Cognitive specificity of anxiety disorders: a review of selected key constructs

Examining the Mediating Role of Resilience and Life Satisfaction in the Relationship Between Anxiety Sensitivity and Perceived Stress

This study examines the mediation role of life satisfaction and resilience variables in the relationships between anxiety sensitivity and perceived stress. The data was collected with the Anxiety Sensitivity Index-3, Life Satisfaction Scale, Perceived Stress Scale, and Brief Psychological Resilience Scale from 347 university students (Mage = 23.15, SD = 5.15; 70% girls, 30% boys). The analyses were examined by structural equation modeling using AMOS 24. The findings suggest that students with high anxiety sensitivity and perceived stress have low resilience and life satisfaction levels. More importantly, resilience and life satisfaction were found to have partial mediation. As a result, it is seen that anxiety sensitivity has a significant effect on reducing perceived stress by increasing students' resilience and life satisfaction. Therefore, this situation facilitates decreased anxiety levels, greater satisfaction with life, and more robust mental health.

A moderated chain mediation model examining the relation between smartphone addiction and intolerance of uncertainty among master's and PhD students

The theories of relational regulation and compensatory Internet use suggest that intolerance of uncertainty influences smartphone addiction (SPA), which in turn is influenced by other aspects. This study used previous results to examine how intolerance of uncertainty affects SPA in PhD and master's degree programs. A convenience sample comprising 1727 master's and PhD students (99.9 %; 50.7 % female; Mage = 27.71; SD = 3.80; range = 21-43) was recruited. Using established questionnaires, we measured SPA, anxiety, positive coping style, perceived social support, and intolerance of uncertainty. The results demonstrated that intolerance of uncertainty positively affects SPA in terms of predictive power. Furthermore, anxiety and positive coping style mediate that link in a cascade fashion. A greater SPA indicates that the individual is less likely to use a positive coping style, has a higher anxiety level, and has a lower tolerance for uncertainty. While thinking about how intolerance of uncertainty affects anxiety and positive coping style, perceived social support mediates the relationship. Intolerance of uncertainty has less impact on anxiety and positive coping style when perceived social support is high. These results indicate the possibility of examining SPA prevention and intervention from several angles. Therefore, emotional regulation, which modifies anxiety and the tendency to use a positive coping style, may reduce the impact of intolerance of uncertainty on SPA. Another successful strategy for reducing smartphone addiction is to provide social support from loved ones and the community at large.

The relationship between tolerance for uncertainty and academic adjustment: the mediating role of students' psychological flexibility during COVID-19

Introduction

University students are among the groups most adversely affected by COVID-19 in terms of their psychological and academic wellbeing, particularly given the pandemic's uncertainty. However, little is known about their psychological flexibility to deal with this uncertain nature of pandemic. This study aimed to examine the mediating role of psychological flexibility (PF) in the relationship between university students' intolerance of uncertainty (IU) and their academic adjustment to the online learning process during COVID-19.

Methods

Data was collected from 388 university students from Türkiye (18-34 (Mage = 21.43, SD = 2.04) who completed five questionnaires - Intolerance of Uncertainty Scale, Acceptance and Action Questionnaire II, Academic Self Efficacy Scale, Educational Stress Scale, and Online Self-Regulatory Learning Scale. Additionally, as indicators of students' academic adjustment, perceived academic performance - ranging 1 to 10, and their last academic grade point average before and during the pandemic were also collected.

Results

The results indicated that PF and IU had a significant effect on the academic adjustment of students during the pandemic. PF had a complete mediating role between the IU and academic adjustment. Results also revealed that online self-regulation, a sub-dimension of academic adjustment, did not show a significant relationship with any other variable in the model.

Discussion

Research findings showed that psychological flexibility is a very important strength for university students to maintain their academic adjustment in stressful times. The results were discussed in light of the relevant research, and recommendations for further research and implications were provided.

Psychometric Properties of the Iranian Version of Contrast Avoidance Questionnaires: Could Contrast Avoidance Be a New Transdiagnostic Construct?

The contrast avoidance model (CAM) hypothesizes that individuals with chronic worry recruit worry to create and maintain a negative emotional state to avoid sudden increases in negative emotions. Preliminary evidence using the contrast avoidance questionnaires (CAQs) suggests that there might be a similar mechanism across mood and other anxiety disorders. To continue to assess the CAQs, they should be adapted for other languages and evaluated across multiple symptom domains. The present study aimed to develop the Persian versions of the CAQs and examine the transdiagnostic nature of CAM across two studies. A large Persian-speaking college student sample (Total n = 1438) was used to evaluate the factor structure of the CAQs (Study 1) and the psychometric properties of CAQs (Study 2). Results supported the two-factor structure of the CAQ-W (worry) and CAQ-GE (general emotion). Results showed that CAQ-W was a significant predictor of anxiety-related measures. However, CAQ-GE and IUS-12 significantly predicted depressive and other symptoms over the CAQ-W. Results demonstrated excellent psychometric properties. They indicate that contrast avoidance, measured via CAQ-GE, could be a transdiagnostic construct, and CAQ-W may be more sensitive to anxiety-specific contrast avoidance among Persian speaking and/or Iranian individuals.

Anxiety and Depression in a Non-Clinical Sample of Young Polish Adults: Presence of Meaning in Life as a Mediator

Early adulthood, between 18 and 25, is viewed as a decisive period of life for the prevention and treatment of anxiety and depression. Although the topic of their mutual relationship is well-known, little has been uncovered about the mechanism underlying this connection. To understand the indirect pathways between anxiety and depression, we chose the sense of meaning of life as a mediator because people's beliefs that their lives are or can be purposeful may protect against depression. The sample was composed of 277 Polish young adults. A small majority of the participants were women (58.8%). The mean age was M = 22.11 (SD = 1.72). We used in the research the Direct Behavior Rating-Scale Items Scale, the Meaning in Life Questionnaire, and the Brief Screen for Depression. Correlational analysis showed that, consistent with past findings, anxiety correlated positively with depression and searching for meaning. It was also negatively associated with presence of meaning. Moreover, depression was negatively linked to presence of meaning and positively with searching for meaning. Regression-based mediation analyses (PROCESS macro 3.4) proved that the relationship between anxiety and depression was mediated by presence of meaning in life, suggesting that having a sense of meaning may be a pathway by which feelings of tension relative to adverse events protect against depression.

