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Hoffman SN, Rassaby MM, Stein MB, Taylor CT. Positive and negative affect change following psychotherapeutic treatment for anxiety-related disorders: A systematic review and meta-analysis. J Affect Disord 2024; 349:358-369. [PMID: 38211753 DOI: 10.1016/j.jad.2024.01.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/05/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Anxiety-related disorders feature elevated negative affect (NA), and in some cases, diminished positive affect (PA). It remains unclear how well extant psychotherapies for anxiety-related disorders improve PA versus NA. METHODS We systematically searched the Cochrane Central Register of Controlled Trials, PubMed, PsychInfo, and Web of Science databases. Records included studies involving (1) patients with a principal or co-principal diagnosis of at least one anxiety-related disorder (i.e., generalized anxiety, social anxiety, panic, agoraphobia, health anxiety, specific phobia, obsessive-compulsive disorder, or posttraumatic stress disorder), and (2) pre- and post-treatment PA and NA scores or a change index between pre- and post-treatment PA and NA scores. Effect sizes were calculated for meta-analyses. RESULTS Fourteen studies with 1001 adults with an anxiety-related disorder were included. Psychotherapeutic interventions included cognitive behavioral, present-centered, and imagery-based approaches. Treatments reduced NA (g = -0.90; 95%CI [-1.19, -0.61]) to a greater extent than they improved PA (g = 0.27; 95%CI [0.05, 0.59]), Z = -5.26, p < .001. The limited number of studies available precluded analyses of the relationship between changes in affect and symptoms. LIMITATIONS Results should be considered with caution given the small number and heterogeneity of included studies. CONCLUSIONS Current psychotherapeutic interventions for anxiety-related disorders may not improve PA and NA to comparable levels.
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Affiliation(s)
- Samantha N Hoffman
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA.
| | - Madeleine M Rassaby
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA.
| | - Murray B Stein
- University of California San Diego, Department of Psychiatry, 9452 Medical Center Drive, 4E-226, La Jolla, CA 921037, USA.
| | - Charles T Taylor
- University of California San Diego, Department of Psychiatry, 9452 Medical Center Drive, 4E-226, La Jolla, CA 921037, USA.
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2
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Panjwani AA, Applebaum AJ, Revenson TA, Erblich J, Rosenfeld B. Intolerance of uncertainty, experiential avoidance, and trust in physician: a moderated mediation analysis of emotional distress in advanced cancer. J Behav Med 2024; 47:71-81. [PMID: 37285106 PMCID: PMC10942744 DOI: 10.1007/s10865-023-00419-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 05/05/2023] [Indexed: 06/08/2023]
Abstract
We tested whether patients' trust in physician moderated the hypothesized indirect association between intolerance of uncertainty (IU; inability to tolerate the unknown) and emotional distress through the mediator, experiential avoidance (EA; efforts to avoid negative emotions, thoughts, or memories), in patients with advanced cancer. The sample included 108 adults with Stage III or IV cancer (53% female; Mage = 63 years) recruited from a metropolitan cancer center. All constructs were measured by standardized self-report instruments. The PROCESS macro for SPSS tested the moderated mediation model. IU evidenced significant direct and indirect relationships with anxiety and depressive symptoms. Trust in physician moderated the indirect relationship between IU and anxiety (not depressive symptoms), albeit in an unexpected direction. Specifically, the indirect relationship between IU and anxiety symptoms through EA was significant for those with moderate to high physician trust but not low trust. Controlling for gender or income did not change the pattern of findings. IU and EA may be key intervention targets, particularly in acceptance-or meaning-based interventions for patients with advanced cancer.
