Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) often co-occur and share overlapping cognitive, emotional, and social characteristics, but the symptom-level processes underlying this comorbidity remain unclear. Using regularised partial correlation network analysis (EBIC-glasso), this study examined the structure, centrality, and connectivity of DSM-5-TR ADHD and ASD symptoms in a clinic-referred sample of 942 adolescents (aged 11–17), based on parent ratings. The network showed clear separation between ADHD and ASD symptom clusters, with stronger internal connections among ADHD symptoms and weaker cross-condition associations. Hyperactive–impulsive symptoms demonstrated the highest centrality overall. The most central symptoms were “Has a strange way of relating to other people” (ASD1), “Has trouble sitting still or staying in my seat” (ADHD11), and “Distracted even when someone is speaking to them” (ADHD3). The strongest bridge symptoms linking the ADHD and ASD symptom clusters were “Gets frustrated when I have to wait my turn to do things” (ADHD17), “Is unaware of, or takes no interest in, other people’s feelings” (ASD4), and “Gets fixated on things” (ASD12). Overall, results suggest that co-occurrence may be shaped by specific highly influential symptoms, particularly hyperactivity-impulsivity and select social-emotional or restrictive/repetitive features, highlighting the value of targeting central and bridging symptoms in assessment and intervention.
Emotional working memory is closely linked to the cognitive and affective processes implicated in social anxiety, suggesting that targeting emotional working memory may help alleviate social anxiety symptoms. The present randomized controlled trial examined the impact of emotional working memory training (eWMT) on Social Anxiety Disorder (SAD) symptoms, attentional bias to threat, and cognitive flexibility in individuals with high social anxiety. Following baseline assessment, 50 eligible participants were randomly assigned to either an eWMT group (n = 25) or a control training group (n = 25). Both groups completed 20 training sessions. Assessment occurred at pre-training, post-training, and a three-month follow-up. Post-test and three-month follow-up results revealed significant improvements in SAD symptoms, social interaction anxiety, and cognitive flexibility following eWMT. Although the analysis of interference scores indicated significant changes over time between groups, the three-way interaction of Time × Word Type × Group in the additional mixed-design analysis did not reach statistical significance, suggesting that the evidence for a specific effect of eWMT on threat-related attentional bias was inconclusive. These findings highlight eWMT as a promising cognitive-affective intervention for improving social anxiety symptoms and cognitive flexibility in students with high social anxiety.
Facilitating opportunities for patients to express choice within psychological treatment has been encouraged as a means of improving adherence to cognitive behavioral therapy. However, the comparative benefits of choice to a lack thereof in the various decision points likely to be encountered withing cognitive behavioral therapy has received little empirical evaluation and has yet to be evaluated in the context in cognitive behavioral therapy skills. In this study, we set out to empirically evaluate the impact of choice on participants’ attitudes towards cognitive behavioral therapy skills, randomizing 400 participants to choose or be randomly assigned to implement cognitive or behavioral coping skills. Analyses evaluated change in participants’ views towards cognitive and behavioral skills after learning about and implementing one of these strategies. Results indicated an interaction between choice and skill in predicting skill attitudes. Participants developed a more favorable view of the practiced skill in all conditions. Attitude change was largest among those who had the opportunity to choose a skill, particularly in the cognitive condition. Among those randomized to a skill, attitude change was lower overall, but still greater in the cognitive than behavioral condition. We did not find that depression symptoms moderated condition effects. Our results suggest that skill use is viewed most favorably when one is offered the opportunity to select a skill. However, when a skill is assigned without an opportunity to express choice, attitudes towards practiced strategies still can be expected to improve.
Socially anxious individuals perceive the average emotion of facial crowds as more negative than it actually is (negative ensemble perception bias). A previous single-session feedback training reduced this bias but did not change state social anxiety. This study examined whether multisession feedback training, evaluated with a follow-up assessment, reduces both ensemble bias and social anxiety. In a parallel-group randomized controlled trial, 99 undergraduates with high social anxiety completed four sessions of an ensemble perception task with feedback (training; n = 49) or without feedback (control; n = 50). Ensemble bias and social anxiety were assessed at baseline, posttest, and one-week follow-up and analyzed with linear mixed-effects models. A mediation model tested whether posttest bias mediated follow-up symptom change. Group differences in change were not significant at posttest. However, from baseline to follow-up, the training group showed greater reductions than the control group in both ensemble bias (d = 0.38) and social anxiety (d = −0.28). Posttest bias did not mediate the effect on follow-up social anxiety, whereas the direct effect was significant. Multisession feedback training reduced ensemble bias and social anxiety, with group differences evident only at follow-up. The direct effect suggests that mechanisms beyond ensemble bias, such as self-efficacy or changes in interpretation, may contribute. Follow-up assessments are important when evaluating such training.
The therapeutic alliance plays a key role in enabling symptom improvement in CBT for psychosis. However, so far it remains unclear which therapist characteristics are particularly relevant for building alliance in CBT for psychosis compared to CBT for other diagnoses. Participants with psychotic disorders (PSY, n = 102) and other mental disorders (CG, n = 64) received disorder specific variants of CBT. We used structural equation models (SEM) with multiple-group comparisons to assess differences between PSY and CG in associations between patients’ perceptions of therapists’ empathy, genuineness, positive regard, competence, and convincingness at baseline and the therapeutic alliance after 5 therapy sessions. In SEM-based mediation analyses, we tested whether latent symptom change was predicted by perceived therapist characteristics via the therapeutic alliance and whether these associations differed between PSY and CG. Multiple-group SEM revealed partial invariance across diagnostic groups, with perceived genuineness showing a stronger association with therapeutic alliance in PSY than in CG. Perceived positive regard was positively associated with the therapeutic alliance across groups. There were no direct, indirect, or total effects of perceived therapist characteristics via the therapeutic alliance on symptom change. Perceived therapist genuineness seems to be particularly important for a strong alliance in CBT for psychosis and could therefore be addressed in CBT training and supervision.
