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DEPARTMENT OF CLINICAL HEALTH

PSYCHOLOGY RESEARCH DAY

Thursday April 20th, 2017

Department of Clinical Health Psychology Max Rady College of Medicine

University of Manitoba

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Schedule at a Glance 1:00 – 2:30 PM

Frederic Gaspard Theatre, Basic Medical Sciences Building

Rapid Fire Research – Brief presentations describing research activities by faculty and students.

2:30 – 3:15 PM

Brodie Centre

Coffee Break & Poster Presentation

3:15-4:30 PM

Frederic Gaspard Theatre, Basic Medical Sciences Building

Dr. Christopher Bowie Improving Cognition in Severe Mental Illness: New Methods to Promote Restoration of Functioning

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Dr. Christopher Bowie Professor, Queens University

Improving Cognition in Severe Mental Illness: New Methods to Promote Restoration of Functioning

Thursday, April 20, 2017

3:15 – 4:30 PM Frederic Gaspard Theatre

Basic Medical Sciences Building Dr. Bowie is a Professor and the Director of Clinical Training in the Department of Psychology, and a member of the Psychiatry Department and Centre for Neuroscience Studies, at Queen’s University in Kingston, Ontario. He is the Head Consulting Psychologist for the Head’s Up Early Psychosis Intervention Program in Kingston and a Clinician Scientist at the Centre for Addiction and Mental Health in Toronto.

Three main objectives of this talk: 1. To recognize the complex path from cognitive impairment to functional disability in severe mental illness 2. To understand how treating cognition can improve everyday outcomes 3. To identify the barriers and obstacles that complicate the transfer of cognitive improvement to reduction in disability

All Are Welcome

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Department of Clinical Health Psychology Max Rady College of Medicine

Research Day 2017 Rapid Fire Oral Presentations

Frederic Gaspard Theatre, Basic Medical Sciences Thursday April 20, 2017 1:00–2:30pm

Chair: Dr. Gregg Tkachuk 1:00 Opening Remarks

1:05 Does “Quick Start” give patients a "Head Start" on treating their anxiety? Data from a

large group brief CBT psychoeducational program. Gillian Alcolado, PhD, CPsych., Patricia Furer, Ph.D., C. Psych., John Walker, Ph.D., C. Psych., Laine Torgrud, Ph.D., C. Psych.

Stepped care models for cognitive-behavioral therapy (CBT) decrease wait times, increase recovery rates, and are cost-effective. In our tertiary care anxiety disorders clinic, wait times for assessment and treatment have historically ranged from 14 to 18 months. A large-group 2-session psychoeducational intervention for anxiety, "Quick Start (QS)", was developed as a waitlist management strategy/stepped care offering. Content includes information on anxiety disorders and an introduction to core CBT strategies. To date, QS has been delivered to over 400 patients on our waitlist. The implementation of QS as a mandatory first step in our program has allowed us to shorten our waitlist (down to 8-10 months) in part by reducing the “no show” rate at assessment (down to 25%). QS also reduces anxiety (F(1, 181) = 111.08, p < .001),as measured by the Depression Anxiety Stress Scale (DASS), a self-report measure completed at QS and again a few months later at assessment. Interestingly, examination of patients who attended one vs. both QS sessions demonstrated that those who attended both sessions had significantly lower anxiety scores than those who only attended one session, t(182) = 2.51, p = .01. Implications for CBT treatment in public health care settings will be discussed.

1:17 A Novel Stress-Diathesis Model to Predict Risk of Post-operative Delirium: Implications

for Intra-operative Management

Renée El-Gabalawy, PhD, Ronak Patel, PhD, C.Psych., Kayla Kilborn, Caitlin Blaney, Christopher Hoban, Lawrence Ryner, Duane Funk, Regina Legaspi, Joseph A. Fisher, James Duffin, David J. Mikulis, and W. Alan C. Mutch

Risk assessment for post-operative delirium (POD) is poorly developed. Improved metrics could greatly facilitate perioperative care as the individual, societal and health care costs associated with POD are staggering. In this feasibility study we develop a novel stress diathesis (vulnerability) model based on comprehensive pre-operative psychiatric and neuropsychological testing, a pre- operative BOLD MRI CO2 stress test, and high fidelity determination of intraoperative parameters

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that may interact facilitating the expression of POD. Twelve patients were studied. Pre-operative psychiatric symptom measures and neuropsychological testing preceded MR images featuring a BOLD MRI CO2 stress test whereby BOLD EPI scans were determined with a rigorously controlled CO2 stimulus. Six of 12 patients had no evidence of POD (non-POD). Three patients had POD and 3 had subthreshold POD (ST-POD) (score ≥ 5/19 on the CAM-S). Average severity for delirium was 1.3 in the non-POD group, 3.2 in the subthreshold group, and 6.1 in the POD group (F-statistic 15.4, p < 0.001). Depressive symptoms, cognitive measures of semantic fluency, and processing speed were significantly associated with POD. Results provide preliminary support for the interacting diatheses and stressors on the POD phenotype. The stress-diathesis model has the potential to aid in risk assessment for POD.

1:29 Development of a group cognitive-behavioral therapy intervention for perinatal

anxiety Patricia Furer, PhD, C. Psych., Gillian M. Alcolado, Ph.D., C. Psych., Kristin Reynolds, Ph.D., C. Psych. Candidate, Elizabeth A. Hebert, Ph.D., C. Psych. Candidate

Anxiety symptoms are common during pregnancy and the postpartum period. However, there is little guidance in how to best treat perinatal anxiety, and only one published study on adapting group cognitive-behavioural therapy (CBT) for this population (Green et al. 2015). The current investigation developed and evaluated such an intervention. Session content includes psychoeducation regarding anxiety during the perinatal period, self-care and pregnancy/postpartum, goal-setting, exposure strategies, nurturing the relationship with baby, challenging negative thoughts, and relapse prevention. A workbook has been developed which provides information and homework exercises in each of these areas. Female patients with varied primary anxiety symptoms, either pregnant or within 12 months postpartum, were invited to participate. Participants (n = 13) completed the Perinatal Anxiety Stress Scale (PASS) pre- and post- group. A repeated measures ANOVA with time as the within-subjects independent variable and total PASS scores as the dependent variable was conducted. Results revealed a significant main effect of time, such that anxiety scores decreased from pre- to post-group, F(1,12) = 19.54, p = .001, ηpartial

2 = .62, with mean scores decreasing from the severe range, to the mild-moderate range, for anxiety symptoms. Thus there is good preliminary evidence for group treatment of perinatal anxiety.

1:41 “It’s Complicated”: Intolerance of Uncertainty in Dating Relationships

Elizabeth Hebert, Larissa Stelmaschuk, Kathryn Sexton, PhD, & Norah K. Vincent, PhD., C.Psych.

