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Zvolensky MJ, Robison JH, Ayers ZS, Senger AR, Clausen BK, Businelle MS, Gallagher MW. Anxiety sensitivity and COVID-19 mental health, fatigue, and well-being: a longitudinal examination among adults from the United States during March-October 2020. Cogn Behav Ther 2024:1-19. [PMID: 38828649 DOI: 10.1080/16506073.2024.2360054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 05/17/2024] [Indexed: 06/05/2024]
Abstract
There is widespread empirical evidence that the COVID-19 pandemic contributed to elevated risk of mental and physical health symptoms and decreased quality of life. The present investigation sought to examine if individual differences in anxiety sensitivity was associated with mental health, psychosomatic, and well-being among a sample of US adults during a 6-month period early in the COVID-19 pandemic. Employing longitudinal research methodology, we tested the hypothesis that the anxiety sensitivity global factor would be related to increased risk of anxiety, depression, fatigue, and lower well-being. Secondary analyses evaluated the lower order anxiety sensitivity factors for the same criterion variables. The sample consisted of 778 participants with an average age of 37.96 (SD = 11.81; range 18-73). Results indicated that, as hypothesized, anxiety sensitivity was associated with increased risk for more severe anxiety, depression, fatigue, and lesser well-being; the observed effects of anxiety sensitivity were relatively robust and evident in adjusted models that controlled for numerous theoretically and clinically relevant factors (e.g. perceived health status). Overall, these results suggest that pandemic functioning could likely be improved via interventions that target elevated anxiety sensitivity as a vulnerability factor for a broad range of aversive psychosomatic symptoms and personal well-being.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Behavioral Science, Anderson Cancer Center, The University of Texas MD, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
| | | | - Zachary S Ayers
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Amy R Senger
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Bryce K Clausen
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Michael S Businelle
- HEALTH Institute, University of Houston, Houston, TX, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Matthew W Gallagher
- Department of Psychology, University of Houston, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
- Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, USA
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2
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Southward MW, Kushner ML, Terrill DR, Sauer-Zavala S. A Review of Transdiagnostic Mechanisms in Cognitive Behavior Therapy. Psychiatr Clin North Am 2024; 47:343-354. [PMID: 38724124 PMCID: PMC11090413 DOI: 10.1016/j.psc.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
Cognitive behavior therapies (CBTs) are the gold standard treatment for many psychiatric conditions. However, relatively little is known about how CBTs work. By characterizing these mechanisms, researchers can ensure CBTs retain their potency across diagnoses and delivery contexts. We review 3 classes of putative mechanisms: CBT-specific skills (eg, cognitive restructuring, behavioral activation), transtheoretical mechanisms (eg, therapeutic alliance, treatment expectancies, self-efficacy beliefs), and psychopathological mechanisms (aversive reactivity, positive affect, attachment style). We point to future research within each class and emphasize the need for more intensive longitudinal designs to capture how each class of mechanisms interacts with the others to improve outcomes.
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Affiliation(s)
| | | | - Douglas R Terrill
- Department of Psychology, University of Kentucky, Lexington, KY, USA
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3
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Xu J, Falkenstein MJ, Kuckertz JM. Feeling more confident to encounter negative emotions: The mediating role of distress tolerance on the relationship between self-efficacy and outcomes of exposure and response prevention for OCD. J Affect Disord 2024; 353:19-26. [PMID: 38423365 PMCID: PMC11059676 DOI: 10.1016/j.jad.2024.02.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND While exposure and response prevention (ERP) is the first-line treatment for obsessive-compulsive disorder (OCD), up to half of patients do not effectively respond. In an effort to better understand the mechanisms behind ERP, the inhibitory learning model emphasizes the roles of increasing perceived self-efficacy and distress tolerance. While self-efficacy and distress tolerance have separately been shown to predict OCD symptoms and treatment outcomes, no studies have assessed their joint effects in ERP. The current study examined distress tolerance as a mediator of the relationship between self-efficacy and ERP outcomes. METHODS Patients in an intensive ERP-based treatment program (N = 116) completed weekly self-report measures. RESULTS Over the course of treatment, as OCD symptoms reduced, self-efficacy and distress tolerance both significantly increased. Importantly, increases in self-efficacy and distress tolerance mediated each other in explaining symptom reduction, suggesting a possible bi-directional effect. LIMITATIONS The temporal relationship between changes in self-efficacy and distress tolerance is worthy of further investigation. In addition, the current sample had limited racial diversity and might not be representative of patients receiving lower levels of care. Findings merit replication to be ascertained of their reliability. CONCLUSIONS Findings suggest that during ERP, patients gain confidence in their abilities both to cope with general challenges and to withstand distress, potentially helping them engage with exposures and overcome initial fears. These findings provide support for the inhibitory learning model and highlight the mechanistic roles of self-efficacy and distress tolerance in ERP. Clinical implications to target both in treatment are discussed.
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Affiliation(s)
- Junjia Xu
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States of America
| | - Martha J Falkenstein
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States of America; Harvard Medical School, United States of America
| | - Jennie M Kuckertz
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States of America; Harvard Medical School, United States of America.
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Clark HL, Dixon LJ, Ramachandran S, Leukel PJ, Lee AA. Psychometric Properties of the Short Scale Anxiety Sensitivity Index Among Adults with Chronic Respiratory Disease. J Clin Psychol Med Settings 2024; 31:186-196. [PMID: 37770802 DOI: 10.1007/s10880-023-09976-y] [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] [Accepted: 09/07/2023] [Indexed: 09/30/2023]
Abstract
Approximately one-third of adults with chronic respiratory disease (CRD) have comorbid depressive and anxiety disorders; yet these disorders are often unrecognized in this patient population. Transdiagnostic processes such as anxiety sensitivity (AS) are useful for identifying mechanisms underlying psychological and heath conditions. The Short-Scale AS Index (SSASI) is a brief self-report measure of AS which has potential clinical utility among CRD populations to evaluate psychological distress and inform comprehensive care. The present study investigated the psychometric properties of the SSASI among adults with CRDs. Participants were recruited from a web-based panel of adults with CRDs (n = 768; 49.3% female; 57.8% White) including adults with asthma only (n = 230), COPD only (n = 321), or co-occurring asthma and COPD (n = 217). Participants completed a battery of self-report questionnaires assessing psychological and medical symptoms. Analyses were conducted to examine the factor structure and measurement invariance across CRD groups. Convergent validity and criterion validity of the SSASI were assessed within each group. Results supported partial measurement invariance across CRD groups. The SSASI demonstrated high reliability, convergent validity, and criterion validity with each CRD group. Findings from this study and existing work indicate that the SSASI is an effective and economical assessment tool for identifying patients CRD who may benefit from psychological interventions to reduce AS.
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Affiliation(s)
- Heather L Clark
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS, 38677, USA
| | - Laura J Dixon
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS, 38677, USA
| | - Sujith Ramachandran
- Department of Pharmacy Administration, University of Mississippi, University, MS, USA
| | - Patric J Leukel
- Department of Pharmacy Administration, University of Mississippi, University, MS, USA
| | - Aaron A Lee
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS, 38677, USA.
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5
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Bantel D, Chmielewski WX, Brähler E, Stöbel-Richter Y, Zenger M, Berth H. Variables associated with oral health-related self-efficacy - results of a cross-sectional study. BMC Oral Health 2023; 23:939. [PMID: 38017511 PMCID: PMC10683143 DOI: 10.1186/s12903-023-03656-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/10/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Oral health-related self-efficacy (OH-SE) is pivotal for oral health and is associated with other oral-health related variables, such as dental fear and anxiety (DF/A) and dental hygiene behaviors (DHB). This study attempts to analyze associations between OH-SE and oral healthrelated variables in a German population to extend previous research by analyzing whether OH-SE can be predicted by these variables, as this might contribute to the development of treatment interventions. METHODS OH-SE, DF/A, oral health-related quality of life (OHRQoL), self-perceived dental condition, satisfaction with general health, DHB, and socioeconomic status were assessed as a part of the Saxon Longitudinal Study in an adult sample (n = 309, 56.3% female, all Saxon secondary school 8th graders in 1987). The associations of OH-SE with these variables were examined by means of correlation, multiple linear regression analyses, and group comparisons. Significance (p), standardized regression coefficients (β), and effect size (Cohen's d) were calculated. RESULTS The correlation analyses revealed increased OH-SE to be accompanied by low levels of DF/A, high levels of OHRQoL, high levels of self-perceived dental condition, increased satisfaction with general health and socioeconomic status (all r ≥ 0.142; all p ≤ 0.013). In the regression analysis, OH-SE was mainly predicted by self-perceived dental condition and satisfaction with general health (R2 = 0.157) as well as by daily frequency of toothbrushing, OHRQoL, and socioeconomic status on a trend-level basis. In the group comparisons OH-SE was lower in participants with moderate for manifest DF/A and higher in individuals with higher OHRQoL, better self-perceived dental condition, increased satisfaction with general health, increased daily frequency of toothbrushing, more dental appointments, and above-average socioeconomic status (trend level; all t ≥ 1.57; p ≤ 0.059). CONCLUSIONS In this cross-sectional study, high levels of OH-SE were mainly predicted by general health as well as self-perceived dental condition. It was also associated with decreased DF/A, increased DHB, higher OHRQoL, and higher socioeconomic status. Future research should analyze these associations in longitudinal designs to address whether interventions focusing on adherence to good DHB improve (dental) health and thus OH-SE. This might be a promising approach, particularly in relation to the treatment of DF/A.
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Affiliation(s)
- David Bantel
- Carl Gustav Carus Faculty of Medicine, Division of Psychological and Social Medicine and Developmental Neuroscience, Research Group Applied Medical Psychology and Medical Sociology, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Witold X Chmielewski
- Institute for Psychological Psychotherapy, University of Bochum, Bochum, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, Leipzig, Germany
| | - Yve Stöbel-Richter
- Faculty of Managerial and Cultural Studies, University of Applied Sciences Zittau/Görlitz, Görlitz, Germany
| | - Markus Zenger
- Department of Applied Human Studies, University of Applied Sciences Magdeburg-Stendal, Stendal, Germany
| | - Hendrik Berth
- Carl Gustav Carus Faculty of Medicine, Division of Psychological and Social Medicine and Developmental Neuroscience, Research Group Applied Medical Psychology and Medical Sociology, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
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Tolin DF, McKay D, Olatunji BO, Abramowitz JS, Otto MW. On the importance of identifying mechanisms and active ingredients of psychological treatments. Behav Res Ther 2023; 170:104425. [PMID: 37913558 PMCID: PMC11034847 DOI: 10.1016/j.brat.2023.104425] [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: 07/28/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
This commentary addresses the thought-provoking article by Lorenzo-Luaces (in press). We review areas of both agreement and disagreement with the author's points, noting that readers should not infer that research into active ingredients and mechanisms is pointless. We conclude with a call for more research into the mechanisms of therapeutic change and the active ingredients of therapeutic interventions, with the aim of disseminating treatments that are both effective and efficient.
