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Topel S, Ma I, van Duijvenvoorde ACK, van Steenbergen H, de Bruijn ERA. Adapting to uncertainty: The role of anxiety and fear of negative evaluation in learning in social and non-social contexts. J Affect Disord 2024; 363:310-319. [PMID: 39043306 DOI: 10.1016/j.jad.2024.07.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 06/24/2024] [Accepted: 07/14/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Navigating social situations can be challenging due to uncertainty surrounding the intentions and strategies of others, which remain hidden and subject to change. Prior research suggests that individuals with anxiety-related symptoms struggle to adapt their learning in uncertain, non-social environments. Anxiety-prone individuals encounter challenges in social functioning, yet research on learning under uncertainty in social contexts is limited. In this preregistered study, we investigated whether individuals with higher levels of trait anxiety and fear of negative evaluation encounter difficulties in adjusting their learning rates in social contexts with stable or volatile outcome contingencies. METHODS We implemented a modified trust game (N = 190), where participants either retained or lost their investments based on their interactions with two players in volatile or stable environments. Participants also completed a matching non-social control task involving interactions with slot machines. RESULTS Results from computational modeling revealed significantly higher learning rates in social compared to non-social settings. Trait anxiety did not affect the adaptability of learning rates. Individuals with heightened fear of negative evaluation were more sensitive to social compared to non-social outcomes, as reflected in their stay/switch behavior and, though less conclusive, in their learning rates. LIMITATIONS While transdiagnostic and dimensional approaches are important for investigating disturbed social functioning, the inclusion of clinical samples in future studies may contribute to a broader generalization of these findings regarding behavioral variances in uncertain social environments. CONCLUSIONS Individuals with increased fear of negative evaluation may demonstrate heightened sensitivity to learning in uncertain social contexts. This leads to heightened responsiveness to recent outcomes in their interactions with others, potentially contributing to their problems in social functioning.
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Affiliation(s)
- Selin Topel
- Leiden University, Institute of Psychology, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
| | - Ili Ma
- Leiden University, Institute of Psychology, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Anna C K van Duijvenvoorde
- Leiden University, Institute of Psychology, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Henk van Steenbergen
- Leiden University, Institute of Psychology, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Ellen R A de Bruijn
- Leiden University, Institute of Psychology, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands
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2
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Brandão T. Perceived Emotional Invalidation, Psychological Distress and Relationship Satisfaction in Couples: An Actor-Partner Interdependence Mediation Analysis. Psychol Rep 2024:332941241279372. [PMID: 39223439 DOI: 10.1177/00332941241279372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Research has demonstrated a clear link between perceived emotional invalidation and increased psychological distress. However, available studies have predominantly focused on individual data, and leave the impact on relationship satisfaction largely unexplored. Considering the systemic-transactional model, our study aimed to examine the association between perceived emotional invalidation, psychological distress, and couple relationship satisfaction from a dyadic perspective. We conducted a cross-sectional study involving 240 mixed-gender couples from Portugal employing the Actor-Partner Interdependence Mediational Model to analyse the data to examine actor and partner direct and indirect effects. Results showed that, for both women and men, own perceived emotional invalidation was associated with own psychological distress but not with own relationship satisfaction. Also, own psychological distress was associated with own relationship satisfaction but only for women. Finally, one actor and one partner indirect effects were found. Women perceived emotional invalidation was associated with their own psychological distress which in turn contributed to lower levels of relationship satisfaction for both them and their partners. This study contributes to a deeper understanding of the dyadic effects of perceived emotional invalidation on psychological distress and relationship satisfaction within romantic relationships identifying interpersonal emotional dynamics as an important target of interventions.
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Affiliation(s)
- Tânia Brandão
- William James Center for Research, Ispa - Instituto Universitário, Lisboa, Portugal
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3
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Malivoire BL, Rowa K, Milosevic I, McCabe RE. Partner symptom accommodation in generalized anxiety disorder: a preliminary examination of correlates with symptoms and cognitive behavioural therapy outcome. Behav Cogn Psychother 2024; 52:478-494. [PMID: 38712614 DOI: 10.1017/s1352465824000213] [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] [Indexed: 05/08/2024]
Abstract
BACKGROUND Symptom accommodation is suggested to maintain anxiety pathology and interfere with treatment effectiveness for anxiety and related disorders. However, little is known about symptom accommodation in generalized anxiety disorder (GAD). AIM This study investigated the associations between romantic partner symptom accommodation, GAD symptoms, intolerance of uncertainty (IU), relationship satisfaction, and cognitive behavioural therapy (CBT) outcomes from the perspective of the person with GAD. METHOD One hundred and twelve people with GAD participated in group CBT and completed measures at pre- and post-treatment. RESULTS All participants endorsed that their partner engaged in symptom accommodation to some extent, and the most commonly endorsed type was providing reassurance. Greater self-reported partner symptom accommodation was associated with greater GAD symptoms, chronic worry severity, IU, and relationship satisfaction at baseline. Partner symptom accommodation was found to significantly decrease over treatment; however, less improvement in symptom accommodation from pre- to post-treatment was associated with worse treatment outcomes. DISCUSSION This study is the first to show that partner symptom accommodation is prevalent in adults with GAD and to elucidate the presentation and frequency of behaviours. The findings provide preliminary evidence that targeting partner symptom accommodation in treatment may improve CBT outcomes.
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Affiliation(s)
- B L Malivoire
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
- Anxiety Treatment and Research Clinic, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - K Rowa
- Anxiety Treatment and Research Clinic, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - I Milosevic
- Anxiety Treatment and Research Clinic, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - R E McCabe
- Anxiety Treatment and Research Clinic, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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4
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Reynolds A, MacLeod C, Grafton B. The role of expectancies and selective interrogation of information in trait anxiety-linked affect when approaching potentially stressful future events. Behav Res Ther 2024; 179:104568. [PMID: 38768554 DOI: 10.1016/j.brat.2024.104568] [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: 10/12/2023] [Revised: 05/01/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
The present study examined cognitive mechanisms underpinning the increased tendency of individuals with high trait anxiety to experience inflation of negative affect when approaching potential stressors. Specifically, the roles of (1) disproportionately negative relative to positive expectancies (i.e., negative expectancy bias) and (2) disproportionately interrogating negative relative to positive information (i.e., negative interrogation bias), each concerning the potential stressor, were examined. High and low trait anxiety participants (N = 286) completed the experimental session, in which they were informed they may view a potentially stressful film. As participants approached the putative film viewing, participants' negative and positive affect, as well as their negative and positive expectancies were assessed. Additionally, negative interrogation bias was assessed by providing participants the opportunity to selectively interrogate information from a larger pool of negative and positive information concerning the putative film viewing. Our findings provide evidence indirect associations between trait anxiety and inflation of negative affect is serially mediated via negative interrogation bias and, in turn, negative expectancy bias. Findings are discussed with regards to limitations and potential implications for public health campaigns, and cognitive interventions for anxiety, highlighting the utility of further examining negative interrogation bias as an avenue for improving the efficacy of each.
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Affiliation(s)
- Amelia Reynolds
- Elizabeth Rutherford Memorial Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Crawley, Western Australia, Australia.
| | - Colin MacLeod
- Elizabeth Rutherford Memorial Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Crawley, Western Australia, Australia
| | - Ben Grafton
- Elizabeth Rutherford Memorial Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Crawley, Western Australia, Australia
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5
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Zech JM, Patel TA, Cougle JR. Correlates of treatment-seeking in DSM-5 generalized anxiety disorder: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions-III. J Anxiety Disord 2024; 106:102909. [PMID: 39047416 DOI: 10.1016/j.janxdis.2024.102909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 07/06/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024]
Abstract
Generalized Anxiety Disorder (GAD) presents a significant personal and societal burden and is associated with chronic medical comorbidities and markedly lower quality of life. Effective treatments exist, less than half of individuals with lifetime GAD will ever seek psychotherapeutic or pharmacological treatment. A thorough understanding of the factors that influence treatment seeking for GAD is warranted. The present study investigates the correlates of GAD treatment seeking, using data from the National Epidemiological Survey on Alcohol and Related Disorders-III (NESARC-III), which assessed for psychiatric disorders using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-5 Version (AUDADIS-5). A series of logistic regressions were run to identify demographic, diagnostic, and symptom-level correlates of treatment seeking in those meeting DSM-5 diagnostic criteria for GAD. Comorbid depression, panic disorder, and PTSD were all uniquely associated with higher rates of GAD-related treatment seeking. Additionally, several accompanying anxiety symptoms were also uniquely predicted treatment seeking, including fatigue, panic attacks, reassurance-seeking, and interpersonal avoidance. Findings underscore the multi-factorial nature of treatment seeking behavior in GAD and highlight the need for further research to fully understand these relationships and devise effective strategies to improve treatment seeking in this population.
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Affiliation(s)
- James M Zech
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Tapan A Patel
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Jesse R Cougle
- Department of Psychology, Florida State University, Tallahassee, FL, United States.
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6
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Costa DLDC, Furlan Damiano R, Alcalá JÁ, Hatzinger M, Mesa F, Perna G, Purebl G, Torzsa P, Vobořilová V, Zwanzger P, Ho R, Bandelow B. How to treat subsyndromal anxiety disorder - practical recommendations for implementation in primary care. Int J Psychiatry Clin Pract 2024:1-10. [PMID: 38909282 DOI: 10.1080/13651501.2024.2362131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 05/27/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Anxiety is a common and disabling condition that significantly impacts quality of life. Subsyndromal anxiety (SSA) refers to anxiety symptoms that do not meet the full diagnostic criteria for an anxiety disorder but pose a risk for developing such disorders. We aimed to provide practical recommendations for the treatment of SSA in primary care settings. METHODS A narrative review was conducted to identify strategies for recognizing and treating patients with SSA. RESULTS The recommendations for treating SSA include lifestyle modifications such as exercise and stress reduction techniques, psychotherapy, and pharmacological treatments, including natural compounds like the lavender oil extract Silexan. Regular follow-up care is essential to monitor treatment response and address ongoing symptoms. Additionally, the use of the GAD-7 tool is recommended for accurately identifying patients with SSA. CONCLUSION Implementing these recommendations in primary care can lead to effective treatment of SSA, preventing the development of more severe anxiety disorders. An integrative approach, combining lifestyle modifications, psychotherapy, and pharmacotherapy, including natural compounds, offers significant benefits for managing anxiety.