Intolerance of uncertainty (IU) is robustly associated with generalized anxiety disorder (GAD) symptom development and maintenance, and individuals with GAD commonly worry about social relationships and problems. IU may impact relationship functioning via several pathways including interpersonal behaviours, egoistic caregiving motivations, and perceptions of satisfaction. However, this remains empirically untested. We recruited heterosexual dating couples (N = 105) from a local university, all of whom completed measures assessing IU, interpersonal problems,

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relationship-specific caregiving motivations, and relationship satisfaction. For both men and women, greater IU predicted more egoistic caregiving motivations and greater interpersonal problems in a path analysis. Specifically, those with greater IU behaved in an overly accommodating, intrusive, or controlling fashion. Greater relationship-based caregiving motivations predicted greater relationship satisfaction. However, higher IU did not predict relationship satisfaction directly. Overall, our findings suggest that IU is an important factor in heterosexual dating relationships, although it may affect the manner in which people relate rather than the satisfaction of those relationships directly. Clinical and research implications will be discussed.

1:53 Resources for Clinical Practice Guidelines in Clinical Psychology: An Environmental Scan

Maxine Holmqvist, PhD., C.Psych. & Jennifer Barnes, MA

Clinical Practice Guidelines (CPGs) are “recommendations, intended to optimize patient care, that are informed by a systematic review of the evidence and an assessment of the benefits and harms of alternative care options” (Institute of Medicine, 2011). Finding CPGS relevant to clinical psychology, however, can be challenging. Many clinical psychologists rely on PsycINFO and MEDLINE to access evidence to inform their practices, and have relatively low knowledge of other online resources. The CPA Clinical Section has proposed developing a CPG database for psychologists, and, as an initial step, our working group conducted an environmental scan to determine what resources are currently available. The scan consisted of a search of the academic literature, broad and targeted internet searches, and expert consultation. Sites were assessed based on their accessibility, comprehensiveness, authoritativeness, and ease of use. A total of 29 unique sites were identified. Most CPG sites were identified through expert consultation, and were not revealed through any of the searches conducted. These results indicate that while many CPGs exist for clinical psychologists, they are not easily accessible to front-line clinicians and sites that compile these often lack key features (e.g., quality assessment).

2:05 Cognitive Behaviour Therapy with First-Episode Psychosis

Colleen Murphy, PhD., C.Psych.

There is growing evidence for the effectiveness of cognitive behavioural therapy for psychosis (CBTp) with schizophrenia and first-episode psychosis. The aim of CBTp is to reduce the distress experienced by persons with psychosis as a result of primary psychotic symptoms (e.g., negative symptoms, hallucinations, delusions) and secondary co-morbid symptoms (e.g., depression and anxiety). The therapeutic model places a strong emphasis on psychoeducation, normalization and collaborative empiricism. This presentation will provide a brief introduction to the CBTp group that is currently being offered through the Early Psychosis Prevention and Intervention Service, an interdisciplinary outpatient program for young persons experiencing their first episode of psychosis. Pilot data from three CBTp groups (n = 40) will also be reviewed.

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2:17 Feasibility of online interventions to improve sleep after traumatic brain injury

Vincent, N., Theadom, A., Barker, S., Jones, K., Dudley, M., & Feigin, V.

Sleep difficulties are common following a brain injury, yet there are currently few evidence-based treatments available for this population. This study aimed to explore feasibility of a web-based cognitive behaviour therapy intervention in improving sleep quality following a brain injury. The sample consisted of 24 adults with a recent mild to moderate traumatic brain injury. Participants were randomised to receive either a cognitive behaviour therapy or an education intervention online. Both interventions were delivered for 20-30 minutes per week, over a six week period. The primary end point was sleep quality, and this was assessed using actigraphy and the Pittsburgh Sleep Quality Index. Both programs were acceptable and feasible following brain injury, with 83.3% of participants successfully completing the interventions. Only those with visual disturbances had difficulty using the programs. Trends in improvement were observed on both objective and self-reported sleep quality as well as quality of life for the cognitive behavior therapy group but only for symptom severity in the control group. Online programs designed to improve sleep are feasible for use for adults following mild to moderate brain injury. Increased benefit may be observed from integrating educational information about brain injury within online sleep interventions

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Poster Presentations Brodie Centre Atrium, University of Manitoba

Bannatyne Campus, 727 McDermot Ave Thursday April 20, 2017 2:30 – 3:15 pm

#1 Trauma exposure and cancer: A preliminary investigation of co-occurrence and

associated symptomatology.

Sommer, J., Kaster, T., Mota, N., Sareen, J., & El-Gabalawy, R.

Background: Extant research suggests there is a relationship between cancer, trauma exposure, and post-traumatic stress disorder (PTSD), but this is largely an understudied area. The aims of this study are to: (1) examine the co-occurrence between trauma exposed adults and those with sub-threshold or full PTSD (referred to as PTSD throughout) and cancer (breast, gastrointestinal (GI), and other cancer), and (2) assess the prevalence between PTSD symptom clusters and cancer among those with PTSD. Method: We analyzed data from Wave 3 of the National Epidemiologic Survey on Alcohol and Related Conditions (n = 36,309). Respondents were categorized into three groups: no trauma exposure (n = 12,115), trauma exposure without PTSD (n = 12,935), and PTSD (n = 10,638). The latter was based on Diagnostic and Statistical Manual of Mental Disorder 5th Edition (DSM-5) criteria assessed by lay interviewers. Cancer was based on self-reported diagnoses by a health professional. We conducted weighted cross-tabulations to examine comorbidity rates of cancer with trauma exposure and PTSD. Cross-tabulations and multivariate logistic regression models, adjusted for sociodemographics, also examined the relationship between PTSD symptomatology and cancer among those with PTSD. Results: Cross-tabulations indicated adults endorsing no trauma had the lowest rates of breast cancer (0.7%), GI cancer (0.1%), other cancer (2.1%), and any cancer (2.7%), compared to adults with trauma exposure (0.4%, 0.3%, 3.7%, and 4.3%, respectively) and PTSD (0.6%, 0.4%, 4.4%, and 5.1%, respectively). Among those with PTSD, individuals with cancer reported lower rates of avoidance/numbing symptoms compared to those without cancer (72.8% versus 76.1%) and higher rates of negative alterations in cognitions and mood (79.0% versus 75.6%). After adjusting for sociodemographics, avoidance/numbing, hyperarousal, and negative alterations in cognitions in mood (odds ratio range = 1.10 to 1.23) were associated with significantly increased odds of cancer, and re-experiencing symptoms were associated with significantly decreased odds of cancer, among those with PTSD. Conclusion: Results suggest higher prevalence rates of cancer among those who are both trauma exposed and those with clinically significant symptoms. Particular PTSD symptoms may be more strongly related to cancer. More research is necessary to understand the nature of this unique finding.

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#2 Trauma-related reactions among university students: An examination of negative and positive correlates of post-traumatic growth.

Sommer, J., Schultz, J., Mackenzie, C., Starzyk, K., Bernstein, M., & El-Gabalawy, R.

