The emergence of generative artificial intelligence (GenAI) presents new opportunities for enhancing exposure therapy for anxiety- and trauma-related disorders. GenAI is not a replacement for clinical expertise but a powerful ancillary tool. This article offers practical guidance for clinicians and patients on how to use GenAI to develop and conduct personalized exposure exercises. To help orient clinicians to these tools, we provide an overview of ethical considerations and describe the fundamentals of how to use GenAI between and within sessions. We discuss how GenAI tools can assist in generating exposure stimuli, such as images, videos, and scripts, as well as conversational agents. We also provide guidance on how these tools can assist in brainstorming and organizing exposure hierarchies. Finally, we discuss how exposure therapy can continue to flourish using GenAI through clinician training, the exchange of GenAI stimuli and procedures, and clear messaging from leadership and organizations.

Telehealth has become a pillar for the delivery of psychotherapy, including exposure-based treatments for anxiety-related disorders. While research broadly supports the efficacy of telehealth-delivered anxiety treatments, clinicians and patients need to weigh the benefits and limitations to make informed decisions. This piece highlights the benefits of supporting continued use of telehealth exposure-based treatments, including access to specialized services, treatment efficiency, facilitation of naturalistic exposures, and family involvement. We also outline challenges related to building rapport, delivering psychoeducation, monitoring safety behaviors, and treating young children or individuals with complex presentations. Strengths and weaknesses are summarized in a checklist that can be used as a preliminary tool for clinicians and patients to assess the suitability of teletherapy. Additionally, we discuss gaps between efficacy and clinician perceptions of feasibility and identify future research directions, including examination of treatment moderators and development of triage frameworks to guide treatment format decisions. Teletherapy holds lasting promise for exposure-based care, but its implementation must be flexible, tailored, and informed by evidence and patient-specific factors.

Although exposure with response prevention (ERP) is the frontline treatment for obsessive-compulsive disorder (OCD), several challenges exist in its implementation. Emerging technologies, including mobile health (mHealth) apps and extended reality (XR), offer innovative solutions to overcome these challenges. In response, we surveyed OCD therapists to establish the utilization of emerging technologies in clinical practice and investigate accompanying barriers. A total of 223 therapists reported their use, interest, and perceived barriers regarding mHealth and XR tools in clinical practice. While 62.1% presently reported using mHealth apps-mostly mindfulness and mood tracking-fewer therapists used them for ERP-specific tasks. Despite high interest in XR by OCD therapists, only 9.1% had used XR in ERP. Barriers to technology utilization included lack of knowledge, limited training, and uncertainty about evidence to support use. Findings highlight a need for clinical resources, therapist training, and further research to determine how to optimize the implementation of ERP using novel technologies.

Obsessive-compulsive disorder (OCD) is a debilitating, often chronic condition with symptoms that are time-consuming and can cause distress or impairment. OCD can involve and have a significant impact on families. Although calls for family-inclusive treatment for OCD exist, results on its effectiveness are mixed. This case report presents Jane, a young adult with OCD in psychiatric residential treatment, and how her symptoms were profoundly affected and maintained in part by maladaptive family processes. Attachment-based family therapy is used in conjunction with exposure and response prevention to reduce Jane's symptoms, minimize family accommodations, address underlying family processes, and improve family dynamics. Treatment outcomes were assessed through standardized tools, clinician observations, and patient self-reports. By the conclusion of treatment, Jane saw reductions in OCD, anxiety, and depressive symptoms, an increase in well-being, and improved family communication. Implications and recommendations will be discussed.

Cognitive behavioral therapies are the first-line psychotherapeutics for fear-based conditions, including anxiety, obsessive-compulsive (OCD), and trauma-related disorders. Despite documented efficaciousness and effectiveness, various factors limit the availability of these evidence-based treatments. Technologies may be used to circumvent treatment barriers, improving access to care and optimizing treatments to address symptoms among those with fear-based conditions. Original research articles in this Special Issue include a study on provider use of digital mental health and extended reality technologies for the treatment of OCD; a stepped-care treatment study on trichotillomania, a condition highly comorbid with fear-based conditions; and a qualitative needs assessment for the development of a digital, trauma-informed, single-session intervention for foster caregivers. The Special Issue also includes two review pieces: one presenting treatment recommendations on generative artificial intelligence for exposure therapies and the second on treatment considerations for telehealth-delivered treatment for OCD.