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Affiliation(s)
- Daniel Lucas da Conceição Costa
- Department and Institute of Psychiatry, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rodolfo Furlan Damiano
- Department and Institute of Psychiatry, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - José Ángel Alcalá
- Clinical Unit of Mental Health. Reina Sofia University Hospital, Cordoba, Spain
| | - Martin Hatzinger
- Psychiatric Services Solothurn, and Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Francisco Mesa
- Health Economy Unit, National Institute of Mental Health, Mexico City, Mexico
| | - Giampaolo Perna
- Department of Biological Sciences, Humanitas University, Milan, Italy
| | - György Purebl
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Věra Vobořilová
- Faculty of Health Care Studies, University of West Bohemia, Pilsen, The Czech Republic
| | - Peter Zwanzger
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany; kbo-Inn-Salzach-Klinikum, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, Wasserburg am Inn, Germany
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University of Göttingen, Göttin-gen, Germany
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7
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Suwalska J, Łukasik S, Cymerys M, Suwalska A, Bogdański P. Determinants of Weight Status and Body, Health and Life Satisfaction in Young Adults. Nutrients 2024; 16:1484. [PMID: 38794722 PMCID: PMC11124030 DOI: 10.3390/nu16101484] [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: 04/03/2024] [Revised: 05/02/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Health behaviors include behavioral patterns and habits that relate to health maintenance, restoration and improvement. They do not only affect the physical condition; they are also associated with life satisfaction. In our study, we focused on young adulthood, a specific lifespan period for establishing long-term health behavior patterns. The aim of the present study was to investigate depressive symptoms, lifestyle and eating behaviors and delineate their associations with overweight/obesity and body, health and life satisfaction in young adults in Poland. We enrolled 800 students (81.4% females and 18.6% males). Diet, physical activity, depressive symptoms, eating behaviors and body, health and life satisfaction were assessed. Multivariate logistic regression models were employed. Almost half of the participants in our study had at least mild symptoms of depression. Symptoms of depression significantly reduced the odds of satisfaction with body, health and life, whereas physical activity increased them. Overweight/obesity significantly reduced the odds of body and health satisfaction. In women, a history of depression and emotional eating increased the odds of being overweight/obese. The results of our study may contribute to the development of educational programs and intervention strategies for young adults.
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Affiliation(s)
- Julia Suwalska
- Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences, 60-569 Poznan, Poland
| | - Sylwia Łukasik
- Institute of Human Biology and Evolution, Faculty of Biology, Adam Mickiewicz University in Poznan, 61-614 Poznan, Poland
| | - Maciej Cymerys
- Department of Internal Medicine, Poznan University of Medical Sciences, 60-786 Poznan, Poland
| | - Aleksandra Suwalska
- Department of Mental Health, Chair of Psychiatry, Poznan University of Medical Sciences, 60-572 Poznan, Poland
| | - Paweł Bogdański
- Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences, 60-569 Poznan, Poland
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8
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Betancourt JL, Alderson RM, Roberts DK, Bullard CC. Self-esteem in children and adolescents with and without attention-deficit/hyperactivity disorder: A meta-analytic review. Clin Psychol Rev 2024; 108:102394. [PMID: 38286088 DOI: 10.1016/j.cpr.2024.102394] [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: 12/29/2023] [Accepted: 01/18/2024] [Indexed: 01/31/2024]
Abstract
Meta-analytic methods were used to examine global and domain-specific (i.e., academic, social, behavioral) self-esteem in children and adolescents with and without ADHD. Potential moderators of effect size heterogeneity were also examined via meta-regressions within a three-level approach. Findings from 49 aggregated global self-esteem effect sizes (ADHDN = 2500, TDN = 9448), 12 academic self-esteem effect sizes (ADHDN = 386, TDN = 315), 11 social self-esteem effect sizes (ADHDN = 258, TDN = 254), and 8 behavioral self-esteem effect sizes (ADHDN = 231, TDN = 211) suggest that children and adolescents with ADHD experience moderate global (ES = 0.46, p < .001), academic (ES = 0.60, p = .009), and social (ES = 0.67, p = .001) self-esteem impairments compared to children and adolescents without the disorder. The aggregated behavioral self-esteem effect size (ES = 0.20, p = .54), however, was not significant, and the global self-esteem effect size was markedly smaller compared to effect sizes for the academic and social domains. Further, examination of potential moderators of effect size heterogeneity indicated null effects for medication status, diagnostic complexity, informant, age, sex, comorbid psychopathology, and self-esteem dimension. Collectively, findings suggest that children and adolescents with ADHD do not hold a ubiquitous negative self-perception of difficulties across academic, social, and behavioral domains of functioning, and unexamined domains that are distal to ADHD may serve to bolster global self-esteem.
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Affiliation(s)
| | - R Matt Alderson
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Delanie K Roberts
- Department of Psychology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Caitlin C Bullard
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA.
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9
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Macdonald-Gagnon G, Stefanovics EA, Potenza MN, Pietrzak RH. Generalized anxiety and mild anxiety symptoms in U.S. military veterans: Prevalence, characteristics, and functioning. J Psychiatr Res 2024; 171:263-270. [PMID: 38325107 DOI: 10.1016/j.jpsychires.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/09/2024]
Abstract
Generalized anxiety disorder (GAD) is a mental disorder characterized by excessive anxiety and worries that impair daily functioning. While prior work has documented the prevalence and correlates of GAD and subthreshold GAD (SGAD) in clinical samples, contemporary data on the epidemiology of anxiety symptoms are lacking, particularly in higher-risk populations such as military veterans. To address this gap, we analyzed data from a large, nationally representative sample of U.S. veterans to examine the: prevalence of probable GAD and mild anxiety symptoms measured using a brief screener; sociodemographic and military characteristics associated with anxiety symptoms; and psychiatric and functional correlates of anxiety symptoms. Results revealed that a total of 7.9% (95% confidence interval [CI] = 6.7-9.3%) and 22.1% (95%CI = 20.5-23.9%) of veterans screened positive for probable GAD and mild anxiety symptoms, respectively. Relative to veterans without anxiety symptoms, those with probable GAD and mild anxiety symptoms were younger, more likely to be female and racial/ethnic minorities, and more likely to have served 2+ deployments. Further, a "dose-response" association was observed between anxiety symptom severity and clinical correlates, with robust associations observed between probable GAD and poorer mental health, suicidal thoughts and behaviors, and functional impairment. Mild anxiety symptoms showed intermediate magnitude associations with these outcomes. Results of this study suggest that 3-of-10 U.S. veterans report anxiety symptoms. While the use of a brief screener to assess mild anxiety symptoms and probable GAD is limited, findings underscore the importance of a dimensional approach to assessing anxiety symptoms and associated clinical and functional characteristics in veterans.
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Affiliation(s)
| | - Elina A Stefanovics
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research and Education Clinical Center (MIRECC), West Haven, CT, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, USA; Yale Child Study Center, Yale University, New Haven, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, USA; Department of Neuroscience, Yale University, New Haven, CT, USA; Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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10
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Stone KW, Jagger MA, Horney JA, Kintziger KW. Changes in anxiety and depression among public health workers during the COVID-19 pandemic response. Int Arch Occup Environ Health 2023; 96:1235-1244. [PMID: 37474659 PMCID: PMC10560145 DOI: 10.1007/s00420-023-02002-6] [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: 06/12/2023] [Accepted: 07/14/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has negatively impacted mental health indicators, leading to an increase in symptoms of anxiety and depression in both the general population of adults and children and many occupational groups. This study aims to examine changes in anxiety and depression among a cohort of public health workers in the U.S. during the first year of the COVID-19 pandemic and identify potential risk factors. METHODS Longitudinal data were collected from a sub-sample (N = 85) of public health workers in 23 U.S. states who completed two surveys in 2020 and 2021. Information on background characteristics, personal well-being, and work environment as well as validated scales to assess generalized anxiety disorder (GAD), depressive disorder, and burnout was collected. Data were analyzed using Stata Version 17, and significant differences were determined using Pearson's Chi2 and Fisher's Exact tests. RESULTS The proportion of those reporting GAD (46.3% to 23.2%) or depression (37.8% to 26.8%) improved from Survey 1 to Survey 2 overall; symptoms of anxiety saw the largest improvement. Persistent depression was associated with sustained burnout, changes in social support, and days worked per week. CONCLUSION Public health workers experienced elevated levels of anxiety and depression during the initial pandemic response, but a reduction in these symptoms was observed in the subsequent year after vaccines had become widely available. However, unmet needs remain for ongoing workplace mental health supports to address burnout, as well as for additional emotional supports outside of work for public health professionals.
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Affiliation(s)
- Kahler W Stone
- Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro, TN, 37132, USA
| | | | - Jennifer A Horney
- Epidemiology Program, University of Delaware, 100 Discovery Blvd, Room 731, Newark, DE, 19713, USA.
| | - Kristina W Kintziger
- Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198, USA
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11
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Cheng AY, Jim PK, Kwan NW, Chan SWW, Cheung JPY, Cheung PWH, Negrini S, Cheung CKC, Wong AYL, Parent EC. Cross-Cultural Adaptation and Psychometric Properties of the Traditional Chinese Version of the Italian Spine Youth Quality of Life (ISYQOL) Questionnaire. Healthcare (Basel) 2023; 11:2683. [PMID: 37830720 PMCID: PMC10572939 DOI: 10.3390/healthcare11192683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/19/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
The Italian Spine Youth Quality of Life (ISYQOL) is a validated health-related quality of life (HRQOL) questionnaire for teenagers with adolescent idiopathic scoliosis (AIS). We culturally-adapted ISYQOL to traditional Chinese (ISYQOL-TC) and then recruited 133 conservatively treated teenagers with AIS to complete the ISYQOL-TC and the Chinese version of the Scoliosis Research Society-22 revised (SRS-22r) questionnaire, nine-item Patient Health Questionnaire (PHQ-9), seven-item Generalized Anxiety Disorder scale (GAD-7), and numeric pain rating scale (NPRS). They repeated ISYQOL-TC two weeks later. The internal consistency, unidimensionality, and test-retest reliability were measured using the Cronbach's alpha, Rasch measurement models, and intra-class correlation coefficients (ICC3,1), respectively. The concurrent validity of the ISYQOL-TC with SRS-22r, and its construct validity with other questionnaires were evaluated using Spearman correlation coefficients. The ISYQOL-TC demonstrated good internal consistency (Cronbach's alpha 0.90 and 0.89 for items 1-13 and items 1-20), and excellent test-retest reliability (ICC3,1 = 0.95-0.96). The Rasch analysis supported the unidimensionality of all 20 items in ISYQOL-TC. The ISYQOL-TC percentage scores were positively correlated with SRS-22r total scores (r = 0.65; p < 0.05), but were negatively related to PHQ-9, GAD-7, and NPRS scores (r = -0.46 to -0.39; p < 0.01). Collectively, the ISYQOL-TC is a reliable and valid instrument for evaluating HRQOL in Chinese teenagers with AIS.
