. Contrary to hypotheses, average anxiety severity and strength of implicit/explicit self-as-anxious associations did not spike at the start of the pandemic, and rates of change did not significantly differ by age from 2011-2020, except for explicit, non-relative self-as-anxious ratings. Instead, anxiety mostly remained stable, with emerging adults exhibiting consistently higher anxiety symptom severity and stronger implicit/explicit self-as-anxious associations than adults age 26+.
Diagnostic criteria from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders does not fully address behavioral and clinical heterogeneity inherent to attention-deficit/hyperactivity disorder (ADHD); however, temperament-based profiles may help explain biological heterogeneity within the disorder. Temperament profiles have been defined and replicated among youths with ADHD and have demonstrated unique patterns of resting-state functional connectivity within a small sample. Two temperament profiles were identified by Kozlowski et al. in the Adolescent Brain Cognitive Development Study, and in the present study, we sought to replicate and validate documented resting-state patterns. Functional connectivity between bilateral amygdalae and 12 Gordon networks was compared between profiles and typically developing (TD) youths. Surgent youths demonstrated stronger right amygdala-dorsal attention network connectivity (β = 0.0434) and right amygdala-retrosplenial temporal network connectivity (β = 0.0442) compared with TD youths. Irritable youths demonstrated unique connectivity patterns compared with TD and surgent youths; however, effects did not survive correction for multiple comparisons. Findings provide support for future research examining temperament profiles among ADHD youths.