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Affiliation(s)
- Aliza A Panjwani
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 12th Fl, 620 University Avenue, Toronto, ON, M5G 2C1, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, US
| | - Tracey A Revenson
- Department of Psychology, Hunter College & The Graduate Center, City University of New York, New York, US
| | - Joel Erblich
- Department of Psychology, Hunter College & The Graduate Center, City University of New York, New York, US
| | - Barry Rosenfeld
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, US
- Department of Psychology, Fordham University, Bronx, US
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3
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Iannattone S, Spaggiari S, Di Riso D, Bottesi G. Profiles of intolerance of uncertainty, separation anxiety, and negative affectivity in emerging adulthood: A person-centered approach. J Affect Disord 2024; 345:51-58. [PMID: 37875226 DOI: 10.1016/j.jad.2023.10.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/07/2023] [Accepted: 10/15/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Although Intolerance of uncertainty (IU), separation anxiety, and negative affectivity seem theoretically interrelated, no empirical study has considered them jointly so far. However, deepening this topic is clinically relevant, especially during the delicate phase of emerging adulthood. This study aimed to pinpoint psychological profiles based on IU, separation anxiety symptoms, and negative affectivity in a group of Italian non-clinical emerging adults. Such profiles were then compared in terms of key psychological and psychosocial characteristics. METHODS 868 young adults (73 % women) aged 18-26 years entered the study. They completed a socio-demographic survey and self-report tools assessing IU, separation anxiety symptomatology, and personality traits. Subgroups exhibiting distinctive patterns of IU, separation anxiety symptoms, and negative affectivity were identified using latent profile analysis. To deepen disparities in psychological and psychosocial features by profile, analyses of variance and chi-square tests were performed. RESULTS Three profiles were detected, respectively with high, low, and moderate levels of the variables considered. In each profile, IU, separation anxiety symptoms, and negative affectivity had a consistent trend. The "High-level" profile had the greatest proportion of women and people who had not spent infancy with both parents. LIMITATIONS The sample included mainly women and university students, and data were collected using self-report questionnaires only. CONCLUSIONS IU, separation anxiety symptoms, and negative affectivity can co-occur, highlighting the importance of transdiagnostic interventions. Preventive efforts should be directed to emerging adult women and those who did not spend infancy with both parents, as they may be particularly vulnerable to internalizing distress.
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Affiliation(s)
- Sara Iannattone
- Department of General Psychology, University of Padova, Padova, Italy.
| | - Silvia Spaggiari
- Department of Developmental Psychology and Socialisation, University of Padova, Padova, Italy.
| | - Daniela Di Riso
- Department of Developmental Psychology and Socialisation, University of Padova, Padova, Italy.
| | - Gioia Bottesi
- Department of General Psychology, University of Padova, Padova, Italy.
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Morse JL, Luong G, Prince MA, Steger MF. Disentangling trait and daily experiences of uncertainty and meaning in life: implications for daily anxiety, negative affect, and somatic symptoms. ANXIETY, STRESS, AND COPING 2024; 37:127-142. [PMID: 37068102 PMCID: PMC10579451 DOI: 10.1080/10615806.2023.2201000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Although there is growing evidence supporting the association between intolerance of uncertainty (IU) and psychopathology, little is known about the covariation of IU and psychological distress day-to-day. The purpose of this ecological momentary assessment (EMA) study was to examine negative emotional and somatic correlates of trait IU and daily uncertainty, while investigating how a source of stability, meaning in life (MIL), might buffer against deleterious effects of IU and uncertainty. DESIGN AND METHODS Adult community members (n = 62) from a mid-size town in the Rocky Mountain region completed baseline measures of IU and MIL and ecological momentary assessments (EMA) of meaning, uncertainty, affect, and somatic symptoms over the course of one week. RESULTS Results indicate individuals high in trait IU experience more uncertainty day-to-day and greater distress when they feel uncertain compared to individuals lower in trait IU; however, MIL plays a stronger protective role for high IU compared to low IU individuals. CONCLUSIONS These findings support and extend previous research showing IU is associated with psychological distress and that MIL may be a critical resource to cultivate. Interventions promoting meaning day-to-day may reduce the effects of uncertainty on the well-being of those highly intolerant of uncertainty.
