A cross-sectional evaluation of the factorial invariance of anxiety sensitivity in adolescents and young adults

Wellness Achieved Through Changing Habits: A Randomized Controlled Trial of an Acceptance-Based Intervention for Adolescent Girls With Overweight or Obesity

Background: Obesity prevalence among adolescent girls continues to rise. Acceptance-based therapy (ABT) is effective for weight loss in adults and feasible and acceptable for weight loss among adolescents. This pilot randomized controlled trial (RCT) assessed effectiveness of an adolescent-tailored ABT intervention on decreasing weight-related outcomes and improving psychological outcomes compared with enhanced care. Methods: In this 6-month, two-arm pilot RCT, participants were randomized to the ABT intervention or to enhanced care. The ABT intervention condition attended 15 virtual, 90-minute group sessions. The enhanced care comparison received 15 healthy lifestyle handouts and virtually met twice with a registered dietitian. The primary outcome assessed was change in BMI expressed as a percentage of the 95th percentile (%BMIp95). Results: Participants included 40 girls (ages 14-19) assigned to ABT (n = 20) or enhanced care (n = 20). A decrease in %BMIp95 was observed within the ABT intervention [d = -0.19, 95% confidence interval, CI: (-0.36 to -0.02)], however, not within the enhanced care comparison [d = -0.01, 95% CI: (-0.09 to 0.07)]. The ABT group showed slight changes in psychological flexibility [d = -0.34, 95% CI: (-0.62 to -0.06)] over enhanced care [d = -0.11, 95% CI: (-0.58 to 0.37)]. There was no significant intervention effect noted between groups. Conclusion: In this pilot RCT, the ABT intervention was as effective as enhanced care for weight loss. However, previous ABT studies occurred in person, and this study was conducted virtually due to COVID-19. Thus, future research investigating the potential effectiveness of ABT in-person among adolescents and optimization of virtual interventions is needed.

Workplace breastfeeding support for working women: A scale development study

Objective

In this study, authors aimed to develop a scale to evaluate workplace breastfeeding support.

Methods

The study was carried out with 490 working women who applied to the women's and children's outpatient clinics of a hospital in Turkey. The study data were collected by using a 'Personal Information Form' and the 'Workplace Breastfeeding Support for Working Women Draft Scale'. The data were analyzed on SPSS 25 and AMOS 21 software packages. In the development process of the scale; Content validity, exploratory factor analysis, item-total score correlation methods and Cronbach's Alpha coefficient were used.

Results

The content validity index of the scale was 0.90, and the Cronbach's alpha value was 0.93. Kaiser-Meyer-Olkin value of the scale was 0.91, Bartlett test values were χ2 = 11,573.924 and p < 0.000. According to the results of the exploratory factor analysis for the construct validity of the scale, the scale consisted of 31 items and 6 factors.

Conclusions

The developed scale can be used to evaluate workplace breastfeeding support for working women as a valid and reliable measurement tool.

A Track from Attachment to Resilience During the Covid 19 Pandemic: Romantic Relationship Tendency

The COVID-19 pandemic involves some psychosocial problems in addition to physical risks, and resilience appears to be a critical feature to cope with these problems. This study aims to present a model examining the relationships between the psychological tendencies associated with romantic relationships, attachment styles, social media usage, and resilience during the COVID-19 pandemic. These relationships were investigated in a sample of unmarried adults (n = 289) with a romantic relationship history of at least six months. The average age of the participants was 27 years. As a result of structural equation modelling, anxious and avoidant attachment styles had no effect on the purpose of social media usage and the purpose of social media usage had no effect on psychological resilience. Also, anxious and avoidant attachment styles affected resilience, and this effect was fully mediated by psychological tendencies associated with romantic relationships. The findings reveal the necessity to consider the psychological tendencies associated with romantic relationships in studies aimed at increasing resilience.

Validity and reliability of the Turkish version of the Body Understanding Measure for Pregnancy scale (BUMPs)

PURPOSE

This study aimed to determine the validity and reliability of the Body Understanding Measure for Pregnancy scale by adapting it to Turkish society.

