bluuebunny/crossref_metadata_2025 huggingface dataset:
Obesity and effects of dapagliflozin on cardiovascular and renal outcomes in patients with type 2 diabetes mellitus in the DECLARE–TIMI 58 trial
Authors: Oyama Kazuma , Raz Itamar , Cahn Avivit , Kuder Julia , Murphy Sabina A , Bhatt Deepak L , Leiter Lawrence A , McGuire Darren K , Wilding John P H , Park Kyong Soo , Goudev Assen , Diaz Rafael , Špinar Jindřich , Gause-Nilsson Ingrid A M , Mosenzon Ofri , Sabatine Marc S , Wiviott Stephen D
Published: August 2021

Aims 

We investigated the associations between obesity, cardiorenal events, and benefits of dapagliflozin in patients with type 2 diabetes mellitus (T2DM).

Methods and results 

DECLARE–TIMI 58 randomized patients with T2DM and either atherosclerotic cardiovascular (CV) disease or multiple risk factors to dapagliflozin vs. placebo. Patients were stratified by body mass index (BMI, kg/m2): normal (18.5 to <25), overweight (25 to <30), moderately obese (30 to <35), severely obese (35 to <40), and very-severely obese (≥40). Outcomes analysed were CV death, hospitalization for heart failure (HHF), renal-specific composite outcome, and atrial fibrillation or flutter (AF/AFL). Of 17 134 patients, 9.0% had a normal BMI, 31.5% were overweight, 32.4% were moderately, 17.2% severely, and 9.8% were very-severely obese. Higher BMI was associated with a higher adjusted risk of HHF and AF/AFL (hazard ratio 1.30 and 1.28, respectively, per 5 kg/m2; P < 0.001 for all). Dapagliflozin reduced body weight by similar relative amounts consistently across BMI categories (percent difference: −1.9 to −2.4%). Although relative risk reductions in CV and renal-specific composite outcomes with dapagliflozin did not significantly differ across the range of BMI (P for interaction ≥0.20 for all outcomes), obese patients (BMI ≥ 30 kg/m2) tended to derive greater absolute risk reduction in HHF and AF/AFL (P for interaction 0.02 and 0.09, respectively) than non-obese patients.

Conclusions 

In DECLARE–TIMI 58, patients with T2DM and higher BMI were more likely to have HHF and AF/AFL. Whereas relative risk reductions in CV and renal outcomes with dapagliflozin were generally consistent across the range of BMI, absolute risk reduction in obesity-related outcomes including HHF and AF/AFL tended to be larger in obese patients with T2DM.

Clinical trial registration

URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01730534.
Larval excretion/secretion of dipters of Lucilia cuprina species induces death in promastigote and amastigote forms of Leishmania amazonensis
Authors: Rodrigues Ana Carolina Jacob , Bortoleti Bruna Taciane da Silva , Carloto Amanda Cristina Machado , Silva Taylon Felipe , Concato Virgínia Márcia , Gonçalves Manoela Daiele , Tomiotto-Pelissier Fernanda , Detoni Mariana Barbosa , Diaz-Roa Andrea , Júnior Pedro Ismael da Silva , Costa Idessania Nazareth , Conchon-Costa Ivete , Bidoia Danielle Lazarin , Miranda-Sapla Milena Menegazzo , Pavanelli Wander Rogério
Published: August 2021

Leishmaniasis is a neglected tropical disease that affects millions of people around the world. Larval excretion/secretion (ES) of the larvae of flies of the Calliphoridae family has microbicidal activity against Gram-positive and Gram-negative bacteria, in addition to some species of Leishmania. Our study aimed at assessing the in vitro efficacy of Lucilia cuprina larval ES against the promastigote and amastigote forms of Leishmania amazonensis, elucidating possible microbicidal mechanisms and routes of death involved. Larval ES was able to inhibit the viability of L. amazonensis at all concentrations, induce morphological and ultrastructural changes in the parasite, retraction of the cell body, roughness of the cytoplasmic membrane, leakage of intracellular content, ROS production increase, induction of membrane depolarization and mitochondrial swelling, the formation of cytoplasmic lipid droplets and phosphatidylserine exposure, thus indicating the possibility of apoptosis-like death. To verify the efficacy of larval ES on amastigote forms, we performed a phagocytic assay, measurement of total ROS and NO. Treatment using larval ES reduced the percentage of infection and the number of amastigotes per macrophage of lineage J774A.1 at all concentrations, increasing the production of ROS and TNF-α, thus indicating possible pro-inflammatory immunomodulation and oxidative damage. Therefore, treatment using larval ES is effective at inducing the death of promastigotes and amastigotes of L. amazonensis even at low concentrations.
Ancestral Physical Stress and Later Immune Gene Family Expansions Shaped Bivalve Mollusc Evolution
Authors: Regan Tim , Stevens Lewis , Peñaloza Carolina , Houston Ross D , Robledo Diego , Bean Tim P
Published: August 2021