Cognitive impairment is a core feature of schizophrenia, significantly affecting patients' daily functioning and quality of life. Cognitive rehabilitation nursing (CRN) has emerged as a promising nonpharmacological approach to improve cognitive deficits. This systematic review and meta-analysis aimed to evaluate the efficacy of CRN in enhancing cognitive function in patients with schizophrenia. A systematic literature search was conducted in Web of Science, PubMed, and Scopus for studies published between 2020 and 2025, using a combination of controlled vocabulary and free-text terms. Eligible studies were original, peer-reviewed articles examining CRN interventions in individuals with schizophrenia, with cognitive or functional outcomes. Fifteen studies comprising 19 intervention arms met the inclusion criteria. Methodological quality was assessed using the Cochrane RoB-2 (Risk of Bias 2) tool for randomized trials and ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) for nonrandomized studies. Standardized mean differences (SMDs) with Hedges' g correction were calculated under a random-effects model. Heterogeneity was examined using I² statistics, and publication bias was evaluated through funnel plots and Egger's test. A total of 19 intervention arms from 15 studies were included. Overall, cognitive rehabilitation yielded a small but favorable effect across cognitive domains (SMD = .35, = .084), with a significant moderate-to-large effect observed for executive function (SMD = 0.63, = .035), particularly in studies employing computerized, individualized, or virtual reality-based interventions. Effects on global cognition, memory, and functional outcomes were smaller and nonsignificant, while social cognition, assessed in one study, showed a small negative effect (SMD = -0.34, = .046). Pharmacological and game-based interventions showed inconsistent efficacy. Substantial heterogeneity was present (I² = 85.3%), with outcome domain emerging as a significant moderator ( < .001). Publication bias analysis indicated potential small-study effects, although no missing studies were identified via the trim-and-fill method. This meta-analysis supports the effectiveness of CRN in improving cognitive outcomes in schizophrenia, with the strongest effects on executive function. Targeted, multimodal, and tech-enhanced interventions showed the greatest promise. Despite heterogeneity, the findings were consistent, reinforcing CRN's role in multidisciplinary psychiatric care.

Youth in foster care exhibit behavioral and emotional challenges, often linked to complex trauma exposure. There is a paucity of accessible evidence-based interventions to support foster caregivers in addressing youths' needs. Self-guided, digital single-session interventions (SSIs) represent a promising solution. As the first phase of an intervention mapping project, we conducted a systematic, qualitative needs assessment with foster caregivers ( = 13) and child welfare providers ( = 6) to inform the design of a trauma-informed SSI for foster caregivers. A team-based, multistage analytic coding strategy guided by grounded theory principles and consisting of inductive and deductive approaches was used. Thematic content analysis and axial coding identified resulting themes. Three areas of challenges and desired support were identified, including validating foster caregivers and addressing systemic challenges, supporting caregivers in navigating foster care transitions, and addressing trauma and developmental challenges in foster youth. Implications for the design of a community-informed SSI are discussed.

Existential obsessions-persistent, intrusive doubts about unanswerable questions such as the nature of reality, identity, free will, and death-are an understudied and underrecognized presentation of obsessive-compulsive disorder (OCD). Although these symptoms align with core OCD features, their abstract and philosophical content distinguishes them from more commonly studied presentations. This article provides a conceptualization of existential obsessions, outlining their phenomenology, cognitive-behavioral underpinnings, and implications for assessment and treatment. We identify four primary content domains, namely, metaphysical, thanatological, ontological, and deterministic obsessions, and draw on established OCD models to explain their development and maintenance. Sociocultural and developmental influences are also highlighted. We then outline treatment recommendations based on the conceptual model and present a research agenda to address gaps in the literature, including the need for targeted assessment tools, empirical tests of proposed mechanisms, and treatment trials. Just as other manifestations of OCD have gained clarity through empirical study, existential obsessions merit scientific attention to enhance recognition and improve outcomes.

This study explores the distinct roles of religiosity and scrupulosity in relation to cognitive factors-obsessive beliefs, fear of self, and inferential confusion-across contact and mental contamination (MC). Unlike prior research, it examines how religiosity and scrupulosity differentially predict contamination concerns through these cognitive factors. A sample of 235 undergraduates (83.4% female, = 18.84 years) completed self-report measures assessing contamination types, scrupulosity, religiosity, fear of self, inferential confusion, and obsessive beliefs. Results showed that scrupulosity, compared with religiosity, was a stronger predictor of contamination, particularly MC, suggesting the importance of distinguishing between normative religious belief and pathological doubt. Fear of self and inferential confusion mediated the link between scrupulosity and MC, while inferential confusion alone mediated contact contamination. These findings highlight the distinct cognitive pathways underlying mental and contact contamination and emphasize the clinical relevance of targeting scrupulosity, fear of self, and inferential confusion-rather than religiosity-in interventions for contamination-related obsessive-compulsive disorder symptoms. Limitations include the sample's limited generalizability, cross-sectional design, and Western context, which may not fully capture cultural and religious influences.