Background: Recently, there is growing interest in adaptive responses to traumatic life experiences, namely post-traumatic growth (PTG). In an undergraduate sample, the aims of this study are to: (1) investigate both the negative (i.e., stress, anxiety, depression, negative affect) and positive (i.e., closure, positive affect, empathy, prosocial personality) correlates of PTG, (2) examine the quadratic relationship between PTG and significant correlates, and (3) understand whether PTG differs across various types of trauma exposures. Method: Participants were 253 undergraduate university students (mean age = 19; females = 54%) at the University of Manitoba. Participants self-reported on a number of psychological constructs using validated measures including the Post Traumatic Growth Inventory (Tedeschi & Calhoun, 1996), which yields a total score and 5 factors (relating to others, new possibilities, personal strength, spiritual change, appreciation of life). Bivariate correlations and hierarchical regressions examined the nature of the relationship between several potential correlates of PTG and its factors. We also conducted analyses of variance to determine whether PTG scores differ according to various trauma types. Results: Results indicated that PTG is associated with both negative health correlates: anxiety and stress (r = .18, p < .01), as well as positive correlates: closure, positive affect, empathy, and prosocial personality factors (self-reported altruism and helpfulness; r range = .15-.26, p < 0.05). Results also indicated a significant curvilinear relationship between PTG and two trauma-related correlates: length of emotional distress (β = -.73, p < .02) and subjective current emotional distress (β = -.64, p < .02). There was also significant PTG mean differences across trauma types for PTG factors, relating to others (F = 3.80, p = .001) and appreciation of others (F = 3.42, p = .002), with highest mean scores for traumatic loss across both factors Conclusion: PTG is associated with both negative and positive correlates. Curvilinear findings support the conceptualization that moderate levels of post-traumatic suffering is associated with highest levels of PTG. Future research should aim to understand behavioural outcomes of PTG and potential adaptive long-term effects.

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#3 Investigating the relationship between rheumatoid arthritis and comorbid anxiety in

terms of disease status.

Blaney, C., & El-Gabalawy, R.

Introduction: Clinical observations have linked patients with rheumatoid arthritis (RA) to high rates of anxiety symptomology; preliminary estimations predict up to 40% of RA patients would meet diagnostic criteria for an anxiety disorder. Despite this prevalence and the growing understanding of the impact of comorbid depression on disease course and complexity, there is a paucity of research investigating the influence of comorbid anxiety in RA. The objectives of my dissertation will include 1) examining the relationship between anxiety (both specific symptoms and general diagnoses) and RA severity/complexity over time, as well as 2) testing the impact of a targeted intervention for comorbid anxiety on RA disease presentation. Methods: The first objective will be accomplished using data from the longitudinal province-wide immune-mediated inflammatory disease (IMID) study established in Manitoba. The second objective will require a pilot study, implementing a problem-solving intervention on patients treated at the Health Science Centre, diagnosed with both RA and anxiety disorders associated with RA in objective 1. Anticipated Results: I expect anxiety disorders involving chronic, enduring stress states (i.e. generalized anxiety disorder, post-traumatic stress disorder) to be associated with worse disease trajectory over time. I also expect an intervention aimed at treating these anxiety disorders will improve RA symptomology. Conclusions/Significance: The proposed research program will significantly contribute to the dearth of literature regarding anxiety in the context of RA, as well as potentially provide means of mitigating worsened health consequences associated with comorbid anxiety for RA patients.

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#4 An examination of chronic pain conditions and mental health correlates in a population-

based survey of Canadian Forces personnel.

Vun, E., Turner, S., Mota, N., Afifi, T., Sareen, J., & El-Gabalawy, R.

Background: Chronic pain conditions and mental disorders have been found to be highly prevalent in military populations compared to the general population. Despite this, little investigation has been conducted on the co-morbidity between chronic pain conditions and mental disorders among this population. Methods: Data were analyzed from the 2013 Canadian Forces Mental Health Survey (CFMHS) using the regular member population (n = 6696). The World Health Organization Composite International Diagnostic Interview (WHO-CIDI) assessed mental disorders and participants self- reported chronic pain conditions (i.e., arthritis, back problems, musculoskeletal conditions, migraines and traumatic brain injury (TBI)/concussion) and indicators of pain severity. Logistic regression models assessed the relationships between the chronic pain conditions and mental disorders. Statistical models adjusted for sociodemographics and comorbid mental disorders. We conducted interaction terms between a) sex and b) pain severity indicators with significant physical conditions on mental disorders. Results: Major depressive episode, general anxiety disorder (GAD), panic disorder and post- traumatic stress disorder (PTSD) were all significantly associated with all pain conditions in the unadjusted and model adjusting for sociodemographic factors only. In the most stringent model that additionally adjusted for comorbid mental disorders, musculoskeletal conditions, back problems and migraines were significantly associated with major depressive episode (odds ratio (OR) range: 1.40-2.02, p < 0.05). Back problems was significantly associated with GAD (OR: 1.78, 95% CI: 1.29-2.47, p < 0.001). Musculoskeletal problems, arthritis and back problems were all associated with significantly increased odds of panic disorder (OR range: 1.75-1.90, p < 0.05). All assessed chronic pain conditions were significantly and strongly associated with PTSD (OR range: 1.86-3.57, p < 0.01). Sex and pain severity interaction analyses were largely non-significant with the exception of the relationship between migraine and PTSD by sex (p < 0.007). Despite non-significance for pain severity indicators, cross-tabulations demonstrated higher rates of mental disorders among physical conditions that were associated with severe pain compared to mild pain. Conclusion: Chronic pain conditions co-occur with mental disorders among Canadian regular force members, and results are particularly robust for PTSD and panic disorder. This knowledge has important clinical implications for targeted interventions.

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#5 A comprehensive evaluation of pre-surgical factors on post-operative delirium: A pilot study.

Hoban, C., Mutch, A., & El-Gabalawy, R.

Objective: Major surgery is associated with a significant risk of postoperative morbidity and mortality. Post-operative delirium (POD) is a serious complication associated with anesthesia and surgery that prolongs hospital stay, increases health care costs and is associated with increased morbidity [1,2]. As such, pre- operative diagnosis of patients at risk of POD, could lead to better management of this problem facing modern peri-operative medicine and anaesthesia. In our current pilot study we seek to identify patients who have the greatest vulnerability to surgery with a variety of potential pre-operative markers. Methods: This study aims to identify anatomic, physiologic and neuropsychological factors that may place a patient at greater risk of POD from high risk surgery.Patients will be recruited from the pre-operative anesthesia clinic where they will be interviewed for suitability along with receiving an initial pre-surgical assessment of delirium using the confusion assessment method (CAM) and respond to self-report questions regarding their psychiatric history. Prior to their surgery, patients will receive comprehensive neuropsychological testing to assess a multitude of cognitive domains. Patients will then undergo a blood oxygen level dependent (BOLD) MRI CO2 stress test to assess voxel-by-voxel cerebrovascular reactivity (CVR). Patients will then be followed post-operatively and have daily CAM assessments performed along with a post-operative non-infused brain MRI to rule out a peri-operative stroke as a possible ethology of the delirium. Anticipated Results and Conclusions: The anticipated results of this pilot study will be the identification of patients at risk for brain ischemia and potentially POD from their initial CVR BOLD MRI. Ultimately, the possibility of identifying at-risk patients through cognitive testing and BOLD MRI CO2 stress testing may create a powerful pre-operative screening tool for POD.