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Affiliation(s)
- David F Tolin
- The Institute of Living, Yale University School of Medicine, United States.
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7
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Zhang X, Zhang L, Yu F, Zhang W. Can Brain Activities of Guided Metaphorical Restructuring Predict Therapeutic Changes? Neuroscience 2023; 531:39-49. [PMID: 37689232 DOI: 10.1016/j.neuroscience.2023.08.031] [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: 02/27/2023] [Revised: 07/27/2023] [Accepted: 08/24/2023] [Indexed: 09/11/2023]
Abstract
The present study examined whether brain activities of metaphorical restructuring could predict improvements in emotion and general self-efficacy (GSES). Sixty-two anxious graduates were randomly assigned to either the metaphor group (n = 31) or the literal group (n = 31). After completing the pretest (T1), the participants were first presented with micro-counseling dialogues (MCD) to guide metaphorical or literal restructuring, and their functional brain activities were simultaneously recorded. They then completed the posttest (T2) and 1 week's follow-up (T3). It was found that (1) compared with the literal group, the metaphor group had more insightful experiences, a greater increase in positive affect and GSES at T2, and a greater decrease in psychological distress at T2 and T3; (2) the metaphor group showed a greater activation in the left inferior frontal gyrus (IFG) and bilateral temporal gyrus, and further activation in the left hippocampus positively predicted T2 GSES scores while that in the IFG and left hippocampus positively predicted the reduction slope of distress over the three time points. One important limitation is that the results should be interpreted with caution when generalizing to clinical anxiety samples due to the participants were graduate students with anxiety symptoms rather than clinical sample. These results indicated that metaphor restructuring produced greater symptom improvements, and activation in the hippocampus and IFG could predict these symptom improvements. This suggests that the activation of the two regions during the restructuring intervention may be a neural marker for symptom improvements.
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Affiliation(s)
- Xiaoyu Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China; School of Psychology, Beijing Sport University, Beijing 100084, China
| | - Lu Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Fei Yu
- Department of Psychology, Hebei Normal University, Shijiazhuang 050010, China
| | - Wencai Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China.
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8
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Boehm LM, Bird CM, Warren AM, Danesh V, Hosey MM, McPeake J, Potter KM, Su H, Eaton TL, Powers MB. Understanding and Managing Anxiety Sensitivity During Critical Illness and Long-Term Recovery. Am J Crit Care 2023; 32:449-457. [PMID: 37907373 DOI: 10.4037/ajcc2023975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Anxiety sensitivity is a fear of symptoms associated with anxiety (eg, rapid respiration and heart rate, perspiration), also known as "fear of fear." This fear is a misinterpretation of nonthreatening symptoms as threatening across 3 domains: physical ("When my heart rate increases, I'm afraid I may have a heart attack"), social ("If people see me perspire, I fear they will negatively evaluate me"), and cognitive ("When I feel these symptoms, I fear it means I'm going crazy or will lose control and do something dangerous like disconnect my IV"). These thoughts stimulate the sympathetic nervous system, resulting in stronger sensations and further catastrophic misinterpretations, which may spiral into a panic attack. Strategies to address anxiety sensitivity include pharmacologic and nonpharmacologic interventions. In intensive care unit settings, anxiety sensitivity may be related to common monitoring and interventional procedures (eg, oxygen therapy, repositioning, use of urine collection systems). Anxiety sensitivity can be a barrier to weaning from mechanical ventilation when patients are uncomfortable following instructions to perform awakening or breathing trials. Fortunately, anxiety sensitivity is a malleable trait with evidence-based intervention options. However, few health care providers are aware of this psychological construct and available treatment. This article describes the nature of anxiety sensitivity, its potential impact on intensive care, how to assess and interpret scores from validated instruments such as the Anxiety Sensitivity Index, and treatment approaches across the critical care trajectory, including long-term recovery. Implications for critical care practice and future directions are also addressed.
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Affiliation(s)
- Leanne M Boehm
- Leanne M. Boehm is an assistant professor, Vanderbilt University School of Nursing, Nashville, Tennessee; and an investigator, Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Claire M Bird
- Claire M. Bird is a postdoctoral fellow, Baylor University Medical Center, Dallas, Texas
| | - Ann Marie Warren
- Ann Marie Warren is a research center director, Trauma Research Center, Baylor Scott & White Research Institute, Dallas, Texas; and an adjunct professor, Texas A&M University College of Medicine, Bryan
| | - Valerie Danesh
- Valerie Danesh is a research investigator, Center for Applied Health Research, Baylor Scott & White Research Institute; and an assistant professor, Baylor College of Medicine, Temple, Texas
| | - Megan M Hosey
- Megan M. Hosey is an assistant professor, Division of Pulmonary and Critical Care Medicine, and the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joanne McPeake
- Joanne McPeake is a research fellow, The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, United Kingdom
| | - Kelly M Potter
- Kelly M. Potter is a research assistant professor, Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center in the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Han Su
- Han Su is an assistant professor, Vanderbilt University School of Nursing; and an investigator, CIBS Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tammy L Eaton
- Tammy L. Eaton is an associate investigator, VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan
| | - Mark B Powers
- Mark B. Powers is a research center director, Trauma Research Center, Baylor Scott & White Research Institute, Dallas, Texas; and an adjunct professor, Texas A&M University College of Medicine, Bryan
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Kuckertz JM, Najmi S, Baer K, Amir N. Refining the Analysis of Mechanism-Outcome Relationships for Anxiety Treatment: A Preliminary Investigation Using Mixed Models. Behav Modif 2023; 47:1242-1268. [PMID: 30943758 DOI: 10.1177/0145445519841055] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Although efficacious treatments exist for anxiety disorders, issues remain regarding how best to conceptualize and measure purported change processes in clinical research. In the current study, we examined the relationship between treatment-specific (exposure therapy, attention bias modification [ABM]) as well as more general change processes with symptoms within a transdiagnostic sample using mixed models. Results indicated that slope of self-efficacy across treatment and between-session habituation across identical exposures was associated with slope of symptom change. Although slope of anxiety ratings within session was not associated with slope of symptom change, it did interact with other candidate exposure processes to predict symptoms. Purported ABM change processes were not associated with outcome. Our use of mixed models exemplifies an emerging trend in this research aimed at minimizing loss of data through aggregation, and our results highlight the utility of integrating treatment-specific as well as more general change processes in mechanistic research.
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Affiliation(s)
| | - Sadia Najmi
- San Diego State University/University of California, San Diego
| | - Kylie Baer
- San Diego State University/University of California, San Diego
| | - Nader Amir
- San Diego State University/University of California, San Diego
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10
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Shokravi M, Maaboudi M, Amiri A, Mirzadeh M, Jabbarian R. The Effectiveness of Cognitive-Behavioral Intervention on Dental Anxiety during Pulpotomy in 7-10 Year-Old Children: A Clinical Trial. Front Dent 2023; 20:32. [PMID: 37724248 PMCID: PMC10505444 DOI: 10.18502/fid.v20i32.13588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/17/2023] [Indexed: 09/20/2023] Open
Abstract
Objectives: Dental anxiety is a common phenomenon experienced by children in the dental setting. However, there is limited research on the effectiveness of cognitive-behavioral interventions in managing this anxiety. Therefore, the aim of this study was to evaluate the impact of a cognitive-behavioral psychologic intervention on dental anxiety in children. Materials and Methods: A total of thirty children, aged 7-10 years, underwent prophylaxis and fluoride therapy. The baseline anxiety levels of the children were determined using the Modified Child Dental Anxiety Scale (MCDAS). The intervention group (N=15) received two 30-minute sessions of cognitive-behavioral exercises. Additionally, a short film demonstrating a cooperative child undergoing pulpotomy was created and parents were instructed to show it to their children at home. During the treatment session, the exercises were reinforced at each step, and the MCDAS questionnaire was administered again. The children's behavior was also assessed using the Venham Clinical Cooperation Scale. Independent t-test, Mann-Whitney, chi-square, and Pearson's correlation coefficient were used for statistical analysis and P<0.05 was considered statistically significant. Results: Postoperatively, the MCDAS score in the intervention group was significantly lower compared to the control group. Notably, the intervention group demonstrated a downward trend in anxiety scores, while the control group showed an increase (P<0.001). Conclusion: Cognitive-behavioral interventions were found to be successful in decreasing dental anxiety in children undergoing pulpotomy. These interventions can be successfully implemented in clinical settings.
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Affiliation(s)
- Marzieh Shokravi
- Department of Pediatric Dentistry, Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Ali Amiri
- Office of Counseling and Mental Health, Student and Cultural Deputy, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Monirsadat Mirzadeh
- Community Medicine, Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Razieh Jabbarian
- Department of Pediatric Dentistry, Dental Caries Prevention Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
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11
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Alpert E, Shotwell Tabke C, Cole TA, Lee DJ, Sloan DM. A systematic review of literature examining mediators and mechanisms of change in empirically supported treatments for posttraumatic stress disorder. Clin Psychol Rev 2023; 103:102300. [PMID: 37320986 DOI: 10.1016/j.cpr.2023.102300] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/27/2023] [Indexed: 06/17/2023]
Abstract
Despite the availability of empirically supported treatments (ESTs) for posttraumatic stress disorder (PTSD), relatively little is known regarding these treatments' mechanisms of change. This systematic review moves beyond previous reviews by summarizing the findings and reviewing the methodological quality of literature that specifically examined mediators/mechanisms of change in ESTs for PTSD. Studies were included if they were written in English, empirical, peer-reviewed, claimed to study mediators/mechanisms of a recommended PTSD treatment, measured the mediator/mechanism during or before and after treatment, and included a posttreatment PTSD or global outcome (e.g., functioning). PsycINFO and PubMed were searched on October 7, 2022. Two coders screened and coded studies. Sixty-two eligible studies were identified. The most consistent mediator/mechanism was reduction in negative posttraumatic cognitions, followed by between-session extinction and decreased depression. Only 47% of studies measured the mediator/mechanism before the outcome and measured the mediator/mechanism and outcome at least three times, and 32% also used growth curve modeling to establish temporal precedence of change in the mediator/mechanism and outcome. Many of the mediators/mechanisms examined had weak or no empirical support. Results highlight the need for improved methodological rigor in treatment mediator and mechanism research. Implications for clinical care and research are discussed. PROSPERO ID: 248088.
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Affiliation(s)
- Elizabeth Alpert
- National Center for PTSD, United States of America; VA Boston Healthcare System, United States of America; Boston University Chobanian & Avedisian School of Medicine, United States of America.
| | - Chelsea Shotwell Tabke
- National Center for PTSD, United States of America; VA Boston Healthcare System, United States of America; Boston University Chobanian & Avedisian School of Medicine, United States of America
| | - Travis A Cole
- National Center for PTSD, United States of America; VA Boston Healthcare System, United States of America
| | - Daniel J Lee
- National Center for PTSD, United States of America; VA Boston Healthcare System, United States of America; Boston University Chobanian & Avedisian School of Medicine, United States of America
| | - Denise M Sloan
- National Center for PTSD, United States of America; VA Boston Healthcare System, United States of America; Boston University Chobanian & Avedisian School of Medicine, United States of America
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12
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Kirsner J, Wilson SJ, Osborne MS. Music performance anxiety: the role of early parenting experiences and cognitive schemas. Front Psychol 2023; 14:1185296. [PMID: 37359876 PMCID: PMC10288882 DOI: 10.3389/fpsyg.2023.1185296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/08/2023] [Indexed: 06/28/2023] Open
Abstract
Music Performance Anxiety (MPA) is a common challenge for classical musicians, however its etiology has received minimal research, particularly in regards to caregiver experiences during childhood and adolescence. The aim of this research was to explore the impact of childhood experiences with parents along with patterns of dysfunctional cognitive schemas that develop through childhood ('Early Maladaptive Schemas'; EMSs) on the manifestation and severity of MPA in adulthood. Study 1 employed 100 adult professional, amateur, and tertiary student classical musicians from across Australia. Participants completed the Young Schema Questionnaire (YSQ) and the Kenny Music Performance Anxiety Inventory (K-MPAI). Study 2 included eight participants from Study 1, five of whom scored 1.5 standard deviations or more above the mean K-MPAI score and three of whom scored 1.5 standard deviations or more below the mean K-MPAI score. Participants were interviewed about experiences of parenting during childhood and adolescence, along with their experiences of MPA and musical training. Interpretative phenomenological analysis was used to explore themes in the interview data. Study 1 factor analysis revealed four higher-order EMS factors, F(4, 95) = 13.74, p < 0.001, one of which was a significant predictor of MPA, t(99) = 3.06, p = 0.003. This factor comprised themes of failure, catastrophising, and incompetence/dependence. Study 2 qualitative analysis revealed various key parenting themes experienced in childhood that differentiated low- and high-MPA scorers in adulthood. Findings from both studies are discussed in light of clinical applications and interventions, and implications for both parents and music educators.
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Affiliation(s)
| | - Sarah J. Wilson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Margaret S. Osborne
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Melbourne Conservatorium of Music, The University of Melbourne, Melbourne, VIC, Australia
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13
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Broman-Fulks JJ, Bergquist JJ, Hall CA, Thomas K, Kelso KC. Incremental Validity of Cognitive-Behavioral Therapy and Acceptance and Commitment Therapy Mechanisms for Anxiety and Panic Symptomology. J Cogn Psychother 2023; 37:43-62. [PMID: 36788001 DOI: 10.1891/jcpsy-d-20-00056] [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: 02/16/2023]
Abstract
Background: acceptance and commitment therapy (ACT) and cognitive-behavioral therapy (CBT) are empirically supported treatments for anxiety and panic disorder (PD), though they differ in their putative vulnerability and maintenance processes. The present study examined the incremental validity of several of these models' proposed core processes, including anxiety sensitivity (AS), dispositional avoidance, experiential avoidance (EA), cognitive fusion (CF), and mindfulness, as well as the interaction of the processes within each model, in the prediction of anxiety and panic symptomology. Methods: a sample of US adults (n = 316) completed self-report measures of AS, dispositional avoidance, EA, CF, mindfulness, anxiety, and PD symptoms. A series of hierarchical multiple regression analyses were conducted. Results: hierarchical regression analyses indicated that AS, dispositional avoidance, and EA predicted anxiety and panic symptoms even after controlling for one another, CF, mindfulness, and demographic variables. Although mindfulness and CF was correlated with anxiety and panic at the univariate level, they did not predict either outcome above and beyond AS, dispositional avoidance, and EA. When interaction terms were added to the models, the interaction between AS and -dispositional avoidance was a significant predictor of panic and anxiety symptoms, whereas the interaction between EA and CF only predicted panic symptoms. None of the interactions that included mindfulness were significant predictors. Conclusions: these findings provide support the independent and interactive predictive value of traditional CBT (AS, dispositional avoidance, and AS-dispositional avoidance) and ACT (EA) processes for anxiety and panic symptoms, but raise questions about the incremental predictive utility of CF and mindfulness.
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Affiliation(s)
| | - John J Bergquist
- Department of Psychology, Appalachian State University, Boone, North Carolina, USA
| | - Christian A Hall
- Department of Psychology, Appalachian State University, Boone, North Carolina, USA
| | - Kelsey Thomas
- Department of Psychology, Auburn University, Auburn, Alabama, USA
| | - Kerry C Kelso
- Department of Psychology, George Mason University, Fairfax, Virginia, USA
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14
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Kyriakoulis P, Kyrios M. Biological and cognitive theories explaining panic disorder: A narrative review. Front Psychiatry 2023; 14:957515. [PMID: 36793941 PMCID: PMC9924294 DOI: 10.3389/fpsyt.2023.957515] [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: 05/31/2022] [Accepted: 01/04/2023] [Indexed: 02/01/2023] Open
Abstract
The current narrative review summarizes and examines several theories of panic disorder (PD) including biological theories, encompassing neurochemical factors, metabolic and genetic theories, respiratory and hyperventilation theories and cognitive theory. Biological theories have informed the development of psychopharmacological treatments; however, they may be limited in their utility given the efficacy of psychological treatments. In particular, behavioral and, more recently, cognitive models have garnered support due to the efficacy of cognitive-behavior therapy (CBT) in treating PD. The role of combination treatments has been found to be superior in the treatment of PD in particular cases, lending support for the need for an integrated approach and model for PD given that the etiology of PD is complex and multifactorial.
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Affiliation(s)
- Peter Kyriakoulis
- Faculty of Arts, Health and Design, Swinburne University, Hawthorn, VIC, Australia
| | - Michael Kyrios
- College of Education, Psychology and Social Work, Órama Institute for Mental Health and Wellbeing, Flinders University, Bedford Park, SA, Australia
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15
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Zainal NH, Hellberg SN, Kabel KE, Hotchkin CM, Baker AW. Cognitive behavioral therapy (CBT) plus attention bias modification (ABM) reduces anxiety sensitivity and depressive symptoms in panic disorder: A pilot randomized trial. Scand J Psychol 2023. [PMID: 36707979 DOI: 10.1111/sjop.12902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Cognitive bias theories propose that reducing threat hypervigilance in mental disorders can augment cognitive behavioral therapy (CBT) outcomes. However, no studies have tested whether adding attention bias modification (ABM) can effectively enhance CBT's effects on anxiety sensitivity (AS), electromyography (EMG), and skin conductance (SC) for panic disorder (PD). This pilot randomized controlled trial (RCT) thus aimed to evaluate the efficacy of CBT + ABM (vs. CBT plus attention training placebo; PBO) on those outcomes. METHOD This study is a secondary analysis (Baker et al., 2020). Adults with PD were randomized to receive CBT + ABM (n = 11) or CBT + PBO (n = 12). Before each of the first five CBT sessions, CBT + ABM and CBT + PBO participants completed a 15-min ABM task or attention training PBO, respectively. AS and depression severity as well as SC and EMG during habituation to a loud-tone startle paradigm were assessed. Hierarchical Bayesian analyses were conducted. RESULTS During pre-post-treatment and pre-follow-up, CBM + ABM (vs. CBT + PBO) led to a notably greater reduction in ASI-Physical (between-group d = -1.26 to -1.25), ASI-Cognitive (d = -1.16 to -1.10), and depression severity (d = -1.23 to -0.99). However, no between-group difference was observed for ASI-Social, EMG, or SC indices. DISCUSSION Adding a brief computerized ABM intervention to CBT for PD protocols may enhance therapeutic change.
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Affiliation(s)
- Nur Hani Zainal
- Department of Healthcare Policy, Harvard Medical School, Boston, MA, USA
| | - Samantha N Hellberg
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine E Kabel
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Claire M Hotchkin
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Amanda W Baker
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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16
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Connors JN, Kroenke K, Monahan P, Chernyak Y, Pettit K, Hayden J, Montgomery C, Brenner G, Millard M, Holmes E, Musey P. Comparing the effectiveness of existing anxiety treatment options among patients evaluated for chest pain and anxiety in the emergency department setting: Study protocol for the PACER pragmatic randomized comparative effectiveness trial. Contemp Clin Trials 2023; 124:107020. [PMID: 36423863 DOI: 10.1016/j.cct.2022.107020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/03/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Anxiety disorders are a common underlying cause of symptoms among low-risk chest pain patients evaluated in the emergency department setting. However, anxiety is often undiagnosed and undertreated in any setting, and causes considerable functional impairment to work, family, and social life. OBJECTIVES The Patient-Centered Treatment of Anxiety after Low-Risk Chest Pain in the Emergency Room (PACER) study is a pragmatic randomized trial to test the comparative effectiveness of existing anxiety treatments of graduated intensities and determine what options work best for patient subgroups based on anxiety severity and other comorbidities. METHODS The PACER trial will enroll 375 emergency department patients with low-risk chest pain and anxiety (GAD-7 score ≥ 8) and randomize them to either: 1) referral to primary care with enhanced care coordination, 2) online self-administered cognitive behavioral therapy with guided peer support, or 3) therapist-administered cognitive behavior therapy. Outcomes include anxiety symptoms (primary) as well as physical symptom burden, depression symptoms, functional impairment, ED recidivism, and occurrence of major adverse cardiac events. Statistical analyses will be conducted primarily using linear mixed models to perform a repeated measures analysis of patient-reported outcomes, assessed at 3, 6, 9, and 12-month follow-ups. DISCUSSION PACER is an innovative and pragmatic clinical trial that will compare the effectiveness of several evidence-based telecare-delivered treatments for anxiety. Results have the potential to inform clinical guidelines for evaluation and management of low-risk chest pain patients and promote adoption of findings in ED departments across the country.