Bivalve molluscs comprise 20,000 species occupying a wide diversity of marine habitats. As filter feeders and detritivores they act as ecosystem engineers clarifying water, creating reefs, and protecting coastlines. The global decline of natural oyster reefs has led to increased restoration efforts in recent years. Bivalves also play an important role in global food security contributing to >20% of worldwide aquaculture production. Despite this importance, relatively little is known about bivalve evolutionary adaptation strategies. Difficulties previously associated with highly heterozygous and repetitive regions of bivalve genomes have been overcome by long-read sequencing, enabling the generation of accurate bivalve assemblies. With these resources we have analyzed the genomes of 32 species representing each molluscan class, including 15 bivalve species, to identify gene families that have undergone expansion during bivalve evolution. Gene family expansions across bivalve genomes occur at the point of evolutionary pressures. We uncovered two key factors that shape bivalve evolutionary history: expansion of bivalvia into environmental niches with high stress followed by later exposure to specific pathogenic pressures. The conserved expansion of protein recycling gene families we found across bivalvia is mirrored by adaptations to a sedentary lifestyle seen in plants. These results reflect the ability of bivalves to tolerate high levels of environmental stress and constant exposure to pathogens as filter feeders. The increasing availability of accurate genome assemblies will provide greater resolution to these analyses allowing further points of evolutionary pressure to become clear in other understudied taxa and potentially different populations of a single species.
Validation of a Deficit-Accumulation Frailty Index in the ASPirin in Reducing Events in the Elderly Study and Its Predictive Capacity for Disability-Free Survival
Authors: Ryan Joanne , Espinoza Sara , Ernst Michael E , Ekram A R M Saifuddin , Wolfe Rory , Murray Anne M , Shah Raj C , Orchard Suzanne G , Fitzgerald Sharyn , Beilin Lawrence J , Ward Stephanie A , Williamson Jeff D , Newman Anne B , McNeil John J , Woods Robyn L
Published: August 2021

Frailty is a state of heightened vulnerability and susceptibility to physiologic stressors that increases with age. It has shown increasing utility in predicting a range of adverse health outcomes. Here, we characterize a 67-item deficit-accumulation frailty index (FI) in 19 110 community-dwelling individuals in the ASPirin in Reducing Events in the Elderly clinical trial. Participants aged 65–98 years were recruited from the United States and Australia and were without diagnosed dementia and cardiovascular disease, and major physical disability. The median FI score was .10 (interquartile range: .07–.14) at baseline, and the prevalence of frailty (FI > .21) increased from 8.1% to 17.4% after 6 years. FI was positively associated with age, and women had significantly higher scores than men at all ages. The FI was negatively correlated with gait speed (r = −.31) and grip strength (r = −.46), and strongly associated with a modified Fried’s frailty phenotype (p < .0001, for all comparisons). Frailty was associated with the primary composite outcome capturing independent life lived free of major disability and dementia, and increased the rate of persistent physical disability (hazard ratio: 21.3, 95% confidence interval: 15.6–28.9). It added significantly to the predictive capacity of these outcomes above age, sex, and ethnicity alone. The FI is thus a useful biomarker of aging even among relatively healthy older individuals and provides important information about an individual’s vulnerability to and risk of disease.
Remembrance and Erasure in the Post-Holocaust United States
Authors: Topp Michael
Published: July 2021

Lee Topp, the author’s father, abandoned his faith just after World War II and hid his Jewishness from his children. Lee’s mother’s first cousin Philip Friedman became one of the United States’s first Holocaust scholars after evading the Nazis during the war. This essay juxtaposes Friedman’s ardent efforts to document the Jewish catastrophe with Topp’s attempts to erase his Jewishness. The author explains how his own life and academic career were shaped by his father’s decisions, and thus as well by the long reach of the Holocaust.
CONSENSUS: a Shiny application of dementia evaluation and reporting for the KU ADC longitudinal Clinical Cohort database
Authors: Sharma Palash , Montgomery Robert N , Graves Rasinio S , Meyer Kayla , Hunt Suzanne L , Vidoni Eric D , Mahnken Jonathan D , Swerdlow Russell H , Burns Jeffrey M , Mudaranthakam Dinesh Pal
Published: August 2021

Background

The University of Kansas Alzheimer’s Disease Center (KU ADC) maintains several large databases to track participant recruitment, enrollment, and capture various research-related activities. It is challenging to manage and coordinate all the research-related activities. One of the crucial activities involves generating a consensus diagnosis and communicating with participants and their primary care providers.

Process

To effectively manage the cohort, the KU ADC utilizes a combination of open-source electronic data capture (EDC) (i.e. REDCap), along with other homegrown data management and analytic systems developed using R-studio and Shiny.

Process evaluation

In this article, we describe the method and utility of the user-friendly dashboard that was developed for the rapid reporting of dementia evaluations which allows clinical researchers to summarize recruitment metrics, automatically generate letters to both participants and healthcare providers, which ultimately help optimize workflows.