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Affiliation(s)
- Ava Ying Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.C.); (P.K.J.); (N.W.K.); (C.K.C.C.)
| | - Pik Kwan Jim
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.C.); (P.K.J.); (N.W.K.); (C.K.C.C.)
| | - Ning Wai Kwan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.C.); (P.K.J.); (N.W.K.); (C.K.C.C.)
| | - Stephen W. W. Chan
- Allied Health Department (Physiotherapy), Hong Kong Children’s Hospital, Hong Kong SAR, China;
| | - Jason P. Y. Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China; (J.P.Y.C.); (P.W.H.C.)
| | - Prudence W. H. Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China; (J.P.Y.C.); (P.W.H.C.)
| | - Stefano Negrini
- Department of Biomedical Surgical and Dental Sciences, University “La Statale”, 20122 Milan, Italy;
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| | - Chelsia K. C. Cheung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.C.); (P.K.J.); (N.W.K.); (C.K.C.C.)
| | - Arnold Y. L. Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (A.Y.C.); (P.K.J.); (N.W.K.); (C.K.C.C.)
| | - Eric C. Parent
- Department of Physical Therapy, University of Alberta, Edmonton, AB T6G 2G4, Canada;
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12
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Quang Dao P, Dat PT, Khoa NN. Anxiety as a mediator in the relationship between the socioeconomic impact of COVID-19 and quality of life: a cross-sectional study in Vietnam. PSYCHOL HEALTH MED 2023; 28:2526-2536. [PMID: 36878882 DOI: 10.1080/13548506.2023.2188231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 02/28/2023] [Indexed: 03/08/2023]
Abstract
Previous studies have investigated the effects of the pandemic on quality of life; both economical and psychosocial effects were explored. Some studies also mentioned mediating factors as mechanisms in this relationship; however, the mediating role of anxiety has not been examined. The present study examined the mediating effects of anxiety on the relationship between socioeconomic impact of COVID-19 and quality of life. An online survey of 280 Vietnamese residents was conducted in the context of the pandemic outbreak. Anxiety was found to be a completely mediating variable in the association between the socioeconomic impact of the pandemic and quality of life during the lockdown period. This finding contributes to a better understanding of how the pandemic affects people's quality of life and serves as the foundation for lessening the negative effects of the epidemic on people's lives.
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Affiliation(s)
- Pham Quang Dao
- Faculty of Psychology, Ural Federal University, Yekaterinburg, Sverdlovsk Oblast, Russia
| | - Pham Tien Dat
- Faculty of Psychology, Ho Chi Minh City University of Education, Ho Chi Minh, Vietnam
| | - Nguyen Ngoc Khoa
- Faculty of Psychology, Ho Chi Minh City University of Education, Ho Chi Minh, Vietnam
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13
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Bimstein JG, O'Bryan EM, Jean A, McLeish AC. Intolerance of Uncertainty, Negative Reinforcement Alcohol Use Motives, and Hazardous Drinking in College Students with Clinically Elevated Worry. Subst Use Misuse 2023:1-8. [PMID: 37270428 DOI: 10.1080/10826084.2023.2215318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Background: Hazardous drinking has remained high for college students in recent years, and individuals who endorse drinking to cope with emotional distress or to conform socially report higher levels of alcohol use. Intolerance of uncertainty, a core process underlying generalized anxiety disorder, has been linked to negative reinforcement drinking motives; however, no research, to date, has examined the role of intolerance of uncertainty in terms of alcohol use motives and hazardous drinking among individuals with generalized anxiety disorder. Objective: The current study was designed to examine the relationships between intolerance of uncertainty, coping and conformity alcohol use motives, and hazardous drinking in an analogue generalized anxiety disorder sample. Methods: Participants were 323 college students (Mage = 19.25, SD = 2.23, Range = 18-40) who endorsed past-year alcohol use and clinically elevated levels of worry. Self-report measures were completed online for course credit. Results: Partially consistent with our hypotheses, uncertainty paralysis predicted greater levels of coping motives, but not conformity motives. Desire for predictability did not predict either drinking motive. Mediation analyses revealed that there was a significant indirect effect of uncertainty paralysis on more hazardous drinking through greater coping motives. Conclusion: Overall, these findings highlight the potential utility of targeting behavioral inhibition due to uncertainty to reduce unhealthy coping via alcohol use and subsequent hazardous alcohol use.
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Affiliation(s)
- Jessica G Bimstein
- Anxiety Disorders Center, Hartford Hospital/Institute of Living, Hartford, Connecticut, USA
| | - Emily M O'Bryan
- Anxiety Disorders Center, Hartford Hospital/Institute of Living, Hartford, Connecticut, USA
- Endicott College, Beverly, Massachusetts, USA
- University of Cincinnati, Cincinnati, Ohio, USA
| | - Anishka Jean
- Anxiety Disorders Center, Hartford Hospital/Institute of Living, Hartford, Connecticut, USA
| | - Alison C McLeish
- University of Cincinnati, Cincinnati, Ohio, USA
- University of Louisville, Louisville, Kentucky, USA
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14
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Kavelaars R, Ward H, Mackie DS, Modi KM, Mohandas A. The burden of anxiety among a nationally representative US adult population. J Affect Disord 2023; 336:81-91. [PMID: 37164067 DOI: 10.1016/j.jad.2023.04.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/07/2023] [Accepted: 04/16/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Anxiety disorders are highly prevalent and are associated with a significant humanistic and economic burden. This study evaluates the impact of anxiety symptoms on direct and indirect costs and quality of life in individuals with self-reported and unrecognized anxiety symptoms. METHODS The 2019 US National Health and Wellness Survey database was analyzed to compare individuals with anxiety symptoms to individuals without symptoms, stratified by responses to a yes/no question about experiencing anxiety symptoms, and further stratified by severity of symptoms based on GAD-7 scores. Individuals who responded 'yes' were characterized as having self-reported anxiety symptoms, and those who responded 'no' were screened for unrecognized anxiety symptoms. RESULTS Overall, 44.0 % of the population experienced anxiety symptoms, of which 32.5 % self-reported experiencing anxiety, while an additional 11.5 % had mild to severe symptoms but did not self-identify as having anxiety. Both groups experienced significantly worse quality of life, and higher direct and indirect costs than a control group who had no anxiety symptoms (GAD-7 ≤ 4). Individuals with more severe anxiety symptoms experienced worse outcomes. LIMITATIONS The data were cross-sectional, so causality could not be determined. Outcomes were based on self-report, and are therefore subject to reporting and recall bias. Prevalence and severity were assessed using the GAD-7, and not clinically validated. CONCLUSION A substantial proportion of the population experiences anxiety symptoms without recognizing it. Anxiety symptoms had a significant impact on quality of life, direct costs, and indirect costs, representing a considerable burden that increased with severity of illness.
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Affiliation(s)
| | - Haley Ward
- NYU Langone Health, 550 1st Ave., New York, NY 10016, USA.
| | - deMauri S Mackie
- Cerner Enviza, 2800 Rock Creek Pkwy, North Kansas City, MO 64117, USA.
| | - Kushal M Modi
- Cerner Enviza, 2800 Rock Creek Pkwy, North Kansas City, MO 64117, USA.
| | - Anita Mohandas
- Twill Inc., 114 5th Ave., 10th Fl., New York, NY 10011, USA.
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15
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Terrill DR, Dellavella C, King BT, Hubert T, Wild H, Zimmerman M. Latent classes of symptom trajectories during partial hospitalization for major depressive disorder and generalized anxiety disorder. J Affect Disord 2023; 331:101-111. [PMID: 36948468 DOI: 10.1016/j.jad.2023.03.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/27/2023] [Accepted: 03/15/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND A variety of treatments have been empirically validated in the treatment of major depressive disorder and generalized anxiety disorder. Researchers commonly evaluate symptom change during treatment using single model curves, however, modeling multiple curves simultaneously allows for the identification of subgroups of patients that progress through treatment on distinct paths. METHODS Latent growth mixture modeling was used to identify and characterize distinct classes of symptom trajectories among two samples of patients with either MDD or GAD receiving treatment in a daily partial hospital program. RESULTS Four depression symptom trajectories were identified in the MDD sample, and three anxiety symptom trajectories were identified in the GAD sample. Both samples shared symptom trajectory classes of responders, rapid responders, and minimal responders, while the MDD sample demonstrated an additional class of early rapid responders. In both samples, low symptom severity at baseline was associated with membership in the responder class, though few other patterns emerged in baseline characteristics predicting trajectory class membership. At treatment discharge, those in the minimal responder class reported poorer outcomes on every clinical measure. Patients within each class reported similar scores at discharge as compared to each other class, indicating that class membership affects clinical measures beyond symptom severity. LIMITATIONS Patient demographic characteristics were relatively homogeneous. Group-based trajectory modeling inherently involves some degree of uncertainty regarding the number and shape of trajectories. CONCLUSIONS Identifying symptom trajectories can provide information regarding how patients are likely to progress through treatment, and thus inform clinicians when a patient deviates from expected progress.
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Affiliation(s)
- Douglas R Terrill
- Department of Psychology, University of Kentucky, United States of America.
| | - Christian Dellavella
- Rhode Island Hospital Department of Psychiatry, United States of America; Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI, United States of America
| | - Brittany T King
- Rhode Island Hospital Department of Psychiatry, United States of America; Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI, United States of America
| | - Troy Hubert
- Department of Psychology, University of Kentucky, United States of America
| | - Hannah Wild
- Department of Psychology, University of Kentucky, United States of America
| | - Mark Zimmerman
- Rhode Island Hospital Department of Psychiatry, United States of America; Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI, United States of America
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16
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Generalized Worry in Patients With Chronic Fatigue Syndrome Following Cognitive Behavioral Therapy: A Prospective Cohort Study in Secondary Care. Behav Ther 2022; 53:828-842. [PMID: 35987542 DOI: 10.1016/j.beth.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 11/24/2022]
Abstract
Research has shown that generalized anxiety disorder is commonly associated with Chronic Fatigue Syndrome (CFS). This prospective cohort study aimed to investigate the prevalence of generalized worry in CFS patients and its relationship with fatigue, anxiety and social functioning, before and after Cognitive Behavioral Therapy (CBT). Our cohort consisted of 470 patients diagnosed with CFS who received CBT at a secondary care, specialist clinic. Patients completed self-report measures investigating levels of generalized worry, fatigue, work and social adjustment, anxiety and depression at baseline (pretreatment), discharge from treatment, 3-month and 6-month follow up (posttreatment). Analysis indicated a high prevalence of generalized worry (72.4%) at assessment. A significant reduction in worry following CBT (M = -3.42, p < .001, 95% CIs: 2.26, 4.57) was observed at discharge, which remained stable at follow-up. Severe baseline worriers had greater overall fatigue score (M = 3.74, p = .026, 95% CIs: .33, 7.15) and worse overall work and social adjustment than mild worriers across time-points (M = 5.42, p = .035 95% CIs: .27, 10.58). Avoidance behavior mediated the association between generalized worry and work and social adjustment (95% bootstrap CIs: 013, .080). The majority of patients with CFS had comorbid generalized worry and severe worriers reported greater fatigue, anxiety, and worse work and social adjustment. This suggests that CFS patients may benefit from targeting generalized worry during CBT.