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Affiliation(s)
- Jill Nault Connors
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Kurt Kroenke
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States; Regenstrief Institute, Inc., Indianapolis, IN, United States
| | - Patrick Monahan
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Yelena Chernyak
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Kate Pettit
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Julie Hayden
- National Alliance on Mental Illness (NAMI) of Greater Indianapolis, Inc., Indianapolis, IN, United States
| | - Chet Montgomery
- Patient Advisory Committee, Community Member, Indianapolis, IN, United States
| | - George Brenner
- Continuing the Care, LLC, Indianapolis, IN, United States
| | - Michael Millard
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, Australia
| | - Emily Holmes
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Paul Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States.
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Patients' symptoms and strengths as predictors of long-term outcomes of CBT for generalized anxiety disorder - A three-level, multi-predictor analysis. J Anxiety Disord 2022; 92:102635. [PMID: 36201995 DOI: 10.1016/j.janxdis.2022.102635] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 08/25/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022]
Abstract
Although cognitive behavioral therapy (CBT) is an effective treatment for generalized anxiety disorder (GAD), GAD often shows a chronic clinical course and common deterioration after treatment. Many trials have examined the efficacy of treatments in GAD, but little is known about intake predictors of long-term treatment outcomes. This study examined potential predictors of long-term treatment outcomes based on the individual's symptom severity and strengths (behavioral, cognitive, interpersonal) at intake. Long-term outcomes were defined as worry at six-month follow-up (six-m FU) and worry decrease from intake and post-treatment to six-m FU. Data from 137 CBT outpatients with a GAD diagnosis from two randomized clinical trials were analyzed using three-level hierarchical linear modeling. Results revealed that worrying decreased up to the six-m FU. In single-predictor models, intake symptom severity and strength measures predicted worry at the six-m FU. In multi-predictor models, only behavioral strengths remained a significant predictor. Worry decrease from intake to the six-m FU was only predicted by behavioral strengths. These findings provide relevant information about intake predictors of long-term outcomes after CBT for GAD and underscore the potential relevance of assessing patients' strengths for clinical practice.
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18
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Lim WL, Tierney S. The Effectiveness of Positive Psychology Interventions for Promoting Well-being of Adults Experiencing Depression Compared to Other Active Psychological Treatments: A Systematic Review and Meta-analysis. JOURNAL OF HAPPINESS STUDIES 2022; 24:249-273. [PMID: 36373089 PMCID: PMC9638203 DOI: 10.1007/s10902-022-00598-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
UNLABELLED This systematic review assesses if positive psychology interventions (PPI) are more effective than other active psychological interventions for increasing the well-being of depressed adults. A review of randomised trials that compared PPI to other active interventions was conducted. A systematic search was undertaken using PsycInfo, PubMed, EMBASE, Web of Science, Scopus, CINAHL, two trial registries, and a manual search. The outcomes were happiness and depression. Ten studies, totalling 1341 participants, were included in the review. The small effect sizes for depression (Hedge's g = 0.15) and happiness (Hedge's g = 0.20) favoured PPI but were not significant, indicating no difference between PPI and other active interventions for the outcomes. Heterogeneity was high mainly due to differences in trial implementation. Risks of bias ranged from moderate to high. The results should be interpreted with caution because of the small number of included studies, high heterogeneity, and presence of bias. Protocol Registration Number PROSPERO CRD42019152513. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10902-022-00598-z.
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Affiliation(s)
- Wei Loong Lim
- Department for Continuing Education, University of Oxford, Oxford, UK
| | - Stephanie Tierney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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19
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Weerdmeester J, van Rooij MMJW, Granic I. Visualization, Self-Efficacy, and Locus of Control in a Virtual Reality Biofeedback Video Game for Anxiety Regulation. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2022; 25:360-368. [PMID: 35612469 DOI: 10.1089/cyber.2022.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The current study aimed to identify specific feedback mechanics and psychological processes that may contribute to positive outcomes in biofeedback applications for anxiety regulation. Specifically, using a dismantling study design, the unique impact of visualizations that directly mirror users' breathing was examined in relation to anxiety regulation as well as locus of control and self-efficacy. Following an anxiety induction, participants (N = 67) were randomly assigned to play one of two variations of a biofeedback video game. In both versions, players' in-game movement was contingent on their breathing; however, the experimental condition additionally included visualizations that directly mirrored players' breathing. Changes in self-reported state anxiety and physiological arousal were measured as well as the level of internal control and self-efficacy participants experienced while playing the game. Results showed that all participants were able to effectively reduce their anxiety and arousal, but no condition differences were found. Implementing mirroring visualizations did not contribute to individuals' ability to self-regulate nor their self-efficacy or locus of control above and beyond receiving feedback based on their in-game movement. Overall, individuals who experienced higher self-efficacy and a stronger internal locus of control were better able to regulate their anxiety, but no clear links were found with changes in self-reported physiological arousal. In light of these results, we recommend the continued exploration of the role of specific design choices and intervention components as well as underlying mechanisms of change in biofeedback interventions, especially pertaining to how individuals perceive themselves and their ability to change.
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Affiliation(s)
- Joanneke Weerdmeester
- Orthopedagogics: Family and Behaviour, Faculty of Social Sciences, Radboud University, Nijmegen, Netherlands
| | - Marieke M J W van Rooij
- Research Support Office, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Isabela Granic
- Health, Aging & Society, Faculty of Social Sciences, McMaster University, Hamilton, Ontario, Canada
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20
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Christensen AB, Rejaye Gryesten J, Kokholm J, Vislie K, Reinholt N, Dichmann K, Poulsen S, Arnfred S. The unified protocol: patient and therapist perspectives on the utility of the group manual. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2022.2061340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Anne Bryde Christensen
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jasmin Rejaye Gryesten
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Julie Kokholm
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Kitty Vislie
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Nina Reinholt
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirstine Dichmann
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Sidse Arnfred
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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21
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Hunt C, Campbell-Sills L, Chavira D, Craske M, Sherbourne C, Sullivan G, Roy-Byrne P, Stein MB, Bomyea J. Prospective relations between anxiety sensitivity and transdiagnostic anxiety following cognitive-behavioral therapy: Evidence from the Coordinated Anxiety Learning management trial. Behav Res Ther 2022; 155:104119. [DOI: 10.1016/j.brat.2022.104119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/28/2022] [Accepted: 05/08/2022] [Indexed: 11/15/2022]
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22
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Influence Mechanisms of Community Sports Parks to Enhance Social Interaction: A Bayesian Belief Network Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031466. [PMID: 35162488 PMCID: PMC8835273 DOI: 10.3390/ijerph19031466] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 12/28/2022]
Abstract
Urban green spaces provide multiple ecosystem services to improve human health and well-being. Cultural ecosystem services (CES) are recognized as the most important services for urban residents through the key of social interaction. Researchers commonly acknowledge the function of community sports parks to enhance social interaction. Nevertheless, existing studies generally do not pay enough attention to the influence mechanisms of community sports parks and social interaction, especially the different types of spaces in community sports parks, which could be due to the complex feature of social interaction. This paper selects three community sports parks in Chongqing as the case study, uses BBN to identify the influence mechanisms of three common types of spaces (fitness equipment space, path space, and sports court space) in community sports parks and social interaction, aiming to explore how community sports parks enhance social interaction. The results indicated that sports court space such as basketball court and badminton court enhanced social interaction best; however, the spaces farther away from the park entrances were generally less effective in enhancing interaction. All these three types of sports spaces showed the influence mechanism of “Spatial Factors-Activity Type-Social Interaction”, while differences existed in the specific spatial influencing factors. The findings highlight that based on the BBN obtained in this study, the threshold range of spatial factors could be adjusted to enhance the effect of community sports parks on social interaction.
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23
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Meyerbröker K, Morina N, Kerkhof GA, Emmelkamp PMG. Potential Predictors of Virtual Reality Exposure Therapy for Fear of Flying: Anxiety Sensitivity, Self-efficacy and the Therapeutic Alliance. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-021-10269-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Rukmini S, Sudhir PM, Bhaskar A, Arumugham SS. Identifying mediators of cognitive behaviour therapy and exposure therapy for social anxiety disorder (SAD) using repeated measures. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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25
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Fitzgerald HE, Hoyt DL, Kredlow MA, Smits JAJ, Schmidt NB, Edmondson D, Otto MW. Anxiety Sensitivity as a Malleable Mechanistic Target for Prevention Interventions: A Meta-Analysis of the Efficacy of Brief Treatment Interventions. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2021; 28:323-337. [PMID: 35300171 PMCID: PMC8923531 DOI: 10.1037/cps0000038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Anxiety sensitivity (AS) is a transdiagnostic risk factor and potential treatment target for prevention of associated psychopathology and negative health behaviors. We conducted a meta-analysis evaluating the efficacy of brief interventions in at-risk samples for reducing AS and associated clinical/behavioral outcomes (e.g., depression, alcohol use) across 28 studies (1,998 participants). AS targeted interventions, compared to control conditions, evidenced a significant moderate effect size for alleviating AS from pre- to post-treatment (d = 0.54) and approached a large effect size from pre-treatment to short-term follow-up (d = 0.78). The effect size for long-term follow-up did not reach significance (d = 0.29). For clinical/behavioral outcomes, AS interventions demonstrated significant small-to-moderate effect sizes for the three timepoints examined (d's = 0.20-0.41). Our findings help validate AS as a modifiable mechanistic target for prevention efforts.
