Stepped care approaches can improve access to posttraumatic stress disorder (PTSD) treatments by matching clients to an intervention level that suits their needs. This randomized controlled non-inferiority trial evaluated the efficacy of an online stepped care approach for PTSD. The approach had two treatment steps: (1) This Way Up (TWU; an online self-guided therapy); and (2) cognitive processing therapy (CPT; standard format therapy), adopting pre-specified criteria for stepping up between treatment steps. Stepped care was evaluated compared to CPT delivered via telehealth among 84 adults with PTSD and subthreshold PTSD (86% female, 87% white, aged 18-79). Stepped care cost less than CPT in terms of clinician time (by 8-10%), but CPT had less dropout (26% versus 43%). Both groups demonstrated significant improvements in PTSD (CAPS-5: g = 1.19 to 2.09; PCL-5: g = 1.23 to 2.59), depression (DASS-21: g = 0.63 to 1.13), and quality of life (AQoL-8D: g = -0.46 to -1.02) over time (baseline, post-treatment, 3-month follow-up, 6-month follow-up), with no differential rates of change over time. Stepped care was non-inferior to CPT on the clinician-rated PTSD measure (at post-treatment) and for depression at all time points. Non-inferiority could not be established for the PCL-5 and quality of life measures, with outcomes favoring CPT. The stepped care approach was feasible, even among participants with high symptom severity and complexities. However, future research is needed to address attrition and improve outcomes compared to CPT, and to identify which clients would benefit from initially receiving low-intensity therapies.

The Responses to Positive Affect (RPA) scale is a widely used 17-item self-report measure that assesses positive rumination and dampening, or the tendency to upregulate or downregulate PA, respectively. The RPA includes one dampening subscale and two positive rumination subscales: self- and emotion-focused. Past work has highlighted the theoretical overlap between the two positive rumination subscales, suggesting that they be combined into one overall amplifying subscale. However, there are mixed applications of this in the literature; yet, no factor analyses have been conducted with multiple samples to examine the statistical difference between the 2- and 3-factor solution of the RPA. Thus, the current multi-site design pooled nine datasets in the United States and United Kingdom, with both clinical and non-clinical samples, to statistically evaluate the 2- and 3-factor solutions across all samples (N = 1995) and examine their association with psychiatric symptoms and affect using meta-analytic techniques. The current findings indicate that the 3-factor solution (CFI = 0.929, TLI = 0.918, RMSEA = 0.068, SRMR = 0.045) outperformed the 2-factor solution (Δχ[2](2) = 140.46, RMSEA = 0.187, p < .001) in the 16-item RPA. Further, our meta-analytic findings indicate important nuances between the two positive rumination subscales, with each one demonstrating unique associations with psychiatric symptoms and affect that are otherwise not found when combined into a single amplifying subscale. Taken together, our findings provide support for the 3-factor solution across all samples, and future work should further aim to disentangle the two positive rumination subscales from one another given their unique associations with depression, anxiety, anhedonia and affect and affect.

Understanding resilience in tertiary students is important, as this developmental period is characterised by elevated stressor exposure and vulnerability to mental health difficulties. Although emotion beliefs and emotional reactivity are each linked to mental health, little is known about their role in resilient functioning following adversity. This study used a three-wave longitudinal design in undergraduate university students (N = 112) to examine whether maladaptive emotion beliefs predict resilient functioning and whether these associations operate through positive and negative emotional reactivity. Emotion beliefs were assessed at baseline (T1), while emotional reactivity, stressor exposure, and mental health were assessed at two follow-up timepoints (T2 and T3). Resilient functioning was indexed relative to stressor exposure, with higher scores indicating better-than-expected emotional functioning. Results showed that positive emotional reactivity was positively associated with resilient functioning, whereas negative emotional reactivity was negatively associated with resilient functioning. Stronger beliefs that emotions are uncontrollable were associated with poorer resilient functioning overall, with some evidence of an indirect pathway through greater negative emotional reactivity. No corresponding associations were observed for beliefs about the usefulness of emotions. However, associations involving emotion beliefs were no longer significant after accounting for baseline mental health. The pattern of structural relationships did not differ significantly across follow-up assessments. These findings highlight emotional reactivity as an important correlate of resilient functioning and provide preliminary evidence that beliefs about emotion controllability may also be relevant, although their unique contribution beyond pre-existing mental health requires further investigation.