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17
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Alcohol Consumption, Loneliness, Quality of Life, Social Media Usage and General Anxiety before and during the COVID-19 Pandemic in Singapore. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095636. [PMID: 35565030 PMCID: PMC9105322 DOI: 10.3390/ijerph19095636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/30/2022] [Accepted: 05/03/2022] [Indexed: 02/01/2023]
Abstract
This cross-sectional study aims to identify factors associated with anxiety levels of adults living in Singapore before and during the COVID-19 pandemic. Data were collected using a web-based survey conducted from July to November 2020, accruing 264 eligible participants. Ordered logistic regression was used to assess factors associated with Generalized Anxiety Disorder-7 (GAD-7), ranked as minimal (0-4), mild (5-9), moderate (10-14), and severe (15-21) before and during the pandemic. About 74% of participants were female, 50% were aged 25-34, and 50% were married. The GAD-7 level went up from the pre-pandemic for moderate (12.5% to 16%) and severe GAD (2% to 11%). Alcohol consumption (AOR 1.79, 95% CI 1.04-3.06), loneliness (AOR 1.28, 95% CI 1.05-1.54), and difficulty in switching off social media (AOR 2.21, 95% CI 1.29-3.79) predicted increased GAD-7 levels. The quality of life (AOR 0.84, 95% CI 0.79-0.90) was significantly associated with decreased GAD-7 levels. The results heighten the awareness that early initiation of mental health support is crucial for the population in addition to the various financial support measures provided by the government as they are adapting to live with the COVID-19 pandemic.
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18
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Dursun P, Alyagut P, Yılmaz I. Meaning in life, psychological hardiness and death anxiety: individuals with or without generalized anxiety disorder (GAD). CURRENT PSYCHOLOGY 2022; 41:3299-3317. [PMID: 35035188 PMCID: PMC8742667 DOI: 10.1007/s12144-021-02695-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 11/03/2022]
Abstract
Generalized anxiety disorder (GAD) is a widespread psychiatric disorder. According to the transdiagnostic approach, death anxiety can underpin predominantly somatic manifestations of GAD. Personal resilience factors such as a sense of a meaningful life, and psychological hardiness, which can protect people from developing clinical symptoms, may be lower in individuals with GAD. So far, there has been no study examining the role of meaning in life dimensions, death anxiety, and hardiness in individuals with GAD in Turkey. Thus, we aimed to investigate to what extent the GAD sample differs from the non-anxious control group in terms of death anxiety, meaning in life dimensions, and hardiness. Secondly, we examined how conceptually predicted death anxiety by meaning in life dimensions and hardiness regardless of diagnosis, age, and gender. Just before the spread of the Covid-19 pandemic, we could only recruit 38 individuals with GAD and 31 non-anxious control subjects. The Death Anxiety Scale, The Meaning in Life Questionnaire and the Psychological Hardiness Scale were administered to all the participants. The one-way MANOVA results with Bonferroni adjustment revealed that individuals with GAD significantly differed from the control group in every way. Hierarchical regression analysis displayed that the presence of meaning made the most significant contribution in predicting death anxiety. In conclusion, existential issues such as death anxiety, hardiness, and meaningful life can be emphasized for the treatment of GAD, and the presence of meaning is the most crucial antidote to avoid death anxiety in all individuals.
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Affiliation(s)
- Pinar Dursun
- Department of Psychology, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Pinar Alyagut
- Department of Philosophy, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Itır Yılmaz
- Antalya Manavgat State Hospital Department of Psychiatry, Antalya, Turkey
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19
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Schreiber RE, Veilleux JC. Perceived invalidation of emotion uniquely predicts affective distress: Implications for the role of interpersonal factors in emotional experience. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2021.111191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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20
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Goger P, Weersing VR. Family based treatment of anxiety disorders: A review of the literature (2010-2019). JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:107-128. [PMID: 34424998 DOI: 10.1111/jmft.12548] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 08/05/2021] [Indexed: 06/13/2023]
Abstract
Anxiety disorders are the most common and impairing mental health problems across the lifespan. Familial factors are strongly implicated in the onset and maintenance of anxiety, but available evidence-based treatments are usually individual-focused. The aim of this review was to evaluate the current evidence base (2010-2019) of family based interventions addressing youth and adult anxiety and highlight findings comparing family based and individual-focused treatments. A systematic literature search was conducted. Articles were considered if they targeted primarily anxiety-related issues and utilized a randomized controlled trial design, resulting in 22 included youth studies. No adult studies met criteria for inclusion. Overall, family based treatments performed better than no-treatment controls and as well as individual-based interventions, with some evidence that family based interventions might outperform individual-based ones in certain populations (i.e., autism). Family based interventions may represent a good alternative for anxiety treatment in youth. Additional research on family based treatment for anxiety is adults is needed.
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Affiliation(s)
- Pauline Goger
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - V Robin Weersing
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
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21
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Chen Y, Cui Q, Sheng W, Tang Q, Lu F, Pang Y, Nan X, He Z, Li D, Lei T, Chen H. Anomalous neurovascular coupling in patients with generalized anxiety disorder evaluated by combining cerebral blood flow and functional connectivity strength. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110379. [PMID: 34111495 DOI: 10.1016/j.pnpbp.2021.110379] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 05/06/2021] [Accepted: 06/04/2021] [Indexed: 01/10/2023]
Abstract
Coupling between neuronal activity and blood perfusion is termed neurovascular coupling, and it provides a new mechanistic perspective into understanding numerous brain diseases. Although abnormal brain activity and blood supply have been separately reported in generalized anxiety disorder (GAD), whether anomalous neurovascular coupling would still be presented in such disease is hitherto unknown. In this study, the neuronal activity and blood supply were measured using the functional connectivity strength (FCS) and cerebral blood flow (CBF). The voxel-wise CBF-FCS correlations and CBF/FCS ratio were separately used to assess global and local neurovascular coupling in participants. Patients with GAD showed decreased voxel-wise CBF-FCS correlation, implicating global neurovascular decoupling. They also exhibited increased CBF/FCS ratio in the right superior parietal gyrus (SPG), and the enhanced CBF/FCS ratio in this region was negatively correlated with the self-esteem scores of GAD. The abnormal neurovascular coupling of GAD may indicate the disrupted balance between the intrinsic functional organization of the brain and corresponding blood perfusion of patients, and the abnormally increased local neurovascular coupling of the right SPG may be correlated with the abnormal self in GAD. These findings provide new information in understanding the brain dysfunction and abnormal cognition of GAD from the perspective of neurovascular coupling.
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Affiliation(s)
- Yuyan Chen
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Qian Cui
- School of Public Affairs and Administration, University of Electronic Science and Technology of China, Chengdu, China.
| | - Wei Sheng
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Qin Tang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Fengmei Lu
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Yajing Pang
- School of Electrical Engineering, Zhengzhou University, Zhengzhou, China
| | - Xiaoyu Nan
- School of Public Affairs and Administration, University of Electronic Science and Technology of China, Chengdu, China
| | - Zongling He
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Di Li
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Ting Lei
- School of Public Affairs and Administration, University of Electronic Science and Technology of China, Chengdu, China
| | - Huafu Chen
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China; MOE Key Lab for Neuroinformation; High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China; Department of Radiology, First Affiliated Hospital to Army Medical University, Chongqing, China.
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22
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Dhira TA, Rahman MA, Sarker AR, Mehareen J. Validity and reliability of the Generalized Anxiety Disorder-7 (GAD-7) among university students of Bangladesh. PLoS One 2021; 16:e0261590. [PMID: 34914811 PMCID: PMC8675645 DOI: 10.1371/journal.pone.0261590] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022] Open
Abstract
This study investigated the reliability and factorial validity of General Anxiety Disorder-7 (GAD-7) in the context of university students in Bangladesh. The research aimed to assess whether the original one-dimensional model or a model containing both somatic and cognitive-emotional factors is appropriate. A repeated cross-sectional survey design based on convenience sampling was used to collect data from 677 university students. The factor structure of the GAD-7 was assessed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and its convergent validity was determined by investigating its correlations with Patient Health Questionnaire-9 (PHQ-9) and Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS). Results showed excellent reliability of GAD-7 as measured by Cronbach's α. CFA suggested that a modified one-factor model is appropriate for the sample. This model provided high values of comparative fit index (CFI), goodness of fit index (GFI), and Tucker Lewis Index (TLI), low value of standardized root mean square residual (SRMR) and a non-significant root mean square error of approximation (RMSEA). Correlation between GAD-7 and PHQ-9 was 0.751 and 0.934 between GAD-7 and PHQ-ADS. Overall, the study provided support for modified unidimensional structure for GAD-7 and showed high internal consistency along with good convergent validity.
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Affiliation(s)
| | - Mahir A. Rahman
- Bangladesh Institute of Development Studies, Dhaka, Bangladesh
| | | | - Jeenat Mehareen
- Department of Economics, East West University, Dhaka, Bangladesh
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23
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Agako A, Donegan E, McCabe RE, Frey BN, Streiner D, Green S. The role of emotion dysregulation in cognitive behavioural group therapy for perinatal anxiety: Results from a randomized controlled trial and routine clinical care. J Affect Disord 2021; 292:517-525. [PMID: 34147963 DOI: 10.1016/j.jad.2021.05.084] [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: 09/30/2020] [Revised: 04/11/2021] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Emotion dysregulation (ED) has been implicated in anxiety disorders and may play an important role in Cognitive Behavioural Therapy (CBT) treatment for perinatal anxiety outcomes although there is a dearth of research in this area. The current study investigated the role of ED in perinatal anxiety treatment outcome to determine whether it impacts CBT treatment outcomes and whether CBT reduces ED. METHODS Secondary analyses were run on a sample of N = 75 women participating in a CBT for perinatal anxiety randomized controlled trial (RCT), and N = 47 women who received the treatment as part of routine clinical care. Participants completed measures of anxiety, depression and ED at baseline, post-CBT/post-waitlist and 3-month follow-up (CBT-RCT group only). MANOVAs were conducted to determine if level of ED moderates treatment outcomes and whether CBT reduces ED. Reliable and clinically meaningful change was calculated. RESULTS Baseline level of ED did not moderate treatment outcomes. There were significant changes in some ED subscales over time in the CBT group compared to waitlist. Changes were reliable and clinically meaningful in 28.6% (RCT) and 16% (routine clinical care) of participants. Participants with high ED at baseline remained in the high range at post-treatment. LIMITATIONS Limitations include low sample size; homogeneity of sample, use of measures not validated in perinatal populations. CONCLUSIONS These findings suggest that ED during the perinatal period may be a stand-alone factor that will need to be separately addressed in psychological treatment.
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Affiliation(s)
- Arela Agako
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada.
| | - Eleanor Donegan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Randi E McCabe
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
| | - David Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Sheryl Green
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
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24
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Tracy A, Jopling E, LeMoult J. The effect of self-referential processing on anxiety in response to naturalistic and laboratory stressors. Cogn Emot 2021; 35:1320-1333. [PMID: 34242133 DOI: 10.1080/02699931.2021.1951675] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Although stressful life events increase risk for symptoms of Generalised Anxiety Disorder (GAD), we know little about mechanisms that increase GAD symptoms during times of stress. Despite evidence that self-referential processing contributes to other forms of psychopathology, namely depression, it is unknown whether self-referential processing also contributes to symptoms of GAD. Thus, we examined the association of self-referential processing with GAD symptoms in response to a naturalistic stressor (Study 1; n=135) and with anxiety-tension in response to a laboratory stressor (Study 2; n=56). In Study 1, participants completed the self-referential encoding task (SRET) in their initial weeks of university, and we assessed GAD symptoms four times across the semester. In Study 2, participants completed the SRET immediately before a laboratory stressor, and we assessed moment-to-moment changes in anxiety-tension. Greater negatively biased self-referential processing was associated with higher GAD symptoms at the start of university and greater reactivity to the laboratory stressor. In contrast, greater positively biased self-referential processing served as a protective factor associated with greater decline in symptoms over time. This study is the first to demonstrate that there are valence-specific effects of self-referential processing on anxiety, suggesting that self-referential processing may be relevant to GAD.