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Affiliation(s)
- Hayley E Fitzgerald
- Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., 2 Floor, Boston, MA 02215
| | - Danielle L Hoyt
- Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., 2 Floor, Boston, MA 02215
| | - M Alexandra Kredlow
- Department of Psychology, Harvard University, 52 Oxford Street, Cambridge, MA 02140
| | - Jasper A J Smits
- Department of Psychology, Institute for Mental Health Research, University of Texas at Austin, 305 E. 23 St., Austin, TX 78712
| | - Norman B Schmidt
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL 32306
| | | | - Michael W Otto
- Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave., 2 Floor, Boston, MA 02215
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Schønning A, Nordgreen T. Predicting Treatment Outcomes in Guided Internet-Delivered Therapy for Anxiety Disorders-The Role of Treatment Self-Efficacy. Front Psychol 2021; 12:712421. [PMID: 34744872 PMCID: PMC8566333 DOI: 10.3389/fpsyg.2021.712421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022] Open
Abstract
Aim: Guided Internet-delivered therapy has shown to be an effective treatment format for anxiety disorders. However, not all patients experience improvement, and although predictors of treatment outcome have been identified, few are consistent over time and across studies. The current study aimed to examine whether treatment self-efficacy (self-efficacy regarding the mastery of obstacles during treatment) in guided Internet-delivered therapy for anxiety disorders in adults could be a predictor of lower dropout rates and greater symptom reduction. Method: The analyzed data comes from an open effectiveness study including 575 patients receiving guided Internet-delivered therapy for panic disorder or social anxiety disorder. Treatment self-efficacy was measured at pre-treatment. Symptom reduction was measured at 10 measurement points, including a 6-month follow-up. A mixed linear model was applied in the analysis. Results: The results showed that high treatment self-efficacy was a predictor of both lower dropout rates and greater symptom reduction. Significant interaction effects between time and treatment self-efficacy were found for several of the nine modules that constitutes the treatment program, suggesting that treatment self-efficacy could be a moderator of symptom reduction. Three of nine modules in the panic disorder treatment and six of nine in the social anxiety disorder treatment showed significant interaction effects. Conclusion: The results suggest that measuring treatment self-efficacy may be a valuable tool to identify patients at risk of dropping out, and that treatment self-efficacy could be a predictor and moderator of symptom reduction in guided Internet-delivered therapy. The implications of the results are discussed.
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Affiliation(s)
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
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Petrinec AB, Hughes JW, Zullo MD, Wilk C, George RL. Smartphone Delivery of Cognitive Behavioral Therapy for Postintensive Care Syndrome-Family: Protocol for a Pilot Study. JMIR Res Protoc 2021; 10:e30813. [PMID: 34346900 PMCID: PMC8374657 DOI: 10.2196/30813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 06/08/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Family members of critically ill patients experience symptoms of postintensive care syndrome-family (PICS-F), including anxiety, depression, and posttraumatic stress disorder. Postintensive care syndrome-family reduces the quality of life of the families of critically ill patients and may impede the recovery of such patients. Cognitive behavioral therapy has become a first-line nonpharmacological treatment of many psychological symptoms and disorders, including anxiety, depression, and posttraumatic stress. With regard to managing mild-to-moderate symptoms, the delivery of cognitive behavioral therapy via mobile technology without input from a clinician has been found to be feasible and well accepted, and its efficacy rivals that of face-to-face therapy. OBJECTIVE The purpose of our pilot study is to examine the efficacy of using a smartphone mobile health (mHealth) app to deliver cognitive behavioral therapy and diminish the severity and prevalence of PICS-F symptoms in family members of critically ill patients. METHODS For our pilot study, 60 family members of critically ill patients will be recruited. A repeated-measures longitudinal study design that involves the randomization of participants to 2 groups (the control and intervention groups) will be used. The intervention group will receive cognitive behavioral therapy, which will be delivered via a smartphone mHealth app. Bandura's social cognitive theory and an emphasis on mental health self-efficacy form the theoretical framework of the study. RESULTS Recruitment for the study began in August 2020. Data collection and analysis are expected to be completed by March 2022. CONCLUSIONS The proposed study represents a novel approach to the treatment of PICS-F symptoms and is an extension of previous work conducted by the research team. The study will be used to plan a fully powered randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov NCT04316767; https://clinicaltrials.gov/ct2/show/NCT04316767. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/30813.
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Affiliation(s)
- Amy B Petrinec
- College of Nursing, Kent State University, Kent, OH, United States
| | - Joel W Hughes
- Department of Psychological Sciences, College of Arts and Sciences, Kent State University, Kent, OH, United States
| | - Melissa D Zullo
- College of Public Health, Kent State University, Kent, OH, United States
| | - Cindy Wilk
- College of Nursing, Kent State University, Kent, OH, United States
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Anxiety Disorders in Late Life: Considerations for Assessment and Cognitive-Behavioral Treatment. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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29
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Transdiagnostic Versus Construct-Specific Cognitive Behavioural Therapy for Emotional Disorders in Patients with High Anxiety Sensitivity: A Double-Blind Randomised Clinical Trial. BEHAVIOUR CHANGE 2021. [DOI: 10.1017/bec.2021.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractAnxiety sensitivity (AS) is a common vulnerability in emotional disorders. Due to the pathological role of AS, individuals with high AS are faced with emotional problems. Thus, cognitive behavioural interventions try to reduce these problems by targeting AS. The present study aimed to compare the efficacy of transdiagnostic cognitive behavioural therapy (T-CBT) and construct-specific CBT (CS-CBT) on AS, anxiety, depression, and positive and negative affect in these patients. To this end, 40 patients with high AS were randomly assigned to one of the three groups of T-CBT, CS-CBT, and wait list. Participants were assessed using the Anxiety and Related Disorders Interview Schedule for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Anxiety Sensitivity Index-3, Beck Anxiety Inventory, Beck Depression Inventory-II, and Positive and Negative Affect Schedule at baseline, post-treatment, 3-month follow-up, and 6-month follow-up. The findings showed that T-CBT and CS-CBT have a significant effect on AS, anxiety, and negative affect; however, contrary to T-CBT, CS-CBT is not effective for reducing depression and positive affect. T-CBT had a more promising efficacy than CS-CBT in all treatment outcomes. The results show better and more stable efficacy of T-CBT among patients with high AS. It is essential to consider AS as a target for cognitive behavioural intervention for the spectrum of emotional disorders.
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Paulus DJ, Gallagher MW, Neighbors C, Zvolensky MJ. Computer-delivered personalized feedback intervention for hazardous drinkers with elevated anxiety sensitivity: A pilot randomized controlled trial. Behav Res Ther 2021; 141:103847. [PMID: 33813352 DOI: 10.1016/j.brat.2021.103847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/05/2020] [Accepted: 03/15/2021] [Indexed: 12/29/2022]
Abstract
Hazardous drinkers with emotional vulnerabilities (e.g., elevated anxiety sensitivity) remain an underserved group. This study aimed to evaluate the feasibility, acceptability, and initial efficacy of a single session remotely-delivered personalized feedback intervention (PFI) targeting alcohol (mis)use and anxiety sensitivity among college students. Hazardous drinkers with elevated anxiety sensitivity (N = 125; 76.8% female; Mage = 22.14; 66.4% racial/ethnic minorities) were randomized to receive the integrated PFI (n = 63) or attention control (n = 62). Follow-up assessments were conducted one-week, one-month and three-months post-intervention. Latent growth curve modeling was used to test pilot outcomes. It was feasible to recruit and retain hazardous drinking students with elevated anxiety sensitivity through follow-up with no group differences in retention. The integrated PFI was rated as more acceptable than the control with medium/large differences (p's < 0.004; d's = 0.54-0.80). The integrated PFI group had statistically significantly greater change in primary outcomes: motivation, hazardous alcohol use, and anxiety sensitivity (p's < 0.05; d's = 0.08-0.37) with larger within-group effect sizes (d's = 0.48-0.61) than in control (d's = 0.26-0.54). Despite a small sample size, this one-session intervention offers promise among a high-risk group of drinkers with emotional vulnerabilities. The computer-based format may allow for mass distribution of a low-cost intervention in the future; however, follow-up testing in larger samples is needed.
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Affiliation(s)
- Daniel J Paulus
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, 15213, USA.
| | - Matthew W Gallagher
- University of Houston, Department of Psychology, Houston, TX, 77204, USA; University of Houston, Texas Institute for Measurement, Evaluation, and Statistics, Houston, TX, 77204, USA
| | - Clayton Neighbors
- University of Houston, Department of Psychology, Houston, TX, 77204, USA
| | - Michael J Zvolensky
- University of Houston, Department of Psychology, Houston, TX, 77204, USA; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX, 77030, USA; Health Institute, University of Houston, Houston, TX, 77204, USA
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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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Schiele MA, Herzog K, Kollert L, Schartner C, Leehr EJ, Böhnlein J, Repple J, Rosenkranz K, Lonsdorf TB, Dannlowski U, Zwanzger P, Reif A, Pauli P, Deckert J, Domschke K. Extending the vulnerability-stress model of mental disorders: three-dimensional NPSR1 × environment × coping interaction study in anxiety. Br J Psychiatry 2020; 217:645-650. [PMID: 32321595 PMCID: PMC7589989 DOI: 10.1192/bjp.2020.73] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The general understanding of the 'vulnerability-stress model' of mental disorders neglects the modifying impact of resilience-increasing factors such as coping ability. AIMS Probing a conceptual framework integrating both adverse events and coping factors in an extended 'vulnerability-stress-coping model' of mental disorders, the effects of functional neuropeptide S receptor gene (NPSR1) variation (G), early adversity (E) and coping factors (C) on anxiety were addressed in a three-dimensional G × E × C model. METHOD In two independent samples of healthy probands (discovery: n = 1403; replication: n = 630), the interaction of NPSR1 rs324981, childhood trauma (Childhood Trauma Questionnaire, CTQ) and general self-efficacy as a measure of coping ability (General Self-Efficacy Scale, GSE) on trait anxiety (State-Trait Anxiety Inventory) was investigated via hierarchical multiple regression analyses. RESULTS In both samples, trait anxiety differed as a function of NPSR1 genotype, CTQ and GSE score (discovery: β = 0.129, P = 3.938 × 10-8; replication: β = 0.102, P = 0.020). In A allele carriers, the relationship between childhood trauma and anxiety was moderated by general self-efficacy: higher self-efficacy and childhood trauma resulted in low anxiety scores, and lower self-efficacy and childhood trauma in higher anxiety levels. In turn, TT homozygotes displayed increased anxiety as a function of childhood adversity unaffected by general self-efficacy. CONCLUSIONS Functional NPSR1 variation and childhood trauma are suggested as prime moderators in the vulnerability-stress model of anxiety, further modified by the protective effect of self-efficacy. This G × E × C approach - introducing coping as an additional dimension further shaping a G × E risk constellation, thus suggesting a three-dimensional 'vulnerability-stress-coping model' of mental disorders - might inform targeted preventive or therapeutic interventions strengthening coping ability to promote resilient functioning.
