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Ma R, Zhang Q, Zhang C, Xu W. Longitudinal associations between family functioning and generalized anxiety among adolescents: the mediating role of self-identity and cognitive flexibility. BMC Psychol 2024; 12:399. [PMID: 39026265 PMCID: PMC11264820 DOI: 10.1186/s40359-024-01908-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 07/15/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Generalized anxiety (GA) is showing a high prevalence among adolescents nowadays; investigations on influencing factors and potential mechanisms are important to inform intervention development. The present two-wave study investigated the ways in which family functioning predicted GA six months later among adolescents, by considering the mediating role of self-identity and cognitive flexibility. METHODS Adolescents were recruited from 27 randomly selected classes in two secondary schools in Chongqing and Fujian Province, China. Survey questionnaires assessing family functioning, self-identity, cognitive flexibility and GA were obtained from 1223 adolescents (Mage = 13.14, SD = 1.35) at two time points of the 6-month interval. RESULTS The association between family functioning (T1) and GA (T2) was significant (r= -0.152, p < 0.01). Self-identity and cognitive flexibility sequentially mediated the relationship between family functioning (T1) and GA (T2) (with the indirect effect = -0.005, 95% CI = -0.007~ -0.002) after controlling for age, gender, and GA at baseline. Cognitive flexibility also showed a significant and direct mediating effect (with the indirect effect = -0.008, 95% CI = -0.012 ~ -0.005). CONCLUSION Findings indicated that family functioning can be a protective factor of GA, and self-identity and cognitive flexibility act as a crucial role in the association between family functioning and GA. Future studies should adopt more time points and long-term follow-up assessments using more robust approaches to improve the reliability of the study findings. Findings may offer some implications that building a harmonious, open and warm family and guiding adolescents to develop self-identity as well as more flexible cognitive style could be helpful to prevent and cope with anxious emotion.
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Affiliation(s)
- Ran Ma
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, National Demonstration Center for Experimental Psychology Education, Beijing Normal University, Beijing, China
| | - Qian Zhang
- School of Psychology, University of Leeds, Leeds, UK
| | - Chunyang Zhang
- China Academy of Civil Aviation Science and Technology, Beijing, China
| | - Wei Xu
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, National Demonstration Center for Experimental Psychology Education, Beijing Normal University, Beijing, China.
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2
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Stavropoulos L, Briggs N, Grisham JR. Self-guided imagery rescripting for worry images: A preliminary experimental investigation. J Clin Psychol 2024; 80:1213-1230. [PMID: 38356250 DOI: 10.1002/jclp.23660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 07/30/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Mental images of feared events are overactive and intrusive in generalized anxiety disorder (GAD). Imagery rescripting involves integration of positive or neutral imagery and corrective information into images to facilitate emotional processing, reduce imagery intrusions, and re-structure underlying schema. Yet only one known study has applied the technique to treatment of worry. The present study aimed first to examine the relationship between trait worry and properties of future-oriented worry images, and second to examine the efficacy of a self-guided imagery rescripting intervention in improving individuals' response to their worries. METHODS Participants recruited through Amazon Mechanical Turk (N = 365) identified their major worry and wrote the script of a worst-case scenario mental image. Participants were randomized to three conditions: re-writing the same worry image script (exposure), or writing scripts of either one or three positive alternative future-oriented images (rescripting conditions). RESULTS In preliminary analyses, trait worry negatively predicted participants' ratings of worry images, including valence and ability to cope, and positively predicted distress, anticipated cost, and belief in their negative meaning. In experimental analyses, linear mixed-effects models revealed anxious response and cognitive appraisal of the threat were significantly lower among participants allocated to rescripting relative to exposure. There was no effect of rescripting type. CONCLUSIONS This investigation demonstrated the impact of a future-oriented imagery rescripting task on anxiety and cognitive biases associated with real worries in an unselected sample. Results may contribute to the development of imagery rescripting interventions for GAD.
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Affiliation(s)
| | - Nancy Briggs
- Stats Central, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, Australia
| | - Jessica R Grisham
- School of Psychology, University of New South Wales, Sydney, Australia
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3
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Freeston MH. What if we have too many models of worry and GAD? Behav Cogn Psychother 2023; 51:559-578. [PMID: 37183586 DOI: 10.1017/s1352465822000649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Mark H Freeston
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
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4
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Dugas MJ, Giguère Marchal K, Cormier S, Bouchard S, Gouin JP, Shafran R. Pain catastrophizing and worry about health in generalized anxiety disorder. Clin Psychol Psychother 2023; 30:852-861. [PMID: 36807639 DOI: 10.1002/cpp.2843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Abstract
Because the diagnostic criteria of generalized anxiety disorder (GAD) are not tied to specific worry domains (worry is 'generalized'), research on the content of worry in GAD is lacking. To our knowledge, no study has addressed vulnerability for specific worry topics in GAD. The goal of the current study, a secondary analysis of data from a clinical trial, is to explore the relationship between pain catastrophizing and worry about health in a sample of 60 adults with primary GAD. All data for this study were collected at pretest, prior to randomization to experimental condition in the larger trial. The hypotheses were that (1) pain catastrophizing would be positively related to the severity of GAD, (2) the relationship between pain catastrophizing and the severity of GAD would not be explained by intolerance of uncertainty and psychological rigidity, and (3) pain catastrophizing would be greater in participants reporting worry about health compared to those not reporting worry about health. All hypotheses were confirmed, suggesting that pain catastrophizing may be a threat-specific vulnerability for health-related worry in GAD. The implications of the current findings include a better understanding of the ideographic content of worry, which could help focus treatment interventions for individuals with GAD.
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Affiliation(s)
- Michel J Dugas
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, Quebec, Canada
| | - Katia Giguère Marchal
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, Quebec, Canada
| | - Stéphanie Cormier
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, Quebec, Canada
| | - Stéphane Bouchard
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, Quebec, Canada
| | | | - Roz Shafran
- Great Ormond Street Institute of Child Health, University College London, London, UK
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5
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Mordeno IG, Gallemit IMJS, Dinding DLL. To Leave is to Die a Little: Assessing the Symptom Structure of Separation Anxiety Disorder in Left-Behind Emerging Adults. Psychiatr Q 2023:10.1007/s11126-023-10024-z. [PMID: 37058269 DOI: 10.1007/s11126-023-10024-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 04/15/2023]
Abstract
The literature on separation anxiety disorder (SAD) presented two contentious issues relating to its assessment. First, studies are scarce in assessing the symptom structure of DSM-5 SAD among the adult population. Second, the accuracy in assessing the severity of SAD through measuring the intensity of disturbance and the frequency of occurrence of symptoms is yet to be studied. To address these limitations, the present study aimed to: (1) examine the latent factor structure of the newly developed separation anxiety disorder symptom severity inventory (SADSSI); (2) evaluate the necessity of using frequency or intensity formats through comparison of differences in the latent level; and (3) investigate SAD latent class analysis. Utilizing 425 left-behind emerging adults (LBA), the findings showed that a general factor with two dimensions (i.e., response formats) measuring frequency and intensity symptom severity separately has excellent fit and good reliability. Finally, the latent class analysis yielded a three-class solution best fitting to the data. Overall, the data provided evidence for the psychometric soundness of SADSSI as an assessment tool for separation anxiety symptoms among LBA.
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Affiliation(s)
- Imelu G Mordeno
- Department of Professional Education, Mindanao State University, Iligan Institute of Technology, Iligan City, Philippines.