Conclusions

We believe this general framework would be beneficial to any institution that build reports and summarizing key metrics of their research from longitudinal databases.
Characterization of β-adrenergic receptors in bovine intramuscular and subcutaneous adipose tissue: comparison of lubabegron fumarate with β-adrenergic receptor agonists and antagonists
Authors: Hwang Jinhee H , Spurlock Michael E , Kube John C , Li Xiang Z , Smith Stephen B
Published: August 2021

Chinese hamster ovary cell constructs expressing either the β 1-, β 2- or β 3-adrenergic receptor (AR) were used to determine whether a novel β-AR modulator, lubabegron fumarate (LUB; Experior, Elanco Animal Health) might exert greater potency for a specific β-AR subtype. EC50 values calculated based on cAMP accumulation in dose response curves indicate that LUB is highly selective for the β 3-AR subtype, with an EC50 of 6 × 10–9 M, with no detectible agonistic activity at the β 2-AR. We hypothesized that the accumulation of lipolytic markers would reflect the agonist activity at each of the β-receptor subtypes of the specific ligand; additionally, there would be differences in receptor subtype expression in subcutaneous (s.c.) and intrmuscular (i.m.) adipose tissues. Total RNA was extracted from adipose tissue samples and relative mRNA levels for β 1-, β2-, and β 3-AR were measured using real-time quantitative polymerase chain reaction. Fresh s.c. and i.m. adipose tissue explants were incubated with isoproterenol hydrochloride (ISO; β-AR pan-agonist), dobutamine hydrochloride (DOB; specific β 1-AA), salbutamol sulfate (SAL; specific β 2-AA), ractopamine hydrochloride (RAC), zilpaterol hydrochloride (ZIL), BRL-37344 (specific β 3-agonist), or LUB for 30 min following preincubation with theophylline (inhibitor of phosphodiesterase). Relative mRNA amounts for β 1-, β 2-, and β 3-AR were greater (P < 0.05) in s.c. than in i.m. adipose tissue. The most abundant β-AR mRNA in both adipose tissues was the β 2-AR (P < 0.05), with the β 1- and β 3-AR subtypes being minimally expressed in i.m. adipose tissue. ISO, RH, and ZH stimulated the release of glycerol and nonesterified fatty acid (NEFA) from s.c. adipose tissue, but these β-AR ligands did not alter concentrations of these lipolytic markers in i.m. adipose tissue. LUB did not affect glycerol or NEFA concentrations in s.c. or i.m. adipose tissue, but attenuated (P < 0.05) the accumulation of cAMP mediated by the β 1- and β 2-AR ligands DOB and SAL in s.c. adipose tissue. Collectively, these data indicate that bovine i.m. adipose tissue is less responsive than s.c. adipose tissue to β-adrenergic ligands, especially those that are agonists at the β 1- and β3-receptor subtypes. The minimal mRNA expression of the β 1- and β 3 subtypes in i.m. adipose tissue likely limits the response potential to agonists for these β-AR subtypes.
Detection of ADB-BUTINACA Metabolites in Human Urine, Blood, Kidney and Liver
Authors: Kavanagh Pierce , Pechnikov Alexandr , Nikolaev Ivan , Dowling Geraldine , Kolosova Mariia , Grigoryev Andrej
Published: August 2021

The N-butyl indazole derivative, N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1-butyl-1H-indazole-3-carboxamide (ADB-BUTINACA or ADB-BINACA), currently a drug of abuse in Russia, is reported to have a cannabinoid receptor potency and efficacy almost three times higher than JWH-018. ADB-BUTINACA was detected in blood from patients with suspected drug intoxications, as well as in blood, kidney and liver samples collected during postmortem investigations. Using liquid chromatography–time-of-flight–mass spectrometry, a number of ADB-BUTINACA metabolites were tentatively identified in urine samples. These include products of mono- and dihydroxylation, hydroxylation of the N-butyl side chain and dehydrogenation, formation of a dihydrodiol, hydrolysis of the terminal amide group, N-dealkylation of the indazole and a combination of these reactions. The dihydrodiol was found to be the predominant metabolite, with its chromatographic peak area exceeding those of other metabolites by almost an order of magnitude. For the routine analysis of blood, liver and kidney samples, the dihydrodiol and monohydroxylated metabolites along with the parent compound are recommended as target analytes. The same metabolites in free and glucuronidated forms are also recommended for analytical confirmation in urine samples.
Global patterns of species richness of the holarctic alpine herbSaxifraga: the role of temperature and habitat heterogeneity
Authors: Liu Lian , Xu Xiaoting , Zhang Lei , Li Yaoqi , Shrestha Nawal , Neves Danilo M , Wang Qinggang , Chang Hong , Su Xiangyan , Liu Yunpeng , Wu Jianyong , Dimitrov Dimitar , Wang Zhiheng , Liu Jianquan
Published: August 2021

The effects of contemporary climate, habitat heterogeneity and long-term climate change on species richness are well studied for woody plants in forest ecosystems, but poorly understood for herbaceous plants, especially in alpine–arctic ecosystems. Here, we aim to test if the previously proposed hypothesis based on the richness–environment relationship could explain the variation in richness patterns of the typical alpine–arctic herbaceous genus Saxifraga.