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Affiliation(s)
- Jessica L Morse
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Gloria Luong
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Mark A Prince
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Michael F Steger
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
- Center for Meaning and Purpose, Colorado State University, Fort Collins, CO, USA
- North-West University, Vanderbijlpark, South Africa
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5
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Liu Y, Chen J, Chen K, Liu J, Wang W. The associations between academic stress and depression among college students: A moderated chain mediation model of negative affect, sleep quality, and social support. Acta Psychol (Amst) 2023; 239:104014. [PMID: 37633175 DOI: 10.1016/j.actpsy.2023.104014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/08/2023] [Accepted: 08/22/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND Growing competition in tight job market and academic excellence as a social norm in Asian culture have made Chinese college students burdened with immense academic stress. OBJECTIVES This study aimed to explore the associations between academic stress and depression, and the mediating roles of negative affect and sleep quality, as well as the moderating role of social support in the relationship between negative affect and sleep quality. METHODOLOGY A convenience sample of 221 male and 479 female college students aged between 17 and 25 completed questionnaires on academic stress, depression, negative affect, sleep quality and social support. RESULTS Results indicated that academic stress could not only directly affect depression (b = 0.31, p < 001), but also affect depression through the mediation role of negative affect and sleep quality. The chain mediating effects includes three paths, namely, the mediating role of negative affect (indirect effect = 0.21, percentage of total effect = 69.58 %), the mediating role of sleep quality (indirect effect = 0.06, percentage of total effect = 21.03 %), and the chain mediating role of negative affect and sleep quality (indirect effect = 0.06, percentage of total effect = 19.86 %). Social support moderated the adverse influence of negative affect on sleep quality. Social support decreases the impact of negative affect on sleep quality. Specifically, the association between negative affect and sleep quality was stronger for college students with low (bsimple = 0.44, p < 0.001) social support than those with high (bsimple = 0.32, p < 0.001) social support. IMPLICATIONS The results advanced our understanding of how academic stress affects college students' depression. These findings provide implications on the cultivation of stress coping strategies, promotion of emotion regulation skills, exaltation of sleep quality, and improvement of the social support level aiming for future depression preventions and interventions. Specific measures include setting up psychological health courses, teaching emotion management strategies, and establishing web-based programme steming from acceptance and commitment therapy. It should be noted that the cross-sectional design means the causal associations among the variables could not be determined.
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Affiliation(s)
- Yongli Liu
- Department of Education Policy and Leadership, The Education University of Hong Kong, Hong Kong, China; Department of Educational, Shanxi Datong University, Datong, China
| | - Junjun Chen
- Department of Education Policy and Leadership, The Education University of Hong Kong, Hong Kong, China
| | - Kun Chen
- Department of Educational Technology, Shanxi Datong University, Datong, China
| | - Jing Liu
- School of Journalism, Shanxi Datong University, Datong 037009, China
| | - Wei Wang
- Department of Psychology, Shanxi Datong University, Datong, China.
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Luong G, Miller JW, Kirkland D, Morse JL, Wrzus C, Diehl M, Chow SM, Riediger M. Valuing Negative Affect Weakens Affect-Health Linkages: Similarities and Differences Across Affect Valuation Measures. MOTIVATION AND EMOTION 2023; 47:347-363. [PMID: 38463946 PMCID: PMC10923588 DOI: 10.1007/s11031-023-10012-7] [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] [Accepted: 03/08/2023] [Indexed: 03/12/2024]
Abstract
Negative affect (NA) has been robustly linked to poorer psychological health, including greater depressive symptoms, personal burnout, and perceived stress. These associations, known as affect-health links, have been postulated by our research team to vary with different levels of negative affect valuation (NAV), such that people who evaluate NA states as more pleasant, helpful, appropriate, and/or meaningful may show weaker affect-health links. Another affect valuation construct is ideal NA, which is the degree to which people ideally want to experience NA states (i.e., desirability of affective states). The current study extends previous research by examining these two different measures of affect valuation (NAV and ideal NA) and comparing the extent to which they moderate affect-health links for psychological health and functioning. Participants from the Health and Daily Experiences (HEADE) study (N = 162 comprising of 56 younger adults and 106 older adults) completed questionnaires in a laboratory setting and ecological momentary assessments of NA 6 times a day for 7 consecutive days (i.e., trait NA). The results demonstrated that the two affect valuation constructs were distinct and showed different patterns of buffering effects. NAV attenuated the association between trait NA and depressive symptoms, personal burnout, and intolerance of uncertainty. Ideal NA attenuated affect-health links for depressive symptoms and perceived stress. These findings point to the importance of sharpening the distinctions between various affect valuation constructs to elucidate their unique contributions to attenuating affect-health links.
