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Scholarly Works (7 results)

  • Thesis
  • Peer Reviewed
UC San Diego Electronic Theses and Dissertations (2020)

Individuals with high social anxiety (HSA) may experience subtle impairments in social processes that, if identified and targeted in treatment, could enhance social relationship functioning. Discordance in positive affect (PA), i.e., mismatch between PA experience and expression, may be one impactful treatment target if it is prevalent among HSA and if it weakens social bonds. The current study tested whether, during a positive social interaction: 1) a cross-section of individuals with HSA vs. low social anxiety display heterogeneous, highly distinct “PA profiles,” reflecting four patterns of discordant or concordant PA; 2) displaying discordant profiles is linked to HSA, and displaying all predicted profiles aside from concordant high PA is linked to additional clinical symptoms; 3) discordance is associated with lower desire for future interaction (DFI) with one’s conversation partner and with conversation partners’ lower reciprocal DFI; and 4) discordant profiles reflect use of specific emotion regulation strategies. Ninety-six adults age 18-55 participated, with scores on the Liebowitz Social Anxiety Scale either ≥ 50 (HSA; n = 70) or ≤ 20 (n = 26). All engaged in a positive laboratory-based relationship formation task with a confederate conversation partner and rated their internally felt PA several times during the interaction. Next, participants and confederates rated their DFI, and participants rated their use of emotion regulation strategies. Automated software was later used to code video recordings of participants’ intensity of smiling. Latent profile analysis tested for the predicted PA profiles. Three of the four predicted profiles emerged, including one concordant high (n = 21), one concordant low (n = 23), and one discordant (high felt, low expressed) PA profile (n = 52). Compared to either of the other two profiles, displaying concordant low PA was associated with higher social anxiety, higher anhedonic depression, and higher use of expressive suppression to regulate emotions. Discordant PA was not more strongly associated with HSA and was not maladaptive for DFI. Instead, concordant low internally felt and low expressed PA was identified as a potentially useful indicator of both clinical severity and impairment in social relationship functioning and may point to more urgent or intensive treatment need.

    Cover page: Patterns of Felt and Expressed Positive Affect in Social Anxiety: Concordance, Discordance, and their Correlates
    • Article
    • Peer Reviewed
    UC San Diego Previously Published Works (2020)

    Background

    Social disconnection is a common and pernicious feature of anxiety and depressive disorders, yet is insufficiently addressed by our best available treatments. To better understand why people with anxiety and depression feel socially disconnected, we tested a positive and negative valence systems framework informed by research on how normative social connections develop and flourish.

    Method

    Individuals seeking treatment for anxiety or depression (N = 150) completed measures of perceived social connectedness, positive and negative valence temperament, social goals, affect, symptoms, and life satisfaction.

    Results

    Feeling less socially connected was associated with diminished life satisfaction, beyond clinical symptom severity. Regression analyses revealed that both diminished positive valence and heightened negative valence temperament, and their corresponding motivational and affective outputs, were significantly and uniquely (with no significant interaction between them) associated with lower perceived connectedness.

    Limitations

    Data was cross-sectional and based on self-report-limiting conclusions about causality and social disconnection processes at different units of analysis.

    Conclusions

    Understanding social disconnection through the lens of a positive and negative valence systems framework may inform transdiagnostic models and treatment approaches.
      Cover page: A tale of two systems: Testing a positive and negative valence systems framework to understand social disconnection across anxiety and depressive disorders
      • Article
      • Peer Reviewed
      UC San Diego Previously Published Works (2017)
      Individuals with social anxiety disorder (SAD) have difficulty forming social relationships. The prevailing clinical perspective is that negative emotions such as anxiety inhibit one's capacity to develop satisfying social connections. However, empirical findings from social psychology and affective neuroscience suggest that positive emotional experiences are fundamental to establishing new social bonds. To reconcile these perspectives, we collected repeated measurements of anxiety, positive emotions (pleasantness), and connectedness over the course of a controlled relationship formation encounter in 56 participants diagnosed with SAD (64% female; Mage=23.3, SD=4.7). Participants experienced both increases in positive emotions and decreases in anxiety throughout the interaction. Change in positive emotions was the most robust predictor of subsequent increases in connectedness, as well as a greater desire to engage one's partner in future social activities, above and beyond reductions in anxiety (medium to large sized effects). Those findings suggest that anxiety-based models alone may not fully explain difficulties in relationship formation in SAD, and underscore the potential value of considering positive emotional experiences in conceptual and treatment models of SAD.
        Cover page: The affective tie that binds: Examining the contribution of positive emotions and anxiety to relationship formation in social anxiety disorder
        • Article
        • Peer Reviewed
        UC Riverside Previously Published Works (2020)

        Background

        Anxiety and depressive disorders are often characterized by perceived social disconnection, yet evidence-based treatments produce only modest improvements in this domain. The well-established link between positive affect (PA) and social connectedness suggests that directly targeting PA in treatment may be valuable.

        Method

        A secondary analysis of a waitlist-controlled trial (N=29) was conducted to evaluate treatment response and process of change in social connectedness within a 10-session positive activity intervention protocol-Amplification of Positivity (AMP)-designed to increase PA in individuals seeking treatment for anxiety or depression (ClinicalTrials.gov Identifier: NCT02330627). Perceived social connectedness and PA/negative affect (NA) were assessed throughout treatment. Time-lagged multilevel mediation models examined the process of change in affect and connectedness throughout treatment.

        Results

        The AMP group displayed significantly larger improvements in social connectedness from pre- to post-treatment compared to waitlist; improvements were maintained through 6-month follow-up. Within the AMP group, increases in PA and decreases in NA both uniquely predicted subsequent increases in connectedness throughout treatment. However, experiencing heightened NA throughout treatment attenuated the effect of changes in PA on connectedness. Improvements in connectedness predicted subsequent increases in PA, but not changes in NA.