The existing research on attachment has been predominantly limited to Western adult populations and parental attachment relationships, leaving significant gaps in our understanding of adolescent development. The present study addresses these limitations by investigating how insecure attachment to mothers, fathers, and peers is associated with psychological distress in early adolescence (grades 7-9), with particular attention to the mediating role of loneliness. This developmental period represents a critical window for intervention, as patterns of social-emotional adjustment established during early adolescence often persist into adulthood. Our sample comprised 813 junior high school students who completed three well-validated self-report measures: the Relationships Structures Questionnaire assessing attachment patterns; the University of California, Los Angeles Loneliness Scale measuring subjective social isolation; and the Depression Anxiety Stress Scales-21 evaluating psychological distress. Using structural equation modeling, we tested three mediation models to examine both direct and indirect pathways from insecure attachment to psychological distress through loneliness. The results revealed several important patterns: First, we observed moderate positive correlations between anxious and avoidant attachment styles ( = .38-.44), suggesting that these insecure attachment patterns frequently co-occur. Second, structural models demonstrated significant total effects of insecure attachment on psychological distress across most relationship figures, with the notable exception of avoidant peer attachment. Third, while both anxious and avoidant attachment positively predicted psychological distress, avoidant peer attachment exhibited a negative association with distress symptoms. Fourth, and most crucially, loneliness emerged as a significant mediator in all models, explaining substantial portions of the attachment-distress relationship. Gender, attachment style, and loneliness together explained 36%-38% of the variance in distress. These findings have important theoretical and practical implications. Theoretically, they extend attachment research beyond its traditional focus on parental relationships by demonstrating the unique and combined influences of multiple attachment figures during early adolescence. Practically, the robust mediating role of loneliness suggests that interventions targeting both attachment security and social connection may be particularly effective for reducing adolescent distress. We recommend that family education programs incorporate attachment-informed parenting strategies while school counseling interventions address peer relationships and loneliness directly.

Research has shown that disgust-based contamination obsessive-compulsive disorder (OCD) is often challenging to treat due to neurological and behavioral differences that can inhibit short-term habituation. This article presents a case study of using a novel functional approach to exposure and response prevention for disgust-based OCD focused on facilitating practice in avoided situations, incorporating concepts from acceptance and commitment therapy as well as emerging literature on using judicious safety behaviors to enable repeated practice. This case involves a 39-year-old male patient with disgust-based contamination OCD treated using this approach. Following a short course of psychotherapy combined with self-directed practice, the patient's measured level of OCD severity (Yale-Brown Obsessive Compulsive Scale) was reduced by 56% over a 5-month period, with the patient meeting remission at posttreatment.

This case illustrates the therapeutic effect of brief cognitive-constructive psychotherapy on an athlete struggling with harmful competitive anxiety. The case material was also later reinterpreted using the framework of schema therapy. The purpose of the intervention was to increase the client's self-awareness and understanding of the ways in which she perceives, understands, accepts, and interprets her beliefs. The focus of this case is on the athlete's personal harmful competitive anxiety and the change in beliefs and anxiety during and after therapy. The original analysis method used was assimilation analysis, and the reinterpretation was based on the reflection on the case material using concepts of schema therapy. The results support the introduction of both cognitive-constructive and schema therapy to help athletes manage their belief systems and harmful competitive anxiety. Treatment differences, effects, and recommendations are discussed.

Hoarding disorder is a highly stigmatized condition, and stigma toward hoarding may prevent treatment-seeking. This study investigated the degree to which modifiable cognitive and behavioral processes (i.e., empathy and psychological inflexibility) predict hoarding stigma. Young adults recruited from a large public university ( = 354) completed an initial baseline survey, and 322 completed a follow-up survey 4 weeks later. Perspective-taking was related to a lower desire for social distance and lower perceived difference, while stigma-related psychological flexibility was associated with lower perceived difference, disdain, and blame. Among a subsample with elevated hoarding symptoms, disdain was linked to greater self-reported willingness to use both in-person and self-help treatment. Perspective-taking and psychological flexibility may be useful targets for preventing or reducing hoarding stigma, particularly in young adults. Limitations include the use of a largely female and White college student sample.