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Affiliation(s)
- Miriam A. Schiele
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Katharina Herzog
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), and Center of Mental Health, Julius-Maximilians-Universität Würzburg, Germany
| | - Leonie Kollert
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Germany
| | - Christoph Schartner
- Department of Physiology University of California San Francisco, USA; and Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Germany
| | - Elisabeth J. Leehr
- Department of Psychiatry and Psychotherapy, University of Münster, Germany
| | - Joscha Böhnlein
- Department of Psychiatry and Psychotherapy, University of Münster, Germany
| | - Jonathan Repple
- Department of Psychiatry and Psychotherapy, University of Münster, Germany
| | - Karoline Rosenkranz
- Institute for Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Germany
| | - Tina B. Lonsdorf
- Institute for Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Germany
| | - Udo Dannlowski
- Department of Psychiatry and Psychotherapy, University of Münster, Germany
| | - Peter Zwanzger
- kbo-Inn-Salzach-Klinikum; and Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University of Munich, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Frankfurt, Germany
| | - Paul Pauli
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy) and Center of Mental Health, Julius-Maximilians-Universität Würzburg, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, and Center for Basics in Neuromodulation, Faculty of Medicine, University of Freiburg, Germany,Correspondence: Katharina Domschke.
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Does Self-Efficacy Predict Functioning in Older Adults with Schizophrenia? A Cross-Sectional and Longitudinal Mediation Analysis. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10171-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Caci B, Miceli S, Scrima F, Cardaci M. Neuroticism and Fear of COVID-19. The Interplay Between Boredom, Fantasy Engagement, and Perceived Control Over Time. Front Psychol 2020; 11:574393. [PMID: 33154730 PMCID: PMC7588354 DOI: 10.3389/fpsyg.2020.574393] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/07/2020] [Indexed: 01/01/2023] Open
Abstract
The Italian government adopted measures to prevent the spread of coronavirus 2019 (COVID-19) infection from March 9, 2020, to May 4, 2020 and imposed a phase of social distancing and self-isolation to all adult citizens. Although justified and necessary, psychologists question the impact of this process of COVID-19 isolation on the mental health of the population. Hence, this paper investigated the relationship between neuroticism, boredom, fantasy engagement, perceived control over time, and the fear of COVID-19. Specifically, we performed a cross-sectional study aimed at testing an integrative moderated mediation model. Our model assigned the boredom to the mediation role and both the fantasy engagement and perceived control of time to the role of moderators in the relationship between neuroticism and the fear of COVID-19. A sample of 301 subjects, mainly women (68.8%), aged between 18 and 57 years (M age = 22.12 years; SD = 6.29), participated in a survey conducted in the 1st-week lockdown phase 2 in Italy from May 7 to 18, 2020. Results suggested that neuroticism is crucial in coping with the COVID-19 pandemic, in line with literature showing high neurotic people having greater emotional reactivity and scarce resources to manage stress. We also found that people with high neuroticism tend to feel bored, and the relationship between neuroticism and boredom seems enhanced if one is involved in negative fantasies. Therefore, this result could also explain the positive effect between boredom and fear of COVID-19 we found in the current study. However, our data show that perceived control over time moderates the association between boredom and fear toward COVID-19. Having a high perceived control over time allows people to reduce boredom's effect on fear of COVID-19. In conclusion, we retain that psychological treatment programs could improve the individuals' perceived control over time to modulate anxiety toward the fear of COVID-19 and promote psychological well-being.
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Affiliation(s)
- Barbara Caci
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Silvana Miceli
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Fabrizio Scrima
- Département de Psychologie, Université de Rouen, Moint Saint-Aignan, France
| | - Maurizio Cardaci
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
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35
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Pace BT, Song J, Suvak MK, Shields N, Monson CM, Stirman SW. Therapist Self-Efficacy in Delivering Cognitive Processing Therapy in a Randomized Controlled Implementation Trial. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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36
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Bouchard S, Allard M, Robillard G, Dumoulin S, Guitard T, Loranger C, Green-Demers I, Marchand A, Renaud P, Cournoyer LG, Corno G. Videoconferencing Psychotherapy for Panic Disorder and Agoraphobia: Outcome and Treatment Processes From a Non-randomized Non-inferiority Trial. Front Psychol 2020; 11:2164. [PMID: 32973638 PMCID: PMC7472915 DOI: 10.3389/fpsyg.2020.02164] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/03/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the context of the COVID-19 pandemic, legislations are being modified around the world to allow patients to receive mental health services through telehealth. Unfortunately, there are no large clinical trial available to reliably document the efficacy of delivering videoconferencing psychotherapy (VCP) for people with panic disorder and agoraphobia (PDA) and whether basic psychotherapeutic processes are altered. METHODS This 2-arm intent-to-treat non-inferiority study reports on a clinical trial on VCP and documents how therapeutic working alliance and motivation toward psychotherapy are associated to treatment outcome. We hypothesized that VCP would not be inferior to standard face-to-face (FF) cognitive behavior therapy for PDA. No specific hypothesis was stated to address working alliance and treatment mechanisms. VCP was compared to a gold-standard psychotherapy treatment for PDA, which was delivered either in person or in videoconference, with a strict tolerance criterion of about 2 points on the primary outcome measure. Seventy one adult patients were recruited. Measures of working alliance were collected after the first, fifth, and last session. Motivation toward therapy at pre-treatment and working alliance after the fifth therapy session were used as predictors of treatment outcome and compared with change in dysfunctional beliefs toward bodily sensations. RESULTS Panic disorder, agoraphobia, fear of sensations and depressed mood all showed significant improvements and large effect-sizes from pre to post-treatment. Gains were maintained at follow-up. No significant differences were found between VCP and FF, and effect sizes were trivial for three of the four outcome measures. Non-inferiority tests confirmed that VCP was no less effective than FF therapy on the primary outcome measure and two of the three secondary outcome measures. Working alliance was very strong in VCP and did not statistically differ from FF. Working alliance and motivation did not predict treatment outcome, which was significantly predicted by the reduction in dysfunctional beliefs. The strength of the therapeutic bond was correlated with change in dysfunctional beliefs. CONCLUSION Mental health professionals can use VCP to provide services to patients with PDA. Building and maintaining a sound working alliance should not be a source concern. Practical recommendations are formulated. ISRCTN TRIAL REGISTRATION NUMBER ISRCTN76456442.
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Affiliation(s)
- Stéphane Bouchard
- Cyberpsychology Lab, Université du Québec en Outaouais, Gatineau, QC, Canada
- Centre Intégré de Santé et de Services Sociaux de l’Outaouais, Gatineau, QC, Canada
| | - Micheline Allard
- Cyberpsychology Lab, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Geneviève Robillard
- Cyberpsychology Lab, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Stéphanie Dumoulin
- Cyberpsychology Lab, Université du Québec en Outaouais, Gatineau, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Tanya Guitard
- Cyberpsychology Lab, Université du Québec en Outaouais, Gatineau, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Claudie Loranger
- Cyberpsychology Lab, Université du Québec en Outaouais, Gatineau, QC, Canada
- Centre Intégré de Santé et de Services Sociaux de l’Outaouais, Gatineau, QC, Canada
| | | | - André Marchand
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Patrice Renaud
- Cyberpsychology Lab, Université du Québec en Outaouais, Gatineau, QC, Canada
| | | | - Giulia Corno
- Cyberpsychology Lab, Université du Québec en Outaouais, Gatineau, QC, Canada
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Levy HC, Worden BL, Davies CD, Stevens K, Katz BW, Mammo L, Diefenbach GJ, Tolin DF. The dose-response curve in cognitive-behavioral therapy for anxiety disorders. Cogn Behav Ther 2020; 49:439-454. [PMID: 32631134 DOI: 10.1080/16506073.2020.1771413] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Previous studies examining the dose-response curve in psychotherapy have suggested that 11-19 sessions may be necessary for at least 50% of individuals to show clinically significant improvement. However, this curve has not been examined specifically for cognitive-behavioral therapy (CBT) for anxiety disorders, for which a more rapid recovery curve may be expected. Survival analysis was used to assess the dose-response curve for 201 patients with anxiety disorders who received weekly CBT at an anxiety specialty clinic. The primary outcome measure was the Outcome Questionnaire-45.2, which patients completed prior to each treatment session. Sixty-four percent of the sample achieved reliable change, and this response occurred in approximately five sessions on average. Fifty percent of the sample achieved clinically significant improvement, which occurred in approximately eight sessions on average. The findings suggest that earlier response may be expected in CBT for anxiety disorders, and are discussed in terms of potential ways to further improve response rates for this treatment.
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Affiliation(s)
- Hannah C Levy
- Anxiety Disorders Center, Institute of Living , Hartford, CT, USA
| | - Blaise L Worden
- Anxiety Disorders Center, Institute of Living , Hartford, CT, USA
| | - Carolyn D Davies
- Anxiety Disorders Center, Institute of Living , Hartford, CT, USA
| | - Kimberly Stevens
- Anxiety Disorders Center, Institute of Living , Hartford, CT, USA
| | - Benjamin W Katz
- Anxiety Disorders Center, Institute of Living , Hartford, CT, USA
| | - Liya Mammo
- Anxiety Disorders Center, Institute of Living , Hartford, CT, USA
| | - Gretchen J Diefenbach
- Anxiety Disorders Center, Institute of Living , Hartford, CT, USA.,Department of Psychiatry, Yale University School of Medicine , New Haven, CT, USA
| | - David F Tolin
- Anxiety Disorders Center, Institute of Living , Hartford, CT, USA.,Department of Psychiatry, Yale University School of Medicine , New Haven, CT, USA
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Francesetti G, Alcaro A, Settanni M. Panic disorder: attack of fear or acute attack of solitude? Convergences between affective neuroscience and phenomenological-Gestalt perspective. ACTA ACUST UNITED AC 2020; 23:421. [PMID: 32913822 PMCID: PMC7451360 DOI: 10.4081/ripppo.2020.421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 02/19/2020] [Indexed: 11/23/2022]
Abstract
There is consensus among scientists in considering Panic Attack (PA) as an exaggerated fear response triggered by intense activation of the amygdala and related Fear brain network. Current guidelines for treatment (e.g. National Institute for Clinical Excellence, NICE, 2011), that are based on this view, do not achieve satisfactory results: one-third of all treated patients report persistent PAs and other Panic Disorder (PD) symptoms, and several meta-analyses report the high likelihood of relapse. Here we review findings from Affective Neuroscience and clinical insights from a phenomenological-Gestalt perspective, putting into question the link between PD and activation of the Fear brain network. We propose an alternative hypothesis about PD etiology: PD is mainly connected to the Panic system, that is activated in situations of separation from affective support and overexposure to the environment. In our view, PA can be understood as an acute attack of solitude which is not adequately recognized by the patient due to the intervention of a dissociative component that makes it impossible to integrate all neuro-physiological responses activated by the Panic/Separation brain system within a coherent emotional feeling. This perspective can explain many evidences that otherwise remain isolated elements without a comprehensive frame: i.e., the association with agoraphobia, the onset of PD during adolescence and young adult life, the need to be accompanied, the connection with air hunger and other respiratory anomalies, the efficacy of antidepressants and the lack of activation of the Hypothalamic-Pituitary-Adrenal (HPA) axe. We discuss future steps to test this hypothesis and the consequences for psychotherapeutic treatment.