Using a newly compiled distribution database of 437 Saxifraga species, we estimated the species richness patterns for all species, narrow- and wide-ranged species. We used generalized linear models and simultaneous autoregressive models to evaluate the effects of contemporary climate, habitat heterogeneity and historical climate on species richness patterns. Partial regressions were used to determine the independent and shared effects of different variables. Four widely used models were tested to identify their predictive power in explaining patterns of species richness.

We found that temperature was negatively correlated with the richness patterns of all and wide-ranged species, and that was the most important environmental factor, indicating a strong conservatism of its ancestral temperate niche. Habitat heterogeneity and long-term climate change were the best predictors of the spatial variation of narrow-ranged species richness. Overall, the combined model containing five predictors can explain ca. 40%–50% of the variation in species richness. We further argued that additional evolutionary and biogeographical processes might have also played an essential role in shaping the Saxifraga diversity patterns and should be considered in future studies.
A Risk Prediction Model to Identify Newborns at Risk for Missing Early Childhood Vaccinations
Authors: Oster Natalia V , Williams Emily C , Unger Joseph M , Newcomb Polly A , deHart M Patricia , Englund Janet A , Hofstetter Annika M
Published: August 2021

Background

Approximately 30% of US children aged 24 months have not received all recommended vaccines. This study aimed to develop a prediction model to identify newborns at high risk for missing early childhood vaccines.

Methods

A retrospective cohort included 9080 infants born weighing ≥2000 g at an academic medical center between 2008 and 2013. Electronic medical record data were linked to vaccine data from the Washington State Immunization Information System. Risk models were constructed using derivation and validation samples. K-fold cross-validation identified risk factors for model inclusion based on alpha = 0.01. For each patient in the derivation set, the total number of weighted adverse risk factors was calculated and used to establish groups at low, medium, or high risk for undervaccination. Logistic regression evaluated the likelihood of not completing the 7-vaccine series by age 19 months. The final model was tested using the validation sample.

Results

Overall, 53.6% failed to complete the 7-vaccine series by 19 months. Six risk factors were identified: race/ethnicity, maternal language, insurance status, birth hospitalization length of stay, medical service, and hepatitis B vaccine receipt. Likelihood of non-completion was greater in the high (77.1%; adjusted odds ratio [AOR] 5.6; 99% confidence interval [CI]: 4.2, 7.4) and medium (52.7%; AOR 1.9; 99% CI: 1.6, 2.2) vs low (38.7%) risk groups in the derivation sample. Similar results were observed in the validation sample.

Conclusions

Our prediction model using information readily available in birth hospitalization records consistently identified newborns at high risk for undervaccination. Early identification of high-risk families could be useful for initiating timely, tailored vaccine interventions.
Introduction
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Berman Rebecca , Kaloudis Angela , Espel-Huynh Hallie , Franklin Dee Ross , Boswell James F.
Published: August 2021

The Renfrew Unified Treatment for Eating Disorders and Co-occurring Emotional Disorders (UT) is an integrative, transdiagnostic, principle-based approach to address patterns of emotion avoidance, emotion sensitivity, and negative affect that produce and maintain the symptoms of eating disorders and co-occurring emotional disorders. The UT model was developed through an extensive process of adapting the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) for use with patients with severe and diverse eating disorders. The modules of the UT are distinct from other approaches due to their cohesive (internal and collective) focus on how each module addresses these shared maintaining mechanisms. There is extensive evidence that eating disorders typically co-occur with other emotional disorders. There is also extensive evidence that eating disorders and other emotional disorders share common maintaining mechanisms, reflecting aspects of emotional functioning.
How to Use This Manual
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Berman Rebecca , Kaloudis Angela , Espel-Huynh Hallie , Franklin Dee Ross , Boswell James F.
Published: August 2021

The authors have designed this manual to be utilized in many settings and modalities, by therapists from various disciplines, and at any frequency of session scheduling to facilitate use by the broadest range of therapists and clients. Research on implementation suggests that evidence-based interventions need to be adapted to the particular needs of a clinical population and setting to be maximally effective. Clinicians may share the impact that a part of a session has had on them or otherwise disclose their experience in the here and now. In the face of troubled emotions and the impulse to avoid, clients may employ “strategies of disconnection,” which may involve withdrawal, anger, or displays of emotional dysregulation. This treatment focuses on emotions and experiences that are by definition difficult for clients to tolerate, and clinicians may also have strong reactions to this process.
Therapist Materials for Preparing for Treatment
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Berman Rebecca , Kaloudis Angela , Espel-Huynh Hallie , Franklin Dee Ross , Boswell James F.
Published: August 2021