#6 An examination of the co-occurrence and correlates of chronic pain and generalized

anxiety disorder in the Canadian population.

Csupak, B. & El-Gabalawy, R.

Introduction: Chronic pain conditions and generalized anxiety disorder (GAD) are both common among the Canadian population. A burgeoning body of research has examined the co-occurrence between mental disorders and chronic pain conditions, but the majority of this research has focused on depressive disorders. Recent research suggests that anxiety may co-occur at higher rates than depressive disorders (1, 2), but no population-based studies to date have investigated GAD. Our objectives of this study are to 1) Establish the prevalence and co-occurrence of chronic pain conditions and indicators of chronic pain severity among those with and without GAD, 2) Understand the effect of comorbid GAD and chronic pain conditions compared to pain conditions alone on a range of negative correlates including pain severity, 30-day disability and restriction in activities. Methods: Ethics was not required for this study as secondary data were used through Statistics Canada, who previously received ethics approval. Data were analyzed from the Canadian Community Health Survey – Mental Health (CCHS-

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MH) conducted between January and December 2012. This includes 25,113 individuals 15 years or older living in the 10 provinces (cumulative household and person response rate = 68.9%). Trained lay intereviewers conducted structured interviews to assess for mental disorders. Pain conditions included arthritis, back problems, and migraine. Participants self-reported on pain severity and functional restriction, and the World Health Organization disability scale measured 30-day disability. All analyses were conducted in SPSS software, which included bootstrapping procedures and statistical weights so that findings were nationally representative. Results: A total of 18,1% of Canadians endorsed having physician diagnosed back problems, and 16.7% and 10.3% endorsed arthritis and migraine, respectively. Migraine co-occurred with GAD at the highest rates, with 6.9% indicating migraines among those with GAD. Comorbidity of GAD and the assessed chronic pain conditions compared to the chronic pain conditions alone resulted in significantly worse disability scores (all p < 0.001), with largest effect sizes for migraines. Participants with comorbidity also reported significantly worse pain severity and limitations in activity compared to the chronic pain conditions alone. Conclusion: Among those with chronic pain conditions, co-occurring GAD results in a more severe disease presentation including greater levels of disability, pain severity, and functional limitations. These findings may emphasize the need for targeted mental health interventions to modulate negative pain outcomes among those with chronic pain conditions.

#7 Anxiety sensitivity on indicators of disease severity among patients with inflammatory

arthritis.

El-Gabalawy, R., Bernstein, M., Mackenzie, C., Sareen, J. & Hitchon, C.

Background: There has been growing interest in anxiety sensitivity, defined as the fear of behaviors or sensations associated with the experience of anxiety, in chronic pain research. However, few studies have investigated anxiety sensitivity in the context of inflammatory arthritis. The current study aimed to understand the relationship between anxiety sensitivity and indicators of severity in inflammatory arthritis. Methods: Data included 148 subjects (mean age = 57.7, 72% female) drawn from a prospective longitudinal Early Arthritis Cohort (symptom less than 12 months at baseline) from 2012 to 2015. Anxiety sensitivity (AS) was assessed using the validated Anxiety Sensit ivity Index. Three factors were investigated: physical AS (fear of autonomic arousal and physical symptoms), cognitive AS (fear of the cognitive aspects of anxiety), and social concerns AS (fear of social consequences of anxiety). Patients completed the ASI on their annual visit. Arthritis activity indicators included patient reported visual analogue scales for pain fatigue, and functional status (modified health assessment questionnaire; mHAQ), physician assessed global disease activity, swollen 28 joint c ount, tender 28 joint count, Lansbury weighted joint count, erythrocyte sedimentation rate (ESR), c- reactive protein (CRP), and composite indices (DAS28ESR-3variable, Clinical Disease Activity Index (CDAI)). Bivariate correlations first examined the cross-sectional relationship between AS factors and indicators of disease severity and adjusted linear and logistic regressions controlling for number of visits examined the longitudinal relationship between change in AS factors on indicators of severity. Only results significant at the 0.01 level are reported to adjust for multiple comparisons. Results:

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Total summed mean scores significantly differed for social AS (M = 6.96, SD = 8.43), cognitive AS (M = 2.80, SD = 4.07), and physical AS (M = 3.56, SD = 4.19). The three AS factors were significantly associated with worse pain levels (r range = 0.250-0.293), fatigue (r range = 0.312-0.403), mHAQ (r range = 0.284-0.340) and CDAI (r range = 0.200- 0.272). The strongest correlations were consistently indicated for the social AS. Only social (r (189) = 0.211) and physical AS (r (195)= 0.250) were significantly associated with physician assessed global functioning and social AS was the only factor associated with the Lansbury Index (r (193) = 0.197). There was no significant relationship between changes in AS on disease severity; however, only higher physical AS scores at baseline significantly predicted persistence indicated by DAS28ESR > 2.6 (adjusted odds ratio = 1.150, 95%CI = 1.036-1.269, p < 0.01). Conclusion: Anxiety sensitivity is associated with several indicators of severity among those with inflammatory arthritis; unique findings emerged across factors and the social AS factor has a particularly strong association with severity indicators.

#8 Pre-operative mental health characteristics in non-cardiac surgery: A preliminary study.

El-Gabalawy, R. Raposo, S., Mackenzie, C., Sareen, J., & Srinathan, S.

Introduction: Non-cardiac surgery can be characterized as a highly stressful event. Additionally, preliminary evidence suggests that adults undergoing non-cardiac surgery may have poorer mental health compared to the general population given that there is a relationship established in prior research between compromised mental and physical health. The current preliminary study aims to (1) assess prevalence rates of anxiety and depressive disorders, and levels of psychological distress, and (2) identify significant demographic, surgical, and health-related factors associated with pre-operative distress in a large sample of non-cardiac surgery patients. Methods: The sample consists of 998 adults undergoing non-cardiac surgery between June 2011 and November 2012. The enrolled patients were selected to participate in a sub-study from a larger cohort study (Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION)). The 2012 Canadian Community Health Survey was used as a comparison population and included identical measures as those assessed in the clinical cohort. Patients were approached the day of surgery and self-reported on (1) a current mental disorder that was diagnosed by a health professional, and (2) pre- operative distress indicated by the Kessler's 6-item Psychological Distress Scale (K6). T- tests and bivariate correlations examined the relationship between pre-operative distress and sociodemographic, health and surgical-related variables. Results: Results indicated that 2.4% and 1.4% of adults indicated a current diagnosis of a mood and anxiety disorder, respectively. Results further indicated that surgical patients had higher overall levels of distress (mean (M) = 3.58, standard error (SE) = 0.095) compared to a population-based sample of Canadians within the same time frame (M = 2.23, SE = 0.028). Lower age, being female, endorsing a mood or anxiety disorder, requiring assistance with ADL's, history of cerebral vascular event, history of chronic pain, higher BMI, undergoing neurosurgery, and undergoing open surgery were associated with significantly elevated levels of pre-operative distress. Discussion: Although a smaller proportion of patients undergoing non-cardiac surgery endorsed a mental disorder, they reported higher levels of distress, compared to the general

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population. There were a number of identified factors associated with higher levels of pre-operative distress that require further exploration. It is essential to understand the impact of pre-operative distress on post-operative outcomes for risk mitigation.

#9 Intolerance of uncertainty and coping in chronic gastrointestinal disease: Managing

perceived threat rather than perceived challenge?

Kathryn A. Sexton, Ph.D., John R. Walker, Ph.D., C.Psych., Lesley A. Graff, Ph.D., C.Psych., Clove Haviva, M.A. & Charles N. Bernstein, M.D., FRCPC

Intolerance of uncertainty (IU) is a transdiagnostic cognitive vulnerability relevant to a range of negative outcomes including worry (Koerner & Dugas, 2008), depressed mood (Norton et al., 2005), and anxiety about health problems (Keefer et al., 2005). As it does in anxiety disorders (Reuman et al., 2015), in the context of an unpredictably relapsing and chronic gastrointestinal disease IU may lead to biased perceptions of uncertainty as threatening and may interfere with effective coping. How individuals cope with disease- related uncertainty in inflammatory bowel disease (IBD) has not been well described. An adaptation of the Ways of Coping Questionnaire for use in health contexts was tailored for IBD and combined with items from an expanded 12-dimensional hierarchy of coping strategies (Skinner et al., 2003). A community sample of 156 participants (64.7% female; aged 28 to 85 years; diagnosed with Crohn’s disease (n=81) or ulcerative colitis (n=75) for 11 to 19 years) identified the most stressful disease-related experience over the past 6 months, rated the frequency of coping strategies used, and completed the Intolerance of Uncertainty Scale, Cohen’s Perceived Stress Scale, Depression Anxiety Stress Scales short form, Health Anxiety Questionnaire, and 3-Item Penn State Worry Questionnaire. IU was significantly associated with use of less adaptive coping strategies that suggest the source of stress was perceived as a threat rather than a manageable challenge.

#10 The IBD Symptom Inventory: Measurement characteristics and validity in a clinic

sample.

Kathryn A. Sexton, Ph.D., John R. Walker, Ph.D., C.Psych, Laura E. Targownik, M.D., FRCPC, Lesley A. Graff, Ph.D., C.Psych, Norine Miller, R.N.. Clove Haviva, M.A., Brooke Beatie, M.A., Sarah Kathleen Petty, B.A. (Hons), Matthew T. Bernstein, M.A., Harminder Singh, M.D., FRCPC, Charles N. Bernstein, M.D., FRCPC

Most measures of inflammatory bowel disease (IBD) symptoms are clinician administered, and existing self-report measures suffer from narrow breadth, inadequate measurement properties, or burdensome length. The IBD Symptoms Inventory (IBDSI) was developed to assess a broader range of patient-reported IBD symptoms by adapting symptom items from clinician-rated inventories. This study evaluated its measurement properties. IBD patients attending outpatient GI clinics in Winnipeg were invited to participate while waiting for their appointment. 267 patients (58.1% female; Crohn’s Disease (CD) n=142, Ulcerative Colitis (UC) n=125; ages 18-81 years) completed the IBDSI, IBD Questionnaire, and Manitoba IBD Index. As part of standard care, participants were administered the Harvey Bradshaw Index for CD or Powell-Tuck Index for UC by a clinical nurse specialist, and a gastroenterologist completed a global assessment of disease activity. Following factor analysis, 35 items were retained assessing symptoms

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on 5 subscales: bowel symptoms, abdominal discomfort, fatigue, bowel complications, and systemic complications. The IBDSI showed strong measurement properties, with a supported factor structure, very good internal consistency, evidence of convergent validity, and excellent sensitivity and specificity to clinician-rated measures of active disease, and is thus recommended for use in either clinic or research settings. A shorter version (24 items) with similar measurement characteristics is available.

#11 A Pilot Study of an Online Chronic Pain Treatment for Military, RCMP, and Veterans.

Pamela L. Holens, PhD., Jeremiah Buhler, B.A. & Kristen Klassen, Ph.D.

Chronic pain is a serious health issue in Canada, and prevalence rates in Canadian military/veteran populations are estimated to be double that of the general population. The purpose of this study was to gather preliminary evidence for the efficacy of an online acceptance-based behavioural treatment (ABBT) for chronic pain designed for military, RCMP, and veteran populations. Military, RCMP, and veterans of these forces who reported experiencing chronic pain of six months or greater duration were recruited through the Winnipeg Operational Stress Injury clinic and participated in an 8- week online treatment for chronic pain. Participants completed a battery of measures underscoring the key facets of the fear-avoidance model of chronic pain at baseline and post-treatment. Results from multiple paired samples t-tests revealed a significant improvement in participants’ pain acceptance, and significant reductions in kinesiophobia and pain catastrophizing. However, participants did not show a significant reduction in pain intensity. The preliminary results support the feasibility of the online ABBT treatment for chronic pain in military, RCMP, and veteran populations.

#12 Development of an Online Chronic Pain Program for Individuals with a Military/RCMP

Background.

Pamela L. Holens, PhD., Heather Simister, Ph.D., Kristen Klassen, Ph.D. & Amber Gilberto, MPN

The objectives of this pilot study were: 1) to develop an online chronic pain management program tailored to a military/RCMP population, and 2) to assess its acceptability and appropriateness for this population. Modifications were made to a pre-existing Acceptance-Based Behavioral Therapy (ABBT) for chronic pain in order to tailor it to a military population. Ten participants were recruited to complete the program and offer their insights and suggestions regarding its acceptability, appropriateness, and efficacy. Participants included veterans and actively serving members of both genders with a median age of 43.5 years. Nearly fifty percent of individuals approached regarding participation in the study declined to participate or dropped out early in the program, with the most frequent reasons being that the online approach was not a good fit for them or they were currently focusing on other concerns. Those who completed the online modules reported finding them informative and helpful. Participants related well to the military/RCMP vignettes in the program, but the ideas of acceptance and mindfulness were noted to be dissonant with their training and experiences. Our online therapy for military/RCMP with chronic pain was deemed appropriate for some, but by no means all, members of this population. Some members

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preferred a face-to-face option, while others reported co-morbid mental health concerns were their current priority. For those comfortable with the online approach, the material in the program was generally deemed acceptable and appropriate, with the possible exception of the concepts of acceptance and mindfulness.

#13 Factors Impacting Treatment Retention in an Online Chronic Pain Management Program

for Military and Veterans.

Pamela L. Holens, PhD., Kristen Klassen, Ph.D. & Jeremiah Buhler, B.A.