The efficacy of transdiagnostic cognitive behavioural therapy on reducing negative affect, anxiety sensitivity and improving perceived control in children with emotional disorders - a randomized controlled trial

In response to the high rate of comorbidity among different types of emotional disorders in children, Transdiagnostic Unified Protocol of Emotional disorder in children (UP-C) was developed to address common underlying mechanisms in the development and maintenance of emotional disorders using empirically supported cognitive and behavioural strategies. Although, studies supported the effectiveness of this protocol in the treatment of wide range of emotional disorders, further studies are needed to examine its effect on transdiagnostic factors. The present study aimed to investigate the efficacy of the UP-C on negative affect, anxiety sensitivity and perceived control in children with emotional disorders. During this randomized controlled trial, 34 children aged 7 to 13 with emotional disorders were randomly assigned to treatment (n=18) and control (n=16) groups. The treatment group and their parents received 15 sessions of UP-C. Negative Affect Schedule for Children (PANASNA- C), Children’s Anxiety Sensitivity Index (CASI), Anxiety Control Questionnaire-Children (ACQ-C) were carried out in all phases (pre-treatment, post-treatment, 3 and 8 months follow- up). The results showed that following UP-C, negative affect (hedges’g=2.01) and anxiety sensitivity (hedges’g=1.05) were significantly reduced, and perceived control (hedges’g= –2.36) was significantly improved. The results remained relatively constant during the follow-ups. Findings provide evidence that the UP-C has significant effect on negative affect, anxiety sensitivity and perceived control as roots of emotional disorders.

Multivariate morphological brain signatures enable individualized prediction of dispositional need for closure

Need for closure (NFC) reflects stable individual differences in the desire for a quick, definite, and stable answer to a question. A large body of research has documented the association between NFC and various cognitive, emotional and social processes. Despite considerable interest in psychology, little effort has been made to uncover the neural substrates of individual variations in NFC. Herein, we took a data-driven approach to predict NFC trait combining machine learning framework and the whole-brain grey matter volume (GMV) features, which represent a reliable brain imaging measure and have been commonly employed to explore neural basis underlying individual differences of cognition and behaviors. Brain regions contributing to the prediction were then subjected to functional connectivity and decoding analyses for a quantitative inference on their psychophysiological functions. Our results indicated that multivariate patterns of GMV derived from multiple regions across distributed brain systems predicted NFC at individual level. The contributing regions are distributed across the emotional processing network (e.g., striatum), cognitive control network (e.g., lateral prefrontal cortex), social cognition network (e.g., temporoparietal junction) and perceptual processing network (e.g., occipital cortex). The current study provided the first evidence that dispositional NFC is embodied in multiple large-scale brain networks, helping to delineate a more complete picture about the neuropsychological processes that support individual differences in NFC. Beyond these findings, the current interdisciplinary approach to constructing and interpreting neuroimaging-based prediction model of personality traits would be informative to a wide range of future studies on personality.

Factors differentiating panic disorder with and without comorbid symptoms of depression

The aim of this study was to examine the sociodemographic and clinical differences between people with a probable diagnosis of panic disorder (PD) and those with PD and a probable comorbid diagnosis major depressive disorder (PD + MDD). We also sought to explore the potential contribution of cognitive variables to help differentiate between PD and PD + MDD. This was a subgroup analysis of 331 patients with PD symptoms who were included in the PsicAP clinical trial. All participants completed scales to evaluate panic, depression, somatization, cognitive and performance variables. A univariate analysis showed significant differences (p < .01) between the groups (PD vs PD + MDD) in clinical variables. Somatization was the best predictor of comorbid PD + MDD (β = .346; p < .01). Cognitive variables do not appear to play an essential role in predicting the presence of depressive symptoms in people with a screen positive for PD. These findings appear to support a transdiagnostic treatment approach for PD, which may be useful regardless of whether comorbid depression is present or not. PRACTITIONER POINTS: Somatic symptoms were associated with a higher probability of be in the PD + MDD group. Cognitive variables do not play a relevant role in the differentiation of both groups. A transdiagnostic approach can be useful for the treatment of PD or PD + MDD group.

Anxiety sensitivities, anxiety and depression levels, and personality traits of patients with chronic subjective tinnitus: a case-control study

Objectives: Tinnitus is a condition that commonly affects individuals' daily activities. We aimed to evaluate the anxiety sensitivity, levels of anxiety and depression, and personality traits of patients with chronic subjective tinnitus.Methods: The study included 42 patients, who visited the Otorhinolaryngology Clinic, complained of having tinnitus for at least 1 year and did not have any previous peripheral vestibular diseases or psychiatric treatment history. Forty-five healthy individuals volunteered to be in the control group. We administered the Tinnitus-Severity-Index (TSI), Anxiety-Sensitivity-Index-3 (ASI-3), Beck-Anxiety Inventory (BAI), Beck-Depression-Inventory (BDI) and Eysenck-Personality- Questionnaire (EPQ) to the study participants.Results: The BDI score was significantly higher in the patient group. The ASI-3, EPQ, and BAI scores of the patients did not differ statistically. A positive correlation was found between the EPQ neuroticism subscale scores and the ASI-3, BDI, and BAI scores of the patient cases. There was also a positive correlation between the TSI scores and the BAI, ASI-3, and neuroticism scores of the tinnitus group.Conclusion: To the best of our knowledge, few studies have evaluated anxiety sensitivity, anxiety and depression levels, and personality traits and no studies evaluating patients and controls together. In cases where tinnitus and psychiatric diseases are comorbid, both conditions should be treated to achieve the best outcomes for the patients' quality of life.KEY POINTSAlthough patients with tinnitus were selected among cases without any psychiatric treatment history, we found that depressive symptoms in this group were high.The participants' anxiety sensitivity, anxiety, and neuroticism scores increased as the severity of their tinnitus increased.The anxiety sensitivity, anxiety, and depressive scores increased along with the increase in the neuroticism scores of the patients with chronic subjective tinnitus.