This chapter aligns with Chapters 1 to 3 in the client workbook. Chapter 1 covers the types of problems this program was designed to address; helps clients determine whether their difficulties fit with this program; and helps clients gain a basic understanding of how the therapy was tested in research. Chapter 2 provides an overview of skills that clients will learn in this treatment; highlights the importance of practicing these skills; describes how this treatment can be used in combination with other treatments like medication, nutrition counseling, and other forms of therapy; and helps determine if now is the right time for a client to begin this program. Chapter 3 teaches the importance of recordkeeping and introduces Form 3.1: Eating, Depression, and Anxiety (EDA), a form to be completed throughout the treatment program.
Therapist Materials for Motivation and Regular Eating
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Berman Rebecca , Kaloudis Angela , Espel-Huynh Hallie , Franklin Dee Ross , Boswell James F.
Published: August 2021

The session covered in Chapter 4 discusses the importance of motivation because motivation and treatment engagement are the most important predictors of outcome. Clients often judge themselves for not having enough motivation. In some ways they feel like they should want treatment, or that they should want to get rid of their eating disorder, or that they ought to be more committed to the process. Motivation fluctuates, and this is normal. The concept of decisional balance is presented to determine the costs and benefits of changing and the costs and benefits of remaining the same. Clients begin to set specific goals (and manageable steps to reach these goals) that they hope to achieve during treatment. This chapter introduces Form 4.1: Regular Eating Food Log, which will be used throughout the treatment program.
Therapist Materials for Regular Eating
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Berman Rebecca , Kaloudis Angela , Espel-Huynh Hallie , Franklin Dee Ross , Boswell James F.
Published: August 2021

Chapter 5 is a supplementary session designed for clients who are not receiving frequent, adjunctive treatment focused directly on eating regularly (such as meetings with a dietitian/nutrition counselor, residential treatment, or daily food coaching). Some clients may not require extensive attention to regular eating because they eat regularly already and have other issues. It is important to log eating and to monitor and discuss connections between eating, symptoms, and emotions. In addition to reviewing food logs, this chapter instructs clients on regular eating and helps clients to identify obstacles to regular eating and to develop specific plans to address those obstacles. Clients also learn to identify strategies to delay automatic compulsive eating between regular eating episodes.
Therapist Materials for the Natural Function of Emotions
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Berman Rebecca , Kaloudis Angela , Espel-Huynh Hallie , Franklin Dee Ross , Boswell James F.
Published: August 2021

The session covered in this chapter looks at the natural, adaptive, helpful function of different emotions. Though emotions are not necessarily serving an adaptive or helpful function when someone has an emotional disorder, it is useful to understand that every emotion does have a useful purpose in nature. Knowing the function of the emotion can help clients understand why they are having certain emotions at certain times. Emotions such as fear, sadness, anxiety, anger, guilt, and disgust are discussed. In this session, clients also explore the function of internal physical sensations, with the aim of understanding that while sensations may be uncomfortable, they are not dangerous.
Therapist Materials for the Three Parts of Emotions (3-Component Model)
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Berman Rebecca , Kaloudis Angela , Espel-Huynh Hallie , Franklin Dee Ross , Boswell James F.
Published: August 2021

The session covered in this chapter looks at the three components of emotions, which are thoughts, physical sensations, and behaviors/urges. These components interact and unfold over time. With regard to thoughts, clients frequently know that they have thoughts, but they have difficulty putting the thoughts into specific words. With regard to physical sensations, clients are often least familiar with thinking about physical sensations as a part of emotion. With regard to behaviors, it is useful to think of urges as well as behaviors, and also to broaden thinking to a wide range of behaviors, including not doing certain things. It is particularly useful to identify the three components of emotion in different, recent situations where they experienced strong emotion or behavioral symptoms, such as binge eating, compensatory behavior, driven exercise, body checking, or skipping a meal.
Therapist Materials for Mindful Emotion Awareness
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Berman Rebecca , Kaloudis Angela , Espel-Huynh Hallie , Franklin Dee Ross , Boswell James F.
Published: August 2021

The session in this chapter covers the concepts involved in mindfulness, including awareness that is present-focused, rather than focused on the past or future, and awareness that is accepting of emotion, rather than being judgmental. In addition, awareness of two types of emotion, primary and secondary, is discussed. People put a lot of pressure on themselves to do mindfulness correctly, and many experience a lot of judgmental thoughts about how well they are executing the tasks. The primary and secondary emotion concept is tricky to grasp. The authors recommend that the therapist take extra time to review many salient examples because clients who really understand this concept tend to do better with flexible thinking and behavioral change in this model.
Therapist Materials for Mood Induction
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Berman Rebecca , Kaloudis Angela , Espel-Huynh Hallie , Franklin Dee Ross , Boswell James F.
Published: August 2021

The session in this chapter takes a deeper look at the principles of the natural course of emotions. There are three components of emotion (thoughts, physical sensations, behaviors/urges) that unfold over time. If we escape or avoid, we never learn that emotions pass on their own, and we end up reinforcing that emotions are scary and dangerous. Secondary emotions often lead to escaping or avoiding. If we stay with the primary emotion and do not react by escaping or avoiding, we can learn new things about the emotion, and it can pass on its own. The session continues by teaching how mood induction is intended to help promote new tolerance of emotion.
Therapist Materials for Core Beliefs
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Berman Rebecca , Kaloudis Angela , Espel-Huynh Hallie , Franklin Dee Ross , Boswell James F.
Published: August 2021