Web-based services are essential for making psychiatric treatments more accessible. Evidence-based treatments, including cognitive behavioral therapy for panic disorder, should be disseminated to a broader segment of society. In our study, we developed a web-based cognitive behavioral psychoeducation program for panic disorder and evaluated its short-term effects in a clinical sample. The 4-week program was administered to 31 patients diagnosed with panic disorder, and related outcomes were assessed using the Panic Disorder Severity Scale (PDSS), Anxiety Sensitivity Index-3 (ASI-3), Health Anxiety Inventory Short Version (SHAI), and Adult Separation Anxiety Questionnaire (ASA). We found a statistically significant decrease in PDSS scores with a large effect size ( = 2.26, 95% CI [1.60, 2.92]). Significant reductions were also observed in ASI-3 ( = 1.18 95% CI [0.62, 1.74]), SHAI ( = 0.57, 95% CI [0.05, 1.10], and ASA scores ( = 1.28, 95% CI [0.72, 1.85]), with medium to large effect sizes. These results suggest that the intervention had a substantial impact on reducing panic-related symptoms in the short term. This approach may be a cost-effective option clinicians can recommend to their patients, particularly in low-resource settings.

The start of college is a powerful time of transition and development for emerging adults. There are many experiences involved with increasing independence and decreasing previous supports, changes in roles and identities, and the formation of new goals and connections. A more comprehensive view of mental health is needed to capture an evolving process that takes into account indicators of both distress and well-being. This article applies Bohlmeijer and Westerhoff's (2021) model of sustainable mental health to cross-sectional young adult risk behavior and mental health data from the Northeastern United States in Fall 2021 and considers loneliness, risk behaviors and self-harm, mental health distress, and flourishing in the context of this model. This research offers an initial application of a model that firmly considers distress and well-being as indicators of youth mental health. It is vital that there is an ongoing consideration to support youth and young adults that experienced the pandemic.

Well-being encompasses several dimensions of individuals' lives, so promoting well-being beyond economic performance is crucial. This study proposed a theoretical model that highlights psychological flexibility as a key to well-being by helping people find meaning in life and achieve flourishing. The study evaluated 636 adults from Lima, Peru, and found a negligible direct relationship between psychological flexibility and emotional (hedonic), psychological (eudaimonic), and social well-being. However, psychological flexibility directly predicted meaning in life and flourishing, indirectly promoting well-being. In conclusion, meaning in life and flourishing mediate the relationship between meaning in life and well-being. The study emphasizes the importance of psychological flexibility and meaning in promoting well-being, suggesting that interventions targeting psychological flexibility may indirectly support individuals in developing a sense of purpose and fulfillment. Positive psychology interventions should incorporate strategies that promote both psychological flexibility and the search for meaning, as they are essential for well-being.

Eating disorders are serious mental health conditions with significant negative health outcomes, high mortality rates, and comorbid mental health conditions. Despite many available interventions for eating disorders, treatment remains challenging due to the difficulty in maintaining treatment gains. Understanding effective treatment processes is crucial. This study aimed to examine the role of self-perception components in predicting eating disorder severity in a residential sample of women and girls. Participants ( = 175) completed measures assessing eating disorder severity, self-kindness, self-judgment, and self-esteem at admission. Correlational analyses and structural equation modeling were used to explore these relationships. Results indicated that self-judgment and self-esteem were significant predictors of eating disorder severity, while self-kindness was not. These findings highlight the importance of targeting self-judgment and self-esteem in treating eating disorders, suggesting potential areas for therapeutic focus to improve treatment outcomes. Further research is needed to refine transdiagnostic interventions for eating disorders and explore their efficacy across clinical settings.

According to cognitive theories, loneliness is associated with biased cognitive processes. However, studies investigating interpretation bias (IB) related to feelings of loneliness are scarce. The current study aimed to investigate (a) whether emotional loneliness (perceived absence of intimacy) and social loneliness (perceived absence of satisfying connections) are associated with a negative IB while controlling for related psychosocial symptoms, and (b) whether these two types of loneliness show content-specific IB. Sample 1 included an unselected university sample ( = 138, 81.9% female, = 20.8 years, = 4.4), and Sample 2 utilized a preselected university sample with elevated anxiety/depression levels ( = 315, 69.5% female, = 23.8 years, = 4.3). Participants completed questionnaires on emotional and social loneliness, social isolation, social anxiety, depression, hostility, and an ambiguous scenarios task measuring IB. The results showed that emotional and social loneliness were uniquely associated with a negative IB related to the unavailability of social network. Social loneliness was additionally positively related to an IB for rejection and negatively to an IB for hostility in Sample 2. These results provide evidence for a content-specific negative IB in both types of loneliness. Future studies are needed to replicate these findings as it could aid in developing an effective treatment program for loneliness targeting underlying cognitions in young adults.