DESIGN AND METHODS

This methodological study was conducted with 265 pregnant women.

FINDINGS

We performed exploratory factor analysis and determined that the scale consists of 17 items and 2 subdimensions. The two-factor structure was confirmed as a result of the confirmatory factor analysis. The Cronbach's alpha value of the scale was 0.87.

PRACTISE IMPLICATIONS

The Body Understanding Measure for Pregnancy scale is a valid and reliable measurement tool for measuring the body satisfaction of pregnant women for Turkish society.

Happiness at Work and Motivation for a Sustainable Workforce: Evidence from Female Hotel Employees

Employment practices that support happiness at work are critical tools for developing a sustainable workforce. In today’s challenging environment, both economically and environmentally, the contribution of a sustainable workforce, which is the most critical asset for hospitality businesses to survive and succeed, cannot be ignored. This study explores the effects of motivational dimensions on happiness at work. These relationships were evaluated using the SPSS for Windows 25.0 and AMOS 23.0 programs. For this purpose, data were collected from 271 female employees in various four- and five-star hotels in North Cyprus. As predicted, the results revealed that motivational dimensions affect the dimensions of happiness at work. This study confirmed that a better understanding of employees’ needs and demands would encourage motivation and result in happier employees. The findings offer important implications for hospitality industry organizations seeking to maximize employee happiness in the workplace and strive for the sustainability of their workforce.

Reciprocal longitudinal associations between anxiety sensitivity and alcohol consumption/problems across adolescence: Examining anxiety as a mediator and race/ethnicity as a moderator

The conditions and populations for which anxiety sensitivity (AS; i.e., the tendency to interpret unpleasant physiological sensations as dangerous) relates to adolescent alcohol use is unclear. This study tested latent-variable cross-lagged panel modeling of AS-alcohol relations in a racially/ethnically heterogenous longitudinal youth cohort (N = 3396; 53.4% female, 45.8% Latinx) assessed annually across high school. Anxiety and race/ethnicity were tested as mediators and moderators, respectively, of AS-alcohol associations. AS prospectively predicted alcohol problems (β's = 0.05-0.07) but not alcohol consumption (β's = 0.02-0.04) across high school. Alcohol problems predicted AS at the end (β = 0.09) but not beginning (β's = 0.01-0.03) of high school and alcohol consumption predicted lower AS at the beginning (β = -0.06) but not end (β's = -0.02-0.01) of high school. Anxiety mediated AS's predictive effects on alcohol problems (βindirect's = 0.01, 95% CI [0.003, 0.03]) across high school. Race/ethnicity did not moderate interrelations of AS, anxiety, and alcohol outcomes. These findings lend support to the risk factor model of AS on alcohol problems (but not consumption) through anxiety and the scar/complication model whereby alcohol problems may exacerbate AS later in adolescence. Addressing reciprocal risk processes between AS, anxiety, and alcohol problems warrant consideration in adolescent behavioral health promotion for various racial/ethnic populations.

Emotional Competence and Anxiety in Childhood and Adolescence: A Meta-Analytic Review

Anxiety is conceptualized as a state of negative emotional arousal that is accompanied by concern about future threat. The purpose of this meta-analytic review was to evaluate the evidence of associations between emotional competence and anxiety by examining how specific emotional competence domains (emotion recognition, emotion expression, emotion awareness, emotion understanding, acceptance of emotion, emotional self-efficacy, sympathetic/empathic responses to others' emotions, recognition of how emotion communication and self-presentation affect relationships, and emotion regulatory processes) relate to anxiety in childhood and adolescence. A total of 185 studies were included in a series of meta-analyses (N's ranged from 573 to 25,711). Results showed that anxious youth are less effective at expressing (r = -0.15) and understanding emotions (r = -0.20), less aware of (r = -0.28) and less accepting of their own emotions (r = -0.49), and report less emotional self-efficacy (r = -0.36). More anxious children use more support-seeking coping strategies (r = 0.07) and are more likely to use less adaptive coping strategies including avoidant coping (r = 0.18), externalizing (r = 0.18), and maladaptive cognitive coping (r = 0.34). Emotion acceptance and awareness, emotional self-efficacy, and maladaptive cognitive coping yielded the largest effect sizes. Some effects varied with children's age. The findings inform intervention and treatment programs of anxiety in youth and identify several areas for future research.