The session in this chapter looks at the concept of core beliefs and how negative automatic thoughts are related to negative core beliefs. Negative core beliefs are the roots from which different types of related automatic thoughts grow. Core beliefs arise from repeated similar experiences and powerful single experiences. Clients learn to identify their personal core beliefs (such as I am worthless, I am unlovable, I will go crazy) by using the downward arrow technique. Although arriving at a core belief and saying it out loud is an emotionally evocative experience, it’s a necessary part of the client’s work. It is also an opportunity for the therapist to hear the client and empathize with the client’s experience. Over time, the client builds a repertoire of experiences that allow for new core beliefs to form, making their original core beliefs less valid.
Therapist Materials for Countering Avoidant Behaviors
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Berman Rebecca , Kaloudis Angela , Espel-Huynh Hallie , Franklin Dee Ross , Boswell James F.
Published: August 2021

The session in this chapter looks at how suppression of thoughts and emotions can be counterproductive. Suppression or attempted avoidance may control things somewhat in the short term but rarely works in the long term, and it increases intensity of emotion when a similar situation is encountered in the future. Subtle behavioral avoidance, cognitive avoidance, and safety signals are introduced, and clients are asked to provide their own examples. Habitual avoidance of emotion creates negative messages about our capabilities and robs us of the chance to learn that the emotion is tolerable and will pass on its own without our efforts to avoid or escape. In this countering avoidant behavior session, clients are taught how to do the opposite of avoidance by developing a willingness to lean into emotions, or approach them, and thereby learn new lessons about emotion, situations, and themselves.
Therapist Materials for Interoceptive Exposures
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Berman Rebecca , Kaloudis Angela , Espel-Huynh Hallie , Franklin Dee Ross , Boswell James F.
Published: August 2021

The session in this chapter focuses on the importance of learning to tolerate physical sensations of emotion and to identify automatic thoughts that accompany physical sensations of emotion. Clients learn this by repeatedly practicing interoceptive exposure exercises (such as hyperventilating and breathing through a thin straw) that stimulate sensations associated with negative emotions. The authors encourage the clinicians leading this treatment to always do the exercises along with their clients. This participation demonstrates the full effort of doing the exercise thoroughly by provoking strong physical sensations in the therapists themselves; models the potential for having a nonthreatening experience of physical sensations; and normalizes the challenge of this exercise. Client avoidance and emotion-driven behaviors are bound to emerge through the course of this session.
Therapist Materials for Skills for Emotion Exposures
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Berman Rebecca , Kaloudis Angela , Espel-Huynh Hallie , Franklin Dee Ross , Boswell James F.
Published: August 2021

The session in this chapter introduces emotion exposures, which involve the planned introduction of a stimulus to provoke habitually avoided emotions in order to reduce avoidance and promote new learning. An emotion exposure can be designed to provoke any emotion, and can be situational or imaginal, in the therapy office or elsewhere. Clients in this treatment program plan emotion exposures for emotions associated with their eating disorder and other emotional issues that are involve patterns of emotional avoidance or suppression. In this session, clients begin filling out a personal emotion exposure hierarchy and learn to identify principles of planning an emotion exposure, as well as how to record before and after exposures.
Therapist Materials for Continuing Progress into the Future
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Berman Rebecca , Kaloudis Angela , Espel-Huynh Hallie , Franklin Dee Ross , Boswell James F.
Published: August 2021

The main point of this final session is to review key concepts from this treatment program and to help the client prepare for what comes next. This session looks at relapse prevention and reviews the important takeaway messages of the program. Clients learn a quick method of applying skills when taking action in the future by reviewing an emotion skills action plan and creating their own practice plan. Clients and therapist evaluate client progress and revisit client treatment goals created at the beginning of treatment. Studies on this treatment have shown that clients continue to see additional improvements in their symptoms for up to a full year after completion.
About This Treatment
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Franklin Dee Ross , Espel-Huynh Hallie , Boswell James F.
Published: August 2021

This chapter allows clients to explore whether this treatment program is right for them, and if so, whether now is the right time to begin. Chapter 2 provides an overview of the skills that clients will learn in this treatment and highlights the importance of practicing these skills. This chapter also describes how this treatment can be used in combination with other treatments like medication, nutrition counseling, and other forms of therapy. This workbook and program are intended to be used in the context of therapy or counseling. The treatment is designed to be flexible. Each chapter has exercises that help clients practice the skills in response to strong emotions in their lives.
Recording Your Experiences: Eating, Depression, and Anxiety (EDA)
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Franklin Dee Ross , Espel-Huynh Hallie , Boswell James F.
Published: August 2021

