Skip to main content
×
Home
    • Aa
    • Aa

Modeling and treating internalizing psychopathology in a clinical trial: a latent variable structural equation modeling approach

  • M. G. Kushner (a1), R. F. Krueger (a2), M. M. Wall (a3), E. W. Maurer (a1), J. S. Menk (a4) and K. R. Menary (a1)...
Abstract
Background

Clinical trials are typically designed to test the effect of a specific treatment on a single diagnostic entity. However, because common internalizing disorders are highly correlated (‘co-morbid’), we sought to establish a practical and parsimonious method to characterize and quantify changes in a broad spectrum of internalizing psychopathology targeted for treatment in a clinical trial contrasting two transdiagnostic psychosocial interventions.

Method

Alcohol dependence treatment patients who had any of several common internalizing disorders were randomized to a six-session cognitive-behavioral therapy (CBT) experimental treatment condition or a progressive muscle relaxation training (PMRT) comparison treatment condition. Internalizing psychopathology was characterized at baseline and 4 months following treatment in terms of the latent structure of six distinct internalizing symptom domain surveys.

Results

Exploratory structural equation modeling (ESEM) identified a two-factor solution at both baseline and the 4-month follow-up: Distress (measures of depression, trait anxiety and worry) and Fear (measures of panic anxiety, social anxiety and agoraphobia). Although confirmatory factor analysis (CFA) demonstrated measurement invariance between the time-points, structural models showed that the latent means of Fear and Distress decreased substantially from baseline to follow-up for both groups, with a small but statistically significant advantage for the CBT group in terms of Distress (but not Fear) reduction.

Conclusions

The approach demonstrated in this study provides a practical solution to modeling co-morbidity in a clinical trial and is consistent with converging evidence pointing to the dimensional structure of internalizing psychopathology.

Copyright
Corresponding author
*Address for correspondence: M. G. Kushner, Ph.D., 282-2A West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA. (Email: kushn001@umn.edu)
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

G Andrews , T Slade , C Issakidis (2002). Deconstructing current comorbidity: data from the Australian National Survey of Mental Health and Well-Being. British Journal of Psychiatry 181, 306314.

DH Barlow , LB Allen , ML Choate (2004). Toward a unified treatment for emotional disorders. Behavior Therapy 35, 205230.

DH Barlow , MG Craske , JA Cerny , JS Klosko (1989). Behavioral treatment of panic disorder. Behavior Therapy 20, 261282.

AT Beck , CH Ward , M Mendelson , J Mock , J Erbaugh (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 5363.

AT Beekman , E de Beurs , AJ van Balkom , DJ Deeg , R van Dyck , W van Tilburg (2000). Anxiety and depression in later life: co-occurrence and communality of risk factors. American Journal of Psychiatry 157, 8995.

D Borsboom , G Mellenbergh , J van Heerden (2003). The theoretical status of latent variables. Psychological Review 110, 203219.

EJ Brown , J Turovsky , RG Heimberg , HR Juster , TA Brown , DH Barlow (1997). Validation of the Social Interaction Anxiety Scale and the Social Phobia Scale across the anxiety disorders. Psychological Assessment 9, 2127.

SA Brown , M Irwin , MA Schuckit (1991). Changes in anxiety among abstinent male alcoholics. Journal of Studies on Alcohol 52, 5561.

TA Brown , LA Campbell , CL Lehman , JR Grisham , RB Mancill (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology 110, 585599.

DL Chambless , GC Caputo , SE Jasin , EJ Gracely , C Williams (1985). The Mobility Inventory for Agoraphobia. Behaviour Research and Therapy 23, 3544.

NR Eaton , RF Krueger , TF Oltmanns (2011). Aging and the structure and the long-term stability of the internalizing spectrum of personality and psychopathology. Psychology and Aging 26, 987993.

KK Ellard , CP Fairholme , CL Boisseau , TJ Farchione , DH Barlow (2010). Unified protocol for the transdiagnostic treatment of emotional disorders: protocol development and initial outcome data. Cognitive Behavioral Practice 17, 88101.

EB Foa , MJ Kozak (1986). Emotional processing of fear: exposure to corrective information. Psychological Bulletin 99, 2035.