Intrusive memories, a hallmark of trauma-related psychopathology, have been conceptualised as conditioned responses (CRs) to trauma-related cues. Yet, some real-world and laboratory findings challenge whether such memories are indeed a result of a neutral conditioned stimulus (CS) signaling a distressing outcome (unconditioned stimulus). Understanding which associative learning processes contribute to intrusive memories would help optimise treatments. The present study critically tested the conditioning account of intrusive memories by examining their cue-specificity. Undergraduates (N = 91) completed a within-subject conditioned-film paradigm using neutral odours as CSs (CS1+, CS2+, CS-) paired with three film types depicting accidents/injury, violence/threat, or neutral scenes. Participants recorded intrusive memories in daily life for eight days. To elicit cue-specific intrusions, participants sprayed an odour (CS2+) on their clothes either upon leaving the lab (Day 0, n = 45) or three days later at home (Day 3, n = 46). On Day 7, participants completed a task in the lab assessing intrusive memories cued by the CS odours. Although exposure to the odour cue on Day 3 produced more intrusive memories than a control odour, these were not selective for the associated film type. In the lab, partial cue-specificity emerged: one conditioned odour (CS1+) elicited mostly cue-specific intrusions, whereas the other (CS2+) evoked intrusions from both distressing film types. Explicit memory for the contingencies enhanced cue specificity in the lab, but not in daily life. These findings call into question the conceptualisation of intrusive memories as CRs, suggesting that associative learning contributes to intrusive memories, but that cue-specificity may be context dependent.

Appearance-related social comparisons (ARSCs) have been identified as a maladaptive process related to appearance concerns and symptoms of body dysmorphic disorder (BDD), social anxiety disorder (SAD), and eating disorders (EDs). The aim of the present study was to test the effects of fading (i.e., systematically reducing or eliminating) these behaviors using a non-treatment experimental design in which the study's purpose was concealed from participants. Women with elevated (i.e., upper quartile) appearance concerns (N = 100) were randomized to either a one-month text message-based ARSC fading condition (n = 50) or a ARSC self-monitoring control condition (n = 50). We found that relative to control, ARSC fading led to lower appearance concerns, appearance importance, BDD symptoms, ED symptoms, and trait anxiety. Further, changes in ARSCs mediated the effect of condition on appearance concerns, BDD symptoms, and ED symptoms. Compared to control, the ARSC fading group also demonstrated less reactivity to one of two in vivo appearance-related stressor tasks. We also explore the incremental role ARSCs contribute to outcomes over related behaviors (e.g., checking, avoidance, reassurance seeking). Importantly, few participants correctly guessed the purpose of the study, and their removal from analyses did not affect study findings. This study provides novel evidence for the importance of ARSCs in the maintenance of appearance-related psychopathology.

Interpretation biases and inflexibility in resolving ambiguous social situations are central to cognitive models of depression and anxiety, yet the mechanisms that shape these interpretation processes remain insufficiently understood. This preregistered experiment tested whether experimentally inducing dampening versus amplifying responses to positive emotion causally influences how people interpret and update ambiguous social information. Dutch adults (n = 268) completed a positive autobiographical memory induction and were randomly assigned to a dampening, amplifying, or control condition. Participants then completed an emotional Bias Against Disconfirmatory Evidence (BADE) task indexing negative interpretation inflexibility, negative interpretation bias, and positive interpretation bias. Dampening increased negative interpretation inflexibility relative to both amplifying and control conditions. Dampening also increased negative interpretation bias relative to the amplifying condition, but no reliable condition differences emerged for positive interpretation bias. These findings suggest that dampening may operate as a proximal cognitive-affective mechanism that reduces the uptake of positive belief-disconfirming evidence, thereby maintaining rigid negative social interpretations. Targeting dampening responses to positive emotion may strengthen belief updating and cognitive flexibility in interventions for depression and anxiety.