Cognitive Errors, Anxiety Sensitivity, and Anxiety Control Beliefs

This study examined the interrelations among negative cognitive errors, anxiety sensitivity, and anxiety control beliefs and explored their unique and specific associations with anxiety symptoms in a community sample of youth. Existing research has suggested that these constructs are related to childhood anxiety disorder symptoms; however, additional research is needed to test the interrelations among negative cognitive errors, anxiety sensitivity, and anxiety control beliefs and to determine if they show unique and specific associations with anxiety symptoms. The results of this study indicated that negative cognitive errors, anxiety sensitivity, and anxiety control beliefs were associated with each other and that they demonstrated unique concurrent associations with childhood anxiety disorder symptoms. Moreover, certain cognitive biases showed specificity in their association with anxiety symptoms versus depressive symptoms.

Anxiety Sensitivity in School Attending Youth: Exploratory and Confirmatory Factor Analysis of the 18-Item CASI in a Multicultural South African Sample

Anxiety sensitivity (AS) is a risk factor for the development of anxiety disorders in youth. To date, the applicability of the Childhood Anxiety Sensitivity Index (CASI) in youth from a low or middle income country (LMIC) setting on the African continent has not been assessed. A representative sample of 1149 secondary school learners from 29 schools in Cape Town, South Africa, participated in the study. Participants completed the CASI on a single occasion. One-, two-, and four-factor models of the CASI were assessed. A one-factor solution that comprised items predominantly represented by physical concerns appeared to provide the best fit to our data, however, relatively low variance (26%) was explained. Subsequent item deletion resulted in a 9-item ‘physical concerns’ factor that showed good construct reliability (0.83) but also explained a low amount of variance (35%). In terms of gender, a one-factor model provided the best fit, however, low variance was explained (i.e., 25%). Configural, metric and scalar invariance of the CASI by gender was determined. Our results suggest that the 18-item CASI is not applicable to our target population and may require adaptation in this population; however, replication of this study in other multicultural adolescent samples in South Africa is first needed to further assess the validity of the AS construct as measured by the CASI.

Cognitive content specificity in anxiety and depressive disorder symptoms: a twin study of cross-sectional associations with anxiety sensitivity dimensions across development

BACKGROUND

The classification of anxiety and depressive disorders has long been debated and has important clinical implications. The present study combined a genetically sensitive design and multiple time points to investigate cognitive content specificity in anxiety and depressive disorder symptoms across anxiety sensitivity dimensions, a cognitive distortion implicated in both disorders.

METHOD

Phenotypic and genetic correlations between anxiety sensitivity dimensions, anxiety and depressive disorder symptoms were examined at five waves of data collection within childhood, adolescence and early adulthood in two representative twin studies (n pairs = 300 and 1372).

RESULTS

The physical concerns dimension of anxiety sensitivity (fear of bodily symptoms) was significantly associated with anxiety but not depression at all waves. Genetic influences on physical concerns overlapped substantially more with anxiety than depression. Conversely, mental concerns (worry regarding cognitive control) were phenotypically more strongly associated with depression than anxiety. Social concerns (fear of publicly observable symptoms of anxiety) were associated with both anxiety and depression in adolescence. Genetic influences on mental and social concerns were shared to a similar extent with both anxiety and depression.

CONCLUSIONS

Phenotypic patterns of cognitive specificity and broader genetic associations between anxiety sensitivity dimensions, anxiety and depressive disorder symptoms were similar at all waves. Both disorder-specific and shared cognitive concerns were identified, suggesting it is appropriate to classify anxiety and depression as distinct but related disorders and confirming the clinical perspective that cognitive therapy is most likely to benefit by targeting cognitive concerns relating specifically to the individual's presenting symptoms across development.