This study examines treatment retention among users of an online, ACT-based treatment for chronic pain that was designed specifically for military, Veterans, and related personnel. Forty-four individuals presenting with chronic pain were offered the opportunity to participate in the 8-session online program. Ninety-five percent chose to participate, but of those, only 71% were deemed to have completed the program, and only 57% completed a pre-determined minimum benchmark number of online homework assignments. Differences in characteristics of completers versus non- completers were examined (e.g. active military vs. Veteran, presence of PTSD, presence of other comorbid diagnoses), and factors that impacted on the likelihood of successfully completing the program were identified (e.g. completion of online assignments, participation in a supplementary group). Of all the factors examined, participation in supplementary group-based sessions had the greatest impact upon retention and successful completion of the program.

#14 Child Abuse History and Suicidality among Military and RCMP at an Outpatient Mental

Health Clinic.

Pamela L. Holens, PhD., Kristen Klassen, Ph.D. & Sarah Chaulk, Psy.D.

The Winnipeg Operational Stress Injury Clinic is an outpatient mental health clinic serving current and veteran members of the Canadian Military and Royal Canadian Mounted Police (RCMP). The purpose of the current study was to examine the potential relationship between suicidal behaviors and a history of childhood abuse in this population. Data was obtained through information provided by clients during their intake interview at the clinic. Multiple logistic regressions were conducted to determine associations between childhood abuse and suicidal ideation, parasuicidal behaviors, and suicide attempts. Results indicated that those with a childhood history of abuse were twice as likely as those who reported no abuse history to have made a suicide attempt at least once during their lifetime. These results are consistent with general population data which suggests that adults who suffered abuse or other negative early childhood experiences are between two and five times more likely than their peers to attempt suicide.

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#15 Stepped-care Model of Psychological Screening and Treatment among Individuals with Type 2 Diabetes Mellitus.

AnnaMarie Carlson, Ph.D.

INTRODUCTION: Rates of anxiety and depression are higher among individuals with diabetes and have been linked to poorer diabetes control (Lloyd et al., 2000). The CDA (2013) endorsed psychological symptom screening. The purpose of the current investigation is to evaluate the effectiveness of a stepped care psychological screening and referral process in a community health care setting. METHOD: Sixty-five individuals with Type 2 Diabetes Mellitus completed the K10 distress scale. Individuals in the moderate range were invited to attend a stress management and/or relaxation class; those in the high range were screened by a psychologist and offered treatment. RESULTS: At the initial screen, rates of distress were higher than expected in the community using the K10 (ABS, 2003). At 3-month follow-up, distress scores were significantly lower, with a shift to majority of individuals scoring in low range (75% vs. 55% initially). Percentage of those in the high group remained the same (14% vs 11% at follow-up). There was a trend that individuals who had treatment with psychologist had lower scores at follow-up that those who did not. DISCUSSION: Results suggest that having a diabetes diagnosis can increase psychological distress and that this may resolve with minimal intervention, but individuals with high distress may require additional service. Results are discussed in terms of challenges in including psychologically based programming in health care.

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#16 Effect of Probable Eating Disorders on Clinical Presentation and Treatment Outcome

Among OCD Patients in Intensive Residential Treatment.

Christine Henriksen, PhD., Lauryn Garner, B. A., Nathaniel Van Kirk, Ph.D., Jason Krompinger, Ph.D., Eric Tifft, B. A., Jesse Crosby, Ph.D., Brian Brennan, M.D., Jason Elias, Ph.D.

Obsessive-compulsive disorder (OCD) and eating disorders (EDs) commonly co-occur and may share etiologic underpinnings. While much research has examined the prevalence and impact of OCD among individuals with EDs, much less research has examined the impact of co-occurring EDs among individuals with OCD. We sought to understand the influence of co-occurring EDs on the clinical presentation and treatment outcome of individuals with severe and treatment-refractory OCD in intensive residential treatment (IRT). Method: We utilized the SCOFF screening instrument to detect probable cases of EDs among patients with a primary OCD diagnosis upon admission to IRT for OCD (N=348, ages 16-79). Participants completed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Obsessive Beliefs Questionnaire, and Hamilton Depression Rating Scale at admission, discharge, and 1-month follow-up. Results: Sixty- seven (19%) patients screened positive for a probable ED at admission and the majority of these individuals (55%) no longer scored above the cut-off for a probable ED at discharge. Independent sample t-tests found that compared to those without a probable ED at admission, patients with a probable ED had higher Y-BOCS scores (t(345)=-3.37, p=.001), stronger obsessive beliefs (t(345)=-4.32, p<.001), and greater depression severity (t(346)=-3.68, p<.001) at admission. Although individuals who had a probable ED at admission had higher Y-BOCS scores at discharge (t(279)=-2.21, p=.028), they did not differ from those without a probable ED in terms of change scores on the Y- BOCS (t(279)=0.79, p=.432) and the proportion of individuals who responded to the treatment (defined as ≥35% reduction in Y-BOCS; χ2(1)=1.13, p=.288). At the 1-month follow-up, probable ED cases did not significantly differ from non-cases on Y-BOCS total scores (t(132)=-1.35, p=.179) or Y-BOCS change scores (t(127)=0.49, p=.622) from discharge to 1-month follow-up. Conclusion: These results suggest that while individuals with co-occurring OCD and EDs are more severe upon admission to IRT, they show a similar response to treatment, making IRT an effective treatment option for these individuals. In addition, it appears that IRT targeting OCD symptoms may have an indirect positive impact on ED symptoms during treatment. Further research is needed to understand the relationship between OCD treatment and change in ED symptoms for these individuals.

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#17 The Usefulness of the WISC-V in FASD Diagnostic Assessment.

Nicole Taylor, Ph.D. & Leah Enns, Ph.D.

The cognitive profiles of children with fetal alcohol spectrum disorder (FASD) and prenatal alcohol exposure obtained using the Wechsler Intelligence Scale for Children, 4th (WISC-IV) and 5th (WISC-V) Editions were compared to determine whether the WISC- V improves FASD diagnostic accuracy and to identify which indices provide the strongest predictive power. 122 children and adolescents matched for FASD diagnosis and assessed at the Manitoba FASD Centre were included (6-16 years, mean age= 9.49 (0.39); 60.7% boys). The samples were comparable across socio-demographic variables (e.g., age, sex). Core indices on the WISC-IV and WISC-V and ancillary indices on the WISC-V were analyzed using logistic regressions to assess whether they increased the probability of accurately diagnosing FASD. While all models were significant, there were telling and significant differences in how much each index on each test improved the probability of an accurate FASD diagnosis. Results suggest that both the WISC -IV and WISC-V are predictive of an FASD diagnosis; however, the WISC-V appears to have equivalent predictive utility with fewer subtests. The predictive value of the WISC-IV appeared to be based on verbal reasoning skills, while the WISC-V aligns more with deficits in spatial reasoning, executive functioning skills, and information processing.

#18 How do you solve a problem like my envy? Examining self-affirmation as a potential

envy-reducing strategy.

Darren C. Neufeld, M.A. & Edward A. Johnson, Ph.D.