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Affiliation(s)
- Alison Tracy
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T1Z4
| | - Ellen Jopling
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T1Z4
| | - Joelle LeMoult
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T1Z4
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25
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Ziobrowski HN, Leung LB, Bossarte RM, Bryant C, Keusch JN, Liu H, Puac-Polanco V, Pigeon WR, Oslin DW, Post EP, Zaslavsky AM, Zubizarreta JR, Kessler RC. Comorbid mental disorders, depression symptom severity, and role impairment among Veterans initiating depression treatment through the Veterans Health Administration. J Affect Disord 2021; 290:227-236. [PMID: 34004405 PMCID: PMC8508583 DOI: 10.1016/j.jad.2021.04.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/21/2021] [Accepted: 04/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Psychiatric comorbidities may complicate depression treatment by being associated with increased role impairments. However, depression symptom severity might account for these associations. Understanding the independent associations of depression severity and comorbidity with impairments could help in treatment planning. This is especially true for depressed Veterans, who have high psychiatric comorbidity rates. METHODS 2,610 Veterans beginning major depression treatment at the Veterans Health Administration (VHA) were administered a baseline self-report survey that screened for diverse psychiatric comorbidities and assessed depression severity and role impairments. Logistic and generalized linear regression models estimated univariable and multivariable associations of depression severity and comorbidities with impairments. Population attributable risk proportions (PARPs) estimated the relative importance of depression severity and comorbidities in accounting for role impairments. RESULTS Nearly all patients (97.8%) screened positive for at least one comorbidity and half (49.8%) for 4+ comorbidities. The most common positive screens were for generalized anxiety disorder (80.2%), posttraumatic stress disorder (77.9%), and panic/phobia (77.4%). Depression severity and comorbidities were significantly and additively associated with impairments in multivariable models. Associations were attenuated much less for depression severity than for comorbidities in multivariable versus univariable models. PARPs indicated that 15-60% of role impairments were attributable to depression severity and 5-32% to comorbidities. LIMITATIONS The screening scales could have over-estimated comorbidity prevalence. The cross-sectional observational design cannot determine either temporal or causal priorities. CONCLUSIONS Although positive screens for psychiatric comorbidity are pervasive among depressed VHA patients, depression severity accounts for most of the associations of these comorbidities with role impairments.
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Affiliation(s)
| | - Lucinda B. Leung
- Center for the Study of Healthcare Innovation,
Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles,
CA, USA,Division of General Internal Medicine and Health Services
Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Robert M. Bossarte
- Department of Behavioral Medicine and Psychiatry, West
Virginia University, Morgantown, WV, USA,Center of Excellence for Suicide Prevention, Canandaigua VA
Medical Center, Canandaigua, NY, USA
| | - Corey Bryant
- Center for Clinical Management Research, VA Ann Arbor, Ann
Arbor, MI, USA
| | - Janelle N. Keusch
- Center for Clinical Management Research, VA Ann Arbor, Ann
Arbor, MI, USA
| | - Howard Liu
- Department of Health Care Policy, Harvard Medical School,
Boston, MA, USA,Center of Excellence for Suicide Prevention, Canandaigua VA
Medical Center, Canandaigua, NY, USA
| | - Victor Puac-Polanco
- Department of Health Care Policy, Harvard Medical School,
Boston, MA, USA,Department of Epidemiology, Columbia University Mailman
School of Public Health, New York, NY, USA
| | - Wilfred R. Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA
Medical Center, Canandaigua, NY, USA,Department of Psychiatry, University of Rochester Medical
Center, Rochester, NY, USA
| | - David W. Oslin
- VISN 4 Mental Illness Research Education and Clinical
Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA,Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, USA
| | - Edward P. Post
- Center for Clinical Management Research, VA Ann Arbor, Ann
Arbor, MI, USA,Department of Medicine, University of Michigan Medical
School, Ann Arbor, MI, USA
| | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School,
Boston, MA, USA,Department of Statistics, Harvard University, Cambridge,
MA, USA
| | - Jose R. Zubizarreta
- Department of Health Care Policy, Harvard Medical School,
Boston, MA, USA,Department of Statistics, Harvard University, Cambridge,
MA, USA,Department of Biostatistics, Harvard University,
Cambridge, MA, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School,
Boston, MA, USA
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Fearn M, Marino C, Spada MM, Kolubinski DC. Self-critical Rumination and Associated Metacognitions as Mediators of the Relationship Between Perfectionism and Self-esteem. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2021; 40:155-174. [PMID: 34177104 PMCID: PMC8211435 DOI: 10.1007/s10942-021-00404-4] [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] [Accepted: 05/25/2021] [Indexed: 10/29/2022]
Abstract
Past research has shown that perfectionism, can negatively impact self-esteem. However, the mediating factors that explain this relationship remain unclear. The current study aimed to investigate whether specific cognitive processes, namely, self-critical rumination and associated metacognitions, mediate this relationship. An opportunity sample of 347 participants completed a battery of online questionnaires measuring clinical perfectionism, self-critical rumination, metacognitions about self-critical rumination, self-esteem, and levels of psychological distress. Several hypotheses were tested to examine the associations between the study variables. Following this, a path analysis was used to determine whether the influence of perfectionistic concerns and perfectionistic striving on self-esteem is mediated by positive metacognitions about self-critical rumination, self-critical rumination, and negative metacognitions about self-critical rumination, serially. Positive metacognitions about self-critical rumination, self-critical rumination, and negative metacognitions about self-critical rumination partially mediated the relationship between perfectionistic concerns and self-esteem and fully mediated the relationship between perfectionistic striving and self-esteem. These results point towards possible interventions for those who struggle with low self-esteem due to their perfectionistic tendencies. Further investigations should explore additional factors that help to explain why perfectionism impacts self-esteem levels, whilst also addressing the limitations of this current research.
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Affiliation(s)
- Monica Fearn
- Division of Psychology, School of Applied Sciences, London South Bank University, London, UK
| | - Claudia Marino
- Dipartimento Di Psicologia Dello Sviluppo e Della Socializzazione, Universita' di Padova, Padova, Italy
| | - Marcantonio M Spada
- Division of Psychology, School of Applied Sciences, London South Bank University, London, UK
| | - Daniel C Kolubinski
- Division of Psychology, School of Applied Sciences, London South Bank University, London, UK
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Wyssen A, Balsiger N, Djurdjevic A, Munsch S, Trier S. [Treatment Evaluation in Inpatient Psychiatry: Transdiagnostic Factors as Correlates of Treatment Outcome - Implications for Clinical Practice and for Effectiveness Research]. PSYCHIATRISCHE PRAXIS 2021; 48:361-370. [PMID: 33626578 DOI: 10.1055/a-1348-9358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM An inpatient psychiatric-psychotherapeutic treatment was evaluated in a naturalistic setting (effectiveness research). Transdiagnostic factors were examined as correlates of treatment outcome. METHODS Self-report questionnaires were administered at the beginning and the end of the inpatient treatment. The sample (N = 378) consisted of women and men (16-80 years, M = 40.4, SD = 15.8) with primary diagnoses of depressive, anxiety or eating disorders. The average treatment duration was 8.2 weeks (SD = 3.8). Primary outcome variables were severity of symptoms and level of psychosocial functioning. As transdiagnostic correlates, self-esteem, self-efficacy, and emotion regulation were included in the regression analyses. RESULTS The change in transdiagnostic factors explained a significant proportion of the treatment outcome (explained variance: 8-27 % self-efficacy, 23-42 % self-esteem, 10-26 % emotion regulation). DISCUSSION/CONCLUSION The present study shows that the evaluation of a treatment in a naturalistic clinical setting is feasible. Transdiagnostic factors explained a substantial part of the statistical variance in treatment outcome across all disorders. Even if the present study design does not allow conclusions about causality, the results underline the relevance of transdiagnostic trainings (e. g., in emotion regulation) to improve effectiveness of treatment approaches.
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Affiliation(s)
- Andrea Wyssen
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Universität Fribourg, Schweiz.,Privatklinik Aadorf, Schweiz.,Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern, Schweiz
| | - Nora Balsiger
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Universität Fribourg, Schweiz
| | | | - Simone Munsch
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Universität Fribourg, Schweiz
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28
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Malivoire BL. Exploring DBT skills training as a treatment avenue for generalized anxiety disorder. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2020. [DOI: 10.1111/cpsp.12339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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Anhedonia is central for the association between quality of life, metacognition, sleep, and affective symptoms in generalized anxiety disorder: A complex network analysis. J Affect Disord 2020; 277:1013-1021. [PMID: 33065810 PMCID: PMC7575821 DOI: 10.1016/j.jad.2020.08.077] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/12/2020] [Accepted: 08/25/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Poor quality of life, sleep problems, anhedonia, and negative metacognitions are common in anxiety and depression. To examine the nature of the relationship between these features and the role of metacognitions, anhedonia, and quality of life in anxiety and depression, we conducted a complex network analysis with items of self-report measures assessing quality of life, sleep, negative thinking styles, anxiety, and depression. METHODS Participants were 226 treatment seeking individuals with a primary DSM-5 diagnosis of generalized anxiety disorder. Node centrality, strength, expected influence, community, and bridge estimation were calculated using partial correlation coefficients and glasso regularization. RESULTS Results revealed that anhedonia was the most central node followed by quality of life nodes. Moreover, anhedonia exhibited the highest strength and expected influence, which were both stable, reliable metrics within the network. Metacognitions were not central nodes in the network, but were strong bridge symptoms between communities. LIMITATIONS The results are limited by the cross-sectional nature of the data and the administration of self-report scales at one time-point, despite different rating anchors. CONCLUSION These findings suggest that anhedonia is a crucial element for the association between quality of life, sleep problems, and negative cognitions.
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30
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Moving Beyond the Negative: Contributions of Positive and Negative Affect on Quality of Life in Patients With Generalized Anxiety Disorder. J Nerv Ment Dis 2020; 208:843-847. [PMID: 32910074 DOI: 10.1097/nmd.0000000000001228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Individuals with generalized anxiety disorder (GAD) report poorer quality of life (QOL) than do nonanxious controls. Further, although positive affect (PA) and negative affect (NA) have been shown to predict QOL, no previous literature has tested this relationship in the context of individuals with GAD. In the present study, we evaluated the unique and interactive contributions of PA and NA on QOL within a sample of individuals diagnosed with GAD (N = 50). Specifically, a hierarchical regression was conducted to evaluate the unique contributions of PA, NA, and their interaction on QOL, over and above symptoms of depression. PA and depression symptoms were both significant predictors of QOL, whereas neither the main effect for NA nor the PA × NA interaction was statistically significant. Results suggest that, for those with GAD, PA uniquely contributes to QOL. Strategies to upregulate PA may be a useful treatment target for increasing QOL in individuals with GAD.
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Nyongesa MK, Mwangi P, Koot HM, Cuijpers P, Newton CRJC, Abubakar A. The reliability, validity and factorial structure of the Swahili version of the 7-item generalized anxiety disorder scale (GAD-7) among adults living with HIV from Kilifi, Kenya. Ann Gen Psychiatry 2020; 19:62. [PMID: 33133222 PMCID: PMC7594456 DOI: 10.1186/s12991-020-00312-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 10/19/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Generalized Anxiety Disorder (GAD) is under-investigated in people living with HIV/AIDS from sub-Saharan Africa. In part, this is due to paucity of culturally appropriate measures for GAD which are psychometrically robust. This study aimed to evaluate the reliability, factorial structure, and validity of Swahili version of the 7-item GAD questionnaire (GAD-7) among adults living with HIV. STUDY DESIGN Descriptive cross-sectional study. METHODS 450 adults receiving comprehensive care from an HIV specialized clinic in Kilifi County, coastal Kenya, were consecutively recruited. Swahili versions of GAD-7, Patient Health Questionnaire (PHQ-9) and a 12-item HIV stigma scale were administered alongside measures of psychosocial and health-related characteristics. Internal consistency, test-retest reliability, factorial structure, convergent validity, and discriminant validity of Swahili GAD-7 were examined using Cronbach's alpha (α), intra-class correlation coefficient (ICC), Confirmatory Factor Analysis (CFA), Pearson's correlation, and analysis of covariance (ANCOVA), respectively. RESULTS Internal consistency of Swahili GAD-7 was good, α = 0.82 (95% CI 0.78, 0.85). Its test-retest reliability (2 weeks apart) was acceptable, ICC = 0.70 (95% CI 0.55, 0.81). A confirmatory analysis of a one-factor solution indicated an excellent fit to the hypothesized structure (RMSEA = 0.00 [95% confidence interval 0.00, 0.05], CFI = 1.00, TLI = 1.00). Multi-group CFA substantiated factorial invariance for sex and age for the one-factor structure of Swahili GAD-7. Scores of GAD-7, Swahili version, significantly correlated with those of PHQ-9 (r = 0.73; p < 0.001) and the HIV stigma scale (r = 0.36; p < 0.001) suggesting good convergent validity. Statistically significant differences were observed between participants on first-line antiretroviral therapy compared to those on second-line treatment (F [1, 441] = 5.55, p = 0.02) indicative of good discriminant validity of Swahili GAD-7. CONCLUSION GAD-7 Swahili version retained its original unidimensional latent structure with good psychometric properties among adults living with HIV from Kilifi, Kenya. It can be used to identify symptoms of GAD in similar research settings. However, to confidently identify those in need of mental health treatment or referral services in HIV primary care clinics, more research on the validity of Swahili GAD-7 is needed especially its discriminant validity and diagnostic accuracy at different cut-off scores.
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Affiliation(s)
- Moses K. Nyongesa
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Paul Mwangi
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya
| | - Hans M. Koot
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Charles R. J. C. Newton
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amina Abubakar
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
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Muratori P, Milone A, Levantini V, Pisano S, Spensieri V, Valente E, Thomaes S, Masi G. Narcissistic traits as predictors of emotional problems in children with oppositional defiant disorder: A longitudinal study. J Affect Disord 2020; 274:494-499. [PMID: 32663981 DOI: 10.1016/j.jad.2020.05.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/05/2020] [Accepted: 05/14/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children's self-views encompass two independent dimensions: self-esteem and narcissism, which recently have received growing attention from researchers and clinicians. The current study sought to test whether these dimensions might predict the developmental course of children with Oppositional Defiant Disorder diagnosis. METHOD The sample (N = 64, M age = 10.1 years, 57 boys) included children with Oppositional Defiant Disorder diagnosis. We examined longitudinal relationships between self-views (both self-esteem and narcissism) and parent-reported internalizing and externalizing behavioral problems. RESULTS The study spanned two time-points, spaced 12 months apart. None of the predictors were longitudinally associated with the levels of externalizing behavioral problems in children. However, narcissism predicted the levels of children's internalizing problems at the follow-up, whereas self-esteem did not. LIMITATIONS The relatively small sample and the lack of assessing causality limit the generalizability of the findings. Results need to be replicated in larger samples. CONCLUSIONS These findings illustrate the value of taking into account children's narcissistic traits in clinical assessment. By broadening knowledge of narcissistic traits in clinical samples of children, we hope to inform assessment procedures in standard clinical practice, as well as the development of tailored interventions to curb the emergence of later negative outcomes related to childhood narcissism, such as internalizing problems.
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Affiliation(s)
- Pietro Muratori
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Viale del Tirreno 331, 56018 Calambrone Pisa, Italy.
| | - Annarita Milone
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Viale del Tirreno 331, 56018 Calambrone Pisa, Italy
| | - Valentina Levantini
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Viale del Tirreno 331, 56018 Calambrone Pisa, Italy
| | - Simone Pisano
- Department of Neuroscience, AORN Santobono-Pausilipon, Naples, Italy.2 Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Valentina Spensieri
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Italy
| | - Elena Valente
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Viale del Tirreno 331, 56018 Calambrone Pisa, Italy
| | - Sander Thomaes
- Department of Psychology, Utrecht University, The Netherlands
| | - Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Viale del Tirreno 331, 56018 Calambrone Pisa, Italy
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33
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Palmer CA, Oosterhoff B, Gentzler AL. Don’t Worry, Be Happy: Associations Between Worry and Positive Emotion Regulation. Int J Cogn Ther 2020. [DOI: 10.1007/s41811-020-00081-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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34
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Qin B, Huang G, Yang Q, Zhao M, Chen H, Gao W, Yang M. Vortioxetine treatment for generalised anxiety disorder: a meta-analysis of anxiety, quality of life and safety outcomes. BMJ Open 2019; 9:e033161. [PMID: 31784448 PMCID: PMC6924794 DOI: 10.1136/bmjopen-2019-033161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/17/2019] [Accepted: 10/24/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the efficacy, tolerability, safety, and impact on quality of life (QoL) and functional status of vortioxetine treatment for patients with generalised anxiety disorder (GAD) by performing a meta-analysis of randomised controlled trials (RCTs). DESIGN Systematic review and meta-analysis. DATA SOURCES Data mining was conducted in January 2019 across PubMed, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials Cochrane Library, Web of science and ClinicalTrials.gov. ELIGIBILITY CRITERIA FOR SELECTING STUDIES All published RCTs, which assessed the effect of vortioxetine treatment for patients with GAD when compared with a placebo group, were included. DATA EXTRACTION AND SYNTHESIS Relevant data were extracted and synthesised narratively. Results were expressed as standardised mean differences or ORs with 95% CIs. RESULTS Our meta-analysis showed that multiple doses (2.5, 5 and 10 mg/day) of vortioxetine did not significantly improve the response rates, compared with placebo (OR 1.16, 95% CI 0.84 to 1.60, p=0.38; OR 1.41, 95% CI 0.82 to 2.41, p=0.21; and OR 1.05, 95% CI 0.76 to 1.46, p=0.75). Moreover, there was no statistically significant difference regarding the remission rates, discontinuation for any reason rates, discontinuation due to adverse events rates, Short-Form 36 Health Survey scores or Sheehan Disability Scale scores between administration of multiple doses (2.5, 5 and 10 mg/day) of vortioxetine and placebo. CONCLUSIONS Although our results suggest that vortioxetine did not improve the GAD symptoms, QoL and functional status impairment of patients with GAD, it was safe and well tolerated. Clinicians should interpret and translate our data with caution, as the meta-analysis was based on a limited number of RCTs.
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Affiliation(s)
- Bin Qin
- Department of Neurology, Affiliated Liuzhou General Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Guangsu Huang
- Department of Neurology, Affiliated Liuzhou General Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Qian Yang
- Department of Neurology, Affiliated Liuzhou General Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Mingjun Zhao
- Department of Pharmacy, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Hong Chen
- Department of Neurology, Affiliated Liuzhou General Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Wen Gao
- Department of Neurology, Affiliated Liuzhou General Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Mingxiu Yang
- Department of Neurology, Affiliated Liuzhou General Hospital of Guangxi University of Science and Technology, Liuzhou, China
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O’Toole MS, Renna ME, Mennin DS, Fresco DM. Changes in Decentering and Reappraisal Temporally Precede Symptom Reduction During Emotion Regulation Therapy for Generalized Anxiety Disorder With and Without Co-Occurring Depression. Behav Ther 2019; 50:1042-1052. [PMID: 31735240 PMCID: PMC7441462 DOI: 10.1016/j.beth.2018.12.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/21/2018] [Accepted: 12/22/2018] [Indexed: 12/18/2022]
Abstract
Emotion Regulation Therapy (ERT) has demonstrated efficacy in both open and randomized trials for generalized anxiety disorder (GAD) with and without co-occurring depression. An important goal in ERT is to teach clients adaptive emotion regulation, including healthier metacognitive abilities such as decentering and cognitive reappraisal. A few studies thus far have demonstrated a mediating role for these metacognitive abilities in other cognitive behavioral therapies (CBTs) for GAD. However, a drawback to most of these has been the ability to demonstrate a causal role for improved metacognitive abilities in outcome. In the present study, we utilized multilevel time-lagged segment analyses to explore the temporal dynamics between session-by-session changes in metacognition and anxiety outcomes from ERT. Thirty-one young adults diagnosed with GAD with and without co-occurring depression received 16 sessions of ERT. Prior to each session, participants completed questionnaires pertaining to metacognition (i.e., decentering and cognitive reappraisal) and anxiety symptoms (i.e., worry, trait anxiousness, and generalized anxiety). Changes in decentering temporally preceded changes in worry and trait anxiousness of a medium to large magnitude, and changes in cognitive reappraisal temporally preceded changes in all three outcomes of a medium to large magnitude. The reverse direction, where mediators were predicted by outcomes, was nonsignificant. These findings support the notion that adaptive metacognitive emotion regulation is involved in reducing worry and anxiety in GAD. Having a clearer understanding of the temporal dynamics between metacognitive abilities and symptoms of anxiety can inform and improve not only ERT but other CBTs for GAD, as well.
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Affiliation(s)
| | | | | | - David M. Fresco
- Kent State University & Case Western Reserve University School of Medicine
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36
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Exploring health-related quality of life of Spanish domestic adult adoptees: sociodemographic characteristics, chronic medical conditions, and gender differences. Qual Life Res 2019; 28:3281-3291. [PMID: 31388816 DOI: 10.1007/s11136-019-02262-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The main objective is to study the health-related quality of life (HRQoL) as a positive approach to health in adult adoptees. We will also consider comparison with population norms, relation to chronic medical conditions, the role of sociodemographic variables, and gender differences among the variables in this study. METHODS This was a cross-sectional study of 179 adult domestic adoptees from Spain aged between 18 and 44. They were recruited from a longitudinal study, which was on its third wave. They answered an interview and the self-report measure Health Survey Short Form (SF-12). ANOVAs and t test analyses to compare groups, and multiple regression to determine predictors of HRQoL, were performed. RESULTS Adoptees are not different from the general population in terms of perceived physical health (PH) and mental health (MH). Both PH and MH are related to different variables (e.g., current age is negatively associated with PH, as is the number of chronic medical conditions with MH). Despite the absence of gender differences in MH perception, there were common and different predictor variables for males and females. The number of chronic medical conditions predicts HRQoL regardless of gender. For women, employment is also a predictor, and for men, other variables are being in a romantic relationship, having children, and low income. CONCLUSIONS Adult adoptees are comparable to general population in terms of HRQoL, but there are associated variables (chronic medical conditions and gender) that should be considered. Post-adoption services should promote health and support in life transitions for this group.