Cognitive behavioural therapy for insomnia (CBT-I) is the gold-standard insomnia treatment, which also produces medium-to-large antidepressant effects at a group level. However, not everyone benefits equally and CBT-I related factors associated with varying depression outcomes are not well understood, limiting the capacity for treatment optimisation and uptake of CBT-I in routine care. This study examined whether trajectories of change in daytime and bedtime general repetitive negative thinking (RNT), daytime and bedtime sleep-related RNT, and low activity levels (improved behavioural activation) were related to the degree to which depressive symptoms improve among individuals receiving CBT-I. Eighty-eight adults (72% females) participated. Data collected at baseline, post-intervention, and 12-week follow-up were analysed using latent growth curve modelling. Participants exhibited clinically significant reductions in depressive symptoms and improvements in both general and sleep-related RNT during daytime and bedtime, along with a boost in activity levels. Moreover, improvement rates in daytime sleep-related RNT and bedtime general RNT were strongly associated with the degree to which depressive symptoms improved, while improvement rates in activity levels were moderately associated with the rate at which depressive symptoms improved. Current preliminary findings suggest that improvements in RNT that is related to insomnia, either conceptually (daytime sleep-related RNT) or temporally, (bedtime general RNT), and improvements in activity levels may be associated with the extent to which depression outcomes improve following CBT-I. This highlights the need for further investigation of these factors as potential mechanisms of change influencing depressive symptoms, using causal experimental designs.

Adaptive functioning relies on the ability to update beliefs in response to new information. However, belief updating is often optimistically biased, with individuals more readily revising their beliefs in response to desirable (good news) than to undesirable (bad news) information. Deficiencies in positive updating have been linked to psychological distress. However, the temporal association between positive belief updating and psychological distress remains unclear. Given that trauma exposure strongly challenges prior beliefs and places heightened demands on belief updating, the present study aims to examine whether baseline belief updating abilities prospectively predict the tendency to develop depressive and posttraumatic stress symptoms 3 months following trauma exposure. In a community sample of Israeli adults (N = 117), belief updating was assessed at T0 (six months prior to the October 7th attacks) using a validated belief updating task. Depressive and posttraumatic stress symptoms were assessed at T0 and at T1 (three months following the October 7th attacks), along with cumulative trauma exposure. Reduced positive updating was associated with higher posttraumatic stress at T1, even when controlling for trauma exposure and baseline (T0) symptoms. Findings suggest that erosion in optimistic bias can prospectively predict psychological distress following trauma exposure. Belief updating may represent a cognitive process relevant to vulnerability and resilience following trauma and stress.

Daily decision-making involves navigating the explore-exploit dilemma (EED), balancing novel information gathering against maintaining current strategies. Individuals with chronic pain often exhibit exploitation responses, choosing pain avoidance over exploring potentially beneficial activities. This study investigated decision-making during the EED in individuals with chronic pain and pain-free individuals, examining whether self-initiated exploration predicts improved outcomes when environmental contingencies change. Participants completed a multi-armed bandit task where contingency changes occurred exclusively for unchosen options, requiring active exploration for discovery. We assessed behavioral performance, computational modeling parameters, and individual difference variables including fear of pain, intolerance of uncertainty, and behavioral activation/inhibition. Initial high exploration rates predicted superior task performance across all groups, despite few participants discovering the contingency change. Contrary to our original hypotheses, no consistent differences emerged between the pain-free and pain groups. However, differences between the pain groups suggested that greater pain severity may be associated with less stable and less exploitative decision-making. These findings highlight the importance of an adaptive balance between exploration and exploitation for discovering environmental changes and achieving optimal long-term outcomes, supporting its role in avoidance extinction relevant to chronic pain treatment.