Cognitive Vulnerabilities for Depression and Anxiety in Childhood: Specificity of Anxiety Sensitivity and Rumination

Background: Childhood anxiety and depression frequently co-occur. Exploring specificity in cognitive processes for anxiety and depression in childhood can provide insight into cognitive vulnerabilities contributing to the development of anxiety and depressive disorders and inform targeted psychological interventions. Anxiety sensitivity and rumination are robust cognitive vulnerabilities for anxiety and depression, respectively. However, despite conceptual similarities, they are rarely considered together within a single study. Aims: The current study explored specific and shared associations between anxiety sensitivity subscales and rumination and anxiety and depressive symptoms in unselected children. Method: Multiple regression analyses explored to what extent specific self-reported anxiety sensitivity subscales (physical, social and mental concerns) and rumination predicted anxiety and depressive symptoms in 147 unselected children, aged 7–11 years. Results: Physical and social concern subscales of anxiety sensitivity were specifically associated with anxiety, whilst rumination was specifically associated with depressive symptoms. The mental concerns subscale of anxiety sensitivity was independently associated with both anxiety and depressive symptoms. These associations were only partially mediated by rumination. Conclusions: Anxiety and depression in young people are characterized by specific and shared cognitions. Evidence for shared and specific associations between the cognitive vulnerabilities of anxiety sensitivity and rumination, and anxiety and depression highlight the utility of transdiagnostic research and confirm that cognitive therapies may benefit from targeting cognitive concerns relating specifically to the patient's presenting symptoms.

Examination of the difficulties in emotion regulation scale and its relation to disordered eating in a young female sample

OBJECTIVE

Difficulties with emotion regulation is considered an important maintaining factor of disordered eating. One of the most commonly used measures of this construct is the Difficulties in Emotion Regulation Scale (DERS). The aim of this study was to explore the factor structure of this measure in young females and to examine its reliability and validity with respect to disordered eating.

METHOD

Females aged 17-25 years (M age = 19.6 years, N = 486) were examined in the analyses. Confirmatory factor analyses were conducted followed by regression analyses examining the DERS subscales as predictors of eating disorder severity and disordered eating behaviors.

RESULTS

The original 6-factor 36-item model did not fit well and analyses indicated a 6-factor 30-item solution was a more suitable fit for our population. Validity and reliability of the 30-item solution were found to be acceptable. Regression analyses also indicated the 36- and 30-item models were able to adequately predict eating disorder severity and disordered eating behaviors with the "Awareness" and "Goals" subscales being predictors of the former, and the "Impulsivity" subscale being a significant predictor of the latter.

DISCUSSION

The overall findings suggest that an abbreviated version of the DERS might be more appropriate than the original version with young females and that this measure exhibits stronger relationships with eating disorder severity and disordered eating behaviors than the longer version. Further examinations of the psychometric properties of the DERS with clinical populations are indicated.

Immediate reduction in temporal sensory summation after thoracic spinal manipulation

BACKGROUND CONTEXT

Spinal manipulative techniques (SMT) have shown clinical effectiveness in some patients with musculoskeletal pain.

PURPOSE

We performed the current experiment to test whether regional pain modulation is to be expected from thoracic SMT.

STUDY DESIGN/SETTING

Randomized experimental design performed in a university pain laboratory.

OUTCOME MEASURES

The primary outcome was experimental pain sensitivity in cervical and lumbar innervated area.

METHODS

Ninety healthy volunteers were randomly assigned to receive one of three interventions (SMT, exercise, or rest) to the upper thoracic spine. Participants completed questionnaires about pain-related affect and expectations regarding each of the interventions. We collected experimental pain sensitivity measures of cervical and lumbar innervated areas before and immediately after randomly assigned intervention. Mixed model analysis of covariance was used to test changes in measures of experimental pain sensitivity.

RESULTS

No interactions or intervention (group) effects were noted for pressure or A-delta-mediated thermal pain responses. Participants receiving SMT had greater reductions in temporal sensory summation (TSS).

CONCLUSIONS

This present study indicates thoracic SMT that reduces TSS in healthy subjects. These findings extend our previous work in healthy and clinical subjects by indicating change in the nocioceptive afferent system occurred caudal to the region of SMT application. However, the duration of reduction in TSS is unknown, and more work needs to be completed in clinical populations to confirm the relevance of these findings.

