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UCLA Electronic Theses and Dissertations UCLA UCLA Electronic Theses and Dissertations Title Examining the Effectiveness and Feasibility of a Self-Guided Version of Positive Affect Treatment Permalink https://escholarship.org/uc/item/9hj133gp Author Loerinc, Amanda Gloria Publication Date 2018 Peer reviewed|Thesis/dissertation eScholarship.org Powered by the California Digital Library University of California UNIVERSITY OF CALIFORNIA Los Angeles Examining the Effectiveness and Feasibility of a Self-Guided Version of Positive Affect Treatment A dissertation submitted in partial satisfaction of the requirements for the degree Doctor of Philosophy in Psychology by Amanda Gloria Loerinc 2018 © Copyright by Amanda Gloria Loerinc 2018 ABSTRACT OF THE DISSERTATION Examining the Effectiveness and Feasibility of a Self-Guided Version of Positive Affect Treatment by Amanda Gloria Loerinc Doctor of Philosophy in Psychology University of California, Los Angeles, 2018 Professor Michelle Craske, Chair Anxiety disorders and depression are among the most prevalent mental disorders with close to one third of the population meeting diagnostic criteria at some point during their lifetimes (Kessler et al., 2005; 2012). Cognitive and behavioral therapies (CBT) are considered to be the most efficacious and empirically supported psychosocial interventions for anxiety and depression (Hofmann & Smits, 2008; Norton & Price, 2007; Tolin, 2010). While research indicates CBT to be superior to several other treatments, placebos, and waitlist controls, there is evidence that not every individual benefits from CBT and response rates hover around 50% at post-treatment (Loerinc et al., 2015). There are also several barriers to evidence-based outpatient treatment for anxiety and depression including cost effectiveness, adherence to the CBT model, and clinical ii attitudes about delivering evidence-based treatments (Addis, 2002; Barlow, 2004; Barlow et al., 1999; Chorpita & Nakamura, 2004). To address the barriers, researchers have begun developing self-guided or internet-based delivery of CBT. Research indicates no differences in effectiveness between self-guided CBT and traditional face-to-face CBT (Cuijpers et al., 2010; Hedman et al., 2012). Additionally, reliance upon the DSM for clinical decision-making does not appropriately align with neuroscience or genetics (Insel et al., 2010) and recent research suggests that anxiety disorders and depression share common higher-order constructs (Brown, 2007). The Research Domain Criteria (RDoC) is an initiative designed to address these limitations (Insel et al., 2010). Thus, using the principals of RDoC, this study sought to examine the effectiveness of a self- guided approach to the treatment of deficits in reward sensitivity using a positive affect protocol. Participants who self-referred for treatment and met criteria for Depression (CSR >4) on the SCID 5 (First et al., 1994) were recruited for the study. Utilizing a multiple baseline experimental design, participants were randomized to a 2, 4, or 6-week baseline prior to treatment administration to test the effects of the positive affect intervention on symptoms of depression and anxiety. The 15-session intervention included pleasant events scheduling, attending to the positive, and cultivating positive emotions. The daily measures largely did not reflect that symptoms remained stable during the baseline phase and reduced during the intervention period. We did find, however, that symptoms of depression and anxiety decreased overall on pre/post measures of depression and anxiety symptoms. Additionally, diagnosis severity of depression decreased for all participants on the SCID 5. iii The dissertation of Amanda Gloria Loerinc is approved. John Carl Piacentini Ayako Janet Tomiyama Bruce L Baker Michelle Craske, Committee Chair University of California, Los Angeles 2018 iv TABLE OF CONTENTS INTRODUCTION …………………………………………………………………...…1 Efficacy of CBT for Specific Anxiety Disorders and Depression………………1 Depression……………………………………………………………….1 Generalized Anxiety Disorder…………………………………………...2 Panic Disorder…………………………………………………………...3 Social Anxiety Disorder…………………………………………………3 Obsessive-compulsive Disorder…………………………………………3 Posttraumatic Stress Disorder…………………………………………...3 Specific Phobias…………………………………………………………4 Barriers to Dissemination and Implementation………………………………….6 Effectiveness of Self-Guided CBT………………………………………………7 Research Domain Criteria (RDoC) Initiative…………………………………..10 Single-Case Designs…………………………………………………………....13 Study Aim and Hypotheses…………………………………………………….14 Interventions Targeting Deficits in Reward Sensitivity………………………..14 Behavioral Activation………………………………………………….15 Cognitive Restructuring (Attending to the Positive)…………………..16 Loving-Kindness and Compassion…………………………………….18 METHOD………………………………………………………………………………20 Participants……………………………………………………………………..20 Measures………………………………………………………………………..21 Intervention……………………………………………………………………..23 Multiple Baseline Design………………………………………………...