- Department of Professional Education, College of Education, MSU-Iligan Institute of Technology, Andres Bonifacio Ave, Tibanga, Iligan City, 9200, Philippines.
| | - I Marie Joy S Gallemit
- School of Graduate Studies, College of Education, Mindanao State University, Iligan Institute of Technology, Iligan City, Philippines
| | - Dame Lent L Dinding
- Department of Psychology, Mindanao State University, Marawi City, Philippines
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Shevlin M, Redican E, Hyland P, Butter S, McBride O, Hartman TK, Murphy J, Vallières F, Bentall RP. Perceived manageability of debt and mental health during the COVID-19 pandemic: A UK population analysis. PLoS One 2022; 17:e0274052. [PMID: 36129896 PMCID: PMC9491596 DOI: 10.1371/journal.pone.0274052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/21/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives This study examined the association between perceived manageability of debt and risk of depression, anxiety, and mental health help-seeking among a nationally representative sample of adults living in the United Kingdom (UK). Methods Data was derived from the COVID-19 Psychological Research Consortium (C19PRC) Study Wave 6 (August/September 2021) which examined the psychological, social, and economic effects of the COVID-19 pandemic on the UK adult population. Bivariate and logistic regression analyses were conducted to determine the association between different levels of perceived debt manageability (i.e., “easily manageable”, “some problems”, “quite serious problems”, “very serious problems”, “cannot manage at all”) and mental health related outcomes. Results Almost a quarter of the sample (24%, n = 494) reported debt management problems, and debt manageability associated with higher levels of anxiety, depression, and mental health help-seeking. After adjusting for demographic variables (e.g. income, receipt of benefits), logistic regression analysis demonstrated a dose-response association between increasing levels of debt manageability problems and mental health outcomes. Specifically, adjusted odds ratios for anxiety ranged from 2.28 (‘some problems’) to 11.18 (‘very serious problems’), for depression ranged from 2.80 (‘some problems’) to 16.21 (‘cannot manage at all’), and for mental health help-seeking ranged from 1.69 (‘some problems’) to 3.18 (‘quite serious problems’, ‘very serious problems’). Conclusion This study highlights that debt manageability problems represent a robust predictor of depression, anxiety, and mental-health help seeking.
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Affiliation(s)
- Mark Shevlin
- Department of Psychology, Ulster University, Londonderry, Northern Ireland, United Kingdom
- * E-mail:
| | - Enya Redican
- Department of Psychology, Ulster University, Londonderry, Northern Ireland, United Kingdom
| | - Philip Hyland
- Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Sarah Butter
- Department of Psychology, Ulster University, Londonderry, Northern Ireland, United Kingdom
| | - Orla McBride
- Department of Psychology, Ulster University, Londonderry, Northern Ireland, United Kingdom
| | - Todd K. Hartman
- Department of Social Statistics, University of Manchester, Manchester, England
| | - Jamie Murphy
- Department of Psychology, Ulster University, Londonderry, Northern Ireland, United Kingdom
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7
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Rook L, Mazza MC, Lefter I, Brazier F. Toward Linguistic Recognition of Generalized Anxiety Disorder. Front Digit Health 2022; 4:779039. [PMID: 35493530 PMCID: PMC9051024 DOI: 10.3389/fdgth.2022.779039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 03/21/2022] [Indexed: 11/21/2022] Open
Abstract
Background Generalized anxiety disorder (GAD) refers to extreme, uncontrollable, and persistent worry and anxiety. The disorder is known to affect the social functioning and well-being of millions of people, but despite its prevalence and burden to society, it has proven difficult to identify unique behavioral markers. Interestingly, the worrying behavior observed in GAD is argued to stem from a verbal linguistic process. Therefore, the aim of the present study was to investigate if GAD can be predicted from the language people use to put their anxious worries into words. Given the importance of avoidance sensitivity (a higher likelihood to respond anxiously to novel or unexpected triggers) in GAD, this study also explored if prediction accuracy increases when individual differences in behavioral avoidance and approach sensitivity are taken into account. Method An expressive writing exercise was used to explore whether GAD can be predicted from linguistic characteristics of written narratives. Specifically, 144 undergraduate student participants were asked to recall an anxious experience during their university life, and describe this experience in written form. Clinically validated behavioral measures for GAD and self-reported sensitivity in behavioral avoidance/inhibition (BIS) and behavioral approach (BAS), were collected. A set of classification experiments was performed to evaluate GAD predictability based on linguistic features, BIS/BAS scores, and a concatenation of the two. Results The classification results show that GAD can, indeed, be successfully predicted from anxiety-focused written narratives. Prediction accuracy increased when differences in BIS and BAS were included, which suggests that, under those conditions, negatively valenced emotion words and words relating to social processes could be sufficient for recognition of GAD. Conclusions Undergraduate students with a high GAD score can be identified based on their written recollection of an anxious experience during university life. This insight is an important first step toward development of text-based digital health applications and technologies aimed at remote screening for GAD. Future work should investigate the extent to which these results uniquely apply to university campus populations or generalize to other demographics.
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8
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Revised Beckian cognitive therapy for generalised anxiety disorder. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abstract
Since its inclusion in the DSM-III, various theories and treatment approaches have been developed for generalised anxiety disorder (GAD). Aaron T. Beck was the first to offer a cognitive conceptualisation of GAD in Anxiety Disorders and Phobias: A Cognitive Perspective. This original cognitive model of GAD was initially found to be promising in treating GAD but has not been developed further. Other theoretical models and treatments of GAD have gained more research attention, such as the Intolerance of Uncertainty model and Meta-Cognitive model. This article offers a brief overview of multiple theories and treatment approaches of GAD followed by an extensive discussion about the original cognitive model and a revised cognitive model of GAD in the Beckian tradition. Specifically, this paper describes how known key psychological maintenance factors of anxiety disorders, i.e. threat beliefs, safety-seeking behaviours and selective attention, can be used to conceptualise the experience of people with GAD and guide treatment. This is done with theoretical discussion as well as clinical examples. Finally, the paper offers suggestions for key ingredients to be included in cognitive therapy for GAD and future directions for research.
Key learning aims
(1)
To understand the clinical implications of the original cognitive model and the revised model of generalised anxiety disorder presented here.
(2)
To understand the role of inflated responsibility for safety, safety-seeking behaviours and elevated evidence requirements in generalised anxiety disorder.
(3)
To understand and be able to implement treatment recommendations of the revised cognitive model of generalised anxiety disorder.
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9
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Cupid J, Stewart KE, Sumantry D, Koerner N. Feeling safe: Judgements of safety and anxiety as a function of worry and intolerance of uncertainty. Behav Res Ther 2021; 147:103973. [PMID: 34607250 DOI: 10.1016/j.brat.2021.103973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 08/29/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
Safety perspectives of generalized anxiety disorder (GAD) propose that safety perception is critical to regulating anxiety. Reduced safety processing may contribute to persistent worry and anxiety that extend to recognizably safe contexts. We explored whether individuals higher in worry and intolerance of uncertainty (IU), central characteristics of GAD, display poorer recognition and use of safety cues, and whether safety perception is related to anxiety. One hundred and eighty-two adults were presented with unfolding potentially threatening scenarios, half of which contained safety information. Participants rated how safe and anxiety-provoking each scenario was as they received new information, as well as overall. Using multilevel modeling, results showed that individuals higher in worry and IU recognize safety information and use it to appraise the safety of a situation. A moderate correlation between safety and anxiety ratings, and inconsistent correspondence between ratings of safety and anxiety, suggest this relationship is complicated by additional factors. Individuals higher in worry and IU may have difficulty accepting their safety appraisals in order to inhibit their anxiety. The implications of the findings and future avenues of research are discussed.
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Affiliation(s)
- Justice Cupid
- Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada.
| | - Kathleen E Stewart
- Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada.
| | - David Sumantry
- Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada.
| | - Naomi Koerner
- Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada.
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10
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Ruan X, Fang S, Zheng Q, Qi S, Tian Y, Ren W. The Association between 5-Hydroxytryptamine Receptor 1B rs13212041 Polymorphism and Trait Anxiety in Chinese Han College Subjects. Life (Basel) 2021; 11:life11090882. [PMID: 34575031 PMCID: PMC8468159 DOI: 10.3390/life11090882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022] Open
Abstract
Trait anxiety is a vulnerable personality factor for anxiety and depression. High levels of trait anxiety confer an elevated risk for the development of anxiety and other psychiatric disorders. There is evidence that 5-hydroxytryptamine receptor 1B (5-HT1B) gene polymorphisms play an important role in emotional disorders. Genotyping for four single-nucleotide polymorphisms (SNP) (rs11568817, rs130058, rs6297, and rs13212041) was conducted for 388 high trait anxious (HTA) individuals and 463 low traitanxious (LTA) individuals in Chinese Han college subjects. The results showed that the frequencies of the C-allele and TC + CC genotype of rs13212041 in the LTA individuals were higher than that in the HTA individuals (p = 0.025 and p = 0.014, respectively). Both the C-allele and TC + CC genotype were associated with trait anxiety decreasing (OR = 0.771 and OR = 0.71, respectively). Furthermore, different gene model analysis also showed that the C allele was a protective factor for trait anxiety in Chinese Han college subjects. These findings suggest that 5-HT1B rs13212014 may play a role in trait anxiety among China Han college subjects. The rs13212014 polymorphism may be involved in decreasing the risk of trait anxiety. These results also provide a novel insight into the molecular mechanism underlying trait anxiety.
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Affiliation(s)
- Xiaofei Ruan
- Key Laboratory of Modern Teaching Technology, Ministry of Education, Xi’an 710062, China;
| | - Suwen Fang
- College of Life Sciences, Shaanxi Normal University, Xi’an 710119, China; (S.F.); (Q.Z.); (S.Q.)
| | - Qi Zheng
- College of Life Sciences, Shaanxi Normal University, Xi’an 710119, China; (S.F.); (Q.Z.); (S.Q.)
| | - Senqing Qi
- College of Life Sciences, Shaanxi Normal University, Xi’an 710119, China; (S.F.); (Q.Z.); (S.Q.)
| | - Yingfang Tian
- Key Laboratory of Modern Teaching Technology, Ministry of Education, Xi’an 710062, China;
- Correspondence: (Y.T.); (W.R.)
| | - Wei Ren
- Key Laboratory of Modern Teaching Technology, Ministry of Education, Xi’an 710062, China;
- Correspondence: (Y.T.); (W.R.)
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Franklin AR, Mathersul DC, Raine A, Ruscio AM. Restlessness in Generalized Anxiety Disorder: Using Actigraphy to Measure Physiological Reactions to Threat. Behav Ther 2021; 52:734-744. [PMID: 33990246 DOI: 10.1016/j.beth.2020.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 01/22/2023]
Abstract
Generalized anxiety disorder (GAD) is characterized by excessive, uncontrollable worry accompanied by symptoms of physiological arousal. Although individuals with GAD report greater subjective arousal than healthy individuals, they show equivalent or even attenuated physiological reactions to threat. This may result from using physiological measures better suited to fear than anxiety. To test this possibility, 102 adults with and without GAD were assessed for restlessness, a core physiological symptom of GAD. They were exposed to an in vivo threat task designed to elicit anxiety in the laboratory. Throughout the task, restlessness was measured physiologically with actigraphy sensors on both ankles and both wrists, and subjectively with self-report ratings. The GAD group reported higher subjective restlessness than the no-GAD group, and in the subset of cases who had restlessness as a clinically significant symptom, actigraphy scores were reliably elevated as well. However, although actigraphy scores increased with proximity to the threat, the increases did not differ by group. These findings provide initial validation for actigraphy as a novel measure of motor restlessness in GAD. In addition, they underscore the value of measuring restlessness using multiple assessment methods. These methods suggest that, in GAD, restlessness reflects a chronic state of arousal rather than a heightened physiological reaction to threat.
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12
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Maheu C, Singh M, Tock WL, Eyrenci A, Galica J, Hébert M, Frati F, Estapé T. Fear of Cancer Recurrence, Health Anxiety, Worry, and Uncertainty: A Scoping Review About Their Conceptualization and Measurement Within Breast Cancer Survivorship Research. Front Psychol 2021; 12:644932. [PMID: 33912113 PMCID: PMC8072115 DOI: 10.3389/fpsyg.2021.644932] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/15/2021] [Indexed: 01/01/2023] Open
Abstract
Objective: Fear of Cancer Recurrence (FCR), Health Anxiety (HA), worry, and uncertainty in illness are psychological concerns commonly faced by cancer patients. In survivorship research, these similar, yet different constructs are frequently used interchangeably and multiple instruments are used in to measure them. The lack of clear and consistent conceptualization and measurement can lead to diverse or contradictory interpretations. The purpose of this scoping review was to review, compare, and analyze the current conceptualization and measurements used for FCR, HA, worry, and uncertainty in the breast cancer survivorship literature to improve research and practice. Inclusion Criteria: We considered quantitative, qualitative, and mixed methods studies of breast cancer survivors that examined FCR, HA, worry, or uncertainty in illness as a main topic and included a definition or assessment of the constructs. Methods and Analysis: The six-staged framework was used to guide the scoping review process. Searches of PubMed, CINAHL, and PsycINFO databases were conducted. The principle-based qualitative analysis and simultaneous content analysis procedures were employed to synthesize and map the findings. Findings: After duplicate removal, the search revealed 3,299 articles, of which 82 studies met the inclusion criteria. Several critical attributes overlapped the four constructs, for example, all were triggered by internal somatic and external cues. However, several unique attributes were found (e.g., a sense of loss of security in the body is observed only among survivors experiencing FCR). Overall, findings showed that FCR and uncertainty in illness are more likely to be triggered by cancer-specific factors, while worry and HA have more trait-like in terms of characteristics, theoretical features, and correlates. We found that the measures used to assess each construct were on par with their intended constructs. Eighteen approaches were used to measure FCR, 15 for HA, 8 for worry, and 4 for uncertainty. Conclusion: While consensus on the conceptualization and measurement of the four constructs has not yet been reached, this scoping review identifies key similarities and differences to aid in their selection and measurement. Considering the observed overlap between the four studied constructs, further research delineating the unique attributes for each construct is warranted.
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Affiliation(s)
- Christine Maheu
- Faculty of Medicine and Health Sciences, Ingram School of Nursing, McGill University, Montréal, QC, Canada
| | - Mina Singh
- Faculty of Health, School of Nursing, York University, Toronto, ON, Canada
| | - Wing Lam Tock
- Faculty of Medicine and Health Sciences, Ingram School of Nursing, McGill University, Montréal, QC, Canada
| | - Asli Eyrenci
- Department of Psychology, Faculty of Humanities and Social Sciences, Maltepe University, Istanbul, Turkey
| | - Jacqueline Galica
- Faculty of Health Sciences, School of Nursing, Queen's University, Kingston, ON, Canada
| | - Maude Hébert
- Département des Sciences Infirmières, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Francesca Frati
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montréal, QC, Canada
| | - Tania Estapé
- Psychosocial Oncology Department, Fundació per l'Educació i la Formació en Càncer (FEFOC) Fundació, Barcelona, Spain
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Cognitive analysis of specific threat beliefs and safety-seeking behaviours in generalised anxiety disorder: revisiting the cognitive theory of anxiety disorders. Behav Cogn Psychother 2021; 49:526-539. [PMID: 33706843 DOI: 10.1017/s135246582100014x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Generalised anxiety disorder (GAD) has been an uneasy member of the anxiety disorders group since its inclusion in the third edition of the DSM. Multiple theories and treatment protocols for GAD and its defining symptom, excessive worry, have comparable efficacy in treating GAD symptoms. Crucially, these theories of GAD and excessive worry fail to explain when and why worry is excessive and when it is adaptive. AIMS In this paper we propose a cognitive behavioural account of the difference between excessive and adaptive states of worry and explore the theme of threat and the function of safety-seeking behaviours as seen in GAD. Specifically, we incorporate the concept of inflated responsibility in a cognitive behavioural analysis of threat appraisal and safety-seeking behaviours in excessive worry and GAD. CONCLUSION It is proposed that when worry is used as a strategy intended to increase safety from perceived social or physical threat then it should be conceptualised as a safety-seeking behaviour. However, when worry is used as a strategy to solve a problem which the person realistically can resolve or to deal explicitly with the feeling of anxiety then it functions as an adaptive coping behaviour. We also propose that the theme of threat in GAD centres on an inflated sense of responsibility for external everyday situations, and the function of safety-seeking behaviours is to attain certainty that responsibility has been fulfilled. The clinical implications of this cognitive behavioural analysis of excessive worry are discussed, as well as future research directions.
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14
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Dietel FA, Möllmann A, Bürkner PC, Wilhelm S, Buhlmann U. Interpretation Bias Across Body Dysmorphic, Social Anxiety and Generalized Anxiety Disorder—A Multilevel, Diffusion Model Account. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-020-10180-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
Background
Interpretation biases are suggested to be transdiagnostic phenomena, but have rarely been compared across different disorders and current concerns.
Methods
We investigated explicit, decision-based, and more implicit, reaction time-based interpretation bias in individuals with body dysmorphic disorder (BDD; N = 29), social anxiety disorder (SAD; N = 36), generalized anxiety disorder (GAD; N = 22), and non-clinical controls (NC; N = 32), using an adapted Word Sentence Association Paradigm (WSAP).
Results
Results indicated that interpretation bias occurred transdiagnostically, while content-specific bias patterns varied meaningfully across groups. BDD and SAD shared explicit and, more inconsistently, implicit interpretation biases for appearance-related and social situations. The GAD group exhibited an explicit and implicit negative interpretation bias for general situations, and an additional implicit lack of positive bias. Mechanistic Wiener diffusion model analyses revealed that interpretation bias patterns were mainly driven by speeded information uptake, potentially mirroring disorder-specific associative memory organization.
Conclusions
These findings have important implications for understanding interpretation biases as both etiological and treatment factors.
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Nahmoud I, Vasquez JG, Cho H, Dennis-Tiwary T, Likhtik E. Salient safety conditioning improves novel discrimination learning. Behav Brain Res 2020; 397:112907. [PMID: 32956774 DOI: 10.1016/j.bbr.2020.112907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/14/2020] [Accepted: 09/08/2020] [Indexed: 12/19/2022]
Abstract
Generalized fear is one purported mechanism of anxiety that is a target of clinical and basic research. Impaired fear discrimination has been primarily examined from the perspective of increased fear learning, rather than how learning about non-threatening stimuli affects fear discrimination. To address this question, we tested how three Safety Conditioning protocols with varied levels of salience allocated to the safety cue compared to classic Fear Conditioning in their impact on subsequent innate anxiety, and differential fear learning of new aversive and neutral cues. Using a high anxiety strain of mice (129SvEv, Taconic), we show that Fear Conditioned animals show little exploration of the anxiogenic center of an open field 24 h later, and poor discrimination during new differential conditioning 7 days later. Three groups of mice underwent Safety Conditioning, (i) the safety tone was unpaired with a shock, (ii) the safety tone was unpaired with the shock and co-terminated with a house light signaling the end of the safety period, and (iii) the safety tone was unpaired with the shock and its beginning co-occurred with a house light, signaling the start of a safety period. Mice from all Safety Conditioning groups showed higher levels of open field exploration than the Fear Conditioned mice 24 h after training. Furthermore, Safety Conditioned animals showed improved discrimination learning of a novel non-threat, with the Salient Beginning safety conditioned group performing best. These findings indicate that high anxiety animals benefit from salient safety training to improve exploration and discrimination of new non-threating stimuli.
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Affiliation(s)
- I Nahmoud
- Chemistry Dept., Hunter College, CUNY, New York, NY, United States
| | - J Ganay Vasquez
- Chemistry Dept., Hunter College, CUNY, New York, NY, United States
| | - H Cho
- Department of Psychology, The Graduate Center, CUNY, NY, United States; Psychology Dept., Hunter College, CUNY, New York, NY, United States
| | - T Dennis-Tiwary
- Department of Psychology, The Graduate Center, CUNY, NY, United States; Psychology Dept., Hunter College, CUNY, New York, NY, United States
| | - E Likhtik
- Biology Dept., Hunter College, CUNY, New York, NY, United States; Program in Biology, The Graduate Center, CUNY, NY, United States.
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Hygen BW, Skalická V, Stenseng F, Belsky J, Steinsbekk S, Wichstrøm L. The co-occurrence between symptoms of internet gaming disorder and psychiatric disorders in childhood and adolescence: prospective relations or common causes? J Child Psychol Psychiatry 2020; 61:890-898. [PMID: 32623728 DOI: 10.1111/jcpp.13289] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Internet gaming disorder (IGD) is highlighted as a condition for further study in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). Some studies indicate that IGD appears comorbid with other psychiatric disorders. We examine concurrent and prospective links between symptoms of IGD and symptoms of common psychiatric disorders in childhood and adolescence to determine whether observed comorbidity is a result of (a) reciprocal relations or (b) common underlying causes. METHODS A community sample (n = 702) of Norwegian children completed the Internet Gaming Disorder Interview (IGDI) to assess DSM-5 defined IGD symptoms at ages 10, 12 and 14 years. The Child and Adolescent Psychiatric Assessment (CAPA) assessed symptoms of depression, anxiety, attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct disorder (CD) at the same time points. RESULTS A Random Intercept Cross-lagged Panel Model (RI-CLPM), which captures pure within-person changes and adjusts for all unmeasured time-invariant factors (e.g., genetics, parent education) revealed no associations between IGD symptoms and psychopathology, except that increased IGD symptoms at ages 10 and 12 predicted decreased symptoms of anxiety two years later. CONCLUSIONS No support emerged for concurrent or prospective relations between IGD and psychiatric symptoms, except in one case: increased IGD symptoms forecasted reduction in anxiety symptoms. Observed co-occurrence between IGD symptoms and mental health problems can mainly be attributed to common underlying factors.
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Affiliation(s)
- Beate Wold Hygen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.,NTNU Social Research, Trondheim, Norway
| | - Věra Skalická
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Frode Stenseng
- Department of Education and Lifelong Learning, Norwegian University of Science and Technology, Trondheim, Norway.,Queen Maud University College, Trondheim, Norway
| | - Jay Belsky
- Department of Human Ecology, University of California, Davis, Davis, CA, USA
| | - Silje Steinsbekk
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Wichstrøm
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway
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17
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Grenier S, Desjardins F, Raymond B, Payette MC, Rioux MÈ, Landreville P, Gosselin P, Richer MJ, Gunther B, Fournel M, Vasiliadis HM. Six-month prevalence and correlates of generalized anxiety disorder among primary care patients aged 70 years and above: Results from the ESA-services study. Int J Geriatr Psychiatry 2019; 34:315-323. [PMID: 30418683 DOI: 10.1002/gps.5023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 11/03/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To estimate the 6-month prevalence of generalized anxiety disorder (GAD) in primary care patients aged 70 years and above and to describe their clinical profile, including types of worries. METHODS/DESIGN Participants (N = 1193) came from the Étude sur la Santé des Aînés (ESA) services study conducted in Quebec, Canada. An in-person structured interview was used to identify GAD and other anxiety/depressive disorders as well as to identify types of worries. Three groups were created (ie, patients with GAD, patients with another anxiety disorder, and patients without anxiety disorders) and compared on several sociodemographic and clinical characteristics using multinomial logistic regression analyses. RESULTS The 6-month prevalence of GAD was 2.7%. Findings also indicated that the most common types of worries were about health, being a burden for loved ones, and losing autonomy. Compared with respondents without anxiety disorders, older patients with GAD were more likely to be women, be more educated, suffer from depression, use antidepressants, be unsatisfied with their lives, and use health services. In comparison with respondents with another anxiety disorder, those with GAD were 4.5 times more likely to suffer from minor depression. CONCLUSIONS GAD has a high prevalence in primary care patients aged 70 years and above. Clinicians working in primary care settings should screen for GAD, since it remains underdiagnosed. In addition, it may be associated with depression and life dissatisfaction. Screening tools for late-life GAD should include worry themes that are specific to aging.
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Affiliation(s)
- Sébastien Grenier
- Centre de recherche, Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada.,Département de psychologie, Université de Montréal, Montreal, Canada
| | - Frédérique Desjardins
- Centre de recherche, Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada.,Département de psychologie, Université de Montréal, Montreal, Canada
| | - Béatrice Raymond
- Centre de recherche, Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada.,Département de psychologie, Université de Montréal, Montreal, Canada
| | - Marie-Christine Payette
- Centre de recherche, Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada.,Département de psychologie, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Marie-Ève Rioux
- Centre de recherche, Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada.,Département de psychologie, Université du Québec à Montréal, Montreal, Quebec, Canada
| | | | - Patrick Gosselin
- Département de psychologie, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-Josée Richer
- Département de psychoéducation, Université de Montréal, Montreal, Quebec, Canada
| | - Bruno Gunther
- Centre de recherche, Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada.,Département de psychologie, Université de Montréal, Montreal, Canada
| | - Mélanie Fournel
- Centre de recherche, Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada
| | - Helen-Maria Vasiliadis
- Département des sciences de la santé communautaire, Faculté de Médecine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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18
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Skodzik T, Adelt MH, Nossek VA, Kuck ST, Ehring T. Does a novel training in mental imagery reduce pathological worry? Behav Res Ther 2018; 109:56-67. [DOI: 10.1016/j.brat.2018.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 11/30/2022]
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19
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Kube T, D'Astolfo L, Glombiewski JA, Doering BK, Rief W. Focusing on situation-specific expectations in major depression as basis for behavioural experiments - Development of the Depressive Expectations Scale. Psychol Psychother 2017; 90:336-352. [PMID: 27935247 DOI: 10.1111/papt.12114] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 11/07/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Dysfunctional expectations are considered to be core features of various mental disorders. The aim of the study was to develop the Depressive Expectations Scale (DES) as a depression-specific measure for the assessment of dysfunctional expectations. Whereas previous research primarily focused on general cognitions and attitudes, the DES assesses 25 future-directed expectations (originally 75 items) which are situation-specific and falsifiable. DESIGN AND METHODS To evaluate the psychometric properties of the DES, the scale was completed by 175 participants with and without severe depressive symptoms in an online survey. Participants additionally completed the Patient Health Questionnaire modules for depression (PHQ-9) and anxiety (GAD-7). People experiencing depressive symptoms were informed about the study with the help of self-help organizations. RESULTS Reliability analyses indicated excellent internal consistency of the scale. An exploratory factor analyses revealed four factors: social rejection, social support, mood regulation, and ability to perform. The DES sum score strongly correlated with the severity of depressive symptoms. The DES sum score also significantly correlated with symptoms of generalized anxiety. CONCLUSION The DES was shown to have excellent reliability; validity analyses were promising. As the DES items are situation-specific and falsifiable, they can be tested by the individual using behavioural experiments and may therefore facilitate cognitive restructuring. Thus, a structured assessment of patients' expectation with help of the DES can provide a basis for interventions within cognitive-behavioural treatment of depression. PRACTITIONER POINTS Assessing situation-specific expectations in patients experiencing depressive symptoms can provide a basis for the conduction of behavioural experiments to test patients' expectations. For the use of behavioural experiments, therapists should choose those dysfunctional expectations which a patient strongly agrees on. To modify patients' expectations, they should be exposed to situations where the discrepancy between patients' expectations and actual situational outcomes can be maximized. The Depressive Expectations Scale can be completed repeatedly to monitor a patient's progress within cognitive-behavioural treatment.
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Affiliation(s)
- Tobias Kube
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
| | - Lisa D'Astolfo
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
| | - Julia A Glombiewski
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
| | - Bettina K Doering
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
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20
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Skodzik T, Leopold A, Ehring T. Effects of a training in mental imagery on worry: A proof-of-principle study. J Anxiety Disord 2017; 45:24-33. [PMID: 27915122 DOI: 10.1016/j.janxdis.2016.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 10/12/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
Abstract
Worry is characterized by a predominance of verbal thinking and relatively little mental imagery. This cognitive bias of verbal and abstract processing has been found to impair emotional processing of worry topics so that worrisome thoughts are maintained. On the other hand, engaging in mental imagery during the worry process fosters emotional processing of worry themes. In the present study, we examined whether training high worriers (n=71) to use more mental imagery in their everyday lives is an effective intervention to reduce pathological worry. Results indicated that our novel training in mental imagery (TMI) led to a significant reduction of worry and impairment, assessed both one and five weeks after the training. Furthermore, in highly anxious participants TMI had beneficial effects on controllability of worry, state anxiety, and positive mood. Theoretical and clinical implications of our findings and methodological limitations of this proof-of-principle study are discussed.
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Affiliation(s)
- Timo Skodzik
- University of Muenster, Department of Clinical Psychology and Psychotherapy, Fliednerstraße 21, 48149 Muenster, Germany.
| | - Alexandra Leopold
- University of Muenster, Department of Clinical Psychology and Psychotherapy, Fliednerstraße 21, 48149 Muenster, Germany
| | - Thomas Ehring
- University of Muenster, Department of Clinical Psychology and Psychotherapy, Fliednerstraße 21, 48149 Muenster, Germany; LMU Munich, Department of Psychology, Leopoldstr. 13, 80802 Munich, Germany
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21
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Krahé C, Mathews A, Whyte J, Hirsch CR. Cognitive bias modification for interpretation with and without prior repetitive negative thinking to reduce worry and rumination in generalised anxiety disorder and depression: protocol for a multisession experimental study with an active control condition. BMJ Open 2016; 6:e013404. [PMID: 27986741 PMCID: PMC5168672 DOI: 10.1136/bmjopen-2016-013404] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Worry and rumination are two forms of repetitive thinking characterised by their negative content and apparently uncontrollable nature. Although worry and rumination share common features and have been conceptualised as part of a transdiagnostic repetitive negative thinking (RNT) process, it remains unclear whether they share the same underlying cognitive mechanisms. This multisession experimental study investigates the tendency to make negative interpretations regarding ambiguous information as a cognitive mechanism underlying RNT. We compare multisession cognitive bias modification for interpretations (CBM-I) with an active control condition to examine whether repeatedly training positive interpretations reduces worry and rumination in individuals with generalised anxiety disorder or depression, respectively. Further, we examine the potential modulatory effects of engaging in RNT immediately prior to CBM-I. DESIGN, METHODS AND ANALYSIS A community sample of individuals meeting diagnostic criteria for either generalised anxiety disorder (n=60) or current major depressive episode (n=60) will be randomly allocated to CBM-I with prior RNT, CBM-I without prior RNT (ie, standard CBM-I), or an active control (no resolution of ambiguity) condition. All conditions receive a 3-week internet-based intervention consisting of one initial session at the first study visit and nine home-based sessions of CBM-I training (or active control). We will assess and compare the effects of CBM-I with and without prior RNT on 'near-transfer' measures of interpretation bias closely related to the training as well as 'far-transfer' outcomes related to RNT and emotional distress. Impact on questionnaire measures will additionally be assessed at 1-month follow-up. Multigroup analyses will be conducted to assess the impact of CBM-I on near-transfer and far-transfer outcome measures.
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Affiliation(s)
- Charlotte Krahé
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Andrew Mathews
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychology, University of California, Davis, California, USA
| | - Jessica Whyte
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Colette R Hirsch
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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22
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Development and Preliminary Validation of the Threat Appraisal Questionnaire for Children (TAQ-C). JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2016. [DOI: 10.1007/s10862-016-9584-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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23
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Fracalanza K, Koerner N, Antony MM. Testing a procedural variant of written imaginal exposure for generalized anxiety disorder. J Anxiety Disord 2014; 28:559-69. [PMID: 24983797 DOI: 10.1016/j.janxdis.2014.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 05/11/2014] [Accepted: 05/30/2014] [Indexed: 12/20/2022]
Abstract
This experiment examined the degree to which it is more beneficial for individuals with generalized anxiety disorder (GAD) to engage in repeated exposure to mental imagery of the same feared scenario versus varying the exposure content. On three consecutive days, individuals with GAD (N=57) spent 20min writing about: (1) the same worst case scenario (consistent exposure; CE), (2) variations of their worst case scenario (varied exposure; VE), or (3) a neutral topic (neutral control; NC). Participants in the CE condition displayed significant decreases in worry, acute cognitive avoidance, and intolerance of uncertainty from baseline to 1-week follow-up; participants in the VE and NC conditions did not. Initial activation of self-reported anxiety (observed in the CE and VE conditions) and between-session reduction in anxiety (observed in the CE condition only) were associated with improvement in worry. Including more references to negative emotion and writing in the present tense were also associated with greater improvement in worry in the CE condition. These findings suggest that writing repeatedly about the same worst case scenario may benefit people with GAD. The study also provides information on potential mechanisms of change.
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Affiliation(s)
| | - Naomi Koerner
- Department of Psychology, Ryerson University, Canada.
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24
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Cabeleira CM, Steinman SA, Burgess MM, Bucks RS, MacLeod C, Melo W, Teachman BA. Expectancy bias in anxious samples. ACTA ACUST UNITED AC 2014; 14:588-601. [PMID: 24798678 DOI: 10.1037/a0035899] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although it is well documented that anxious individuals have negative expectations about the future, it is unclear what cognitive processes give rise to this expectancy bias. Two studies are reported that use the Expectancy Task, which is designed to assess expectancy bias and illuminate its basis. This task presents individuals with valenced scenarios (Positive Valence, Negative Valence, or Conflicting Valence), and then evaluates their tendency to expect subsequent future positive relative to negative events. The Expectancy Task was used with low and high trait anxious (Study 1: n = 32) and anxiety sensitive (Study 2: n = 138) individuals. Results suggest that in the context of physical concerns, both high anxious samples display a less positive expectancy bias. In the context of social concerns, high trait anxious individuals display a negative expectancy bias only when negatively valenced information was previously presented. Overall, this suggests that anxious individuals display a less positive expectancy bias, and that the processes that give rise to this bias may vary by type of situation (e.g., social or physical) or anxiety difficulty.
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Affiliation(s)
- Cindy M Cabeleira
- Elizabeth Rutherford Memorial Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
| | | | - Melissa M Burgess
- Elizabeth Rutherford Memorial Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
| | - Romola S Bucks
- Elizabeth Rutherford Memorial Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
| | - Colin MacLeod
- Elizabeth Rutherford Memorial Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
| | - Wilson Melo
- Institute of Psychology, Federal University of Rio Grande do Sul
| | - Bethany A Teachman
- Elizabeth Rutherford Memorial Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
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25
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Stefan S, David D. The functions of worry and its relation to performance in controllable and uncontrollable situations. Cogn Emot 2013; 27:521-9. [DOI: 10.1080/02699931.2012.722075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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26
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Confirmatory factor analysis of the Dutch Intolerance of Uncertainty Scale: Comparison of the full and short version. J Behav Ther Exp Psychiatry 2013; 44:21-9. [PMID: 22842528 DOI: 10.1016/j.jbtep.2012.07.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 06/25/2012] [Accepted: 07/09/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES The Intolerance of Uncertainty Scale (IUS) was developed for assessing reactions to ambiguous situations, uncertainty, and future events. The IUS has been validated in different languages, but equivocal factor structures, in combination with highly interrelated items and factors, resulted in a redundancy of the items of the English version. In the current study, the psychometric properties of the Dutch version of the IUS were examined, and compared with the shortened 12-item version (IUS-12). METHODS Confirmatory factor analyses were used to investigate different factor structures of both the full and short version of the IUS. RESULTS Results indicated that the IUS-12 model with two factors (Prospective Anxiety and Inhibitory Anxiety) provides the best fit. The reduced measure has equally good internal consistency, and is highly correlated with the full version. LIMITATIONS Future research could investigate whether the current findings generalize to clinical populations. CONCLUSION To summarize, the usage of the short 12-item version of the IUS should be encouraged in future research concerning intolerance of uncertainty.
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27
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Coutu MF, Durand MJ, Marchand A, Labrecque ME, Berbiche D, Cadieux G. Factors associated with generalized anxiety in workers undergoing work rehabilitation for persistent musculoskeletal pain. Disabil Rehabil 2013; 35:1599-607. [PMID: 23294407 DOI: 10.3109/09638288.2012.748833] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To document in workers having a work disability due to a musculoskeletal disorder (MSD), the presence and variation over time of their intolerance of uncertainty and its maintenance factors as defined in Dugas et al.'s generalized anxiety disorder (GAD) model, i.e. worries, negative problem orientation, beliefs about the usefulness of worrying, cognitive avoidance and their consequences on depressive symptoms. METHODS An observational, prospective repeated-measures design was retained. Thirty-nine workers with an MSD having caused a work absence of over three months and who were beginning a work rehabilitation program were recruited and evaluated at four moments (beginning of rehabilitation program, first hours of work exposure, 50% of regular working hours and end of rehabilitation program). Validated self-report questionnaires measuring intolerance of uncertainty and its maintenance factors were administered. Finally, the Worry and Anxiety Questionnaire measured the presence and intensity of GAD symptoms as defined in the DSM-IV-TR. RESULTS Fifty percent of the workers initially exhibited GAD symptoms. Concerning the variation over time, improvements were noted in all GAD-related factors during the program, particularly with the first hours of work exposure. At the end of rehabilitation, only 21% of the participants still met GAD diagnostic criteria. CONCLUSION Workers with an MSD causing a work disability averaging one year in length and enrolled in a work rehabilitation program exhibited a high level of anxiety at the beginning of the work rehabilitation program. Workers perceived a usefulness in worrying and presented some intolerance of uncertainty and some cognitive avoidance strategies. According to Dugas et al.'s GAD model, the intensity of the symptoms associated with GAD development and maintenance factors was, however, not typical of a GAD. IMPLICATION FOR REHABILITATION: A reconceptualization of the problem in terms of reducing the work disability rather than reducing pain may constitute a promising avenue to reduce anxiety symptoms. Future studies should look at the specific impact of work exposure, not only on pain symptoms but also on worries. The high level of anxiety and the reported worries by workers stresses the importance of studying the hypothesis of a workplace phobia in order to improve clinical practice guidelines.
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Affiliation(s)
- Marie-France Coutu
- CAPRIT and School of Rehabilitation, Université de Sherbrooke, Longueuil QC, Canada.
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Anderson KG, Dugas MJ, Koerner N, Radomsky AS, Savard P, Turcotte J. Interpretive style and intolerance of uncertainty in individuals with anxiety disorders: a focus on generalized anxiety disorder. J Anxiety Disord 2012; 26:823-32. [PMID: 23023161 DOI: 10.1016/j.janxdis.2012.08.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 07/23/2012] [Accepted: 08/30/2012] [Indexed: 11/26/2022]
Abstract
Interpretations of negative, positive, and ambiguous situations were examined in individuals with generalized anxiety disorder (GAD), other anxiety disorders (ANX), and no psychiatric condition (CTRL). Additionally, relationships between specific beliefs about uncertainty (Uncertainty Has Negative Behavioral and Self-Referent Implications [IUS-NI], and Uncertainty Is Unfair and Spoils Everything [IUS-US]) and interpretations were explored. The first hypothesis (that the clinical groups would report more concern for negative, positive, and ambiguous situations than would the CTRL group) was supported. The second hypothesis (that the GAD group would report more concern for ambiguous situations than would the ANX group) was not supported; both groups reported similar levels of concern for ambiguous situations. Exploratory analyses revealed no differences between the GAD and ANX groups in their interpretations of positive and negative situations. Finally, the IUS-US predicted interpretations of negative and ambiguous situations in the full sample, whereas the IUS-NI did not. Clinical implications are discussed.
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Affiliation(s)
- Kristin G Anderson
- Concordia University, Department of Psychology, 7141 Sherbrooke St. West, L-PY-170, Montreal, Quebec, Canada H4B 1R6
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30
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Fisher JE, Sass SM, Heller W, Silton RL, Edgar JC, Stewart JL, Miller GA. Time course of processing emotional stimuli as a function of perceived emotional intelligence, anxiety, and depression. ACTA ACUST UNITED AC 2010; 10:486-97. [PMID: 20677866 DOI: 10.1037/a0018691] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
An individual's self-reported abilities to attend to, understand, and reinterpret emotional situations or events have been associated with anxiety and depression, but it is unclear how these abilities affect the processing of emotional stimuli, especially in individuals with these symptoms. The present study recorded event-related brain potentials while individuals reporting features of anxiety and depression completed an emotion-word Stroop task. Results indicated that anxious apprehension, anxious arousal, and depression were associated with self-reported emotion abilities, consistent with prior literature. In addition, lower anxious apprehension and greater reported emotional clarity were related to slower processing of negative stimuli indexed by event-related potentials (ERPs). Higher anxious arousal and reported attention to emotion were associated with ERP evidence of early attention to all stimuli regardless of emotional content. Reduced later engagement with stimuli was also associated with anxious arousal and with clarity of emotions. Depression was not differentially associated with any emotion processing stage indexed by ERPs. Research in this area may lead to the development of therapies that focus on minimization of anxiety to foster successful emotion regulation.
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Affiliation(s)
- Joscelyn E Fisher
- Department of Psychology, University of Illinois at Urbana-Champaign, USA.
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Kang SG, Shin JH, Song SW. Reliability and validity of the Korean version of the Penn State Worry Questionnaire in primary school children. J Korean Med Sci 2010; 25:1210-6. [PMID: 20676335 PMCID: PMC2908793 DOI: 10.3346/jkms.2010.25.8.1210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 02/09/2010] [Indexed: 11/25/2022] Open
Abstract
Worry is a generalized psychological phenomenon seen among most people. When worry is excessive and nearly uncontrollable, people usually suffer psychological pain. The Penn State Worry Questionnaire for Children (PSWQ-C) was developed to measure worry objectively. It comprises 14 items for measuring excessive, generalized, and uncontrollable worry in children. This study, conducted with a large group of elementary children (3rd through 6th graders, ages 8-12 yr; N=973), investigated the reliability and validity of the Korean version of the Penn State Worry Questionnaire for Children (PSWQ-CK). The PSWQ-CK showed high reliability by test-retest and also excellent internal consistency results. To examine the validity of the PSWQ-CK, we calculated its correlation with the Revised Children's Manifest Anxiety Scale (RCMAS). The PSWQ-CK had a higher correlation with the worry/oversensitivity factor than with other subscales of the RCMAS, and it showed no correlation with the lie factor. When 3 reversed PSWQ-CK items were eliminated, the instrument showed higher internal consistency. However, this did not improve its correlation with other anxiety-measuring tools. In conclusion, the PSWQ-CK's reliability and validity were satisfactory, and it is a useful tool for objectively measuring the worry of Korean children of this age group.
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Affiliation(s)
- Sung-Goo Kang
- Department of Family Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jin-Hee Shin
- Department of Family Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Sang-Wook Song
- Department of Family Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
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Olatunji BO, Wolitzky-Taylor KB, Sawchuk CN, Ciesielski BG. Worry and the anxiety disorders: A meta-analytic synthesis of specificity to GAD. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.appsy.2011.03.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Paulus MP, Stein MB. Interoception in anxiety and depression. Brain Struct Funct 2010; 214:451-63. [PMID: 20490545 PMCID: PMC2886901 DOI: 10.1007/s00429-010-0258-9] [Citation(s) in RCA: 558] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 04/21/2010] [Indexed: 12/21/2022]
Abstract
We review the literature on interoception as it relates to depression and anxiety, with a focus on belief, and alliesthesia. The connection between increased but noisy afferent interoceptive input, self-referential and belief-based states, and top-down modulation of poorly predictive signals is integrated into a neuroanatomical and processing model for depression and anxiety. The advantage of this conceptualization is the ability to specifically examine the interface between basic interoception, self-referential belief-based states, and enhanced top-down modulation to attenuate poor predictability. We conclude that depression and anxiety are not simply interoceptive disorders but are altered interoceptive states as a consequence of noisily amplified self-referential interoceptive predictive belief states.
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Affiliation(s)
- Martin P Paulus
- Department of Psychiatry, University of California, San Diego, 8939 Villa La Jolla Drive, La Jolla, CA 92037, USA.
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Rood L, Roelofs J, Bögels SM, Alloy LB. Dimensions of Negative Thinking and the Relations with Symptoms of Depression and Anxiety in Children and Adolescents. COGNITIVE THERAPY AND RESEARCH 2009; 34:333-342. [PMID: 20676215 PMCID: PMC2899011 DOI: 10.1007/s10608-009-9261-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 07/16/2009] [Indexed: 11/27/2022]
Abstract
The current study sought to examine three forms of negative, repetitive thinking in non-clinical children and adolescents aged between 10 and 18. More specifically, this study addressed the degree to which stress-reactive rumination can be differentiated from other forms of repetitive thinking, such as emotion-focused rumination and worry, and the associations between the various indices of repetitive thinking and symptoms of anxiety and depression. Participants completed a battery of self-report questionnaires including measures of stress-reactive rumination, emotion-focused rumination, worry, and symptoms of anxiety and depression. Results showed that stress-reactive rumination, emotion-focused rumination and worry are related but distinct forms of repetitive negative thinking. Positive associations were found between all indices of repetitive thinking and symptoms of depression and anxiety, but the effects of emotion-focused rumination disappeared when controlling for the other forms of repetitive thinking. The findings are discussed in the light of current theories and previous research, and directions for future research are provided.
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Affiliation(s)
- Lea Rood
- Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Jeffrey Roelofs
- Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Susan M. Bögels
- Department of Education, University of Amsterdam, Amsterdam, The Netherlands
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Zhong J, Wang C, Li J, Liu J. Penn State Worry Questionnaire: structure and psychometric properties of the Chinese version. J Zhejiang Univ Sci B 2009; 10:211-8. [PMID: 19283876 DOI: 10.1631/jzus.b0820189] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Penn State Worry Questionnaire (PSWQ) is a measure of worry phenomena and has been demonstrated valid in cross-cultural populations. The present study examined the factor structure and psychometric properties of the Chinese version of PSWQ (Ch-PSWQ) in a Chinese college sample (n=1243). Exploratory factor analysis of the Ch-PSWQ revealed a two-factor solution (engagement of worry and absence of worry). Confirmatory factor analysis and model comparison supported that the model of one factor with method effect provided the best fit to the data. The Ch-PSWQ and its factors evidenced good internal consistency and both convergent and discriminate validity. The present study supports the opinion that the second factor of PSWQ not only contains the component of evaluating pathological worry, but also might represent other traits.
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Affiliation(s)
- Jie Zhong
- Department of Psychology, Peking University, and Beijing Anding Hospital, Beijing 100871, China.
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36
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Miranda R, Fontes M, Marroquín B. Cognitive content-specificity in future expectancies: Role of hopelessness and intolerance of uncertainty in depression and GAD symptoms. Behav Res Ther 2008; 46:1151-9. [DOI: 10.1016/j.brat.2008.05.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 04/24/2008] [Accepted: 05/08/2008] [Indexed: 10/21/2022]
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Abstract
The experience of childhood cancer can be one of the most severe stressors that parents endure. Studies using illness-specific measures of parental stress indicate that moderate-to-severe parenting stress is quite common in the first year of childhood cancer treatment, and as many as 5% to 10% of these parents go on to develop posttraumatic stress disorder. This review of the literature suggested that although parenting stress symptoms may be relatively transitory for most parents dealing with childhood cancer, the impact of these stress symptoms on parent and child functioning is substantive and worthy of therapeutic attention. The stresses entailed in childhood cancer should be viewed as complex and varied across stages of diagnosis and treatment. Factors associated with increased risk of parental posttraumatic stress symptoms include poor social support, adverse experience with invasive procedures, negative parental beliefs about the child's illness and/or associated treatment, and trait anxiety. For those parents with risk factors that might forebode more severe and enduring stress reactions to their children's cancer, therapeutic strategies are proposed to ameliorate their stress and reduce the development and/or maintenance of posttraumatic stress symptoms.
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38
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Hunt C. The treatment of generalised anxiety disorder. CLIN PSYCHOL-UK 2008. [DOI: 10.1080/13284200108521077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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39
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Paulus MP. The role of neuroimaging for the diagnosis and treatment of anxiety disorders. Depress Anxiety 2008; 25:348-56. [PMID: 18412061 PMCID: PMC4429203 DOI: 10.1002/da.20499] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Neuroimaging comprises a set of tools, which include different types of magnetic resonance imaging such as functional magnetic resonance imaging (fMRI), Magnetic Resonance Spectroscopy (MRS), Arterial Spin Labeling (ASL), and radiotracer imaging such as positron emission tomography and single photon emission computed tomography. The focus of this review is to address the question whether fMRI can contribute to the diagnosis and treatment of anxiety disorders. Key anxiety processes and neural substrates are reviewed. The main findings and shortcomings of fMRI in the context of anxiety are briefly summarized. Finally, the next stages of developing fMRI for diagnosis and treatment are highlighted. The main conclusion of this review is that fMRI could become a clinical tool for the diagnosis and treatment of anxiety disorders, but neuroimaging groups will need to better develop its specificity and sensitivity so that fMRI results can be meaningful for an individual patient not just for groups of individuals.
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Affiliation(s)
- Martin P. Paulus
- Department of Psychiatry, University of California, San Diego (UCSD),Psychiatry Service, Veterans Affairs San Diego Health Care System
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Crittendon J, Hopko DR. Assessing worry in older and younger adults: Psychometric properties of an abbreviated Penn State Worry Questionnaire (PSWQ-A). J Anxiety Disord 2007; 20:1036-54. [PMID: 16387472 DOI: 10.1016/j.janxdis.2005.11.006] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Revised: 11/08/2005] [Accepted: 11/15/2005] [Indexed: 11/21/2022]
Abstract
Among older adults, recent work indicated that Penn State Worry Questionnaire (PSWQ) data fit poorly with previously established models, leading to use of model modification procedures to create an abbreviated worry questionnaire (PSWQ-A; Hopko, D. R., Stanley, M. A., Reas, D. L., Wetherell, J. L., Beck, J. G., Novy, D. M., et al. (2003). Assessing worry in older adults: Confirmatory factor analyses of the Penn State Worry Questionnaire and psychometric properties of an abbreviated model. Psychological Assessment, 15, 173-183). Given limitations of this prior study that included the post hoc statistical development of the scale and undefined relevance toward assessing worry in younger cohorts, psychometric properties of the PSWQ-A were explored among independent samples of older (n = 115) and younger adults (n = 183). Exploratory factor analyses supported a unidimensional model (breadth and control of worry) that accounted for substantial variance in older (57%) and younger adult samples (70%) and was associated with high factor loadings (.66-.89). Internal consistency (alpha = .89-.94) and test-retest reliability (r = .87-.95) was strong in both samples. Moderate to strong convergent validity with measures of worry and anxiety was evident (r = .46-.83), as was support for the construct validity of the PSWQ-A via its relation to the PSWQ (r = .65-.83) and similar relations with other anxiety and worry measures. Although further study is required, the PSWQ-A may be a parsimonious method to assess worry in older and younger adults.