Anxiety as a context for understanding associations between hypochondriasis, obsessive-compulsive, and panic attack symptoms

In the context of the integrative model of anxiety and depression, we examined whether the essential problem of hypochondriasis is one of anxiety. When analyzed, data from a large nonclinical sample corresponded to the integrative model's characterization of anxiety as composed of both broad, shared and specific, unique symptom factors. The unique hypochondriasis, obsessive-compulsive, and panic attack symptom factors all had correlational patterns expected of anxiety with the shared, broad factors of negative emotionality and positive emotionality. A confirmatory factor analysis showed a higher-order, bifactor model was the best fit to our data; the shared and the unique hypochondriasis and anxiety symptom factors both contributed substantial variance. This study provides refinements to an empirically based taxonomy and clarifies what hypochondriasis is and, importantly, what it is not.

Supra-threshold scaling, temporal summation, and after-sensation: relationships to each other and anxiety/fear

This study investigated the relationship of thermal pain testing from three types of quantitative sensory testing (ie, supra-threshold stimulus response scaling, temporal summation, and after-sensation) at three anatomical sites (ie, upper extremity, lower extremity, and trunk). Pain ratings from these procedures were also compared with common psychological measures previously shown to be related to experimental pain responses and consistent with fear-avoidance models of pain. Results indicated that supra-threshold stimulus response scaling, temporal summation, and after-sensation, were significantly related to each other. The site of stimulation was also an important factor, with the trunk site showing the highest sensitivity in all three quantitative sensory testing procedures. Supra-threshold response measures were highly related to measures of fear of pain and anxiety sensitivity for all stimulation sites. For temporal summation and after-sensation, only the trunk site was significantly related to anxiety sensitivity, and fear of pain, respectively. Results suggest the importance of considering site of stimulation when designing and comparing studies. Furthermore, psychological influence on quantitative sensory testing is also of importance when designing and comparing studies. Although there was some variation by site of stimulation, fear of pain and anxiety sensitivity had consistent influences on pain ratings.

Spinal manipulative therapy has an immediate effect on thermal pain sensitivity in people with low back pain: a randomized controlled trial

BACKGROUND

Current evidence suggests that spinal manipulative therapy (SMT) is effective in the treatment of people with low back pain (LBP); however, the corresponding mechanisms are unknown. Hypoalgesia is associated with SMT and is suggestive of specific mechanisms.

OBJECTIVE

The primary purpose of this study was to assess the immediate effects of SMT on thermal pain perception in people with LBP. A secondary purpose was to determine whether the resulting hypoalgesia was a local effect and whether psychological influences were associated with changes in pain perception.

DESIGN

This study was a randomized controlled trial.

SETTING

A sample of convenience was recruited from community and outpatient clinics.

PARTICIPANTS

Thirty-six people (10 men, 26 women) currently experiencing LBP participated in the study. The average age of the participants was 32.39 (SD=12.63) years, and the average duration of LBP was 221.79 (SD=365.37) weeks.

INTERVENTION AND MEASUREMENTS

Baseline demographic and psychological measurements were obtained, followed by quantitative sensory testing to assess temporal summation and Adelta fiber-mediated pain perception. Next, participants were randomly assigned to ride a stationary bicycle, perform low back extension exercises, or receive SMT. Finally, the same quantitative sensory testing protocol was reassessed to determine the immediate effects of each intervention on thermal pain sensitivity.

RESULTS

Hypoalgesia to Adelta fiber-mediated pain perception was not observed. Group-dependent hypoalgesia of temporal summation specific to the lumbar innervated region was observed. Pair-wise comparisons indicated significant hypoalgesia in participants who received SMT, but not in those who rode a stationary bicycle or performed low back extension exercises. Psychological factors did not significantly correlate with changes in temporal summation in participants who received SMT.

LIMITATIONS

Only immediate effects of SMT were measured, so the authors are unable to comment on whether the inhibition of temporal summation is a lasting effect. Furthermore, the authors are unable to comment on the relationship between their findings and changes in clinical pain.