Standard of proof and intolerance of uncertainty in obsessive-compulsive disorder and social anxiety disorder

BACKGROUND AND OBJECTIVES

Researchers have identified intolerance of uncertainty (IU) as a dysfunctional thought that contributes to OCD. Case examples of OCD suggest that uncertainty and anxiety persist despite low likelihoods of feared outcomes. In this study we examined how people with OCD react to minimal amounts of uncertainty relative to non-anxious individuals and a clinical comparison group of people with social anxiety disorder (SAD).

METHODS

We created a questionnaire to measure the distress people feel when there is only minimal uncertainty regarding a given outcome and if they prefer situations with the certainty of negative outcomes in the present versus living with uncertainty. Part two of our study tested whether IU is related to performance on neutral and idiographic versions of the Beads Task.

RESULTS

OCD and SAD subjects reacted to hypothetical scenarios involving minimal risk with greater negative affect than did non-anxious subjects; however, after repeating analyses to account for comorbid disorders, OCD subjects' scores did not differ from those of non-anxious subjects. Only SAD subjects showed a preference for negative information in the present versus the uncertainty of a future outcome. Part two of our study revealed that self-reported IU was only marginally associated with performance on the neutral Beads Task.

LIMITATIONS

High rates of comorbidity made it difficult to identify the specific relationship of IU with other anxiety disorders.

CONCLUSIONS

IU for general, non-OCD specific scenarios may not figure prominently in all individuals with OCD, but rather may play a larger, more consistent role in anxiety disorders such as SAD. Additionally, the number of beads or words viewed on Beads Task may be an inadequate behavioral measure of IU.

Effects of Rumination and Worry on Sleep

Recent research suggests that the stress-sleep relationship is mediated by pre-sleep arousal (PSA) and that cognitive arousal has a stronger mediating effect than somatic arousal; however, this has not been directly tested. Using multilevel moderated mediation, we compared the effects of cognitive arousal and somatic arousal within the stress-sleep relationship. We also assessed whether two forms of repetitive negative thought-rumination and worry-are similarly involved in the stress-sleep relationship. Data was collected from 178 participants across the United States via an online platform. Participants completed baseline self-report surveys examining rumination tendencies and worry tendencies. Over the course of 2 weeks, participants completed daily questionnaires assessing daily stress, PSA, and sleep quality. Results indicated that indirect effects from stress to sleep quality via PSA were statistically significant at low and high levels of rumination and worry, and people at high levels of rumination and worry had stronger relationships between stress and PSA. Across all models, cognitive arousal consistently accounted for more of the variance in the stress-sleep relationship as compared to somatic arousal. Implications for the cognitive behavioral treatment of insomnia are discussed.

Catastrophizing, pain, and functional outcomes for children with chronic pain: a meta-analytic review

Pediatric chronic pain is associated with numerous negative outcomes including increased physical disability, increased rates of depression and anxiety, and decreased quality of life (QOL). Pain catastrophizing-broadly conceptualized as including rumination, magnification, and helplessness cognitions surrounding one's pain-has been linked with poor functional outcomes in children with chronic pain. Pain catastrophizing in pediatric chronic pain is often considered a key factor on which to focus treatment efforts. However, absent a systematic review that integrates the relevant literature, this call for routine assessment and targeted treatment may be premature. This study aimed to: (1) meta-analytically quantify the relationship between catastrophizing and pain and functional/psychosocial outcomes (functional disability/physical functioning, anxiety, depression, and QOL) in children with chronic pain, and (2) examine potential moderators of these relationships. Using a random-effects model, a total of 111 effect sizes from 38 studies were analyzed. Effect sizes ranged from medium to large, with anxiety, depression, and QOL demonstrating a strong association with catastrophizing. Pain intensity and physical disability had a moderate association with catastrophizing. These relationships were robust, minimizing potential publication bias. None of the examined moderators were significant. The strong relationships found between catastrophizing and anxiety, depression, and QOL suggest that successfully intervening on catastrophizing could have far reaching implications in improving pain outcomes in pediatric chronic pain.

Pain anxiety differentially mediates the association of pain intensity with function depending on level of intolerance of uncertainty

Uncertainty about symptom duration, cause, prognosis and treatment is common in patients who seek medical care, yet individual ability to manage this uncertainty varies. Intolerance of uncertainty is considered an important factor in the etiology and persistence of negative emotions- in particular, depression and anxiety. We explored the contribution of intolerance of uncertainty to anxiety due to pain and physical function in patients seeking care at an orthopedic medical practice. Participants (N = 105, mean age of 51 ± 17, 63% male) were administered PROMIS Physical Function v1.2 Upper Extremity CAT, Numerical Rating Scale (NRS), Pain Anxiety Symptoms Scale-short form (PASS-20), and the Intolerance of Uncertainty Scale-short version (IUS-12). Results showed that the mediating role of pain anxiety is contingent upon the level of intolerance of uncertainty. Specifically, a minimum level of intolerance of uncertainty is required for the development of pain anxiety and its effect on function, and as intolerance of uncertainty rises from low to medium to high levels, the effect of pain on function goes from being independent of the anxiety to being more and more carried by and through anxiety about pain. These findings support the contention that intolerance of uncertainty plays a crucial role in the relationship between pain, pain anxiety, and physical function. Intolerance of uncertainty appears to be a trans-diagnostic target for coping skills training.