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Affiliation(s)
- Gianni Francesetti
- International Institute for Gestalt Therapy and Psychopathology - IPsiG.,Department of Psychology, University of Turin
| | - Antonio Alcaro
- Santa Lucia Foundation, European Centre for Brain Research, Italy
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Carey TA, Griffiths R, Dixon JE, Hines S. Identifying Functional Mechanisms in Psychotherapy: A Scoping Systematic Review. Front Psychiatry 2020; 11:291. [PMID: 32362848 PMCID: PMC7180170 DOI: 10.3389/fpsyt.2020.00291] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 03/24/2020] [Indexed: 11/13/2022] Open
Abstract
The identification of fundamental mechanisms is an important scientific pursuit in many fields of enquiry. With regard to the development of psychological treatments, understanding the mechanisms through which change occurs such that psychological distress resolves, can enable us to develop more effective and efficient interventions. In the field of psychotherapy, mechanisms are often identified either statistically or conceptually. The most powerful and useful mechanisms, however, are functional rather than statistical or conceptual. More specifically, with regard to mechanisms relevant to psychotherapy, it is difficult to identify what any of these mechanisms actually do in a mechanistic sense. That is, the mechanics of putative mechanisms are generally unspecified. In order to obtain a rigorous and comprehensive account of the current mechanisms in psychotherapy, as well as to evaluate their usefulness, a systematic scoping review was conducted. The systematic scoping review did not yield any mechanisms that were expressed in functional terms. We argue that, in order for psychotherapy to improve its effectiveness and efficiency, the standard for what is accepted as a useful mechanism needs to be substantially raised. Only functional mechanisms that express plausible actions consistent with known biological processes should be used to inform therapeutic interventions.
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Affiliation(s)
- Timothy A. Carey
- Institute of Global Health Equity Research, University of Global Health Equity, Kigali, Rwanda
| | - Robert Griffiths
- Mental Health Nursing Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - James E. Dixon
- North West Boroughs Healthcare NHS Foundation Trust, Warrington, United Kingdom
| | - Sonia Hines
- Centre for Remote Health, Flinders University, Alice Springs, NT, Australia
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40
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Asnaani A, Tyler J, McCann J, Brown L, Zang Y. Anxiety sensitivity and emotion regulation as mechanisms of successful CBT outcome for anxiety-related disorders in a naturalistic treatment setting. J Affect Disord 2020; 267:86-95. [PMID: 32063577 DOI: 10.1016/j.jad.2020.01.160] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/08/2019] [Accepted: 01/26/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Numerous randomized controlled trials (RCTs) have examined the efficacy of cognitive behavioral therapy (CBT) in reducing anxiety symptoms. However, relatively fewer studies have examined the effectiveness of CBT in naturalistic treatment settings. There is even less known about the mechanisms underlying successful outcomes in naturalistic samples receiving CBT. This study aimed to examine the absolute and relative mediation of emotion regulation (ER) difficulties and anxiety sensitivity (AS) on anxiety symptom reduction. METHODS Participants were treatment-seeking patients (N = 247) at an outpatient anxiety clinic. Measures of difficulties in ER, AS, and disorder specific symptoms were administered at baseline, mid, and post-treatment. A composite anxiety score was calculated to measure anxiety disorder symptom severity across anxiety-related diagnoses. RESULTS Individual mediation models revealed that both AS and ER significantly mediated the reduction in anxiety-related symptoms over the course of treatment. A multiple mediation model found that ER was the strongest mediator (indirect effect = -1.030, 95% CI = -2.172 to -0.153). Further analyses revealed that the ER subscale of impulse control difficulties (e.g., the tendency to avoid when confronted with a feared stimulus) was the strongest mediator (indirect effect = -0.849, 95% CI = -1.913 to -0.081). LIMITATIONS This study relied solely on self-report measures of ER, AS, and anxiety pathology, and did not have a control group. CONCLUSIONS These results suggest that improvement in the ability to control impulses may act as a mechanism of anxiety symptom reduction and may be important to target in CBT with naturalistic samples.
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Affiliation(s)
- Anu Asnaani
- University of Utah, Department of Psychology, 380 S 1530 E Behavioral Sciences Building, Salt Lake City, UT, United States 84112.
| | - Jeremy Tyler
- University of Pennsylvania, Department of Psychiatry, Center for the Treatment and Study of Anxiety, 3535 Market St, Suite 600 North, Philadelphia, PA, United States 19104
| | - Jesse McCann
- University of Pennsylvania, Department of Psychiatry, Center for the Treatment and Study of Anxiety, 3535 Market St, Suite 600 North, Philadelphia, PA, United States 19104
| | - Lily Brown
- University of Pennsylvania, Department of Psychiatry, Center for the Treatment and Study of Anxiety, 3535 Market St, Suite 600 North, Philadelphia, PA, United States 19104
| | - Yinyin Zang
- Peking University, School of Psychological and Cognitive Sciences, Beijing Key Laboratory of Behavior and Mental Health, No. 5 Yiheyuan Road, Haidian District, Beijing, China 100871.
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41
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Ren Y, Li M. Influence of physical exercise on social anxiety of left-behind children in rural areas in China: The mediator and moderator role of perceived social support. J Affect Disord 2020; 266:223-229. [PMID: 32056881 DOI: 10.1016/j.jad.2020.01.152] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/24/2019] [Accepted: 01/26/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE to explore the influence of physical exercise on social anxiety of left-behind children in rural areas, and to verify the mediator and moderator role of perceived social support. METHODS 797 rural left-behind children were studied with physical exercise rating scale, social anxiety scale and perceived social support assessment scale. The Pearson correlation coefficient was calculated between physical exercise and social anxiety, and regression and structural equation models were used to check whether perceived social support played a mediator and moderator role or not. RESULTS the effect of physical exercise on social anxiety of left-behind children in rural areas is significant (P < 0.01); exercise time, exercise intensity and exercise frequency have significant effects on social anxiety; perceived social support has significant effects on social anxiety (P < 0.01); family support, friend support and other support have significant negative effects on social anxiety. Regression analysis shows that the dimensions of perceived social support (family support, friend support and other support) have some mediator effects in explaining social anxiety in sports. Perceived social support plays a moderator role in the relationship between physical exercise and social anxiety. CONCLUSIONS The results suggests the impact of perceived social support on left-behind children in rural areas. Specifically, perceived social support has a positive impact on the level of social anxiety and a positive impact on physical exercise. It is suggested that attention should be paid to social support of rural left-behind children in the process of mental health education and school physical education.
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Affiliation(s)
- Yujia Ren
- Physical Education Institute, Hunan First Normal University, Changsha 410205, China
| | - Menglong Li
- Physical Education Institute, Hunan First Normal University, Changsha 410205, China.
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Gallagher MW, Long LJ, Richardson A, D’Souza J, Boswell JF, Farchione TJ, Barlow DH. Examining Hope as a Transdiagnostic Mechanism of Change Across Anxiety Disorders and CBT Treatment Protocols. Behav Ther 2020; 51:190-202. [PMID: 32005336 PMCID: PMC7000132 DOI: 10.1016/j.beth.2019.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 01/13/2023]
Abstract
Hope is a trait that represents the capacity to identify strategies or pathways to achieve goals and the motivation or agency to effectively pursue those pathways. Hope has been demonstrated to be a robust source of resilience to anxiety and stress and there is limited evidence that, as has been suggested for decades, hope may function as a core process or transdiagnostic mechanism of change in psychotherapy. The current study examined the role of hope in predicting recovery in a clinical trial in which 223 individuals with 1 of 4 anxiety disorders were randomized to transdiagnostic cognitive behavior therapy (CBT), disorder-specific CBT, or a waitlist controlled condition. Effect size results indicated moderate to large intraindividual increases in hope, that changes in hope were consistent across the five CBT treatment protocols, that changes in hope were significantly greater in CBT relative to waitlist, and that changes in hope began early in treatment. Results of growth curve analyses indicated that CBT was a robust predictor of trajectories of change in hope compared to waitlist, and that changes in hope predicted changes in both self-reported and clinician-rated anxiety. Finally, a statistically significant indirect effect was found indicating that the effects of treatment on changes in anxiety were mediated by treatment effects on hope. Together, these results suggest that hope may be a promising transdiagnostic mechanism of change that is relevant across anxiety disorders and treatment protocols.
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Fairweather-Schmidt AK, Wade TD. Common genetic architecture and environmental risk factors underpin the anxiety-disordered eating relationship: Findings from an adolescent twin cohort. Int J Eat Disord 2020; 53:52-60. [PMID: 31429983 DOI: 10.1002/eat.23155] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/30/2019] [Accepted: 08/04/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Despite established comorbidity between anxiety and disordered eating (DE), and a plethora of research using various methodologies to examine this overlap, use of twin modeling to expose whether a shared genetic liability underpins these conditions remains rare. METHOD Data from a longitudinal sample of female twins were selected: measures of risk for DE from Wave 1 (N = 699, 351 pairs, aged 12-15 years), and the Eating Disorder Examination (EDE) and Children's Anxiety Sensitivity Index (CASI) from Wave 2 (N = 669, 338 pairs, aged 16-19 years). At this time, they also completed Children's Anxiety Sensitivity Index (CASI). Bivariate Cholesky decomposition models adjusting for age and body mass index centile investigated the covariance structure between the CASI and EDE. RESULTS Modeling both genetic and nonshared environmental influences parsimoniously fit these data. All paths were significant. Additive genetic influences were notable for CASI and EDE phenotypes; 14% of the heritable variance was contributed by CASI to the expression of EDE. There was also a smaller but significant contribution of nonshared environmental influences. A multinomial logistic regression indicated body dissatisfaction (RRR = 1.53; 95% CI = 1.07-2.18) differentiated groups with highest EDE scores from the highest CASI scores. DISCUSSION Shared genetic and environmental influences appear to underpin the relationship, and potentially the observed comorbidity, between anxiety sensitivity and DE. The age of onset is typically earlier for anxiety than DE, suggesting a significant opportunity for early intervention work to reduce the likelihood of subsequent development of DE.