Envy is a toxic emotion that emerges in response to threatening perceptions of others possessing undeserved benefits and is detrimental to one's health and wellbeing (Smith, Combs, & Thielke, 2008). Brief self-affirmation interventions have demonstrably reduced a range of self-integrity threats and defensive processing (Cohen & Sherman, 2014) and may plausibly attenuate envy reactions. To investigate this hypothesis, undergraduate participants completed online dispositional measures one week prior to completing either a brief self-affirmation or control essay (Cohen, Aronson, & Steele, 2000). Subsequently, pairs of participants were exposed to threat from a primarily unsolvable intelligence test. All participants were also exposed to envy-inducing stimuli, namely being ostensibly outperformed by their opponent and being told they received inferior monetary payouts across a competitive Prisoner's Dilemma game. Results showed that affirmed participants reported lower envy toward their ostensibly smarter rival and reported greater use and helpfulness of recommended strategies (but not lower envy) when recalling their most intense recent envy-inducing experience at one- month follow-up, relative to controls. Potential mediators and moderators of self- affirmation effects are discussed.

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#19 Factors Associated with Dementia Diagnosis in a Mild Cognitive Impairment Clinic.

Colleen Millikin, Ph.D. & Lesley Koven, Ph.D.

The Early Cognitive Change Clinic for Older Adults (ECCCOA) seeks to provide assessment and group intervention for people with mild cognitive impairment, but many patients present with dementia. We aimed to identify factors associated with dementia diagnosis in ECCCOA. Patients diagnosed with MCI or dementia, based on ECCCOA assessment, were compared with respect to demographic variables, referral source (family medicine [physician/nurse practitioner] vs. specialist physician [neurologist/psychiatrist/geriatrician]), and MMSE and/or MOCA scores. Of 78 patients, 29 (37.2%) were diagnosed with MCI and 30 (38.5%) with dementia. Patients with dementia (PWD) were more likely to be female. Age and education were similar. Half of patients with MCI (PWM) were referred by family medicine and half by specialist physicians (10/10). Family medicine referrals were more common in PWD (17/7; not statistically significant). Mean MMSE did not differ (PWM: 27.2, PWD: 26.8). Among patients with MOCA scores, PWM performed better (23.7) than PWD (21.1). In those with both MMSE and MOCA, the difference score (MMSE-MOCA) was significantly higher among PWD (6.1) vs. PWM (3.0). The trend toward disproportionate PWD referrals from family medicine suggests a need for CME regarding diagnosis of MCI/dementia. The MMSE-MOCA disparity score may help identify individuals with early stage dementia.

#20 Forensic psychology practice in Canada: A survey of current practices and attitudes

among clinical forensic psychologists.

David Hill, Psy.D. & Sabrina Demetrioff, Ph.D.

In this study, we conducted an online survey of clinical-forensic psychologists in Canada. The main goal of the study was to obtain an overview of the demographic characteristics, education, and clinical training of Canadian psychologists in forensic practice. In addition, we gathered information about current clinical practices, types of forensic psychological assessments, and interdisciplinary practice issues. Our sample included 110 participants (52% female, 48% male) from 10 Canadian provinces. Participants’ ages ranged from 27-75 (M = 46.57, SD = 11.62) and the sample was predominantly Caucasian (94%). There was a wide range of years of experience since completion of highest degree (range = 1-45 years). Results revealed that 38% of participants reported working in correctional facilities, 17% in private practice, 16% in forensic hospitals, and 11% in outpatient forensic clinics. 71% of respondents indicated that they were part of a multidisciplinary team. Regarding assessment practices, the most common types of evaluations were violence risk assessments (70%), general risk assessments (54%), and presentence assessments (30%). The majority of participants (91%) endorsed a desire for more opportunities for forensic psychology continuing

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education in Canada. We will discuss the implications of the results for clinical-forensic practice and training in forensic psychology.

#21 Memory improvement following brief CBT for maladaptive beliefs about memory in

compulsive checkers

Gillian Alcolado, Ph.D., Kelsey Hannon, B.A. & Adam S. Radomsky, Ph.D.

There has been debate as to whether obsessive-compulsive checking is caused by a memory deficit, or by distorted cognitions. Neuropsychological studies examining visual and auditory memory in individuals with obsessive-compulsive disorder (OCD) have yielded mixed results. The cognitive theory of checking posits that beliefs about memory, rather than poor memory, may drive checking behaviour. Thus it is possible that these maladaptive beliefs have also produced poor test results. If this were the case, then when these maladaptive beliefs are altered through treatment, performance should improve. The current study examined changes in memory performance following a brief cognitive-behavioural intervention targeting maladaptive beliefs about memory. We hypothesized that verbal and visual memory scores would improve for individuals who received a component of treatment designed to enhance maladaptive beliefs about memory, as compared to those who were waitlisted. Participants (N = 24) who met diagnostic criteria for OCD and who exhibited clinically significant levels of checking were randomly assigned to a waitlist condition or to immediately receive two weekly therapy sessions. At pre- and post-assessment time points participants completed alternate versions of the Rey Complex Figure Task and the Rey Auditory Verbal Learning Test to assess visual and auditory memory, respectively. Results revealed a significant interaction between condition and time and time, F(1,21) = 5.980, p = .023, ηp

2 = .222, such that the immediate condition improved their performance on a visual memory task over the pre- to post-assessment period, but the waitlist condition did not. However, there were no changes in verbal memory over the same time period, with respect to time, condition, or an interaction (all p’s > 0.10). Results will be framed with respect to implications for cognitive-behavioural theories of and interventions for OCD and compulsive checking.

#22 Distraction Use During CBT: Do Beliefs About the Importance of Distraction Matter?

Jessica Senn, PhD & Adam Radomsky, PhD

Numerous studies have investigated the use of distraction during exposure therapy for anxiety. Although some studies have found that distraction interferes with exposure, others have found that it enhances treatment outcome. It is therefore important to determine why studies in this area lead to such discrepant results, and what factors might relate to whether distraction is beneficial or countertherapeutic. One potentially relevant factor is the impact of individual differences in beliefs about the importance of distraction (a factor that is not typically assessed in distraction studies) on exposure outcome. Specifically, it would be helpful to know whether distraction use is more or less effective during CBT based on how much an individual typically relies on distraction when anxious. We hypothesized that individuals who typically see distraction as necessary to deal with anxiety will not benefit as much from exposure when it

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incorporates distraction. In the current study, participants (n = 39, projected n = 92) with subclinical levels of contamination fear completed a questionnaire assessing beliefs about distraction use, the Function of Distraction Scale (FODS). The FODS includes items related to how important, necessary, and effective the respondent views distraction to be when dealing with anxiety. Participants then completed a 20-minute exposure to a contaminant with either no distraction or distraction (which could include low, moderate, or high levels of distraction, which was manipulated for the purpose of a larger study). For individuals who were assigned to use any level of distraction, beliefs about the utility/necessity of distraction when anxious (high scores on the FODS) were negatively correlated with treatment outcome (as measured by change in approach on a behavioral approach test), r = -.57, p = .001. For individuals who did not use distraction during exposure, beliefs about distraction had no impact on exposure outcome, r = -.11, p = .77. Results will be discussed in terms of cognitive-behavioral treatments for anxiety disorders.

#23 An informational pathway to the development of memory bias for threat in the

presumed absence of attentional bias

Jessica Senn, PhD, Adam Radomsky, PhD, Monique Lahoud, PhD, & Laurie Gelfand, PhD

Attentional bias for threat is well supported in the literature; however, research on memory bias for threat has been somewhat inconsistent. These inconsistencies are likely due to a lack of ecologically valid protocols in many earlier studies. With recent research employing more ecologically valid protocols, memory bias for threat has now been observed for a variety of threatening stimuli (see Mitte, 2008 for a review). An important theoretical question remains, namely whether memory bias for threat is only observed due to an attentional bias at encoding. In one previous study, Senn and Radomsky (2012) showed that a memory bias for threat could be produced in the presumed absence of attentional bias by adding threat through both information and direct experience following the initial learning of neutral objects. The current study aimed to evaluate whether a memory bias for threat could develop in the presumed absence of attentional bias, through informational means alone. A vignette about working on a classroom project with two other students was read to participants (N = 96), and their memory for the information and items mentioned in this vignette was tested. The experimenter then provided one additional sentence to the vignette that they had “forgotten” the first time. Half of the participants heard a sentence that made some items in the vignette become threatening (one student who had touched many items during the vignette actually had the flu), and the other half heard a sentence that was neutral (one student in the vignette got into graduate school). Memory for the information and items in the vignette was then tested a second time. Participants who were provided threatening information showed a proportionate memory bias for threat- related items compared to participants who received neutral information, F(1, 93) = 7.12, p = .01. This memory bias for threat-related items was not present at the first memory test, F(1, 94) = 0.00, p = .99. Results will be discussed in terms of pathways to fear development and cognitive-based approaches to understanding and treating anxiety disorders.

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#24 Maladaptive Beliefs about Distraction: Why Are They Important and How Can They Be Measured?

Jessica Senn, PhD & Adam Radomsky, PhD

Numerous studies have investigated the impact of distraction use on exposure outcome in the treatment of anxiety, with mixed results. However, very few studies have attempted to consider other factors that may be related to these discrepant results, such as the type of distraction that is employed or individual differences (e.g., coping style, personality, etc.). One potentially important factor may be the beliefs an individual holds about the importance of using distraction when anxious. For example, it is possible that if an individual tends to believe that distraction is necessary in order for them to be able to engage with exposure (or cope with anxiety, more generally), it may be better to advise against distraction use for this individual; whereas if an individual does not hold such beliefs, distraction use may be less detrimental to outcome. In order to better understand the relationship between beliefs about distraction and exposure outcome, a reliable and valid measure of these beliefs is needed. The current study aimed to create and validate a measure of maladaptive beliefs about distraction (i.e., that distraction is necessary to be able to cope with anxiety), namely the Beliefs about Distraction Inventory (BADI). An exploratory factor analysis was conducted with an unselected student sample (N = 475). The resulting two-factor solution accounted for 51% of the variance in the sample, and included two interpretable subscales: ‘Distraction is Necessary’ and ‘Distraction is Effective’. Convergent and divergent validity were strongly established, and BADI scores also correlated with symptoms of anxiety and depression. Internal consistency was excellent, α = .95, and scores were stable over time, with excellent retest reliability after a four week delay, r = .81, p < .001. Results will be discussed in terms of associations of the BADI with other measures, relevance to anxiety disorders and cognitive-behavior therapy, and the importance of being able to accurately measure this construct.

#25 The Impact of Level of Distraction on Exposure Outcome in a Contamination-Fearful

Sample

Jessica Senn, PhD & Adam Radomsky, PhD

Introduction: Cognitive behaviour therapy is an effective treatment for anxiety that often involves exposure to feared stimuli. Early theories of fear reduction posit that using distraction during exposure will interfere with treatment outcome; therefore, distraction has historically been discouraged during exposure. Recent research suggests that distraction may not in fact be countertherapeutic, which is especially important given high rates of treatment refusal and drop-out: incorporating distraction during exposure may increase treatment acceptability without reducing treatment benefits. Previous studies investigating distraction use in exposure have used a wide variety of distraction tasks, leading to difficulties drawing definitive conclusions. The current study therefore aimed to investigate the impact of differing levels of distraction on exposure outcome. We predicted that moderate levels of distraction would facilitate

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fear reduction while high levels of distraction would interfere, and that using distraction would lead to greater treatment acceptability and changes in self-efficacy. Method: Participants (n = 121) were assigned to one of four conditions: no, low, moderate, or high distraction. Behavioural approach (a measure of fear based on willingness to approach a feared stimulus) and self-efficacy were measured before and after a 20- minute exposure and at one-week follow-up. Treatment acceptability was measured immediately following the exposure. Results: Behavioural approach increased for all conditions pre- to post-exposure, F(1, 120) = 125.27, p < .001, and post-exposure to follow-up, F(1, 117) = 20.01, p < .001; however, there were no significant time by condition interactions. Self-efficacy increased pre- to post-exposure in all conditions, F(1, 120) = 43.11, p < .001, and there was also a significant time by condition interaction, F(3, 120) = 3.40, p = .020, with more significant increases for individuals using moderate distraction; there were no changes over the follow-up period. Treatment acceptability differed significantly across conditions, F(3, 123) = 7.23, p < .001, with the moderate and high distraction conditions rating the treatment as more acceptable. Conclusions: Distraction, at any level, may not have a negative impact on treatment outcome, and is effective in increasing self-efficacy and treatment acceptability. Distraction use during exposure may therefore be helpful in reducing treatment refusal and drop-out rates.

#26 A Descriptive Study: What cancer patients want to know about sleep problems.

Norah Vincent, PhD., Cheryl Harris, PhD., & J. B. Lee,

Insomnia is a common effect of cancer and its treatment. More than 25% of cancer survivors meet diagnostic criteria for insomnia disorder (Savard, Simard, Blanchet, Ivers, & Morin, 2001; Davidson, MacLean, Brundage, & Schulze, 2002; Mao et al., 2007), a rate at least two times higher than that of the general population (Morin, LeBlanc, Daley, Gregoire, & Merette, 2006). Despite the pervasiveness of the problem, insomnia is underdiagnosed and undertreated in cancer survivors, resulting in significant suffer ing and associated consequences such as fatigue, cognitive issues, mood disturbance, functional disability, decreased quality of life, and immunosuppression (Davidson, MacLean, Brundage, & Schulze, 2002; Savard, Simard, Ivers, & Morin, 2005; Howell et al., 2014). The current research describes psychoeducational information pertinent to sleep among cancer patients which is currently being delivered as part of a randomized controlled trial. The content covered includes the causes of insomnia, the link between cancer and disturbed sleep, sleep medications, the relationships between sleep, anxiety, depression, and pain, age-related changes in sleep and sleep disorders, and complementary medicine approaches to insomnia (e.g., chamomile, valerian and kava).