What's the Worry with Social Anxiety? Comparing Cognitive Processes in Children with Generalized Anxiety Disorder and Social Anxiety Disorder

Social anxiety disorder (SAD) in children is often comorbid with generalized anxiety disorder (GAD). We investigated whether worry, intolerance of uncertainty, beliefs about worry, negative problem orientation and cognitive avoidance, that are typically associated with GAD, are present in children with SAD. Participants included 60 children (8-12 years), matched on age and gender. Groups included children: with primary GAD and without SAD (GAD); with primary SAD and without GAD (SAD); and without an anxiety disorder (NAD). GAD and SAD groups scored significantly higher than the NAD group on worry, intolerance of uncertainty, negative beliefs about worry and negative problem orientation, however, they did not score differently from each other. Only the GAD group scored significantly higher than the NAD group on cognitive avoidance. These findings further understanding of the structure of SAD and suggest that the high comorbidity between SAD and GAD may be due to similar underlying processes within the disorders.

Processes Contributing to the Maintenance of Flying Phobia: A Narrative Review

Flying phobia is a highly prevalent anxiety disorder, which causes sufferers significant distress and life interference. The processes which maintain flying phobia remain poorly understood. A systematic search of the literature was performed to identify what research has been conducted into the processes which may be involved in the fear of flying and whether processes which are believed to maintain other anxiety disorder diagnoses have been investigated in flying phobia. The results of the literature review are presented and related to existing cognitive behavioral theory and research. The results indicate that little research has been conducted into a number of areas considered important in the wider cognitive behavioral literature on anxiety disorders: namely attention, mental imagery, memory, worry, and safety-seeking behaviors. The review proposes a hypothetical model, derived from cognitive behavioral theory, for the processes which may be involved in maintaining flying phobia, and considers a number of areas for future research.

Intolerance of uncertainty in emotional disorders: What uncertainties remain?

The current paper presents a future research agenda for intolerance of uncertainty (IU), which is a transdiagnostic risk and maintaining factor for emotional disorders. In light of the accumulating interest and promising research on IU, it is timely to emphasize the theoretical and therapeutic significance of IU, as well as to highlight what remains unknown about IU across areas such as development, assessment, behavior, threat and risk, and relationships to cognitive vulnerability factors and emotional disorders. The present paper was designed to provide a synthesis of what is known and unknown about IU, and, in doing so, proposes broad and novel directions for future research to address the remaining uncertainties in the literature.

Penn State Worry Questionnaire - 10: A new tool for measurement-based care

The Penn State Worry Questionnaire - Past Week (PSWQ-PW) is an adaptation of the widely used Penn State Worry Questionnaire, measuring pathological worry weekly. However, it contains problematic negatively worded items and has not been validated in a large sample yet. To meet the needs of measurement-based care (MBC), we developed a shortened version (PSWQ-10) based on the PSWQ-PW, retaining only positively worded items, and examined its psychometric properties and clinical utility. Patients with Generalized Anxiety Disorder (GAD), Major Depressive Disorder (MDD), and other anxiety disorders completed the PSWQ-10 and other instruments during routine evaluation in an academic anxiety clinic. A second cohort from a perinatal clinic was evaluated similarly. The PSWQ-10 displayed excellent internal consistency, convergent and discriminant validity, and criterion group validity. Patients with GAD scored significantly higher than those with other anxiety disorders but did not differ from those with MDD. The PSWQ-10 showed sensitivity to change over time and demonstrated excellent psychometric properties in the perinatal population. The PSWQ-10 is a reliable, valid, efficient, and straightforward worry-focused instrument that can be readily used in MBC and help clinicians objectively measure worry as a treatment outcome in broad clinical populations.

Is there cardiac risk in panic disorder? An updated systematic review

BACKGROUND

The recognized relationship between panic disorder (PD) and cardiac disorders (CDs) is not unequivocal. We reviewed the association between PD and coronary artery disease (CAD), arrhythmias, cardiomyopathies, and sudden cardiac death.

METHODS

We undertook an updated systematic review, according to PRISMA guidelines. Relevant studies dating from January 1, 2000, to December 31, 2014, were identified using the PubMed database and a review of bibliographies. The psychiatric and cardiac diagnostic methodology used in each study was then to very selective inclusion criteria.

RESULTS

Of 3044 studies, 14 on CAD, 2 on cardiomyopathies, and 1 on arrhythmias were included. Overall, the studies supported a panic-CAD association. Furthermore, in some of the studies finding no association between current full-blown PD and CAD, a broader susceptibility to panic, manifesting as past PD, current agoraphobia, or subthreshold panic symptoms, appeared to be relevant to the development of CAD. Preliminary data indicated associations between panic, arrhythmias, and cardiomyopathies.

LIMITATIONS

The studies were largely cross-sectional and conducted in cardiological settings. Only a few included blind settings. The clinical conditions of patients with CDs and the qualifications of raters of psychiatric diagnoses were highly heterogeneous. CDs other than CAD had been insufficiently investigated.

CONCLUSIONS

Our review supported a relationship between PD and CDs. Given the available findings and the involvement of the cardiorespiratory system in the pathophysiology of PD, an in-depth investigation into the panic-CDs association is highly recommended. This should contribute to improved treatment and prevention of cardiac events and/or mortality, linked to PD.

Impact of Mindfulness-Based Cognitive Therapy on Intolerance of Uncertainty in Patients with Panic Disorder

OBJECTIVE

Intolerance of uncertainty (IU) is a transdiagnostic construct in various anxiety and depressive disorders. However, the relationship between IU and panic symptom severity is not yet fully understood. We examined the relationship between IU, panic, and depressive symptoms during mindfulness-based cognitive therapy (MBCT) in patients with panic disorder.

METHODS

We screened 83 patients with panic disorder and subsequently enrolled 69 of them in the present study. Patients participating in MBCT for panic disorder were evaluated at baseline and at 8 weeks using the Intolerance of Uncertainty Scale (IUS), Panic Disorder Severity Scale-Self Report (PDSS-SR), and Beck Depression Inventory (BDI).

RESULTS

There was a significant decrease in scores on the IUS (p<0.001), PDSS (p<0.001), and BDI (p<0.001) following MBCT for panic disorder. Pre-treatment IUS scores significantly correlated with pre-treatment PDSS (p=0.003) and BDI (p=0.003) scores. We also found a significant association between the reduction in IU and PDSS after controlling for the reduction in the BDI score (p<0.001).

CONCLUSION

IU may play a critical role in the diagnosis and treatment of panic disorder. MBCT is effective in lowering IU in patients with panic disorder.

Cognitive Dissonance About Thought-Action Fusion Beliefs Improves and Maintains the Effects of Thought-Action Fusion-Specific Psychoeducation

The effects of psychoeducation on thought-action fusion (TAF) beliefs are understudied. We tested whether adding mock electroencephalography (EEG)-based computer trials that induce cognitive dissonance about TAF beliefs, prior to TAF-specific psychoeducation, would enhance and maintain the reduction of TAF beliefs. An unselected sample of 140 Singaporean undergraduates (89 females, 51 males) was randomly assigned to a combined intervention, TAF-specific psychoeducation-only, or control group. Self-report measures of TAF beliefs and cognitive dissonance about TAF beliefs were administered 4 times in the initial session, and once at 1-month follow-up. Findings included the following: (a) greatest cognitive dissonance about TAF beliefs in the initial session with the combined intervention; (b) greater reduction in TAF beliefs in the initial session in both intervention groups, compared with the control group; and (c) incremental reduction in TAF beliefs in the initial session and maintenance at 1-month follow-up with the combined intervention. Cognitive dissonance should be investigated extensively in other aspects of cognitive behavioral therapy (CBT) procedures for TAF beliefs (e.g., behavioral experiments, exposure, and response prevention) to determine whether it contributes to therapeutic change with these techniques. Our combined intervention procedure should also be examined for relevant psychopathology (e.g., obsessive-compulsive symptoms).

Gray and white matter volume abnormalities in generalized anxiety disorder by categorical and dimensional characterization

Increasing efforts have been made to investigate the underlying pathophysiology of generalized anxiety disorder (GAD), but only limited consistent information is available on gray (GM) and white matter (WM) volume changes in affected adults. Additionally, few studies employed dimensional approaches to GAD pathology. This study compares structural brain imaging data from n=19 GAD subjects and n=24 healthy comparison (HC) subjects, all medication-free and matched on age, sex and education. Separate categorical and dimensional models were employed using voxel-based morphometry for GM and WM. Significantly higher GM volumes were found in GAD subjects mainly in basal ganglia structures and less consistently in the superior temporal pole. For WM, GAD subjects showed significantly lower volumes in the dlPFC. Largely consistent findings in dimensional and categorical models point toward these structural alterations being reliable and of importance for GAD. While lower volume in the dlPFC could reflect impaired emotional processing and control over worry in GAD, basal ganglia alterations may be linked to disturbed gain and loss anticipation as implicated in previous functional GAD studies. As perturbations in anticipation processes are central to GAD, these areas may warrant greater attention in future studies.

Examining Anxiety and Depression Comorbidity Among Chinese and European Canadian University Students

Clark and Watson’s tripartite model of comorbidity between anxiety and depression has been well-supported by empirical evidence among European descent samples in North America. Its applicability to Chinese biculturals remains to be challenged due to two Chinese-specific symptom reporting style in somatization and under-endorsement of positive affect. The current study began with an evaluation of a revised Clark and Watson’s tripartite model of comorbidity by adopting a comprehensive assessment of anxiety- and depression-specific component, and by incorporating cognitive aspects of symptomatology. The revised model’s applicability to a Chinese Canadian university sample was then empirically tested, followed by an investigation of the potential impact of cultural experiences on symptomatology. Item response theory (IRT)–informed statistical analyses were applied to each of the 14 anxiety and depression symptom measures that 251 European Canadian and 206 Chinese Canadian university student participants completed to remove items that functioned differentially across samples. Sample-specific exploratory factor analyses identified a two-factor structure (Affective-Somatic and Cognitive) among the Chinese Canadian sample, and a three-factor structure (Mixed, Cognitive, and Autonomic Hyperarousal) among the European Canadian sample. Worry and Autonomic Hyperarousal scales reflected the most between-group structural differences. These results indicated that different cultural groups responded differently to clinical assessment items commonly used in North America, and that applicability of the tripartite model of comorbidity across cultural groups was limited. Symptom factors were found related to specific (i.e., negative acculturative experiences and collective self-esteem) but not to generic indicators of acculturation (i.e., Chinese or Canadian Orientation).

Is a gin and tonic more like gin or tonic? A comparison of comorbid and non-comorbid anxiety disorder diagnostic pairs

Despite findings indicating that anxiety disorders are more likely to co-occur with each other than occur in isolation, little research has explored precise areas of overlap and differentiation among comorbid pairs of anxiety disorders. Furthermore, many studies comparing phenomena across anxiety disorders define comparison groups based on principal diagnoses, with lesser regard for comorbid diagnoses, raising the question as to whether this is a valid approach to analyzing comparisons. To better understand the extent to which comparisons by principal diagnoses are valid, the current study investigated whether comorbid hierarchically opposing diagnostic pairs showed similarities and differences from their non-comorbid, or "pure", counterparts on measures of clinician-rated functioning, specific symptoms, vulnerability factors, and demographic characteristics. The study included a total of 353 participants with diagnoses of either Panic Disorder (PD) only, Social Phobia (SP) only, Generalized Anxiety Disorder (GAD) only, or some comorbid pair of the three. Consistent with hypotheses, results demonstrated that hierarchically opposing diagnostic pairs showed more overlap than differentiation with each other and with non-comorbid counterparts on measures of a given specific non-comorbid diagnosis, indicating that defining comparisons by principal diagnoses may be invalid and misleading. The implications regarding the nosological structure of the DSM and research practice will be discussed.

Mediators of transdiagnostic group cognitive behavior therapy

The efficacy of cognitive-behavioral therapy (CBT) for anxiety is well established. Investigations into the mechanisms of change in CBT report changes in cognitive vulnerabilities mediating improvements over the course of treatment. As anxiety disorders share certain risk factors, there is a trend toward CBT emphasizing these vulnerabilities, including negative affectivity (NA) and also more specific constructs such as anxiety sensitivity (AS) and intolerance of uncertainty (IU). The purpose of this investigation was to analyze potential mediators of anxiety reduction over the course of transdiagnostic group CBT. NA, AS, and IU all decreased over the course of treatment. Among the potential mediators, change in NA had a significant relationship with change in anxiety but change in AS and change in IU did not. Neither the main effect of primary diagnosis nor the interactions between potential mediators and primary diagnoses were significant, indicating that there were no differential changes in anxiety or the potential mediators across primary diagnoses. Results strongly point toward NA as an overarching mediator of anxiety reduction during transdiagnostic group CBT.

How to tell a wife from a hat: affective feedback in perceptual categorization

How do people understand that their perception is correct? In line with the recurring idea of perception as prediction, the affective feedback account of hypotheses testing suggests that correct perceptual predictions are reinforced with positive affect. In four experiments, we tested whether correct categorization of a degraded image will lead to more positive liking ratings. The obtained findings supported the proposed approach: subjects liked the images they were able to perceive correctly more than others. Importantly, these findings were independent of the initial affective valence of stimuli. A further investigation demonstrated that this effect exists only when answers are at least moderately confident. The obtained findings add to the growing amount of literature on the role of affect in basic cognitive processing.

Evaluation of magical thinking: validation of the Illusory Beliefs Inventory

Magical thinking has been related to obsessive-compulsive disorder; yet, little research has examined this construct in other anxiety disorders. The Illusory Beliefs Inventory (IBI) is a recently developed measure of magical thinking. The aim of this study was to investigate the psychometric properties of this new measure and to determine if magical thinking accounts for pathological worry beyond the well-researched constructs of intolerance of uncertainty (IU) and perfectionism. A sample of 502 participants completed an online survey. Confirmatory factor analysis identified a three-factor solution for the IBI, and the measure had good internal consistency (α = .92), test-retest reliability (r = .94) and discriminant validity. Magical thinking, IU, and perfectionism all predicted pathological worry; however, magical thinking accounted for less than 1% of unique variance in worry, suggesting that it is not strongly related to worry. Further investigation regarding the validity and clinical utility of the IBI is required.

"But it might be a heart attack": intolerance of uncertainty and panic disorder symptoms

Panic disorder models describe interactions between feared anxiety-related physical sensations (i.e., anxiety sensitivity; AS) and catastrophic interpretations therein. Intolerance of uncertainty (IU) has been implicated as necessary for catastrophic interpretations in community samples. The current study examined relationships between IU, AS, and panic disorder symptoms in a clinical sample. Participants had a principal diagnosis of panic disorder, with or without agoraphobia (n=132; 66% women). IU was expected to account for significant variance in panic symptoms controlling for AS. AS was expected to mediate the relationship between IU and panic symptoms, whereas IU was expected to moderate the relationship between AS and panic symptoms. Hierarchical linear regressions indicated that IU accounted for significant unique variance in panic symptoms relative to AS, with comparable part correlations. Mediation and moderation models were also tested and suggested direct and indirect effects of IU on panic symptoms through AS; however, an interaction effect was not supported. The current cross-sectional evidence supports a role for IU in panic symptoms, independent of AS.

A role for the precuneus in thought-action fusion: evidence from participants with significant obsessive-compulsive symptoms

Likelihood thought-action fusion (TAF-L) refers to a cognitive bias in which individuals believe that the mere thought of a negative event increases its likelihood of occurring in reality. TAF-L is most commonly associated with obsessive-compulsive disorder (OCD) but is also present in depression, generalized anxiety disorder and psychosis. We induced TAF-L in individuals with high (High-OC, N = 23) and low (Low-OC, N = 24) levels of OC traits, and used low resolution electromagnetic tomography (LORETA) to localise the accompanying electrical brain activity patterns. The results showed greater TAF-L in the High-OC than in the Low-OC group (p < .005), which was accompanied by significantly greater upper beta frequency (19-30 Hz) activity in the precuneus (p < .05). Further, the precuneus activity was positively correlated with self-reported magnitude of TAF-L (p < .01), suggesting a specific role of this region in this cognitive bias. Results are discussed with reference to self-referential processing and the default-mode network.