……..25 Procedure………………………………………………...……...........................25 Statistical Analysis. ………………………………………………...…..............27 RESULTS………………………………………………………………………………28 Daily Measures…………………………………………………………………28 Questionnaires………………………………………………………………….29 v SCID……………………………………………………………………………..30 Completed Participants…………………………………………………………..30 Participant 1……………………………………………………………...30 Participant 2……………………………………………………………...35 Participant 3……………………………………………………………...39 Participant 4……………………………………………………………...43 Participant 5……………………………………………………………...47 Participant 6……………………………………………………………...51 Non-completers…………………………………………………………………..56 DISCUSSION……………………………………………………………………………56 APPENDIX………………………………………………………………………………62 REFERENCES…………………………………………………………………………..75 vi Amanda Gloria Loerinc [email protected] 405 Hilgard Avenue Los Angeles, CA 90095 EDUCATION 2018 (expected) University of California, Los Angeles Doctor of Philosophy, Clinical Psychology 2013 University of California, Los Angeles Master of Arts, Clinical Psychology 2010 Boston University Bachelor of Arts, Psychology HONORS AND AWARDS 2015 Invited to attend the DBT Strategic Planning Meeting with Marsha Linehan, Ph.D. University of Washington 2015 Beck Institute for Cognitive Behavioral Therapy Student Scholarship University of Pennsylvania 2015 Clinical Scientist Award University of California, Los Angeles 2013 & 2014 Graduate Summer Research Mentorship Award University of California, Los Angeles 2012 University Fellowship University of California, Los Angeles 2011 DSM 5 Anxiety Disorders Editorial Committee University of California, Los Angeles 2010 Cum Laude, Honors in Psychology Boston University 2007-2010 Dean’s List Boston University RESEARCH EXPERIENCE 2015 – 2018 Doctoral Student and Principal Investigator, Dissertation UCLA Department of Psychology 2012 – 2014 Doctoral Student and Principal Investigator, Master’s Thesis Department of Psychology, University of California, Los Angeles 2012 – 2018 Graduate Student Researcher UCLA Department of Psychology CLINICAL EXPERIENCE 2017 – 2018 Psychology Intern VA Sepulveda Ambulatory Care Center vii 2014 – 2016 Chief Extern/Adult CBT Extern Harbor-UCLA Medical Center 2012 – 2017 Graduate Student Therapist UCLA Department of Psychology PUBLICATIONS Herts, K., Loerinc, A. G., Owens, E., & Keenan-Miller, D. (2017). A model for competency based supervision training. The California Psychologist, 50, 40-42. Niles, A., Loerinc, A. G., Krull, J. L., Roy-Byrne, P., Stein, M. G., Sullivan, G., Sherbourne, C., Bystritsky, A., & Craske, M. G. (2017). Advancing personalized medicine: application of a novel statistical method to identify treatment moderators in the Coordinated Anxiety Learning and Management Study. Behavior Therapy, 48, 490-500. Loerinc, A. G., Meuret, A. E., Twohig, M., Rosenfield, D., Bluett, E., & Craske, M.G. (2015). Response rates for CBT for anxiety disorders: need for standardized criteria. Clinical Psychology Review, 42, 72-82. PRESENTATIONS SYMPOSIA Loerinc, A. G., & Craske, M. G. (November, 2016). Examining the effectiveness of a self- guided version of Positive Affect Treatment. Paper presented at the Association for Behavioral and Cognitive Therapies (ABCT), New York, NY. Loerinc, A. G., Niles, A., Krull, J., & Craske, M. G. (November, 2015). Testing a composite moderator of response to evidence based treatment vs. usual care in the Coordinated Anxiety Learning and Management (CALM) study. Paper presented at the Association for Behavioral and Cognitive Therapies (ABCT), Chicago, IL. Loerinc, A. G., & Craske, M.G. (May, 2014). The effects of interpretation bias training prior to exposure on fear reduction in individuals with contamination fears. Paper presented at the Association for Psychological Science (APS), San Francisco, CA. Loerinc, A. G., Meuret A. E., Twohig, M., Rosenfield, D., & Craske, M. G. (April, 2013). Response rates in CBT for anxiety disorders and measurement matters. Paper presented at the Anxiety Disorders Association of America (ADAA), La Jolla, CA. Baker, A. S., Mortazavi, A., Loerinc, A. G., & Craske, M. G. Exposure therapy and surprise: utilizing the Rescorla-Wagner model in clinical treatment. (November, 2011). Paper presented at the Association for Behavioral and Cognitive Therapies (ABCT), Toronto, ON. viii Introduction Anxiety disorders and depression are among the most prevalent mental disorders with close to one third of the population meeting diagnostic criteria at some point during their lifetimes (Kessler et al., 2005; 2012). Cognitive and behavioral therapies, herein
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