In this chapter, clients learn about the importance of recordkeeping. They are introduced to the Eating, Depression, and Anxiety (EDA) rating scale and to Form 3.1: Eating, Depression, and Anxiety (EDA), which is used throughout the treatment program. In this treatment, clients will learn to identify specific triggers of episodes of eating symptoms, anxiety, depression, and other distressing emotional experiences. They will also learn to identify objective, specific aspects of their eating and emotions, including behaviors, physical feelings, and thoughts. Since practice is so important, clients will learn how to monitor their experiences for one week.
Regular Eating
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Franklin Dee Ross , Espel-Huynh Hallie , Boswell James F.
Published: August 2021

The session described in this chapter is a supplementary session directed toward clients who are not receiving frequent, adjunctive treatment focused directly on eating regularly (such as meetings with a dietitian/nutrition counselor, residential treatment, or daily food coaching). During this session, clients learn about regular eating, including the importance of regular eating and specifically what it would look like for the individual client. The basic framework for regular eating is three meals and two or three snacks a day at spaced intervals. Together with the therapist, the client will brainstorm ideas for overcoming obstacles to regular eating and look at strategies to tackle compulsive eating.
The Natural Function of Emotions
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Franklin Dee Ross , Espel-Huynh Hallie , Boswell James F.
Published: August 2021

During this session, clients learn about the natural and adaptive function (the evolutionary purpose) of emotions. This chapter looks at emotions such as fear, sadness, anxiety, anger, guilt, shame, and disgust. Because some of these emotions are unpleasant, people have a tendency to think of them as bad. Every emotion has a purpose, however, and can be helpful to understand their natural functions. The symptoms of eating disorders, anxiety, and depression are all perpetuated by difficulties coping with uncomfortable or distressing emotional experiences. Understanding how emotions can be adaptive and natural can help us to cope with them better, and to fear or avoid them less.
Mindful Emotion Awareness
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Franklin Dee Ross , Espel-Huynh Hallie , Boswell James F.
Published: August 2021

During this session, clients learn the concepts involved in mindfulness. One concept include the awareness of two types of emotion, primary and secondary. Primary is the initial reaction to the event, whereas secondary is a reaction to that emotion. Another concept is that mindful awareness is present-focused, not focused on the past or future. A third concept is that mindful awareness is involves being accepting of emotion rather than judgmental. It takes practice to develop awareness of the different parts of emotion, to develop a focus on the present moment, and to develop non-judgment of emotion. Clients participate in a guided mindfulness exercise as well as a nonjudgmental emotion awareness exercise.
Mood Induction
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Franklin Dee Ross , Espel-Huynh Hallie , Boswell James F.
Published: August 2021

During this session, clients begin by reviewing the principles of the natural course of emotions (the three components of emotion, and how emotional experiences unfold over time). Clients hopefully have begun to notice that some of the behaviors they engage in when experiencing strong emotions are intended to make those emotions go away, either by avoiding them, reducing them, or escaping them—which means that clients never get to learn that if they have an uncomfortable emotion, and they don’t judge it or try to escape from it, the emotion is going to rise for a while and then come under control on its own. Mood induction, which is introduced in this session, is intended to help promote new tolerance of emotion.
Countering Emotion-Driven Behaviors
Authors: Thompson-Brenner Heather , Smith Melanie , Brooks Gayle , Franklin Dee Ross , Espel-Huynh Hallie , Boswell James F.
Published: August 2021

One very important aspect of emotions is that they tell us to act in a certain way or drive certain behaviors. Emotion-driven behaviors (EDBs) are different from emotion avoidance in that EDBs happen in response to an emotion that has been triggered. Avoidance strategies tend to happen before an emotion has had a chance to occur. The same action can be avoidance or an EDB depending on when it takes place in the emotional process. Just like emotion avoidance, EDBs can become powerful habits in maintaining the cycle of emotions when the goal is to get away from the emotion. In this session, clients learn to identify EDBs and when and how these EDBs can become problematic. The homework for this session is to substitute opposite actions in place of problematic EDBs.
Growth and the Multiple Dimensions of Well-Being
Authors: Tiberius Valerie
Published: August 2021

What is the possible role of adversity in promoting the development of wisdom and well-being? This chapter focuses on examining psychological discussions of post-traumatic growth and discusses whether and how we would expect suffering, adversity, or trauma to push an individual in positive and negative ways, with an emphasis on multiple dimensions of psychological well-being. The chapter interweaves insights from the philosophical literature to arrive at a better understanding of whether and to what degree post-traumatic growth is likely to occur or if growth following adversity is part of the cultural narrative that does not effectively translate to the individual.
Current Assessment and Interpretation of Perceived Post-Traumatic Growth
Authors: Park Crystal L. , Boals Adriel
Published: August 2021