RG Heimberg , CS Dodge , DA Hope , CR Kennedy , LJ Zollo , RE Becker (1990). Cognitive behavioral group treatment for social phobia: comparison with a credible placebo control. Cognitive Therapy and Research 14, 123.

PR Houck , DA Spiegel , MK Shear , P Rucci (2002). Reliability of the self-report version of the Panic Disorder Severity Scale. Depression and Anxiety 15, 183185.

L Hu , PM Bentler (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling 6, 155.

KS Kendler , CA Prescott , J Myers , MC Neale (2003). The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Archives of General Psychiatry 60, 929937.

RC Kessler , W Chiu , O Demler , E Walters (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617627.

RC Kessler , J Ormel , M Petukhova , KA McLaughlin , JG Green , LJ Russo , DJ Stein , AM Zaslavsky , S Aguilar-Gaxiola , J Alonso , L Andrade , C Benjet , G de Girolamo , R de Graaf , K Demyttenaere , J Fayyad , JM Haro , CY Hu , A Karam , S Lee , J Lepine , H Matchsinger , C Mihaescu-Pintia , J Posada-Villa , R Sagar , TB Üstün (2011). Development of lifetime comorbidity in the World Health Organization World Mental Health Surveys. Archives of General Psychiatry 68, 90100.

RF Krueger (1999). The structure of common mental disorders. Archives of General Psychiatry 56, 921926.

RF Krueger , MS Finger (2001). Using item response theory to understand comorbidity among anxiety and unipolar mood disorders. Psychological Assessment 13, 140151.

RF Krueger , KE Markon (2006). Reinterpreting comorbidity: a model-based approach to understanding and classifying psychopathology. Annual Review of Clinical Psychology 2, 111133.

MG Kushner , K Abrams , P Thuras , KL Hanson , M Brekke , S Sletten (2005). Follow-up study of anxiety disorder and alcohol dependence in comorbid alcoholism treatment patients. Alcoholism: Clinical and Experimental Research 29, 14321443.

MG Kushner , MM Wall , RF Krueger , KJ Sher , E Maurer , P Thuras , S Lee (2012). Alcohol dependence is related to overall internalizing psychopathology load rather than to particular internalizing disorders: evidence from a national sample. Alcoholism: Clinical and Experimental Research 36, 325331.

W Mansell , A Harvey , ER Watkins , R Shafran (2008). Cognitive behavioral processes across psychological disorders: a review of the utility and validity of the transdiagnostic approach. International Journal of Cognitive Therapy 1, 181191.

W Mansell , A Harvey , E Watkins , R Shafran (2009). Conceptual foundations of the transdiagnostic approach to CBT. Journal of Cognitive Psychotherapy 23, 619.

HW Marsh , B Muthén , T Asparouhov , O Lüdtke , A Robitzsch , AJS Morin , U Trautwein (2009). Exploratory structural equation modeling, integrating CFA and EFA: application to students' evaluations of university teaching. Structural Equation Modeling 16, 439476.

JB McGlinchey , M Zimmerman (2007). Examining a dimensional representation of depression and anxiety disorders' comorbidity in psychiatric outpatients with item response modeling. Journal of Abnormal Psychology 116, 464474.

W Meredith (1993). Measurement invariance, factor analysis and factorial invariance. Psychometrika 58, 525543.

TJ Meyer , ML Miller , RL Metzger , TD Borkovec (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy 28, 487495.

RE Millsap , SB Hartog (1988). Alpha, beta and gamma change in evaluation research: a structural equation approach. Journal of Applied Psychology 73, 574584.

S Mineka , D Watson , LA Clark (1998). Comorbidity of anxiety and unipolar mood disorders. Annual Review of Psychology 49, 377412.

TE Moffitt , H Harrington , A Caspi , J Kim-Cohen , D Goldberg , AM Gregory , R Poulton (2007). Depression and generalized anxiety disorder: cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years. Archives of General Psychiatry 64, 651660.

SI Vrieze (2012). Model selection and psychological theory: a discussion of the differences between the Akaike information criterion (AIC) and the Bayesian information criterion (BIC). Psychological Methods 17, 228243.

D Watson (2009). Differentiating the mood and anxiety disorders: a quadripartite model. Annual Review of Clinical Psychology 5, 221247.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords: