Gard, D. E., Pleet, M. M., Bradley, E. R., Penn, A., Gallenstein, M. L., Riley, L. S., DellaCrosse, M., Garfinkle, E., Michalak, E. E., & Woolley, J. D. (2021). Evaluating the risk of psilocybin for the treatment of Bipolar depression: A review of the research literature and published case studies. Journal of Affective Disorders Reports, 6. https://doi.org/10.1016/j.jadr.2021.100240
ABSTRACT: Growing evidence suggests that psilocybin, the active ingredient in hallucinogenic mushrooms, can rapidly and durably improve symptoms of depression, leading to recent breakthrough status designation by the FDA and legalization for mental health treatment in some jurisdictions. Depression in bipolar disorder is associated with significant morbidity and has few effective treatments. However, there is little available scientific data on the risk of psilocybin use in people with bipolar disorder. Individuals with bipolar disorder have been excluded from modern clinical trials, out of understandable concerns of activating mania or worsening the illness course. As psilocybin becomes more available, people with these disorders will likely seek psilocybin treatment for depression and have likely already been doing so in unregulated settings. Our goal here is to summarize the known risks of psilocybin use (and similar substances) in bipolar disorder and to systematically evaluate examples of published case history data, in order to critically evaluate the relative risk of psilocybin as a treatment for bipolar depression. We found 17 cases suggesting that there is potential risk for activating a manic episode, thereby warranting caution. Nonetheless, the relative lack of systematic data or common case examples indicating risk appears to show that a cautious trial, using modern trial methods focusing on appropriate ‘set’ and ‘setting’, targeted at those lowest at risk for mania in the bipolar spectrum (e.g., bipolar 2 disorder), is very much needed, especially given the degree to which depression impacts this population.
Gard, D. E., & Leung, L. N. (2021). How Meaning Is Made: Ambiguity Tolerance as a Central, Operationalizable Concept for Psychotherapy Integration. International Journal of Integrative Psychotherapy, 11(1), 97-123.
ABSTRACT: Ambiguity tolerance has been defined as the ability and skill to hold multiple interpretations and meanings of experience in mind simultaneously. Whereas many effective psychotherapy theoretical approaches appear conflicting and disparate in their focus (e.g., unconscious processes, cognitive distortions, reinforcement, radical acceptance, narratives, emotion regulation, etc.), all work to help individuals expand their understanding of their experiences, that is, to not rely on simplistic, overly personalized interpretations of meaning. This article asserts that successful therapeutic approaches essentially work to increase clients’ tolerance of ambiguity (albeit from different perspectives), thereby encouraging them to see the complexity and nuance of their situation rather viewing it as simple, black and white, either/or, or easily understood. Thus, all theoretically grounded forms of psychotherapy increase clients’ ability to avoid harm and increase connectedness and growth by helping them broaden their understanding of their past experiences and their current stressors. In spite of this overlap in theoretical models of psychotherapy, it can be difficult to know how to operationalize these similarities in approaches. The authors argue that ambiguity tolerance is a common mechanism in psychotherapy and can be easily operationalized through existing (and user-created) measures. The literature on ambiguity tolerance and related constructs is reviewed, and the authors suggest that greater attention to ambiguity tolerance (as a predictor of individual success and a broader mechanism of change in psychotherapy) will allow for more powerful and effective approaches to psychotherapy as well as greater theoretical integration.
Mote, Jasmine & Gard, David & Gonzalez, Rachel & Fulford, Daniel. (2019). How did that interaction make you feel? The relationship between quality of everyday social experiences and emotion in people with and without schizophrenia. PLOS ONE. 14. e0223003. 10.1371/journal.pone.0223003.
ABSTRACT: People with schizophrenia report positive emotion during social interactions in ecological momentary assessment (EMA) studies; however, few of these studies examine the qualities of social interactions (e.g., intimacy) that may affect emotion experience. In the current EMA study, people with (n = 20) and without schizophrenia (n = 15) answered questions about the quality of their social interactions, including their emotion experiences. We also explored the relationship between EMA-reported social experiences and trait loneliness, negative symptoms, and social functioning. People with and without schizophrenia did not differ in EMA-reported proportion of time spent with others, extent of involvement during social interactions, intimacy of interactions, or average number of social interactions. Both people with and without schizophrenia reported more positive than negative emotion during social experiences. However, people with schizophrenia reported more loneliness, more severe negative symptoms, and impaired social functioning compared to people without schizophrenia. Further, specific qualities of social interactions (intimacy of interaction, involvement during interaction) were related to happiness during interactions only in people without schizophrenia. These results suggest that while people with and without schizophrenia report similar rates of in-the-moment social emotion experiences, the impact of social interaction quality on emotion may differ between groups.
Campellone, Timothy & Truong, Brandy & Gard, David & Schlosser, Danielle. (2018). Social motivation in people with recent-onset schizophrenia spectrum disorders. Journal of Psychiatric Research. 99. 10.1016/j.jpsychires.2018.01.006.
ABSTRACT: People with schizophrenia-spectrum disorders (SSD) often experience impairments in non-social motivation. In this study, we extended this line of investigation by examining specific components of social motivation and the extent to which these components work together in people with and without a recent-onset SSD. Sixty-four people with a recent-onset SSD and 26 controls completed a task that allowed us to examine changes in anticipated pleasure, decisions to trust, and effort expenditure over the course of repeated interactions with positive or negative outcomes. Compared to controls, we found that people in the SSD group placed less trust, tended to anticipate less pleasure, and expended less effort to increase the likelihood of future interactions with positive outcomes. Further, in the SSD group, effort expenditure was not associated with either anticipated pleasure or decisions to trust. While there were no group differences in anticipated pleasure or trust placed during interactions with negative outcomes, people in the SSD group expended less effort to decrease to the likelihood of future interactions. Taken together, our findings suggest that people with a recent-onset SSD may experience both impairment and disconnection between various components of social motivation for interactions with positive outcomes. Implications for interventions for social engagement in people with SSD are discussed.
Gard, D. E., Kring, A. M., Gard, M. G., Horan, W. P., & Green, M. F. (2007a). Anhedonia in schizophrenia: Distinctions between anticipatory and consummatory pleasure. Schizophrenia Research, 93(1–3), 253–260. https://doi.org/10.1016/j.schres.2007.03.008
ABSTRACT: Research on anhedonia in schizophrenia has revealed mixed results, with patients reporting greater anhedonia than healthy controls on self-report measures and semi-structured interviews, but also reporting comparable experiences of positive emotions in response to pleasurable stimuli. Basic science points to the importance of distinguishing between anticipatory and consummatory (or in-the-moment) pleasure experiences, and this distinction may help to reconcile the mixed findings on anhedonia in schizophrenia. In two studies, we tested the hypothesis that anhedonia in schizophrenia reflects a deficit in anticipatory pleasure but not consummatory pleasure. In Study 1, we used experience sampling methodology to assess reported experiences of consummatory and anticipated pleasure among schizophrenia patients and controls. In Study 2, schizophrenia patients and controls completed a self-report trait measure of anticipatory and consummatory pleasure and interviews that assessed negative symptoms, including anhedonia, and community functioning. In both studies, we found evidence for an anticipatory but not a consummatory pleasure deficit in schizophrenia. In addition, anticipatory pleasure was related to clinical ratings of anhedonia and functional outcome. Clinical and research implications of these findings are discussed.
Gard, D. E., Sanchez, A. H., Starr, J., Cooper, S., Fisher, M., Rowlands, A., & Vinogradov, S. (2014b). Using self-determination theory to understand motivation deficits in schizophrenia: The “why” of motivated behavior. Schizophrenia Research, 156(2–3), 217–222. https://doi.org/10.1016/j.schres.2014.04.027
ABSTRACT: Self-determination theory (SDT) provides a model for understanding motivation deficits in schizophrenia, and recent research has focused on problems with intrinsic motivation. However, SDT emphasizes that motivated behavior results from three different factors: intrinsic motivators (facilitated by needs for autonomy, competency, and relatedness), extrinsic motivators (towards reward or away from punishment), or when intrinsic and extrinsic motivators are absent or thwarted a disconnect-disengagement occurs resulting in behavior driven by boredom or 'passing time'. Using a novel approach to Ecological Momentary Assessment, we assessed the degree to which people with schizophrenia were motivated by these factors relative to healthy control participants. Forty-seven people with and 41 people without schizophrenia were provided with cell phones and were called four times a day for one week. On each call participants were asked about their goals, and about the most important reason motivating each goal. All responses were coded by independent raters (blind to group and hypotheses) on all SDT motivating factors, and ratings were correlated to patient functioning and symptoms. We found that, relative to healthy participants, people with schizophrenia reported goals that were: (1) less motivated by filling autonomy and competency needs, but equivalently motivated by relatedness; (2) less extrinsically rewarding, but equivalently motivated by punishment; (3) more disconnected-disengaged. Higher disconnected-disengaged goals were significantly associated with higher negative symptoms and lower functioning. These findings indicate several important leverage points for behavioral treatments and suggest the need for vigorous psychosocial intervention focusing on autonomy, competence, and reward early in the course of illness.
Gard, D. E., Fisher, M., Garrett, C., Genevsky, A., & Vinogradov, S. (2009). Motivation and its Relationship to Neurocognition, Social Cognition, and Functional Outcome in Schizophrenia. Schizophrenia Research, 115(1), 74–81. https://doi.org/10.1016/j.schres.2009.08.015
ABSTRACT: A burgeoning area of research has focused on motivational deficits in schizophrenia, producing hypotheses about the role that motivation plays in the well-known relationship between neurocognition and functional outcome. However, little work has examined the role of motivation in more complex models of outcome that include social cognition, despite our increased understanding of the critical role of social cognition in community functioning in schizophrenia, and despite new basic science findings on the association between social cognitive and reward processing in neural systems in humans. Using path analysis, we directly contrasted whether motivation 1) causally influences known social cognitive deficits in schizophrenia, leading to poor outcome or 2) mediates the relationship between social cognitive deficits and outcome in this illness.
Cooper, S., Lavaysse, L. M., & Gard, D. E. (2015). Assessing motivation orientations in schizophrenia: Scale development and validation. Psychiatry Research, 225(1–2), 70–78. https://doi.org/10.1016/j.psychres.2014.10.013
ABSTRACT: Motivation deficits are common in several disorders including schizophrenia, and are an important factor in both functioning and treatment adherence. Self-Determination Theory (SDT), a leading macro-theory of motivation, has contributed a number of insights into how motivation is impaired in schizophrenia. Nonetheless, self-report measures of motivation appropriate for people with severe mental illness (including those that emphasize SDT) are generally lacking in the literature. To fill this gap, we adapted and abbreviated the well-validated General Causality Orientation Scale for use with people with schizophrenia and with other severe mental disorders (GCOS-clinical populations; GCOS-CP). In Study 1, we tested the similarity of our measure to the existing GCOS (using a college sample) and then validated this new measure in a schizophrenia and healthy control sample (Study 2). Results from Study 1 (N=360) indicated that the GCOS-CP was psychometrically similar to the original GCOS and provided good convergent and discriminant validity. In Study 2, the GCOS-CP was given to individuals with (N=44) and without schizophrenia (N=42). In line with both laboratory-based and observer-based research, people with schizophrenia showed lower motivational autonomy and higher impersonal/amotivated orientations. Additional applications of the GCOS-CP are discussed.
Gard, D. E., Sanchez, A. H., Cooper, K., Fisher, M., Garrett, C., & Vinogradov, S. (2014a). Do people with schizophrenia have difficulty anticipating pleasure, engaging in effortful behavior, or both? Journal of Abnormal Psychology, 123(4), 771–782. https://doi.org/10.1037/abn0000005
ABSTRACT: Motivation deficits are common in schizophrenia, but little is known about underlying mechanisms, or the specific goals that people with schizophrenia set in daily life. Using neurobiological heuristics of pleasure anticipation and effort assessment, we examined the quality of activities and goals of 47 people with and 41 people without schizophrenia, utilizing ecological momentary assessment. Participants were provided cell phones and called 4 times a day for 7 days, and were asked about their current activities and anticipation of upcoming goals. Activities and goals were later coded by independent raters on pleasure and effort. In line with recent laboratory findings on effort computation deficits in schizophrenia, relative to healthy participants, people with schizophrenia reported engaging in less effortful activities and setting less effortful goals, which were related to patient functioning. In addition, patients showed some inaccuracy in estimating how difficult an effortful goal would be, which in turn was associated with lower neurocognition. In contrast to previous research, people with schizophrenia engaged in activities and set goals that were more pleasure-based, and anticipated goals as being more pleasurable than controls. Thus, this study provided evidence for difficulty with effortful behavior and not anticipation of pleasure. These findings may have psychosocial treatment implications, focusing on effort assessment or effort expenditure. For example, to help people with schizophrenia engage in more meaningful goal pursuits, treatment providers may leverage low-effort pleasurable goals by helping patients to break down larger, more complex goals into smaller, lower-effort steps that are associated with specific pleasurable rewards.
Genevsky, A., & Gard, D. E. (2012). The effect of choice on the physiology of emotion: An affective startle modulation study. International Journal of Psychophysiology, 84(1), 80–85. https://doi.org/10.1016/j.ijpsycho.2012.01.013
ABSTRACT: The affective startle modulation task has been an important measure in understanding physiological aspects of emotion and motivational responses. Research utilizing this method has relied primarily on a 'passive' viewing paradigm, which stands in contrast to everyday life where much of emotion and motivation involves some active choice or agency. The present study investigated the role of choice on the physiology of emotion. Eighty-four participants were randomized into 'choice' (n=44) or 'no-choice' (n=40) groups distinguished by the ability to choose between stimuli. EMG eye blink responses were recorded in both anticipation and stimulus viewing. Results indicated a significant attenuation of the startle magnitude in choice condition trials (relative to no-choice) across all picture categories and probe times. We interpret these findings as an indication that the act of choice may decrease one's defensive response, or conversely, lacking choice may heighten the defensive response. Implications for future research are discussed.
Kross, E., Gard, D., Deldin, P., Clifton, J., & Ayduk, O. (2012a). “Asking Why” From a Distance: Its Cognitive and Emotional Consequences for People With Major Depressive Disorder. Journal of Abnormal Psychology, 121(3), 559–569. https://doi.org/10.1037/a0028808
ABSTRACT: Although analyzing negative experiences leads to physical and mental health benefits among healthy populations, when people with depression engage in this process on their own they often ruminate and feel worse. Here we examine whether it is possible for adults with depression to analyze their feelings adaptively if they adopt a self-distanced perspective. We examined this issue by randomly assigning depressed and nondepressed adults to analyze their feelings surrounding a depressing life experience from either a self-distanced or a self-immersed perspective and then examined the implications of these manipulations for depressotypic thought accessibility, negative affect, implicit and explicit avoidance, and thought content. Four key results emerged. First, all participants were capable of self-distancing while analyzing their feelings. Second, participants who analyzed their feelings from a self-distanced perspective showed lower levels of depressotypic thought accessibility and negative affect compared to their self-immersed counterparts. Third, analyzing negative feelings from a self-distanced perspective led to an adaptive shift in the way people construed their experience--they recounted the emotionally arousing details of their experience less and reconstrued them in ways that promoted insight and closure. It did not promote avoidance. Finally, self-distancing did not influence negative affect or depressotypic thought accessibility among nondepressed participants. These findings suggest that whether depressed adults' attempts to analyze negative feelings lead to adaptive or maladaptive consequences may depend critically on whether they do so from a self-immersed or a self-distanced perspective.