        Conclusions

        These preliminary findings suggest that positive activity interventions may be valuable for enhancing social connectedness in individuals with clinically impairing anxiety or depression, possibly through both increasing positive emotions and decreasing negative emotions.
          Cover page: Enhancing Social Connectedness in Anxiety and Depression Through Amplification of Positivity: Preliminary Treatment Outcomes and Process of Change
          • Article
          • Peer Reviewed
          UC San Diego Previously Published Works (2021)
          Social impairments are common across many psychiatric conditions. Standardized dyadic assessments intended to elicit social affiliation between unacquainted partners are used to elucidate mechanisms that disrupt relationship formation and inform possible treatment targets; however, the psychometric properties of such paradigms remain poorly understood. This study evaluated the psychometric properties of a controlled social affiliation paradigm intended to induce connectedness between a target participant and trained confederate. Individuals with an anxiety or depressive disorder diagnosis (clinical group; n = 132) and those without (control group; n = 35) interacted face-to-face with a trained confederate; partners took turns answering a series of increasingly intimate questions about themselves. Social connectedness, affect, and affiliative behavior measures were collected during the interaction. Participant symptom and social functioning measures were collected to examine validity. The paradigm elicited escalating social connectedness throughout the task for both participants and confederates. Parallel forms (i.e., different question sets) elicited similar affiliation outcomes. Self-reported (but not behavioral) affiliation differed across some demographic variables (e.g., participant gender, Hispanic ethnicity). Within-task affiliation measures were associated with one another and with global social connectedness and social anxiety symptom measures, but not with somatic anxiety measures. Clinical participants reported lower social affiliation and positive affect reactivity and higher negative affect reactivity than healthy participants. These findings provide initial psychometric support for a standardized and controlled dyadic affiliation paradigm that could be used to reliably probe social disconnection mechanisms across psychopathology.
            Cover page: Psychometric Evaluation of a Controlled Social Affiliation Paradigm: Findings From Anxiety, Depressive Disorder, and Healthy Samples
            • Article
            • Peer Reviewed
            UC San Francisco Previously Published Works (2022)

            Background

            Guidelines recommend screening for primary aldosteronism in patients diagnosed with hypertension and obstructive sleep apnea. Recent studies have shown that adherence to these recommendations is extremely low. It has been suggested that cost is a barrier to implementation. No analysis has been done to rigorously evaluate the cost-effectiveness of widespread implementation of these guidelines.

            Methods

            We constructed a decision-analytic model to evaluate screening of the hypertensive obstructive sleep apnea population for primary aldosteronism as per guideline recommendations in comparison with current rates of screening. Probabilities, utility values, and costs were identified in the literature. Threshold and sensitivity analyses assessed robustness of the model. Costs were represented in 2020 US dollars and health outcomes in quality-adjusted life-years. The model assumed a societal perspective with a lifetime time horizon.

            Results

            Screening per guideline recommendations had an expected cost of $47,016 and 35.27 quality-adjusted life-years. Continuing at current rates of screening had an expected cost of $48,350 and 34.86 quality-adjusted life-years. Screening was dominant, as it was both less costly and more effective. These results were robust to sensitivity analysis of disease prevalence, test sensitivity, patient age, and expected outcome of medical or surgical treatment of primary aldosteronism. The screening strategy remained cost-effective even if screening were conservatively presumed to identify only 3% of new primary aldosteronism cases.

            Conclusions

            For patients with hypertension and obstructive sleep apnea, rigorous screening for primary aldosteronism is cost-saving due to cardiovascular risk averted. Cost should not be a barrier to improving primary aldosteronism screening adherence.
              Cover page: Screening for primary aldosteronism in the hypertensive obstructive sleep apnea population is cost-saving
              • Article
              • Peer Reviewed
              UC San Francisco Previously Published Works (2022)

              Background

              Resistant hypertension is common in patients with primary aldosteronism and in those with obstructive sleep apnea. Primary aldosteronism treatment improves sleep apnea. Despite Endocrine Society guidelines' inclusion of sleep apnea and hypertension co-diagnosis as a primary aldosteronism screening indication, the state of screening implementation is unknown.

              Methods

              All hypertensive adult patients with obstructive sleep apnea (n = 4751) at one institution between 2012 and 2020 were compared with a control cohort without sleep apnea (n = 117,815). We compared the association of primary aldosteronism diagnoses, risk factors, and screening between both groups. Patients were considered to have screening if they had a primary aldosteronism diagnosis or serum aldosterone or plasma renin activity evaluation.

              Results

              Obstructive sleep apnea patients were predominantly men and had higher body mass index. On multivariable analysis, hypertensive sleep apnea patients had higher odds of drug-resistant hypertension (odds ratio [OR] 2.70; P < .001) and hypokalemia (OR 1.26; P < .001) independent of body mass index, sex, and number of antihypertensive medications. Overall, sleep apnea patients were more likely to be screened for primary aldosteronism (OR 1.45; P < .001); however, few patients underwent screening whether they had sleep apnea or not (pre-guideline publication 7.8% vs 4.6%; post-guidelines 3.6% vs 4.6%; P < .01). Screening among eligible sleep apnea patients remained low prior to and after guideline publication (4.4% vs 3.4%).

              Conclusions

              Obstructive sleep apnea is associated with primary aldosteronism risk factors without formal diagnosis, suggesting screening underutilization and underdiagnosis. Strategies are needed to increase screening adherence, as patients may benefit from treatment of concomitant primary aldosteronism to reduce sleep apnea severity and its associated cardiopulmonary morbidity.
                Cover page: Screening for Primary Aldosteronism is Underutilized in Patients with Obstructive Sleep Apnea
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