Positive reappraisal is a key method for managing distressing emotions and reframing troubling circumstances into a challenge that is more easily handled or resolved. One of the main ways that people positively reframe their stressful experiences is by perceiving that they have grown or benefitted from them. This chapter provides a historical perspective on the study of perceived growth. Topics that are covered include nuances in the terminology ranging from character growth, stress-related growth, hardiness, and post-traumatic growth. In sum, the various concepts that have been used in this literature will be discussed and distinguished, as opposed to being used interchangeably. The authors also provide a discussion of directions for future research.
Using Methods from Personality Psychology to Study Post-Traumatic Growth
Authors: Jayawickreme Eranda , Mendonça Sara Etz
Published: August 2021

This chapter discusses methodological approaches for examining the causality, accuracy, stability, and mechanisms of short-term adversity-driven change in samples drawn from different populations, each highly likely to be exposed to different forms of challenge and failure. This methodological work builds on Frazier et al.’s (2009) groundbreaking longitudinal study. The authors discuss the advantages of using longitudinal multimethod measurement burst designs and a profile approach utilizing a round-robin design, as well as a qualitative assessment. Each methodology promises to address novel questions concerning the perception, meta-perception, and development of character following challenge and failure. The chapter also examines individual difference factors, such as social support and cumulative life adversity, which may moderate this relationship. Given that participants from different populations likely differ in the amount of cumulative adversity they have experienced, the authors also examine the possibilities and limitations of lifetime adversity in acting as a catalyst for subsequent growth.
Post-Traumatic Growth in Later Adulthood
Authors: Luong Gloria , Coatsworth J. Doug , Chow Sy-Miin
Published: August 2021

This chapter focuses on conceptual notions and methodological approaches for examining whether post-traumatic growth is possible in older adults, with an emphasis on individual and dyadic approaches. A majority of the literature to this point has focused on examining changes in the individual who experienced the traumatic event, but much less is known regarding how a partner or spouse responds to the traumatic event. This chapter discusses how the use of multimethod prospective longitudinal measurement burst designs can provide insights into this growth following a traumatic event. The authors discuss as an example the case when at least one partner is planning to transition into assisted living. An increasing number of individuals reaching old age must make the decision to transition into an assisted living or similar type of home. The use of multimethod prospective longitudinal designs enables the researcher to delineate the extent to which character virtues may change on different time scales in terms of state character virtues assessed in daily life (e.g., how altruistic a person is in a given moment or day) versus trait characteristics (e.g., how altruistic a person is, on average) and elucidate hypothesized transactional mechanisms (e.g., individual differences, dyadic, and contextual factors, such as experiences of daily stressors) that may promote or inhibit changes in character virtues.
Prospectively Examining the Effects of a Cancer Diagnosis on Patients, Spouses/Partners, and Their Relationship
Authors: Cheung Elaine O. , Penedo Frank J. , Moskowitz Judith T. , Yanez Betina , Kircher Sheetal M. , Kundu Shilajit D. , Flury Sarah C. , Moreno Patricia I.
Published: August 2021

Patients and their caregivers commonly report positive psychological change following the diagnosis and treatment of cancer, a phenomenon referred to as perceived growth. However, most studies have examined patient and caregiver growth as separate, parallel processes, without considering their dynamic interplay or the shared interpersonal context. Furthermore, previous research is limited by cross-sectional designs that use retrospective self-report measures to capture perceived change following cancer, rather than prospective designs to capture actual, measured changes in positive traits such as character strengths (i.e., character growth). This chapter discusses the challenges involved in examining post-traumatic growth in cancer patient populations and the advantages of incorporating a dyadic process approach as opposed to solely focusing on individual-level change. A dyadic process approach will permit examination of whether disclosure, support, empathy, and cognitive processing operate as mechanisms of character growth and will discuss the need for longitudinal data to fully examine post-traumatic growth as a dyadic outcome. To further elaborate on this dyadic approach, the authors propose an expanded theoretical model to delineate the intrapersonal and shared dyadic processes that underlie character and couple growth among cancer patients and caregivers.
Using Culturally and Contextually Informed Theorizing in Research on Post-Traumatic Growth
Authors: White Rebecca M. B. , Carlo Gustavo , Knight George P. , Yun-Tein Jenn , Gonzales Nancy A. , Curlee Alexandria
Published: August 2021

There is popular and scholarly interest in the idea that adverse experiences may promote character/virtue development. Scholarship can address previous methodological and conceptual limitations by studying character development processes in groups that demonstrate high exposure to adversity and high virtues. Though there is substantial within-group diversity, prior research shows that Mexican Americans display high character strengths (including relatedness, spirituality, and prosocial behaviors) and high rates of exposure to adversities. The authors discuss conceptual models that explore the cultural development of character growth from late childhood to early adulthood, with an emphasis on longitudinal changes in relatedness, spirituality, and prosocial behaviors among individuals who are diverse on adversity exposures and individual characteristics that might trigger growth following adversity. To address prior critical methodological and conceptual limitations, the discussion centers on differentiating among whether individuals who have experienced no adversities, traumatic events, and chronic adversities may show differential trajectories of change and the exploration of mechanisms that may support growth processes. The work advances an understanding of character strength development in a rapidly growing and relatively vulnerable US population.