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Jongeneel A, Pot-Kolder R, Counotte J, van der Gaag M, Veling W. Self-esteem moderates affective and psychotic responses to social stress in psychosis: A virtual reality study. Schizophr Res 2018; 202:80-85. [PMID: 29954700 DOI: 10.1016/j.schres.2018.06.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 04/24/2018] [Accepted: 06/14/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Higher liability to psychosis is associated with low self-esteem and increased sensitivity to social stress. Recently, we reported a positive relation between liability to psychosis and affective and psychotic responses to social stress. This study investigated how self-esteem moderates paranoia, peak subjective distress and stress reactivity of people with different psychosis liability in response to social stressors in virtual reality. METHODS Ninety-four individuals with lower (41 siblings and 53 controls) and 75 persons with higher psychosis liability (55 with recent onset psychotic disorder and 20 at ultra-high risk for psychosis) explored five times a virtual café with various social stressors (crowdedness, ethnic minority status, and hostility). They rated momentary paranoia (State Social Paranoia Scale) after each experiment and subjective distress on a visual analogue scale before and after the experiments. Positive and negative self-esteem were assessed with the Self-Esteem Rating Scale. RESULTS Momentary paranoia, peak subjective distress, and reactivity to social stressors were associated with negative self-esteem, but not positive self-esteem. Effects of both positive and negative self-esteem on psychotic and affective stress responses, but not stress reactivity, became significantly stronger when individuals were exposed to more stressful environments. Effects of self-esteem on momentary paranoia and peak subjective distress did not differ between the high liability and low liability group. Persons with lower psychosis liability had a stronger effect of negative self-esteem on stress reactivity than persons with higher liability. CONCLUSIONS Positive and negative self-esteem may play an important role in affective and psychotic responses to social stress.
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Affiliation(s)
- Alyssa Jongeneel
- VU University and Amsterdam Public Health research institute, Department of Clinical Psychology, Amsterdam, the Netherlands; Parnassia Psychiatric Institute, The Hague, the Netherlands.
| | - Roos Pot-Kolder
- VU University and Amsterdam Public Health research institute, Department of Clinical Psychology, Amsterdam, the Netherlands; Arkin Mental Health Care Institute, Amsterdam, the Netherlands
| | | | - Mark van der Gaag
- VU University and Amsterdam Public Health research institute, Department of Clinical Psychology, Amsterdam, the Netherlands; Parnassia Psychiatric Institute, The Hague, the Netherlands
| | - Wim Veling
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
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Karaaslan Ö, Hacimusalar Y. Evaluation of body image, sexual dysfunctions and quality of life in female patients with generalized anxiety disorder. ARCH CLIN PSYCHIAT 2018. [DOI: 10.1590/0101-60830000000178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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González-Blanch C, Fernando Hernández-de-Hita, Muñoz-Navarro R, Ruíz-Rodríguez P, Medrano LA, Moriana JA, Cano-Vindel A. Domain-specific associations between disability and depression, anxiety, and somatization in primary care patients. Psychiatry Res 2018; 269:596-601. [PMID: 30205353 DOI: 10.1016/j.psychres.2018.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/26/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
This study explores the associations between different disability domains and the most prevalent symptoms of mental disorders in primary care patients (i.e. depression, anxiety, and somatization). A total of 1241 participants from 28 primary care centres completed self-report measures of depression, anxiety, and somatization. This same sample also completed the Sheehan Disability Scale (SDS) to assess functional impairment in work, social life, and family life domains. Associations between the symptoms and each disability domain were examined using hierarchical regression analyses. Depression emerged as the strongest predictor of all three disability domains. Somatization was associated only with the work domain, and anxiety was associated only with the family life domain. Clinical symptoms explained a greater proportion of the variance than sociodemographic variables. In primary care patients, depression, anxiety and somatizations were associated with distinct domains of disability. Early provision of effective treatments in the primary care setting may be crucial to reduce the societal burden of common mental disorders.
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Affiliation(s)
- César González-Blanch
- Mental Health Centre, University Hospital Marqués de Valdecilla- IDIVAL. Santander, Spain.; Faculty of Health Sciences, Universidad Europea del Atlántico, Santander, Spain.
| | | | - Roger Muñoz-Navarro
- Department of Basic Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain
| | | | | | - Juan Antonio Moriana
- Department of Psychology, University of Córdoba/Maimónides Institute for Research in Biomedicine of Córdoba-IMIBIC/Reina Sofía University Hospital, Spain
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Costa FS, Cademartori MG, Silva MF, Nascimento GG, Shqair AQ, Pinheiro RT, Demarco FF, Goettems ML. Anxiety symptoms have a direct effect on oral health perception in young women. Qual Life Res 2018; 27:1583-1588. [PMID: 29392599 DOI: 10.1007/s11136-018-1797-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE Assess the influence of anxiety symptoms on oral health related-quality of life in young women from a cohort study in Southern Brazil. METHODS A sample of 535 young mothers were analyzed. Interviews and psychological evaluations were carried out by trained psychologists. The Brazilian version of the Corah's dental anxiety scale and the Beck anxiety inventory were used to evaluate dental anxiety and anxiety symptoms, respectively. The oral health-related quality of life (OHRQoL) was assessed by the Oral Impacts on Daily Performance instrument. Dental examinations were performed by trained dentists to assess oral health status (DMFT). The effect of anxiety symptoms on oral health-related quality of life was estimated using the parametric g-formula. RESULTS The prevalence of negative impact on OHRQoL was of 46.3 and 28% of the women presented anxiety symptoms. Unadjusted analysis showed that women with anxiety symptoms had 2.5 higher impact on OHRQoL (OR 2.55; CI 95% 1.72-3.79). The parametric g-formula revealed that anxiety had a direct effect on oral health perception (OR 1.16; CI 95% 1.04-1.30), not mediated by dental anxiety. CONCLUSION Oral health-related quality of life is influenced by anxiety symptoms, regardless of dental anxiety.
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Affiliation(s)
- Francine S Costa
- Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Manuela F Silva
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Gustavo G Nascimento
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Ayah Q Shqair
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Ricardo T Pinheiro
- Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | - Flávio F Demarco
- Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Marília L Goettems
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil.
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Hwang J, Legarreta M, Bueler CE, DiMuzio J, McGlade E, Lyoo IK, Yurgelun-Todd D. Increased efficiency of brain connectivity networks in veterans with suicide attempts. Neuroimage Clin 2018; 20:318-326. [PMID: 30105203 PMCID: PMC6086217 DOI: 10.1016/j.nicl.2018.04.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/31/2018] [Accepted: 04/21/2018] [Indexed: 01/09/2023]
Abstract
Background Suicide is a public health concern for United States veterans and civilians. Prior research has shown neurobiological factors in suicide. However, studies of neuroimaging correlates of suicide risk have been limited. This study applied complex weighted network analyses to characterize the neural connectivity in white matter in veterans with suicide behavior. Methods Twenty-eight veterans without suicide behavior (NS), 29 with a history of suicidal ideation only (SI), and 23 with prior suicide attempt (SA) completed diffusion tensor brain imaging, the Columbia Suicide Severity Rating Scale and Barratt Impulsiveness Scale (BIS). Structural connectivity networks among 82 parcellated brain regions were produced using whole-brain tractography. Global and nodal metrics of network topology have been calculated. Results SA had shorter characteristic path length and greater global efficiency and mean weighted degree of global network metrics (p < 0.024). SA had more hub nodes than NS and SI. The left posterior cingulate cortex (PCC) showed significantly greater weighted degree in SA relative to others (p < 0.0003). Nonplanning subscale of BIS correlated with the weighted degrees of the left PCC within SA. In rich club connectivity, SA had higher local connections than others (p = 0.001). Conclusion Veterans with prior suicide attempt had altered connectivity networks characteristics in the white matter. These findings may be distinctive neurobiological markers for individuals with suicide attempt. Strong connectivity in the left PCC may be implicated in impulsivity in veterans with suicide attempt.
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Affiliation(s)
- Jaeuk Hwang
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, United States; Department of Psychiatry, University of Utah, Salt Lake City, UT, United States; Department of Psychiatry, Soonchunhyang University Hospital, Seoul, South Korea
| | - Margaret Legarreta
- MIRECC, Department of Veterans Affairs, Salt Lake City, UT, United States
| | | | - Jennifer DiMuzio
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, United States
| | - Erin McGlade
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, United States; Department of Psychiatry, University of Utah, Salt Lake City, UT, United States; MIRECC, Department of Veterans Affairs, Salt Lake City, UT, United States
| | - In Kyoon Lyoo
- Ewha Brain Institute, Ewha W. University, Seoul, South Korea; Department of Brain and Cognitive Sciences, Ewha W. University, Seoul, South Korea
| | - Deborah Yurgelun-Todd
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, United States; Department of Psychiatry, University of Utah, Salt Lake City, UT, United States; MIRECC, Department of Veterans Affairs, Salt Lake City, UT, United States.
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Berghoff CR, Forsyth JP, Ritzert TR, Eifert GH, Anderson DA. Evaluation of the contribution of values clarification to a brief mindfulness meditation intervention for anxiety. J Clin Psychol 2018. [PMID: 29542812 DOI: 10.1002/jclp.22610] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Evaluate the incremental effects of a computerized values clarification (VC) activity on anxiety symptomology and quality of life over and above establishment of a mindfulness meditation (MM) practice. METHOD Anxious participants (N = 120, Female = 86; Mage = 22.26) were randomly assigned to a 2-week, 10-min daily MM practice + control task or a 2-week, 10-min daily MM practice + VC task. Pre-assessments and post-assessments included well-established and ideographic self-report measures. RESULTS Overall decreases in past week and past 24-h anxiety symptom frequency, as well as increased quality of life during the previous 24-h cycle only. VC did not have a demonstrable impact on outcomes. CONCLUSIONS Though findings are preliminary, brief VC exercises may not enhance outcomes that follow from mindfulness practice. Additional research is needed to isolate specific and shared impacts of mindfulness-based and values-based treatment strategies on anxiety symptoms and quality of life.