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Affiliation(s)
- Julie Crittendon
- The University of Tennessee-Knoxville, Department of Psychology, Room 301D, Austin Peay Building, Knoxville, TN 37996-0900, USA
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Depression, Generalized Anxiety Disorder, and Certainty in Pessimistic Predictions about the Future. COGNITIVE THERAPY AND RESEARCH 2007. [DOI: 10.1007/s10608-006-9063-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Koerner N, Dugas MJ. An investigation of appraisals in individuals vulnerable to excessive worry: the role of intolerance of uncertainty. COGNITIVE THERAPY AND RESEARCH 2007. [DOI: 10.1007/s10608-007-9125-2] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Starcevic V, Berle D. Cognitive specificity of anxiety disorders: a review of selected key constructs. Depress Anxiety 2006; 23:51-61. [PMID: 16402368 DOI: 10.1002/da.20145] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Cognitive models of anxiety disorders propose that certain cognitive constructs, that is, underlying beliefs and cognitive processes, may be specific for particular disorders. In this article, we review the specificity of four representative cognitive constructs-anxiety sensitivity, pathological worry, intolerance of uncertainty, and thought-action fusion-for particular disorders. Conceptual overlap, inconsistent definitions, and insufficient consideration of the components of these constructs are limitations of the existing literature. We suggest that the constructs are unlikely to be pathognomonic for any given disorder or to occur in isolation. Rather, the association of each cognitive construct is evident, to varying degrees, with different disorders. Relative to other disorders, anxiety sensitivity is to a certain extent specific for panic disorder, as are pathological worry for generalized anxiety disorder, intolerance of uncertainty for generalized anxiety disorder and obsessive-compulsive disorder, and thought-action fusion for obsessive-compulsive disorder. We discuss the implications of these findings for diagnostic systems and treatment, and suggest areas for further research.
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Affiliation(s)
- Vladan Starcevic
- University of Sydney and Nepean Hospital, Penrith, New South Wales, Australia.
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Berenbaum H, Thompson RJ, Pomerantz EM. The relation between worrying and concerns: the importance of perceived probability and cost. Behav Res Ther 2006; 45:301-11. [PMID: 16677599 DOI: 10.1016/j.brat.2006.03.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Revised: 12/20/2005] [Accepted: 03/14/2006] [Indexed: 11/30/2022]
Abstract
The relation between worrying and individuals' concerns was examined in a sample of 197 college students. Participants described the five undesirable outcomes that they thought about most often, indicated how likely they thought the outcomes were, and how upset they would be by them. Worry severity was measured using the Penn State Worry Questionnaire. The relation between worry severity and the life domains about which individuals were concerned was quite weak. In contrast, as predicted, greater worry was associated with higher probability and cost estimates. In addition, cost estimates moderated the relation between worry severity and probability estimates. The potential importance of perceived threat for understanding worrying is discussed.
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Affiliation(s)
- Howard Berenbaum
- Psychology Department, University of Illinois at Urbana-Champaign, 603 E. Daniel Street, Champaign, IL 61820, USA.
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45
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Dugas MJ, Hedayati M, Karavidas A, Buhr K, Francis K, Phillips NA. Intolerance of Uncertainty and Information Processing: Evidence of Biased Recall and Interpretations. COGNITIVE THERAPY AND RESEARCH 2005. [DOI: 10.1007/s10608-005-1648-9] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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46
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Provencher MD, Dugas MJ, Ladouceur R. Efficacy of problem-solving training and cognitive exposure in the treatment of generalized anxiety disorder: A case replication series. COGNITIVE AND BEHAVIORAL PRACTICE 2004. [DOI: 10.1016/s1077-7229(04)80057-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
OBJECTIVE To provide an overview of theory and research regarding the phenomenology and function of worry. METHOD A systematic literature search focusing on conceptualizations of worry as a cognitive activity and worry research over the last 20 years was conducted. RESULTS Worry can be both functional and dysfunctional. Disruption to daily functioning, perceived uncontrollability, pervasiveness and extensive coverage of worry themes (including "remote" events and the presence of meta-worry), all have specificity to more severe and dysfunctional worry. CONCLUSIONS Research investigating both the relationship between worry and anxiety and the attributes of severe worriers, has brought attention to its role in fostering emotional disturbance and has clarified factors relevant to treatment.
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Affiliation(s)
- Gemma Gladstone
- School of Psychiatry, University of New South Wales and Mood Disorders Unit, Black Dog Institute, Prince of Wales Hospital, Randwick, New South Wales 2031, Australia.
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Abstract
The stability of worry content was investigated in a sample of 27 individuals diagnosed with Generalized Anxiety Disorder. During an initial evaluation, participants were asked to describe the content of their current worries, and the examining psychiatrist rated the frequency and intensity of these topics. During the following year, the investigators interviewed the participants on a monthly basis assessing the intensity and frequency of original worries, intensity and frequency of new worries, overall worry level, and general anxiety level. Analysis of this longitudinal data indicated level of overall worry and anxiety remained fairly stable over a 12-month period. Although the intensity and frequency of original worries decreased over time, few original worry topics completely remitted. In fact, at the end of the 12-month monitoring period, worry content identified at baseline continued to account for over 65% of the overall worry variance. Most participants did identify new worry topics during the course of the 12-month period, and the frequency and intensity of the new worries were comparable to the decrease in frequency and intensity of the original worries.
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Affiliation(s)
- Joseph I Constans
- Department of Psychiatry, Louisiana State University School of Medicine, New Orleans, USA.
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Uhlenhuth EH, Starcevic V, Warner TD, Matuzas W, McCarty T, Roberts B, Jenkusky S. A general anxiety-prone cognitive style in anxiety disorders. J Affect Disord 2002; 70:241-9. [PMID: 12128236 DOI: 10.1016/s0165-0327(01)00457-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study compared scores on the Anxious Thoughts & Tendencies (AT&T) questionnaire, a putative measure of a general anxiety-prone cognitive style, among patients with panic disorder without agoraphobia (PD, n=62), panic disorder with agoraphobia (PDA, n=29), generalized anxiety disorder (GAD, n=43), limited social phobia (LSP, n=34), generalized social phobia (GSP, n=33), and community residents (n=319). METHOD Candidates for treatment studies completed a diagnostic interview and the AT&T. AT&T scores were compared among anxious groups using analysis of variance. Then depressed and non-depressed patients were compared. The final analysis compared anxious groups without comorbid depressive or anxiety disorders. RESULTS AT&T scores were highest in PDA patients, followed by patients with GAD or GSP, then patients with PD or LSP, with community residents lowest. Depressed patients were higher than non-depressed patients. Patients with current or past comorbid depressive disorders did not differ. The ranking of anxious groups on AT&T scores remained unchanged after exclusion of patients with comorbid disorders. Patients with PD or LSP without comorbidity had the same AT&T levels as the community sample. CONCLUSIONS The AT&T discriminates PDA and GAD from PD per our hypothesis. The low AT&T levels among patients with PD and LSP suggest no association with a general anxiety-prone cognitive style. LSP and GSP may be distinct disorders. The cognitive style assessed by the AT&T is also associated with depression and may be a marker for vulnerability to depression. Definitive conclusions about a pathogenic role for cognitions require their measurement before the onset of the disorder.
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Affiliation(s)
- E H Uhlenhuth
- Department of Psychiatry, University of New Mexico School of Medicine, 2400 Tucker, N.E., Albuquerque, NM 87131-5326, USA.
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50
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Roemer L, Orsillo SM. Expanding our conceptualization of and treatment for generalized anxiety disorder: Integrating mindfulness/acceptance-based approaches with existing cognitive-behavioral models. ACTA ACUST UNITED AC 2002. [DOI: 10.1093/clipsy.9.1.54] [Citation(s) in RCA: 173] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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