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Affiliation(s)
- A Kate Fairweather-Schmidt
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Tracey D Wade
- Discipline of Psychology, College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
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Gallagher MW, Long LJ, Phillips CA. Hope, optimism, self‐efficacy, and posttraumatic stress disorder: A meta‐analytic review of the protective effects of positive expectancies. J Clin Psychol 2019; 76:329-355. [DOI: 10.1002/jclp.22882] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Matthew W. Gallagher
- Department of Psychology, Texas Institute for Measurement, Evaluation, and StatisticsUniversity of HoustonHouston Texas
| | - Laura J. Long
- Department of Psychology, Texas Institute for Measurement, Evaluation, and StatisticsUniversity of HoustonHouston Texas
| | - Colleen A. Phillips
- Department of Psychology, Texas Institute for Measurement, Evaluation, and StatisticsUniversity of HoustonHouston Texas
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Breuninger C, Tuschen-Caffier B, Svaldi J. Dysfunctional cognition and self-efficacy as mediators of symptom change in exposure therapy for agoraphobia – Systematic review and meta-analysis. Behav Res Ther 2019; 120:103443. [DOI: 10.1016/j.brat.2019.103443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 07/02/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
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Boettcher J, Weinbrecht A, Heinrich M, Renneberg B. Treatment of Social Anxiety Disorder and Avoidant Personality Disorder in Routine Care: A Naturalistic Study of Combined Individual and Group Therapy. VERHALTENSTHERAPIE 2019. [DOI: 10.1159/000497738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Carpenter JK, Pinaire M, Hofmann SG. From Extinction Learning to Anxiety Treatment: Mind the Gap. Brain Sci 2019; 9:brainsci9070164. [PMID: 31336700 PMCID: PMC6680899 DOI: 10.3390/brainsci9070164] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 12/27/2022] Open
Abstract
Laboratory models of extinction learning in animals and humans have the potential to illuminate methods for improving clinical treatment of fear-based clinical disorders. However, such translational research often neglects important differences between threat responses in animals and fear learning in humans, particularly as it relates to the treatment of clinical disorders. Specifically, the conscious experience of fear and anxiety, along with the capacity to deliberately engage top-down cognitive processes to modulate that experience, involves distinct brain circuitry and is measured and manipulated using different methods than typically used in laboratory research. This paper will identify how translational research that investigates methods of enhancing extinction learning can more effectively model such elements of human fear learning, and how doing so will enhance the relevance of this research to the treatment of fear-based psychological disorders.
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Affiliation(s)
- Joseph K Carpenter
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd floor, Boston, MA 02215, USA
| | - Megan Pinaire
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd floor, Boston, MA 02215, USA
| | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd floor, Boston, MA 02215, USA.
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Paulus DJ, Brandt CP, Lemaire C, Zvolensky MJ. Trajectory of change in anxiety sensitivity in relation to anxiety, depression, and quality of life among persons living with HIV/AIDS following transdiagnostic cognitive-behavioral therapy. Cogn Behav Ther 2019; 49:149-163. [PMID: 31264940 DOI: 10.1080/16506073.2019.1621929] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Persons living with HIV/AIDS (PLHIV) disproportionately suffer from anxiety and depressive symptoms and disorders. Although past work has examined the efficacy of cognitive-behavioral therapy (CBT) for depression, and to a lesser extent anxiety, among PLHIV, little is known regarding potential mechanisms underlying improvement in anxiety/depression among this group. Anxiety sensitivity is a well-established risk/maintenance factor for anxiety and depressive disorders and is hypothesized to play an important role in maintaining anxiety among PLHIV. Past work has identified anxiety sensitivity as a mechanism of action underlying changes in various anxiety domains yet it is unknown whether changes in anxiety sensitivity relate to changes in anxiety symptoms among PLHIV undergoing transdiagnostic CBT for anxiety. The current study sought to examine treatment-related changes in anxiety sensitivity and how the trajectory of change relates to anxiety and depressive symptoms as well as overall quality of life. Individuals (n = 35) with HIV/AIDS and elevated anxiety symptoms received CBT for anxiety. Results indicated that reductions in anxiety sensitivity were significantly related to changes in anxiety, depression, and quality of life. Together, these data suggest that changes in anxiety sensitivity are significantly related to changes in anxiety/depression and quality of life among PLHIV seeking treatment.
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Affiliation(s)
- Daniel J Paulus
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,Department of Psychology, University of Houston, Houston, TX, USA
| | | | | | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Health Institute, University of Houston, Houston, TX, USA
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Zaidouni A, Ouasmani F, Benbella A, Kasouati J, Bezad R. The Effect of Nursing Consultation Based on Orem's Theory of Self-care and Bandura's Concept on Infertility Stress. J Hum Reprod Sci 2019; 12:247-254. [PMID: 31576084 PMCID: PMC6764230 DOI: 10.4103/jhrs.jhrs_159_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Infertility is one of the most stressful experiences in a couple's life. Several approaches have been proposed to manage infertility stress during the medically assisted technology process. OBJECTIVE The objective was to examine the effect of nursing consultation on the stress experienced by infertile couples before starting infertility treatment. MATERIALS AND METHODS This cross-sectional study was conducted from November 2017 to November 2018 among 120 infertile couples (240 patients) for whom stress was assessed. One hundred and thirteen patients of them who had a high infertility stress level were invited to participate in this randomized study (57 were assigned to the control group and 56 were included in the intervention group). The intervention group received nursing consultation based on Orem's theory and Bandura's concept in addition to the routine nursing care. Perceived Stress Scale-10 (PSS-10) and General Self-Efficacy Scale (GSES) were used before and after nursing intervention. STATISTICAL ANALYSIS The Chi-square test followed by a paired t-test and independent t-test was used for data analysis by SPSS software (version 20). RESULTS AND DISCUSSION There were no statistically significant differences before nursing intervention between the two groups in terms of PSS-10 (t = 1.18, P = 0.23) and GSES (t = -0.40, P = 0.689) scores, but a significant difference emerged in the intervention group following the nursing intervention: a reduction of the PSS score (t = -8.91, P = 0.000) and an increase in the GSES score (t = -5.25, P = 0.000, with 95% confidence interval (CI)). CONCLUSION Nursing consultation has been shown to be beneficial in decreasing perceived stress and increased self-efficacy for infertile couples undergoing assisted reproductive technologies.
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Affiliation(s)
- Asmaa Zaidouni
- Assisted Reproductive Technology Center of the Reproductive Health Hospital, Rabat, Morocco
- Department of Medical Biotechnology (Med Biotech), Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
| | - Fatima Ouasmani
- Department of Nursing, Higher Institute of Nursing Professions and Technics of Health, Rabat, Morocco
| | - Amal Benbella
- Assisted Reproductive Technology Center of the Reproductive Health Hospital, Rabat, Morocco
- Department of Medical Biotechnology (Med Biotech), Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
| | - Jalal Kasouati
- Department of Bacteriology, Military Teaching Hospital Mohamed V, Rabat, Morocco
- Laboratory of Biostatistics, Epidemiology and Clinical Research, Faculty of Medicine and Pharmacy, University Mohamed V, Rabat, Morocco
| | - Rachid Bezad
- Assisted Reproductive Technology Center of the Reproductive Health Hospital, Rabat, Morocco
- Department of Medical Biotechnology (Med Biotech), Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
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Keefe JR, Chambless DL, Barber JP, Milrod BL. Treatment of anxiety and mood comorbidities in cognitive-behavioral and psychodynamic therapies for panic disorder. J Psychiatr Res 2019; 114:34-40. [PMID: 31015099 DOI: 10.1016/j.jpsychires.2019.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 03/08/2019] [Accepted: 04/11/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND It is not known whether common anxiety/mood comorbidities of panic disorder (PD) improve with panic-focused psychological treatment, nor whether there is differential efficacy between therapies in treating comorbidities. METHODS In a randomized controlled trial for PD with and without agoraphobia comparing Cognitive-Behavioral Therapy (CBT) and Panic-Focused Psychodynamic Psychotherapy (PFPP), symptomatic comorbidities of agoraphobia, MDD, GAD, and social anxiety disorder (SAD) were assessed pre-to-post treatment with the Anxiety Disorders Interview Schedule (ADIS). Comparative efficacy of CBT versus PFPP for treating comorbid disorders was tested at termination and 1 year's follow-up. Covariance between panic and comorbidity improvements was also analyzed. RESULTS Most treatment completers (n = 120) evidenced diagnostic remission of their comorbidity (range = 54-69%), which typically reflected a subclinical score on the ADIS (mean range = 1.3 to 1.8). These improvements were generally retained at follow-up. However, patients with MDD dropped out significantly more often (HR = 2.79). No significant symptom change or remission differences emerged between CBT and PFPP for any comorbidity at termination or at follow-up. Panic change was strongly related to improvements in agoraphobia (r = 0.70) and MDD (r = 0.53), moderately related for GAD (r = 0.31), and not significantly related for SAD (r = 0.20). DISCUSSION Patients completing panic-focused psychotherapies often experience meaningful remission for diagnoses of agoraphobia, MDD, GAD, and SAD, with no detectable differences between treatments, although sample sizes for the MDD and SAD comparisons were small. In addition, additional efforts may be needed to keep MDD-comorbid patients in treatment.
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Affiliation(s)
- John R Keefe
- University of Pennsylvania, Department of Psychology, 425 S. University Avenue, Levin Building, 4th Floor, Philadelphia, PA, 19104, USA; Weill Cornell Medical College, Department of Psychiatry, New York, NY, USA.
| | - Dianne L Chambless
- University of Pennsylvania, Department of Psychology, 425 S. University Avenue, Levin Building, 4th Floor, Philadelphia, PA, 19104, USA
| | - Jacques P Barber
- Adelphi University, Gordon F. Derner School of Psychology, Garden City, NY, USA
| | - Barbara L Milrod
- Weill Cornell Medical College, Department of Psychiatry, New York, NY, USA
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