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Affiliation(s)
| | - John P Forsyth
- Department of Psychology, University at Albany, State University of New York
| | | | | | - Drew A Anderson
- Department of Psychology, University at Albany, State University of New York
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Mennin DS, Fresco DM, O'Toole MS, Heimberg RG. A randomized controlled trial of emotion regulation therapy for generalized anxiety disorder with and without co-occurring depression. J Consult Clin Psychol 2018; 86:268-281. [PMID: 29504794 PMCID: PMC5841545 DOI: 10.1037/ccp0000289] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Generalized anxiety disorder (GAD) and major depression (MDD), especially when they co-occur, are associated with suboptimal treatment response. One common feature of these disorders is negative self-referential processing (NSRP; i.e., worry, rumination), which worsens treatment outcome. Emotion Regulation Therapy (ERT) integrates principles from affect science with traditional and contemporary cognitive-behavioral treatments to identify and modify the functional nature of NSRP by targeting motivational and regulatory mechanisms, as well as behavioral consequences. METHOD Building on encouraging open trial findings, 53 patients with a primary diagnosis of GAD (43% with comorbid MDD) were randomly assigned to immediate treatment with ERT (n = 28) or a modified attention control condition (MAC, n = 25). RESULTS ERT patients, as compared with MAC patients, evidenced statistically and clinically meaningful improvement on clinical indicators of GAD and MDD, worry, rumination, comorbid disorder severity, functional impairment, quality of life, as well as hypothesized mechanisms reflecting mindful attentional, metacognitive, and overall emotion regulation, which all demonstrated mediation of primary outcomes. This superiority of ERT exceeded medium effect sizes with most outcomes surpassing conventions for a large effect. Treatment effects were maintained for nine months following the end of acute treatment. Overall, ERT resulted in high rates of high endstate functioning for both GAD and MDD that were maintained into the follow-up period. CONCLUSIONS Findings provide encouraging support for the efficacy and hypothesized mechanisms underlying ERT and point to fruitful directions for improving our understanding and treatment of complex clinical conditions such as GAD with co-occurring MDD. (PsycINFO Database Record
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Affiliation(s)
- Douglas S Mennin
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University
| | - David M Fresco
- Department of Psychological Sciences, Kent State University
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Bártolo A, Monteiro S, Pereira A. Factor structure and construct validity of the Generalized Anxiety Disorder 7-item (GAD-7) among Portuguese college students. CAD SAUDE PUBLICA 2017; 33:e00212716. [PMID: 28977285 DOI: 10.1590/0102-311x00212716] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 06/27/2017] [Indexed: 02/06/2023] Open
Abstract
: The Generalized Anxiety Disorder 7-item (GAD-7) scale has been presented as a reliable and valid measure to assess generalized anxiety symptoms in several clinical settings and among the general population. However, some researches did not support the original one-dimensional structure of the GAD-7 tool. Our main aim was to examine the factor structure of GAD-7 comparing the one-factor model fit with a two-factor model (3 somatic nature symptoms and 4 cognitive-emotional nature symptoms) in a sample of college students. This validation study with data collected cross-sectionally included 1,031 Portuguese college students attending courses in the six schools of the Polytechnic Institute of Coimbra, Coimbra, Portugal. Measures included the GAD-7, Hospital Anxiety and Depression Scale (HADS) and the University Student Risk Behaviors Questionnaire. Confirmatory factor analysis (CFA) procedures confirmed that neither factor structure was well fitting. Thus, a modified single factor model allowing the error terms of items associated with relaxing difficulties and irritability to covary was an appropriate solution. Additionally, this factor structure revealed configural and metric invariance across gender. A good convergent validity was found by correlating global anxiety and depression. However, this measure showed a weak association with consumption behaviors. Our results are relevant to clinical practice, since the comprehensive approach to GAD-7 contributes to knowing generalized anxiety symptoms trajectory and their correlates within the university setting.
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Affiliation(s)
- Ana Bártolo
- Departamento de Educação e Psicologia, Universidade de Aveiro, Aveiro, Portugal.,Centro de Investigação em Tecnologias e Serviços de Saúde, Universidade de Aveiro, Aveiro, Portugal
| | - Sara Monteiro
- Departamento de Educação e Psicologia, Universidade de Aveiro, Aveiro, Portugal
| | - Anabela Pereira
- Departamento de Educação e Psicologia, Universidade de Aveiro, Aveiro, Portugal.,Centro de Investigação em Didática e Tecnologia na Formação de Formadores, Universidade de Aveiro, Aveiro, Portugal
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Crouch TA, Lewis JA, Erickson TM, Newman MG. Prospective Investigation of the Contrast Avoidance Model of Generalized Anxiety and Worry. Behav Ther 2017; 48:544-556. [PMID: 28577589 DOI: 10.1016/j.beth.2016.10.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/19/2016] [Accepted: 10/20/2016] [Indexed: 11/29/2022]
Abstract
The factors that maintain generalized anxiety disorder (GAD) symptoms and worry over time are not entirely clear. The Contrast Avoidance Model (CAM) postulates that individuals at risk for pathological worry and GAD symptoms uniquely fear emotional shifts from neutral or positive emotions into negative emotional states, and consequently use worry to maintain negative emotion in order to avoid shifts or blunt the effect of negative contrasts. This model has received support in laboratory experiments, but has not been investigated prospectively in the naturalistic context of daily life. The present study tested the CAM in a longitudinal experience sampling study with a subclinical sample. Participants selected to represent a broad range of symptoms (N = 92) completed baseline measures of GAD and depression symptoms, and eight weekly assessments of worry, experiences of negative emotional contrasts during their worst event of the week, and situation-specific negative emotion. Consistent with the CAM, GAD symptoms prospectively predicted higher endorsement of negative contrast experiences as worst events, independent of depression symptoms. Unsurprisingly, higher negative contrasts predicted higher negative emotion. However, both higher baseline GAD symptoms and weekly worry uniquely moderated (reduced) this relationship, providing consistent support for the idea that worry may blunt the emotional effects of contrasts. Depression symptoms did not have the same moderating effect. These findings support the CAM in an ecologically valid context.
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DiNapoli EA, Pierpaoli CM, Shah A, Yang X, Scogin F. Effects of Home-Delivered Cognitive Behavioral Therapy (CBT) for Depression on Anxiety Symptoms among Rural, Ethnically Diverse Older Adults. Clin Gerontol 2017; 40:181-190. [PMID: 28452665 PMCID: PMC6174534 DOI: 10.1080/07317115.2017.1288670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND We examined the effects of home-delivered cognitive-behavioral therapy (CBT) for depression on anxiety symptoms in an ethnically diverse, low resource, and medically frail sample of rural, older adults. METHOD This was a secondary analysis of a randomized clincial trial with 134 rural-dwelling adults 65 years and older with decreased quality of life and elevated psychological symptomatology. Anxiety symptoms were assessed with the anxiety and phobic anxiety subscales of the Symptom Checklist-90-Revised (SCL-90-R). RESULTS Compared to a minimal support control condition, CBT for depression resulted in significantly greater improvements in symptoms of anxiety and phobic anxiety from pre-treatment to post-treatment. CONCLUSION Home-delivered CBT for depression can be an effective treatment for anxiety in a hard-to-reach older populations. CLINICAL IMPLICATIONS Additional research should explore integrated anxiety and depression protocols and other treatment modalities, including bibliotherapy or telehealth models of CBT, to reduce costs associated with its in home delivery. Flexibility in administration and adaptations to the CBT protocol may be necessary for use with vulnerable, rural older adults.
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Affiliation(s)
- Elizabeth A DiNapoli
- a VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.,b University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA
| | | | - Avani Shah
- c University of Alabama , Tuscaloosa , Alabama , USA
| | - Xin Yang
- c University of Alabama , Tuscaloosa , Alabama , USA
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Byrne ME, Eichen DM, Fitzsimmons-Craft EE, Taylor CB, Wilfley DE. Perfectionism, emotion dysregulation, and affective disturbance in relation to clinical impairment in college-age women at high risk for or with eating disorders. Eat Behav 2016; 23:131-136. [PMID: 27673706 PMCID: PMC5124520 DOI: 10.1016/j.eatbeh.2016.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 09/10/2016] [Accepted: 09/13/2016] [Indexed: 01/24/2023]
Abstract
Individuals with eating disorders (EDs) demonstrate impaired quality of life; however, less than one-third report severe clinical impairment. Thus, it is important to determine factors that may identify those who are most likely to report marked impairment. Perfectionism, emotion dysregulation, and aspects of affective disturbance, such as anxiety and depression, are independently associated with eating pathology and clinical impairment in eating and other disorders. However, little research has explored these three factors concurrently in relation to eating pathology. It is possible that the combined interaction effect of these constructs could be especially harmful. The current study examined the influence of these constructs and their interactions on clinical impairment in college-aged women at high risk for or with a DSM-5 clinical or subclinical ED. Although the three-way interaction of perfectionism, emotion dysregulation, and affective disturbance (i.e., anxiety or depression) was not significant, the two-way interaction between perfectionism and emotion dysregulation was significant such that those who were high in both perfectionism and emotion dysregulation reported the highest levels of clinical impairment. This suggests that the combination of perfectionism and emotion dysregulation may be especially problematic for those with or at high risk for EDs. Interestingly, perfectionism alone was not a predictor of clinical impairment when accounting for the other constructs, implying that perfectionism may have a greater impact when in conjunction with emotion dysregulation. Understanding the impact of combined perfectionistic tendencies and emotion dysregulation on clinical impairment may better inform treatment and more directly target contributors to impaired quality of life.
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Affiliation(s)
- Meghan E Byrne
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, United States.
| | - Dawn M Eichen
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
| | - Ellen E Fitzsimmons-Craft
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States; Department of Psychiatry and Behavioral Sciences, Palo Alto University, Palo Alto, CA, United States
| | - Denise E Wilfley
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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Murphy J, Rowell L, McQuaid A, Timulak L, O'Flynn R, McElvaney J. Developing a model of working with worry in emotion-focused therapy: A discovery-phase task analytic study. COUNSELLING & PSYCHOTHERAPY RESEARCH 2016. [DOI: 10.1002/capr.12089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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50
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Methamphetamine-induced deficits in social interaction are not observed following abstinence from single or repeated exposures. Behav Pharmacol 2016; 26:786-97. [PMID: 26536631 DOI: 10.1097/fbp.0000000000000158] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of the current study was to assess social interaction (SI) following acute and repeated methamphetamine (MA) administration. Rats were injected with 5.0 mg/kg of MA and SI was tested 30 min or 24 h later. In another group of animals, MA sensitization was induced using 5.0 mg/kg of MA, and SI was assessed after 1 or 30 days of abstinence. SI was reduced in rats injected with MA 30 min, but not 24 h, before testing, compared with saline controls. Impaired SI was observed in combination with active avoidance of the conspecific animal. Repeated injections of MA progressively reduced locomotor activity and increased stereotypy, indicating that animals were sensitized. However, no differences in SI were observed 24 h or 30 days following the induction of sensitization. The absence of detectable differences in SI following MA sensitization may be attributable to the relatively short regimen used to induce sensitization. However, the current series of experiments provides evidence that an acute injection of MA decreases SI and simultaneously increases avoidance behavior, which supports a link between psychostimulant use and impaired social functioning. These data suggest that the acute injection model may provide a useful model to explore the neural basis of impaired social functioning and antisocial behavior.
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