This study was conducted to test the reliability and validity of the Pathogenic Belief Scale (PBS) on adult individuals. Participants consisted of 299 adults, including 189 (63.2%) females and 110 (36.8%) males, with a mean age of 21.16 years ( = 3.68). Personal Information Form, Pathogenic Belief Scale-R, Cognitive Distortions Scale, and Dysfunctional Attitude Scale were used as data collection tools. The three-dimensional structure of the PBS was confirmed by confirmatory factor analysis on the Turkish sample (χ = 204.990, = 186, χ/ = 1.102, comparative fit index = 0.997, normed fit index = 0.997, standardized root mean square residual = .058, and root-mean-square error of approximation = .019 (90% confidence interval [.001, .032]). Factor loadings were found to be between .470 and .761. The analyses also showed that the internal consistency reliability coefficients were at a quite good level for the undeserving dimension (α = .874, = 0.875), the cannot rely on others dimension (α = 0.794, = 0.799), and the interpersonal guilt dimension (α = .847, = 0.857). The Turkish version of the PBS is a valid and reliable tool that can be used to evaluate the pathogenic beliefs of individuals. The research results were discussed, and certain inferences were made for the future in line with the limitations.

University students, especially those with attention-deficit/hyperactivity disorder (ADHD), experience distress due to procrastination. However, the existing treatment for adult ADHD does not adequately address procrastination. A brief procrastination-focused cognitive behavioral therapy program was developed for the current study, and its effects on procrastination, depression, and life satisfaction were assessed. Using a single-case AB design, procrastination behaviors and mood during the baseline and intervention periods were recorded. Data from 24 students with ADHD symptoms (mean age = 20.42 years, = 1.50) were analyzed using interrupted time series and counterfactual analyses. The effects of the program on the depressive symptoms and life satisfaction were also examined. The intervention changed the trajectory of the students' procrastination behaviors, significantly reducing them compared with baseline. They also reported improved life satisfaction following the intervention. This novel intervention appears effective in reducing procrastination among university students with ADHD symptoms.

Trichotillomania is a debilitating and chronic condition involving repeated hair pulling from various areas of the body. Trichotillomania often begins in childhood, suggesting that the development and understanding of treatments for trichotillomania in youth are of utmost importance, especially for successful early intervention. While habit reversal training (HRT) is considered the gold standard treatment for trichotillomania in young people, this article reviews a nascent treatment approach for trichotillomania in youth, acceptance-enhanced behavior therapy (AEBT). AEBT combines HRT and acceptance and commitment therapy skills. Each component of AEBT is described and reviewed. A detailed case exemplar of the 10-session protocol is presented. Future research directions and important clinical considerations are discussed.

Pediatric obsessive-compulsive disorder (OCD) affects approximately .25%-3% of children, and if left untreated, can cause significant impairment for the child and family. Cognitive behavioral therapy with exposure and response prevention (ERP) is the gold-standard treatment for pediatric OCD. When using ERP with children and adolescents, it is essential to assess and target family factors in treatment in order to help the youth make therapeutic progress. The following case study illustrates the successful implementation of family-based ERP in a young female with contamination OCD. It further highlights strategies for targeting family accommodation and family conflict within the course of treatment.

This study aimed to examine the psychometric properties of the Chinese version of the family accommodation scale for obsessive-compulsive disorder (OCD) patient version (FAS-PV). A total of 171 adult OCD patients and 145 family members were enrolled in the present study. The majority of the adult OCD patients (89.5%) reported engaging in at least one accommodating behavior in the past week. The FAS-PV comprised three components that included (a) direct participation and facilitation, (b) provision of reassurance and assumption, and (c) modification of routines and avoidance. The FAS-PV demonstrated excellent internal consistency. The correlation between the total FAS-PV score and the criteria measure demonstrated excellent convergent validity when assessing the OCD symptom severity, global functioning, family functioning, and functioning impairment. The findings supported that the FAS-PV could be used widely in evaluating and identifying the accommodating behavior both in clinical and in research settings, especially in adult OCD patients who usually present to the clinic alone.

