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Salguero JM, Ramos-Cejudo J. A multi-study examination of the relevance of the metacognitive beliefs about uncontrollability in emotion regulation and clinical symptoms. J Affect Disord 2023; 340:812-819. [PMID: 37611642 DOI: 10.1016/j.jad.2023.08.090] [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: 06/06/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/25/2023]
Abstract
Transdiagnostic approaches to psychopathology have postulated that factors related to perceived control are particularly relevant to mental health. Here we focused on a specific perceived control-related construct: metacognitive beliefs about uncontrollability. Evidence suggests that dysfunctional metacognitive beliefs play a role in the activation and maintenance of maladaptive emotion regulation strategies and emotional distress. Metacognitive beliefs about the uncontrollability and danger of worry are the most strongly associated with psychopathology. In this multi-study research, we hypothesized that metacognitive beliefs about uncontrollability make a specific contribution to emotion regulation strategies and clinical symptoms. We tested our hypotheses in four different studies, both cross-sectionally and longitudinally (N = 2224). Participants completed measures of metacognitive beliefs, maladaptive strategies (e.g., worry, thought suppression), and clinical symptoms (e.g., generalized anxiety, emotional distress, depressive and anxiety symptoms). Our results showed that uncontrollability beliefs were the strongest variable associated with maladaptive emotion regulation strategies and clinical symptoms (cross-sectionally), and the only ones that predicted them in the long term. We discuss the theoretical and clinical implications of these results in the light of the metacognitive model and control-related theories.
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Affiliation(s)
- José M Salguero
- Department of Personality, Evaluation, and Psychological Treatment, University of Malaga, Spain.
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2
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Snyder HR, Silton RL, Hankin BL, Smolker HR, Kaiser RH, Banich MT, Miller GA, Heller W. The dimensional structure of internalizing psychopathology: Relation to diagnostic categories. Clin Psychol Sci 2023; 11:1044-1063. [PMID: 37982000 PMCID: PMC10655959 DOI: 10.1177/21677026221119483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Recent approaches aim to represent the dimensional structure of psychopathology, but relatively little research has rigorously tested sub-dimensions within internalizing psychopathology. This study tests pre-registered models of the dimensional structure of internalizing psychopathology, and their relations with current and lifetime depressive and anxiety disorders diagnostic data, in adult samples harmonized across three sites (n=427). Across S-1 bifactor and hierarchical models, we found converging evidence for both general and specific internalizing dimensions. Depression, generalized anxiety disorder (GAD), social anxiety disorder (SAD), and panic attacks were all associated with a general internalizing factor that we posit primarily represents motivational anhedonia. GAD was also associated with a specific anxious apprehension factor, and SAD with specific anxious apprehension and low positive affect factors. We suggest that dimensional approaches capturing shared and specific internalizing symptom facets more accurately describe the structure of internalizing psychopathology and provide useful alternatives to categorical diagnoses to advance clinical science.
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Affiliation(s)
| | | | - Benjamin L Hankin
- Department of Psychology, University of Illinois at Urbana-Champaign
| | - Harry R Smolker
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Roselinde H Kaiser
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Marie T Banich
- Department of Psychology and Neuroscience, University of Colorado Boulder
- Institute of Cognitive Science, University of Colorado Boulder
| | - Gregory A Miller
- Department of Psychology, University of Illinois at Urbana-Champaign
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, UCLA
| | - Wendy Heller
- Department of Psychology, University of Illinois at Urbana-Champaign
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3
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Inness BE, Furtado M, Barrett E, Stallwood E, Streiner DL, McCabe RE, Green SM. Psychometric properties of the PSWQ in a sample of pregnant and postpartum women. J Reprod Infant Psychol 2023:1-16. [PMID: 37139571 DOI: 10.1080/02646838.2023.2209101] [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: 05/05/2023]
Abstract
BACKGROUND Generalized anxiety disorder (GAD)-characterised by excessive and uncontrollable worry-is the most frequently diagnosed anxiety disorder during pregnancy and the postpartum period. Identification of GAD often relies on assessment of its cardinal feature, pathological worry. The Penn State Worry Questionnaire (PSWQ) is the most robust measure of pathological worry to date but has not been extensively evaluated for use during pregnancy and the postpartum period. This study evaluated the internal consistency, construct validity, and diagnostic accuracy of the PSWQ in a sample of pregnant and postpartum women with and without a principal GAD diagnosis. METHODS One hundred forty-two pregnant and 209 postpartum women participated in this study. Sixty-nine pregnant and 129 postpartum participants met criteria for a principal diagnosis of GAD. RESULTS The PSWQ demonstrated good internal consistency and converged with measures assessing similar constructs. Pregnant participants with principal GAD scored significantly higher on the PSWQ than those with no psychopathology and postpartum participants with principal GAD scored significantly higher than those with principal mood disorders, other anxiety and related disorders, and no psychopathology. A cut-off score of 55 and 61 or greater was determined for detecting probable GAD during pregnancy and the postpartum period, respectively. Screening accuracy of the PSWQ was also demonstrated. CONCLUSIONS This study underscores the robustness of the PSWQ as a measure of pathological worry and probable GAD and supports its use in the detection and monitoring of clinically significant worry symptoms during pregnancy and postpartum period.
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Affiliation(s)
- Briar E Inness
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Furtado
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Emily Barrett
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Emma Stallwood
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Randi E McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Sheryl M Green
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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4
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Weber-Goericke F, Muehlhan M. High and low worriers do not differ in unstimulated resting-state brain connectivity. Sci Rep 2023; 13:3052. [PMID: 36810628 PMCID: PMC9944913 DOI: 10.1038/s41598-023-28333-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 01/17/2023] [Indexed: 02/24/2023] Open
Abstract
Chronic, excessive and uncontrollable worry presents an anxiety rising and distressing mental activity relevant in a range of psychological disorders. Task based studies investigating its underlying neural mechanisms reveal fairly heterogenous results. The current study aimed to investigate pathological worry related effects on the functional neural network architecture in the resting unstimulated brain. Using resting-state functional magnetic resonance imaging (rsfMRI) we compared functional connectivity (FC) patterns between 21 high worriers and 21 low worriers. We, on the one hand, conducted a seed-to-voxel analysis based on recent meta-analytic findings and, on the other hand, implemented a data-driven multi voxel pattern analysis (MVPA) approach to yield brain clusters showing connectivity differences between the two groups. Additionally, the seed regions and MVPA were used to investigate whether whole brain connectivity is associated with momentary state worry across groups. The data did not reveal differences in resting-state FC related to pathological worry, neither by the seed-to-voxel or MVPA approach testing for differences linked to trait worry nor by using the MVPA to test for state worry related aberrations. We discuss whether the null findings in our analyses are related to spontaneous fluctuations in momentary worry and the associated presence of multiple fluctuating brain states that could cause mutually cancelling effects. For future studies investigating the neural correlates of excessive worry, we propose a direct worry induction for better control of the situation.
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Affiliation(s)
- Fanny Weber-Goericke
- Department of Psychology, Technische Universität Dresden, Chemnitzer Strasse 46, 01187, Dresden, Germany.
| | - Markus Muehlhan
- Department of Psychology, Faculty of Human Science, Medical School Hamburg, Am Kaiserkai 1, 20457, Hamburg, Germany. .,ICAN Institute for Cognitive and Affective Neuroscience, Medical School Hamburg, Am Kaiserkai 1, 20457, Hamburg, Germany.
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Corpas J, Moriana JA, Venceslá JF, Gálvez-Lara M. Cognitive processes associated with emotional disorders: implications for efficient psychological treatments. J Ment Health 2023; 32:54-62. [PMID: 33989506 DOI: 10.1080/09638237.2021.1922651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Emotional disorders (EDs) are the most prevalent worldwide. Despite psychotherapies are their treatment of choice, there are difficulties to apply them properly in mental health services. Since literature shows that cognitive processes are associated with anxiety and depressive symptoms, more information is needed in order to improve psychological treatments. AIMS To determine the relation between cognitive factors with specific and non-specific ED symptoms in order to promote the development of accurate psychological treatments. METHODS We analyzed the relation between rumination, worry, and metacognition with generalized anxiety, panic, and depression disorder symptoms from a clinical sample of 116 individuals through correlation and linear regression analyses. RESULTS Although each specific disorder had a closer link with a particular cognitive process, all general ED symptoms were associated with the three cognitive factors studied. CONCLUSIONS For "pure" disorders, targeting a concrete cognitive process might be an optimal therapeutic option. However, due to the high comorbidity among EDs, we support the dissemination of the transdiagnostic treatment approach in which all cognitive factors are taken into account.
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Affiliation(s)
- Jorge Corpas
- Department of Psychology, University of Córdoba, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,Reina Sofia University Hospital, Córdoba, Spain
| | - Juan A Moriana
- Department of Psychology, University of Córdoba, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,Reina Sofia University Hospital, Córdoba, Spain
| | - Jose F Venceslá
- Department of Psychology, University of Córdoba, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,Reina Sofia University Hospital, Córdoba, Spain
| | - Mario Gálvez-Lara
- Department of Psychology, University of Córdoba, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,Reina Sofia University Hospital, Córdoba, Spain
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Toward an integrative model of transdiagnostic risk factors and suicide: A network comparison of psychiatric outpatients. J Psychiatr Res 2022; 154:252-260. [PMID: 35961181 DOI: 10.1016/j.jpsychires.2022.07.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/20/2022] [Accepted: 07/21/2022] [Indexed: 11/21/2022]
Abstract
Predictive models using traditional statistical methods have largely failed to describe suicide etiology. Network theory, which conceptualizes factors as mutually interacting, reinforcing elements of a complex outcome, can model relationships between transdiagnostic and neurocognitive vulnerability factors. The present study used a network approach to produce an atheoretical model of psychological factors and their interrelationships within a population of ideators and non-ideators. We developed two network models (i.e., suicidal ideators and psychiatric controls) describing the relationships between a diverse set of risk factors and symptom measures for a population of psychiatric outpatients. We compared networks using three measures of network structure (i.e., network structure invariance, global strength invariance, edge invariance) and described the differences. Network structures for ideators (N = 229) and non-ideators (N = 454) were stable and accurate. In non-ideators, cognitive-affective depression symptoms (Expected Influence [EI]: 2.06), trauma avoidance (EI: 1.08), and negative affect (EI: 0.81) were most influential to the psychological network. In ideators, cognitive-affective depression symptoms (EI: 1.77), intolerance of uncertainty-negative self-referent implications (EI: 1.29), and negative affect (EI: 1.19) were most influential. Invariance testing did not indicate significant differences in overall network structure between ideators and non-ideators (p = .111), but did indicate significant differences in node strength (p = .013). Significant differences in node EI were detected for intolerance of uncertainty-negative self-referent implications, anxiety sensitivity physical concerns, thwarted belongingness, worry, and negative affect. These findings indicated differences in network structures for suicidal psychiatric outpatients and provide crucial directions for future research on therapeutic targets for suicidal thoughts and behaviors.
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Osborne LM, Voegtline K, Standeven LR, Sundel B, Pangtey M, Hantsoo L, Payne JL. High worry in pregnancy predicts postpartum depression. J Affect Disord 2021; 294:701-706. [PMID: 34343928 PMCID: PMC8442474 DOI: 10.1016/j.jad.2021.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 05/28/2021] [Accepted: 07/10/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Anxiety in pregnancy is one of the strongest risk factors for postpartum depression (PPD), and high worry is a hallmark of many anxiety disorders. We sought to determine whether the Penn State Worry Questionnaire (PSWQ), designed for the general population, could identify high worry in pregnancy and predict the development of PPD symptoms (PPDS). METHODS We followed women (N = 295) with and without mood and anxiety disorders across pregnancy and up to 6 months postpartum. Diagnoses were confirmed by SCID and by an experienced perinatal psychiatrist, and we administered the PSWQ and the Edinburgh Postnatal Depression Scale (EPDS) at up to 6 time points. We determined the trajectory of worry across time and its relationship to PPDS. RESULTS Women with a history or current diagnosis of major depressive disorder (MDD) or generalized anxiety disorder (GAD) were more likely to experience high antenatal worry (defined as PSWQ >60), p < .004 for MDD and <0.001 for all others. High antenatal worry was the only significant predictor of PPDS, with an OR of 3.91 (95% CI 1.44-10.65); neither psychiatric diagnosis nor elevated antenatal depressive symptoms was significantly associated with PPDS in a multivariate model. LIMITATIONS Our study used self-report measures in a largely homogeneous population, which may limit the generalizability of our results. CONCLUSIONS The PSWQ may be a useful clinical tool in pregnancy. High worry is a strong predictor of PPDS, and is a better predictor of PPDS than psychiatric diagnosis or elevated antenatal depressive symptoms in this population.
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Affiliation(s)
- Lauren M Osborne
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, United States; Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, United States.
| | - Kristin Voegtline
- Department of Pediatrics, Johns Hopkins University School of Medicine, United States
| | - Lindsay R Standeven
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, United States
| | - Bridget Sundel
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, United States
| | - Meeta Pangtey
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, United States
| | - Liisa Hantsoo
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, United States
| | - Jennifer L Payne
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, United States; Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, United States
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8
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Mohammadkhani S, Akbari M, West A, Mazloom M, Gezloo F. The Relationship of Metacognition with Worry: The Mediating Role of Emotional Flexibility and Affective Style. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2021. [DOI: 10.1007/s10942-021-00422-2] [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]
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9
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What's Worrying Our Students? Increasing Worry Levels over Two Decades and a New Measure of Student Worry Frequency and Domains. COGNITIVE THERAPY AND RESEARCH 2021; 46:406-419. [PMID: 34658461 PMCID: PMC8501938 DOI: 10.1007/s10608-021-10270-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 10/26/2022]
Abstract
Background The frequency and severity of mental health problems in student populations have been a growing cause for concern worldwide, and studies have identified measures of a number of mental health symptoms that have been steadily increasing in frequency and intensity over the past 20-25 years. Methods In two studies we investigate the levels and domains of pathological worrying in university student participants. Study 1 is a retrospective study of Penn State Worry Questionnaire (PSWQ) data collected between 2001 and 2019. Study 2 describes the development of the Student Worry Questionnaire, a short and easily delivered measure of student worrying that identifies both frequency of worry as well as the student-relevant domains across which worrying occurs. Results Study 1 revealed a steady increase in student worry scores of around 20% between 2001 and 2019, with a significant positive correlation between year of data collection and mean PSWQ score. The domain scores in Study 2 indicated that academic work was a significantly higher worry than any of the other domains, and worries about intimate relationships and 'what people think of me' were also worries that scored higher than either financial or health worries. Conclusions The present studies indicate that pathological worrying can be added to the list of anxiety- and stress-related symptoms that have been shown to be on the increase in student populations in recent decades, and we discuss whether these increases represent a greater willingness to report symptoms or a genuine increase in experienced symptoms over time.