To be sure, to be sure: intolerance of uncertainty mediates symptoms of various anxiety disorders and depression

The Intolerance of Uncertainty Model was initially developed as an explanation for worry within the context of generalized anxiety disorder. However, recent research has identified intolerance of uncertainty (IU) as a possible transdiagnostic maintaining factor across the anxiety disorders and depression. The aim of this study was to determine whether IU mediated the relationship between neuroticism and symptoms related to various anxiety disorders and depression in a treatment-seeking sample (N=328). Consistent with previous research, IU was significantly associated with neuroticism as well as with symptoms of social phobia, panic disorder and agoraphobia, obsessive-compulsive disorder, generalized anxiety disorder, and depression. Moreover, IU explained unique variance in these symptom measures when controlling for neuroticism. Mediational analyses showed that IU was a significant partial mediator between neuroticism and all symptom measures, even when controlling for symptoms of other disorders. More specifically, anxiety in anticipation of future uncertainty (prospective anxiety) partially mediated the relationship between neuroticism and symptoms of generalized anxiety disorder (i.e. worry) and obsessive-compulsive disorder, whereas inaction in the face of uncertainty (inhibitory anxiety) partially mediated the relationship between neuroticism and symptoms of social anxiety, panic disorder and agoraphobia, and depression. Sobel's test demonstrated that all hypothesized meditational pathways were associated with significant indirect effects, although the mediation effect was stronger for worry than other symptoms. Potential implications of these findings for the treatment of anxiety disorders and depression are discussed.

Can levels of a general anxiety-prone cognitive style distinguish between various anxiety disorders?

BACKGROUND

The question of whether certain anxiety disorders are especially related to a cognitive style characterized by an exaggerated perception of threat and appraisal of the future as excessively unpredictable (general anxiety-prone cognitive style) remains open.

OBJECTIVES

This study aimed to compare patients with generalized social anxiety disorder (SAD), generalized anxiety disorder (GAD), panic disorder with agoraphobia (PDA), and panic disorder without agoraphobia (PD) in terms of the levels of general anxiety-prone cognitive style when the severity of general distress and psychopathology is controlled for and to ascertain whether a co-occurring depressive disorder contributes substantially to the levels of this cognitive style.

METHODS

The Anxious Thoughts and Tendencies Scale, a measure of a general anxiety-prone cognitive style, and Symptom Checklist 90-Revised were administered to 204 patients with various anxiety disorders who attended an outpatient anxiety disorders clinic and were diagnosed based on a semistructured diagnostic interview.

RESULTS

Patients with principal diagnoses of SAD and GAD had a more prominent general anxiety-prone cognitive style than patients with principal diagnoses of PD and PDA when the severity of general distress and psychopathology was controlled for. The presence or absence of a co-occurring depressive disorder had no bearing on this finding.

CONCLUSIONS

The general cognitive component characterizes SAD and GAD more than it does PD and PDA, and a co-occurring depressive disorder does not affect this finding. These results have implications for distinguishing between various anxiety disorders.

Changes in intolerance of uncertainty during cognitive behavior group therapy for social phobia

BACKGROUND AND OBJECTIVES

Recent research suggests that intolerance of uncertainty (IU), most commonly associated with generalized anxiety disorder, also contributes to symptoms of social phobia. This study examines the relationship between IU and social anxiety symptoms across treatment.

METHOD

Changes in IU, social anxiety symptoms, and depression symptoms were examined following cognitive behavior group therapy (CBGT) for social phobia (N=32).

RESULTS

CBGT led to significant improvements in symptoms of social anxiety and depression, as well as reductions in IU. Reductions in IU were associated with reductions in social anxiety but were unrelated to improvements in depression symptoms. Reductions in IU were predictive of post-treatment social phobia symptoms after controlling for pre-treatment social phobia symptoms and changes in depression symptoms following treatment.

LIMITATIONS

The relationship between IU and social anxiety requires further examination within experimental and longitudinal designs, and needs to take into account additional constructs that are thought to maintain social phobia.

CONCLUSIONS

Current findings suggest that the enhancing tolerance of uncertainty may play a role in the optimal management of social phobia. Theoretical and clinical implications are discussed.

Increasingly certain about uncertainty: Intolerance of uncertainty across anxiety and depression

Intolerance of uncertainty (IU) - a dispositional characteristic resulting from negative beliefs about uncertainty and its implications - may be an important construct in anxiety disorders and depression. Despite the potential importance of IU, clinical data on the construct remains relatively scant and focused on generalized anxiety disorder and obsessive-compulsive disorder. The present study systematically investigated IU, as measured by the Intolerance of Uncertainty Scale-12 (IUS-12), across groups diagnosed with anxiety disorders (i.e., social anxiety disorder, panic disorder, generalized anxiety disorder, obsessive-compulsive disorder) or depression (clinical sample: n=376; 61% women), as well as undergraduate (n=428; 76% women) and community samples (n=571; 67% women). Analysis of variance revealed only one statistically significant difference in IUS-12 scores across diagnostic groups in the clinical sample; specifically, people with social anxiety disorder reported higher scores (p<.01; η(2)=.03) than people with panic disorder. People diagnosed with an anxiety disorder or depression reported significantly and substantially higher IUS-12 scores relative to community and undergraduate samples. Furthermore, IUS-12 score distributions were similar across diagnostic groups as demonstrated by Kernel density estimations, with the exception of panic disorder, which may have a relatively flat distribution of IU. Response patterns were invariant across diagnostic groups as demonstrated by multi-group confirmatory factor analyses, but varied between clinical and nonclinical samples. Overall, the findings suggest IU may serve as an important transdiagnostic feature across anxiety disorders and depression. In addition, robust support was found for the proposed 2-factor model of the IUS-12. Comprehensive findings, implications, and future research directions are discussed.

Temperament, character and anxiety sensitivity in panic disorder: a high-risk study

BACKGROUND

Adult patients with panic disorder (PD) show high levels of harm avoidance and anxiety sensitivity. Peculiar temperament profiles and high anxiety sensitivity have been proposed as developmental risk factors for PD in adult age. Since familial-genetic influences play a role both in PD and in anxiety sensitivity and temperament profiles, this study aims to investigate the possible association between family history of PD and peculiar temperament-character profiles or high anxiety sensitivity in offspring of patients with PD.

SAMPLING AND METHODS

Thirty-four children of patients with PD with/without agoraphobia and 30 children of healthy subjects were compared. Temperament and character dimensions and anxiety sensitivity levels of children were obtained by the Junior Temperament and Character Inventory and the Childhood Anxiety Sensitivity Index.