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Affiliation(s)
- Gloria Luong
- Department of Human Development and Family Studies, Colorado State University
| | - James W. Miller
- Department of Human Development and Family Studies, Colorado State University
| | - David Kirkland
- Department of Human Development and Family Studies, Colorado State University
| | - Jessica L. Morse
- University of California, San Diego
- VA San Diego Healthcare System
| | - Cornelia Wrzus
- Department of Psychological Aging Research, Ruprecht Karls University of Heidelberg
| | - Manfred Diehl
- Department of Human Development and Family Studies, Colorado State University
| | - Sy-Miin Chow
- Department of Human Development and Family Studies, The Pennsylvania State University
| | - Michaela Riediger
- Department of Developmental Psychology, Friedrich Schiller University Jena
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7
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Kupcova I, Danisovic L, Klein M, Harsanyi S. Effects of the COVID-19 pandemic on mental health, anxiety, and depression. BMC Psychol 2023; 11:108. [PMID: 37041568 PMCID: PMC10088605 DOI: 10.1186/s40359-023-01130-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/20/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic affected everyone around the globe. Depending on the country, there have been different restrictive epidemiologic measures and also different long-term repercussions. Morbidity and mortality of COVID-19 affected the mental state of every human being. However, social separation and isolation due to the restrictive measures considerably increased this impact. According to the World Health Organization (WHO), anxiety and depression prevalence increased by 25% globally. In this study, we aimed to examine the lasting effects of the COVID-19 pandemic on the general population. METHODS A cross-sectional study using an anonymous online-based 45-question online survey was conducted at Comenius University in Bratislava. The questionnaire comprised five general questions and two assessment tools the Zung Self-Rating Anxiety Scale (SAS) and the Zung Self-Rating Depression Scale (SDS). The results of the Self-Rating Scales were statistically examined in association with sex, age, and level of education. RESULTS A total of 205 anonymous subjects participated in this study, and no responses were excluded. In the study group, 78 (38.05%) participants were male, and 127 (61.69%) were female. A higher tendency to anxiety was exhibited by female participants (p = 0.012) and the age group under 30 years of age (p = 0.042). The level of education has been identified as a significant factor for changes in mental state, as participants with higher levels of education tended to be in a worse mental state (p = 0.006). CONCLUSIONS Summarizing two years of the COVID-19 pandemic, the mental state of people with higher levels of education tended to feel worse, while females and younger adults felt more anxiety.
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Affiliation(s)
- Ida Kupcova
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, Sasinkova 4, Bratislava, 811 08, Slovakia
| | - Lubos Danisovic
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, Sasinkova 4, Bratislava, 811 08, Slovakia
| | - Martin Klein
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Sasinkova 4, Bratislava, 811 08, Slovakia
| | - Stefan Harsanyi
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, Sasinkova 4, Bratislava, 811 08, Slovakia.
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8
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Fishbein JN, Haslbeck J, Arch JJ. Network intervention analysis of anxiety-related outcomes and processes of acceptance and commitment therapy (ACT) for anxious cancer survivors. Behav Res Ther 2023; 162:104266. [PMID: 36739856 DOI: 10.1016/j.brat.2023.104266] [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: 05/30/2022] [Revised: 12/11/2022] [Accepted: 01/25/2023] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Psychotherapies like Acceptance and Commitment Therapy (ACT) are thought to target multiple clinical outcomes by intervening on multiple mechanistic process variables. However, the standard mediation approach does not readily model the potentially complex associations among multiple processes and outcomes. The current study is one of the first to apply network intervention analysis to examine the putative change processes of a psychotherapy. METHODS Using data from a randomized trial of ACT versus minimally-enhanced usual care for anxious cancer survivors, we computed pre-to post-intervention (n = 113) residualized change scores on anxiety-related outcomes (general anxiety symptoms, cancer-related trauma symptoms, and fear of cancer recurrence) and putative processes of the intervention (experiential avoidance, self-compassion, and emotional approach coping). We estimated a network model with intervention condition and residualized change scores as nodes. RESULTS Contrary to the expectation that intervention effects would pass indirectly to outcomes via processes, network analysis indicated that two anxiety-related outcomes of the trial may have acted as primary mechanisms of the intervention on other outcome and process variables. CONCLUSIONS Network intervention analysis facilitated flexible evaluation of ACT's change processes, and offers a new way to test whether change occurs as theorized in psychotherapies.
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Affiliation(s)
- Joel N Fishbein
- Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO, 80309, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - Jonas Haslbeck
- Psychological Methods Group, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018WT, Amsterdam, the Netherlands
| | - Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO, 80309, USA; Division of Cancer Prevention and Control, University of Colorado Cancer Center, 1665 Aurora Court, Aurora, CO, 80045, USA
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9
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Rodriguez-Moreno S, Guillén AI, Tirpak JW, Marín C, Cardona ND, Eustis EH, Farchione TJ, Barlow DH, Panadero S. Mediators and Moderators of Therapeutic Change in the Unified Protocol for Women Experiencing Homelessness. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10335-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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10
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Arani AM, Hosseini S, Lotfinia S, Ebrahimi LS, Mousavi SE, Mohammadzadeghan R, Hosseini SM. The Comparative Efficacy of Unified Transdiagnostic Protocol (UP) and Mindfulness-Based Stress Reduction Protocol (MBSR) on Emotion Regulation and Uncertainty Intolerance in Infertile Women Receiving IVF. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09917-1. [PMID: 36309929 DOI: 10.1007/s10880-022-09917-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 10/31/2022]
Abstract
Some emotional and social aspects of infertility affect the response of the infertile women to the treatment. The purpose of this study was to compare the efficacy of unified transdiagnostic protocol (UP) and mindfulness-based stress reduction protocol (MBSR) on emotion regulation and uncertainty intolerance in infertile women receiving IVF. Forty-five infertile women with symptoms of anxiety and depression were included in the study. They were randomly assigned in two intervention groups and one control group. The UP was performed for 10 sessions and MBSR was performed for eight sessions. All participants completed emotion regulation and uncertainty intolerance questionnaires at pre-test, post-test, and follow-up stages. Both interventions had a significant effect on increasing patients' emotion regulation (p ≤ 0.05), but only unified transdiagnostic protocol had a significant effect on intolerance of uncertainty (p ≤ 0.05). Findings show that UP and MBSR have increased emotion regulation. Also UP could reduce the rate of uncertainty intolerance.
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Intolerance of Uncertainty and Perfectionistic Beliefs About Parenting as Cognitive Mechanisms of Symptom Change During Cognitive Behavior Therapy for Perinatal Anxiety. Behav Ther 2022; 53:738-750. [PMID: 35697435 DOI: 10.1016/j.beth.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A recent randomized controlled trial of group cognitive behavior therapy (CBGT) for perinatal anxiety showed that CBGT is effective in reducing anxiety and depression in pregnant and postpartum women. In secondary analyses, the role of potential mechanisms of symptom change was examined, including intolerance of uncertainty (IU), self-oriented parenting perfectionism (SOPP) and societal-prescribed parenting perfectionism (SPPP). METHOD The sample included 75 women (Mage = 31.99, SD = 3.57; 37.3% pregnant, 62.7% postpartum) who sought treatment for anxiety and completed the 6-week CBGT or 6-week waitlist within the larger trial. Measures of anxiety (State-Trait Inventory for Cognitive and Somatic Anxiety; STICSA), depression (Edinburgh Postnatal Depression Scale; EPDS), and the proposed mediators (IU, SOPP, SPPP) were completed at baseline and 6-weeks post-baseline. RESULTS Two moderated mediation models were evaluated to identify potential mediators of the effect of condition (CBGT, waitlist) on anxiety (STICSA; Model 1) or depressive symptoms (EPDS; Model 2). In Model 1, changes in IU partially mediated the effect of condition on anxiety (STICSA) for both pregnant and postpartum women. Changes in SOPP and SPPP were partial mediators for postpartum women only. Change in depression (EPDS) was also a partial mediator for pregnant women in this model. In Model 2, none of the cognitive variables mediated the effect of condition on depressive symptoms (EPDS). However, change in anxiety (STICSA) was a significant mediator of the effect of condition on depression (EPDS) and only among pregnant women. CONCLUSIONS The results provide support for IU, SOPP and SPPP as mechanisms of change during CBGT and identify differences in important mechanisms among pregnant and postpartum women.