This clinical case assessed the efficacy of cognitive behavioral therapy (CBT) in treating major depressive disorder in a 26-year-old female, Sara, attributing her depression to pregnancy, financial constraints, parental duties, and emotional stress. Sara had eight sessions of CBT, during which her symptoms were measured using the Hamilton Depression Rating Scale (HAM-D) and the Beck Depression Inventory-Second Edition (BDI-II). Sara's depressive symptoms dramatically decreased after the intervention, moving her HAM-D and BDI-II scores from moderate to mild depression and from clinically depressed to mild, respectively. The assessment showed improved interest, concentration, energy levels, and a more positive self-perception. Integrating Malaysian cultural elements into CBT, emphasizing family support, community engagement, and spirituality positively impacted Sara. This study emphasizes the value of culturally appropriate CBT for depression as it can help with symptom management, challenging negative thoughts, and bolstering self-esteem. This method identifies and addresses cultural impacts on mental health, recommending the incorporation of cultural aspects in therapy, enhancing relapse prevention and quality of life for Malaysians experiencing depression.

The clinical literature encourages further exploration of the relationship between anxiety and paranoid ideation with the overall objective of identifying processes that mitigate such relationship, thus establishing targets for cognitive intervention. Empirical studies demonstrate that increased levels of anxiety precede the emergence of paranoid cognitions. Yet, possible mediators are still to be investigated. In all, 273 adults completed a battery of standardized questionnaires, and collated data were analyzed statistically. Generalized anxiety was positively associated with paranoid ideation, for both ideas of reference and persecutory beliefs. Although the relationship was not mediated by cognitive flexibility in its entirety, perceived control over internal experiences and external events, an essential constituent of cognitive flexibility, acted as a significant mediator. The results highlight the importance of increasing adaptive perceptions of control among individuals experiencing generalized anxiety, which would likely reduce the co-occurrence of paranoid ideation and lower the risk of transitioning into clinical levels of paranoia.

Mental health concerns among young adult populations have increased in recent years, with standard treatment approaches presenting many undue barriers (e.g., time and cost constraints and limited availability of therapists). Single-session interventions (SSIs) have been explored as an alternative, scalable intervention to address these barriers to care. We evaluated the acceptability and feasibility of a SSI in a real-world setting and found promising effects of the SSI on symptoms of depression in a young adult population. Given these findings, we offer support for the SSI as an accessible treatment alternative to perhaps be integrated into tiered care treatment models or settings with limited access to care.

Research suggests that metacognitions could be important in explaining symptoms of body dysmorphic disorder (BDD), but the effect of metacognitive therapy (MCT) on BDD is unknown. The aim of this consecutive case series was to explore MCT for BDD, delivered individually within a public mental health setting. Treatment was based on MCT manuals for obsessive-compulsive disorder and generalized anxiety disorder. Of 11 eligible participants, 2 declined treatment, 8 completed treatment, and 1 dropped out. MCT for BDD was associated with significant reductions in BDD symptoms, comorbid symptoms of depression and anxiety, and metacognitions. All treatment completers were characterized as treatment responders (i.e., >30% improvement), and improvements were maintained at 3-month follow-up. MCT could be a promising treatment for BDD. Future studies should explore MCT for BDD in controlled trials and explore how to motivate individuals with BDD for psychological treatment.

Childhood maltreatment (CM) is associated with elevated depression and anxiety in young adulthood; however, there is a dearth of research identifying the intermediary pathways that link CM to these phenomena. The present study investigated two psychological factors-, sensitivity to and avoidance of sudden negative emotional shifts, and , the fear of arousal-related body sensations-as potential mediators of the relationship between CM and psychological distress in young adulthood. Our sample consisted of 280 undergraduate students who completed self-report measures of childhood maltreatment, anxiety sensitivity, contrast avoidance (i.e., the Contrast Avoidance Questionnaire), and psychological distress. We constructed a series of parallel mediation models to test whether contrast avoidance and anxiety sensitivity mediate the relationships between child maltreatment and psychological distress. CM was related to anxiety and stress indirectly through both contrast avoidance and anxiety sensitivity but was related to depression only through contrast avoidance. There were no significant differences in the magnitude of the indirect effects between contrast avoidance and anxiety sensitivity for the models predicting anxiety and stress. Contrast avoidance and anxiety sensitivity both appear to play important roles in understanding how early experiences of CM relate to psychological distress in young adulthood. Theoretical and clinical implications are discussed.