RESULTS

Children of patients with PD and children of healthy subjects differed neither in temperament and character dimensions nor in anxiety sensitivity levels.

CONCLUSIONS

Our results show that family history of PD is not associated with peculiar temperament and character profiles or high anxiety sensitivity in children, suggesting that these factors may not be early expressions of familial vulnerability to PD. Since the sample is small and the study has a cross-sectional design, longitudinal studies in larger samples are warranted to confirm these findings and to clarify the role of anxiety sensitivity and temperament-character dimensions in the development of PD.

A transdiagnostic examination of intolerance of uncertainty across anxiety and depressive disorders

Intolerance of uncertainty (IU) has been identified as a potential maintaining factor for generalised anxiety disorder; however, there is a growing evidence to suggest that IU may contribute to other anxiety and depressive disorders. Moreover, certain components of IU (namely prospective and inhibitory IU) have been shown to be differentially associated with symptoms of emotional disorders. The aim of this study was to determine the extent to which individuals with various anxiety and depressive disorders endorsed IU, firstly as a trait variable (with prospective and inhibitory components) and secondly in reference to regularly occurring, diagnostically relevant situations (situation-specific IU). The degree to which diagnosis predicted IU was examined in a highly comorbid clinical sample (N=218). Regardless of specific diagnoses, the degree of comorbidity emerged as a significant predictor of prospective IU and situation-specific IU. Conversely, specific diagnoses of social phobia, generalised anxiety disorder, depression, and obsessive compulsive disorder were uniquely related to inhibitory IU. These findings suggest that IU is a transdiagnostic construct and have implications for current diagnosis-specific and transdiagnostic theory and clinical practice.

Long-term effects of short-term psychodynamic psychotherapy and cognitive-behavioural therapy in generalized anxiety disorder: 12-month follow-up

OBJECTIVE

In a previous randomized controlled trial (RCT), short-term efficacy of cognitive-behavioural therapy (CBT) and short-term psychodynamic psychotherapy (STPP) in generalized anxiety disorder (GAD) was demonstrated. In this article, long-term stability of these effects will be examined. Effects of CBT and STPP will be compared.

METHOD

In the original RCT, patients with GAD were treated with either CBT (n = 29) or STPP (n = 28). Treatments were carried out according to manuals and included up to 30 sessions. As the primary outcome measure the Hamilton Anxiety Rating Scale was used. In addition to short-term outcome previously reported, treatment effects were assessed 12 months after termination of treatment.

RESULTS

Both CBT and STPP yielded large improvements at 12-month follow-up. No significant differences were found between treatments concerning the primary outcome measure. This result was corroborated by 3 self-report measures of anxiety. However, in measures of trait anxiety and worry, CBT was superior. Concerning depression, differences reported at posttreatment were no longer significant at 12-month follow-up.

CONCLUSIONS

In GAD, both CBT and STPP yield large and stable effects 12 months after treatment. Concerning trait anxiety and worry, CBT seems to be superior. For STPP, further studies should be carried out to confirm the results.

Distorted Cognitive Processing in Youth: The Structure of Negative Cognitive Errors and Their Associations with Anxiety

The Children's Negative Cognitive Error Questionnaire (CNCEQ) is commonly used to measure four errors in young people's thinking, but research has failed to support the factorial validity of the measure. The primary objective of the present study was to examine the factor structure of a refined and extended version of the CNCEQ. Revision of the CNCEQ involved the exclusion of items rated as contaminated, and the addition of items measuring cognitive errors closely associated with anxiety ('threat conclusion' and 'underestimation of the ability to cope'). A secondary objective was to determine the relation between the negative cognitive errors and anxiety. Principal component analysis of data from 481 children and adolescents indicated five distinct negative cognitive error subscales labeled 'underestimation of the ability to cope', 'personalizing without mind reading', 'selective abstraction', 'overgeneralizing', and 'mind reading' which contained the new 'threat conclusion' items. Confirmatory factor analysis in an independent sample of 295 children and adolescents yielded further support for the five-factor solution. All cognitive errors except 'selective abstraction' were correlated with anxiety. Multiple regression analysis indicated that the strongest predictors of anxiety were the two subscales containing new items, namely 'underestimation of the ability to cope' and 'mind reading'. The results are discussed with respect to further development of the instrument so as to advance the assessment of distorted cognitive processing in young people with internalizing symptoms.

Achieving certainty about the structure of intolerance of uncertainty in a treatment-seeking sample with anxiety and depression

Evidence is accumulating that intolerance of uncertainty (IU) may be a transdiagnostic maintaining factor across the anxiety disorders and depression. However, psychometric studies of the most commonly used measure of IU have typically used undergraduate students, and the factor structure has been highly inconsistent. Previous studies have also tended to focus on one diagnostic subgroup or related symptom, thereby limiting transdiagnostic comparisons. The first aim of this study was to test the latent structure of a commonly used measure of IU in a treatment-seeking sample with anxiety and depression (n=463). The second aim was to examine psychometric properties of the best fitting solution, including internal reliability, convergent validity, and discriminant validity. Confirmatory factor analysis was used to compare the goodness of fit of five models previously found with undergraduate and community samples. A two-factor solution, comprising of prospective anxiety and inhibitory anxiety, was the best fitting model. The total scale and subscales demonstrated excellent internal reliability. Convergent validity was demonstrated by the scales correlating with symptoms associated with five anxiety disorders and depression, as well as neuroticism, distress and disability. IU explained unique variance in all symptom measures, even after controlling for neuroticism and other symptom measures. Evidence of discriminant validity was also found for each IU subscale. Findings support reliability and validity of the two-factor solution, and are consistent with IU being a transdiagnostic maintaining factor.