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12
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Norton PJ. Transdiagnostic cognitive behavioural therapy. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2022.2064212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Peter J. Norton
- School of Psychology, Counselling and Psychotherapy, Cairnmillar Institute, Hawthorn East, Australia
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13
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Nishikawa Y, Fracalanza K, Rector NA, Laposa JM. Social anxiety and negative interpretations of positive social events: What role does intolerance of uncertainty play? J Clin Psychol 2022; 78:2513-2524. [PMID: 35435997 DOI: 10.1002/jclp.23363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/17/2022] [Accepted: 03/29/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Although previous studies have demonstrated the association between social anxiety symptom severity and the tendency to appraise positive social events negatively among individuals with social anxiety disorder, no study has examined mediators of this relationship. The current study sought to examine whether intolerance of uncertainty and its subfactors mediate the relationship between social interaction anxiety and the tendency to interpret positive social events negatively. METHOD One hundred and sixty-five individuals with social anxiety disorder completed measures of social interaction anxiety symptom severity, intolerance of uncertainty, and negative interpretations of positive social events. RESULTS Total intolerance of uncertainty and the inhibitory-intolerance of uncertainty subscale scores significantly mediated the relationship between social interaction anxiety and negative interpretations of positive events. Exploratory post-hoc analyses regarding the possible contributing role of depression demonstrated mixed results. The same mediation pattern was found in the full sample as well as those without a secondary comorbid mood disorder diagnosis. In contrast, serial mediation showed a mediating role of depressive symptom severity. CONCLUSION Inhibitory-intolerance of uncertainty plays a role in the relationship between social interaction anxiety and negative interpretations of positive social events.
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Affiliation(s)
- Yasunori Nishikawa
- Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Katie Fracalanza
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Neil A Rector
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Judith M Laposa
- Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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14
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Yang Z, Zhao X, Zhu Z, Fu Y, Hu Y. How Patients with an Uncertain Diagnosis Experience Intolerance of Uncertainty: A Grounded Theory Study. Psychol Res Behav Manag 2021; 14:1269-1279. [PMID: 34408511 PMCID: PMC8367199 DOI: 10.2147/prbm.s318263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/30/2021] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To develop a conceptual framework to explain how patients with uncertain diagnoses experience intolerance of uncertainty (IU) in order to achieve an in-depth understanding of the process of facing uncertainty in this population. PATIENTS AND METHODS A grounded theory study using semi-structured interviews was conducted with 21 patients with uncertain diagnoses in China from December 2018 to March 2019. The coding process followed the procedures of Strauss and Corbin: open coding, axial coding, and selective coding. RESULTS We developed a conceptual framework called 'Facing an Uncertain Diagnosis'. This framework considers not only the external and internal context of IU generation but also the ongoing process of how IU impacts patients' psychological status, cognitive response, behavior, and decision making. CONCLUSION We suggest that healthcare professionals should be aware of the high level of IU and its psychological, cognitive, and behavioral manifestations in patients with uncertain diagnoses. Healthcare professionals should also be more cautious in shared decision making with patients with uncertain diagnoses.