CONCLUSIONS

Inhibition of Adelta fiber-mediated pain perception was similar for all groups. However, inhibition of temporal summation was observed only in participants receiving SMT, suggesting a modulation of dorsal horn excitability that was observed primarily in the lumbar innervated area.

Brave men and timid women? A review of the gender differences in fear and anxiety

Substantial evidence indicates that women report greater fear and are more likely to develop anxiety disorders than men. Women's greater vulnerability for anxiety disorders can be partly understood by examining gender differences in the etiological factors known to contribute to anxiety. This review examines evidence for gender differences across a broad range of relevant factors, including biological influences, temperamental factors, stress and trauma, cognitive factors, and environmental factors. Gender differences are observed with increasing consistency as the scope of analysis broadens to molar levels of functioning. Socialization processes cultivate and promote processes related to anxiety, and moderate gender differences across levels of analysis.

Anxiety sensitivity, conscious awareness and selective attentional biases in children

The current study investigated whether physical anxiety sensitivity (AS) is associated with selective attentional biases to affective stimuli in children. The dot-probe paradigm was used to examine the deployment of attention towards words pertaining to anxiety symptomatology, socially threatening words, and positive words, in samples of 8-10-year-old children. Word pairs were presented under both masked and unmasked conditions. Irrespective of masking, children high in physical AS displayed an attentional vigilance for emotional words relative to neutral words, whereas those low in physical AS displayed a relative avoidance of such material. The results of this study are interesting as they not only suggest the presence of automatic AS-related biases in childhood, but that this is a general emotionality bias rather than one related to specific anxiety-related stimuli.

Immediate effects of spinal manipulation on thermal pain sensitivity: an experimental study

Background

The underlying causes of spinal manipulation hypoalgesia are largely unknown. The beneficial clinical effects were originally theorized to be due to biomechanical changes, but recent research has suggested spinal manipulation may have a direct neurophysiological effect on pain perception through dorsal horn inhibition. This study added to this literature by investigating whether spinal manipulation hypoalgesia was: a) local to anatomical areas innervated by the lumbar spine; b) correlated with psychological variables; c) greater than hypoalgesia from physical activity; and d) different for A-delta and C-fiber mediated pain perception.

Methods

Asymptomatic subjects (n = 60) completed baseline psychological questionnaires and underwent thermal quantitative sensory testing for A-delta and C-fiber mediated pain perception. Subjects were then randomized to ride a stationary bicycle, perform lumbar extension exercise, or receive spinal manipulation. Quantitative sensory testing was repeated 5 minutes after the intervention period. Data were analyzed with repeated measures ANOVA and post-hoc testing was performed with Bonferroni correction, as appropriate.

Results

Subjects in the three intervention groups did not differ on baseline characteristics. Hypoalgesia from spinal manipulation was observed in lumbar innervated areas, but not control (cervical innervated) areas. Hypoalgesic response was not strongly correlated with psychological variables. Spinal manipulation hypoalgesia for A-delta fiber mediated pain perception did not differ from stationary bicycle and lumbar extension (p > 0.05). Spinal manipulation hypoalgesia for C-fiber mediated pain perception was greater than stationary bicycle riding (p = 0.040), but not for lumbar extension (p = 0.105).

Conclusion

Local dorsal horn mediated inhibition of C-fiber input is a potential hypoalgesic mechanism of spinal manipulation for asymptomatic subjects, but further study is required to replicate this finding in subjects with low back pain.

Anxiety sensitivity taxonicity across gender among youth

The present investigation comparatively evaluated the latent class structure and parameters of anxiety sensitivity (AS) among female and male youth using the Childhood Anxiety Sensitivity Index. Participants were 4462 adolescents (2189 females) in grades 7-12 (M(age)=15.6 years). Consistent with prediction, taxometric analyses indicated the latent structure of AS was taxonic in both males and females, demonstrating the taxonic latent structure of AS is similarly observed across gender. Also consistent with prediction, the base rate of the AS taxon differed between genders -- higher for females (12%) compared to males (7%). These findings are discussed in terms of their implications for the study of AS and panic vulnerability among youth.