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Affiliation(s)
- Zhongfang Yang
- School of Nursing, Fudan University, Shanghai, People’s Republic of China
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, People’s Republic of China
| | - Xia Zhao
- Peking Union Medical College Hospital, Beijing, People’s Republic of China
| | - Zheng Zhu
- School of Nursing, Fudan University, Shanghai, People’s Republic of China
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, People’s Republic of China
| | - Yanfen Fu
- School of Nursing, Dali University, Dali, Yunnan, Province, People’s Republic of China
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai, People’s Republic of China
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, People’s Republic of China
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Mahmoodi M, Bakhtiyari M, Masjedi Arani A, Mohammadi A, Saberi Isfeedvajani M. The comparison between CBT focused on perfectionism and CBT focused on emotion regulation for individuals with depression and anxiety disorders and dysfunctional perfectionism: a randomized controlled trial. Behav Cogn Psychother 2020; 49:1-18. [PMID: 33355063 DOI: 10.1017/s1352465820000909] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND There is considerable evidence indicating that similar aetiological and maintenance processes underlie depressive and anxious psychopathology. According to the literature, perfectionism and emotion regulation are two transdiagnostic constructs associated with symptoms of emotional disorders. AIMS This study is the first randomized controlled trial comparing the efficacy of cognitive behavioural therapy for perfectionism (CBT-P) and the unified protocol for the transdiagnostic treatment of emotional disorders (UP). METHOD Seventy-five participants with a range of depressive and anxiety disorders and elevated perfectionism were randomized to three conditions: CBT-P, UP or a waitlist control (WL). RESULTS Repeated measures ANOVA indicated that the treatment groups reported a significantly greater pre-post reduction in the severity of symptoms of disorders, as well as a significantly greater pre-post increase in quality of life, all with moderate to large effect sizes compared with the WL group. Treatment gains were maintained at 6-month follow-up. The CBT-P group reported a significantly greater pre-post reduction in perfectionism compared with UP, and the UP group reported a significantly greater pre-post improvement in emotion regulation compared with CBT-P. CONCLUSIONS Findings support CBT for perfectionism and regard UP as efficacious treatments for individuals with depression and anxiety disorders who also have dysfunctional perfectionism. It appears that perfectionism cannot be a serious obstacle to UP. As this is a preliminary study and has some limitations, it is recommended that further research be conducted.
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Affiliation(s)
- Mohammad Mahmoodi
- Department of Clinical Psychology, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Maryam Bakhtiyari
- Department of Clinical Psychology, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Abbas Masjedi Arani
- Department of Clinical Psychology, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Abolfazl Mohammadi
- Department of Psychology, University of Saskatchewan (USASK), Saskatoon, Canada
| | - Mohsen Saberi Isfeedvajani
- Medicine, Quran and Hadith Research Center & Department of Community Medicine, Faculty of Medicine, Baqiyatallah University of Medical Science, Tehran, Iran
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Khakpoor S, Mohammadi Bytamar J, Saed O. Reductions in transdiagnostic factors as the potential mechanisms of change in treatment outcomes in the Unified Protocol: a randomized clinical trial. RESEARCH IN PSYCHOTHERAPY (MILANO) 2019; 22:379. [PMID: 32913807 PMCID: PMC7451383 DOI: 10.4081/ripppo.2019.379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/21/2019] [Indexed: 11/22/2022]
Abstract
Transdiagnostic approaches emphasize on the share underlying features of emotional disorders. In their view, these transdiagnostic factors play an important role in the etiology, maintenance, and treatment of emotional disorders. This study aimed to investigate the transdiagnostic factors as the potential mechanisms of change in the Unified Protocol (UP) for the transdiagnostic treatment of emotional disorders outcomes. The present study is a randomized clinical trial. Twenty-six individuals were selected based on the Beck anxiety inventory and Beck depression inventory and randomly assigned into two groups of control and treatment (n=13). The treatment group received 20 one-hour individual UP sessions. Beck Depression Inventory, Beck Anxiety Inventory, Difficulty in emotion regulation scale, Intolerance of Uncertainty scale and Acceptance and Action questionnaire were carried out in all three phases. UP enhances the difficulty in emotion regulation (large effect size, SEsg=1.81), intolerance of uncertainty (SEsg=1.91), and experiential avoidance (SEsg=1.78). In addition, the results of linear regression show the association between changes in anxiety and depression with changes in transdiagnostic factors. The difficulty in emotion regulation, intolerance of uncertainty and experiential avoidance can be considered as the potential mechanism of change in improving UP outcomes.
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Affiliation(s)
- Sahel Khakpoor
- Master of Clinical Psychology, Education and Treatment Center of Beheshti Hospital, Zanjan University of Medical Sciences, Zanjan
| | - Jahangir Mohammadi Bytamar
- Master of Clinical Psychology, Education and Treatment Center of Valiasr Hospital, Zanjan University of Medical Sciences, Zanjan
| | - Omid Saed
- Department of Clinical Psychology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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Kumar S, Saini R, Jain R. Hand preference and intolerance of uncertainty: Atypical cerebral lateralization advantages lower intolerance of uncertainty. Laterality 2019; 25:22-42. [DOI: 10.1080/1357650x.2019.1611843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Sanjay Kumar
- Department of Psychology, D.A.V. College, Muzaffarnagar, UP, India
| | - Reena Saini
- Department of Psychology, D.A.V. College, Muzaffarnagar, UP, India
| | - Ranjeeta Jain
- Department of Psychology, D.A.V. College, Muzaffarnagar, UP, India
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18
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Jacquart J, Dutcher CD, Freeman SZ, Stein AT, Dinh M, Carl E, Smits JAJ. The effects of exercise on transdiagnostic treatment targets: A meta-analytic review. Behav Res Ther 2018; 115:19-37. [PMID: 30473437 DOI: 10.1016/j.brat.2018.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The present study meta-analytically reviewed the effects of exercise on four transdiagnostic treatment targets: anxiety sensitivity (AS), distress tolerance (DT), stress reactivity (SR), and general self-efficacy (GSE). METHODS We conducted systematic searches of peer-reviewed studies in bibliographical databases (Cochrane Library, psychINFO, PubMed) before April 1, 2018. Only randomized controlled trials (RCT) evaluating the effect of exercise on AS, DT, SR, or GSE using at least one validated outcome instrument in a sample of adolescents (≥13 years old) or adults were selected. We employed a meta-analysis of effects using random-effects pooling modeling for each treatment target. RESULTS The systematic search yielded 28 RCTs meeting eligibility criteria. Exercise interventions had a large effect on reducing AS (six studies, Hedges's g = 0.72, p = .001), a medium effect on increasing GSE (eight studies, Hedges's g = 0.59, p < .001), and a small effect on reducing SR (ten studies, Hedges's g = 0.32, p < .001). Evidence from four studies suggested that exercise interventions had a small but non-significant effect on increasing DT (Hedges's g = 0.21, p = .26). CONCLUSIONS This meta-analysis provides preliminary evidence exercise can engage certain transdiagnostic targets. Further research is required to optimize exercise intervention parameters to achieve the strongest effects on these important mechanistic variables.
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Affiliation(s)
- Jolene Jacquart
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, 305 E 23rd Street Stop E9000, Austin, TX, 78712-1043, USA.
| | - Christina D Dutcher
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, 305 E 23rd Street Stop E9000, Austin, TX, 78712-1043, USA
| | - Slaton Z Freeman
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, 305 E 23rd Street Stop E9000, Austin, TX, 78712-1043, USA
| | - Aliza T Stein
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, 305 E 23rd Street Stop E9000, Austin, TX, 78712-1043, USA
| | - Mike Dinh
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, 305 E 23rd Street Stop E9000, Austin, TX, 78712-1043, USA
| | - Emily Carl
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, 305 E 23rd Street Stop E9000, Austin, TX, 78712-1043, USA
| | - Jasper A J Smits
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, 305 E 23rd Street Stop E9000, Austin, TX, 78712-1043, USA
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Nicholson JR, Sommer B. The research domain criteria framework in drug discovery for neuropsychiatric diseases: focus on negative valence. Brain Neurosci Adv 2018; 2:2398212818804030. [PMID: 32166151 PMCID: PMC7058263 DOI: 10.1177/2398212818804030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/24/2018] [Indexed: 12/22/2022] Open
Abstract
Drug discovery, particularly in the field of central nervous system, has had very limited success in the last few decades. A likely contributor is the poor translation between preclinical and clinical phases. The Research Domain Criteria of the National Institutes of Mental Health is a framework which aims to identify new ways of classifying mental illnesses that are based on observable behaviour and neurobiological measures, and to provide a guiding and evolving framework to improve the translation from preclinical to clinical research. At the core of the Research Domain Criteria approach is the assumption that the dimensional constructs described can be assessed across different units of analysis, thus enabling a more precise quantitative understanding of their neurobiological underpinnings, increasing the likelihood of identifying new and effective therapeutic approaches. In the present review, we discuss how the Research Domain Criteria can be applied to drug discovery with the domain Negative Valence, construct Potential Threat (‘Anxiety’) as an example. We will discuss the evidence supporting the utility of the Research Domain Criteria approach and evaluate how close we are to achieving a common thread of translational research from gene to self-report.
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Affiliation(s)
- Janet R Nicholson
- CNS Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Bernd Sommer
- CNS Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
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