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10
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Zainal NH, Chan WW, Saxena AP, Taylor CB, Newman MG. Pilot randomized trial of self-guided virtual reality exposure therapy for social anxiety disorder. Behav Res Ther 2021; 147:103984. [PMID: 34740099 DOI: 10.1016/j.brat.2021.103984] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/14/2021] [Accepted: 10/04/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Virtual reality exposure therapy (VRE) has shown promising efficacy for the treatment of social anxiety disorder (SAD) and related comorbidities. However, most trials conducted to date were therapist-led, and little is known about the efficacy of self-guided VRE. Therefore, this randomized controlled trial (RCT) aimed to determine the efficacy of a self-directed VRE for SAD. METHOD Forty-four community-dwelling or undergraduate adults diagnosed with SAD based on the Mini International Neuropsychiatric Interview were randomly assigned to VRE designed to last four sessions or more (n = 26) or waitlist (WL; n = 18). Self-reported SAD severity (Social Phobia Diagnostic Questionnaire and Social Interaction Anxiety Scale), job interview anxiety (Measure of Anxiety in Selection Interviews), trait worry (Penn State Worry Questionnaire), and depression symptoms (Patient Health Questionnaire-9) were administered at baseline, post-treatment, 3-month-follow-up (3MFU), and 6-month-follow-up (6MFU). Piecewise multilevel modeling analyses were conducted to manage clustering in the data. RESULTS VRE vs. WL resulted in greater reductions in SAD symptom severity, job interview fear, and trait worry, with moderate-to-large effect sizes (Hedge's g = -0.54 to -1.11) from pre-to-post treatment. Although significant between-group differences did not emerge for change in depression, VRE led to change in depression, whereas waitlist did not. These gains were also maintained at 3MFU and 6MFU. Further, facets of presence increased during the course of VRE (g = 0.36-0.45), whereas cybersickness decreased (g = -0.43). DISCUSSION Brief, self-guided VRE might ameliorate SAD and comorbid worry, for young-to-middle-aged adults with SAD. Other theoretical and practical implications were also discussed.
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Salguero JM, Ramos-Cejudo J, García-Sancho E. Metacognitive Beliefs and Emotional Dysregulation Have a Specific Contribution on Worry and the Emotional Symptoms of Generalized Anxiety Disorder. Int J Cogn Ther 2019. [DOI: 10.1007/s41811-019-00048-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Kowalski J, Wypych M, Marchewka A, Dragan M. Neural Correlates of Cognitive-Attentional Syndrome: An fMRI Study on Repetitive Negative Thinking Induction and Resting State Functional Connectivity. Front Psychol 2019; 10:648. [PMID: 30971987 PMCID: PMC6443848 DOI: 10.3389/fpsyg.2019.00648] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/08/2019] [Indexed: 11/13/2022] Open
Abstract
Aim Cognitive-attentional syndrome (CAS) is the main factor underlying depressive and anxiety disorders in the metacognitive approach to psychopathology and psychotherapy. This study explore neural correlates of this syndrome during induced negative thinking, abstract thinking, and resting states. Methods n = 25 people with high levels of CAS and n = 33 people with low levels of CAS were chosen from a population-based sample (N = 1225). These groups filled-in a series of measures of CAS, negative affect, and psychopathology; they also underwent a modified rumination induction procedure and a resting state fMRI session. Resonance imaging data were analyzed using static general linear model and functional connectivity approaches. Results The two groups differed with large effect sizes on all used measures of CAS, negative affect, and psychopathology. We did not find any group differences in general linear model analyses. Functional connectivity analyses showed that high levels of CAS were related to disrupted patterns of connectivity within and between various brain networks: the default mode network, the salience network, and the central executive network. Conclusion We showed that low- and high-CAS groups differed in functional connectivity during induced negative and abstract thinking and also in resting state fMRI. Overall, our results suggest that people with high levels of CAS tend to have disrupted neural processing related to self-referential processing, task-oriented processing, and emotional processing.
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Affiliation(s)
| | - Marek Wypych
- Laboratory of Brain Imaging, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Artur Marchewka
- Laboratory of Brain Imaging, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
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Marsh C, Hammond MD, Crawford MT. Thinking about negative life events as a mediator between depression and fading affect bias. PLoS One 2019; 14:e0211147. [PMID: 30682113 PMCID: PMC6347156 DOI: 10.1371/journal.pone.0211147] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 01/08/2019] [Indexed: 11/30/2022] Open
Abstract
The current research examined the links between depressive symptomology and anxiety on the fading of affect associated with positive and negative autobiographical memories. Participants (N = 296) recalled and rated positive and negative events in terms of how pleasant or unpleasant they were at the time they occurred and at the time of event recollection. Multilevel mediation analyses identified evidence that higher levels of depressive symptoms were directly associated with lower affect fade for both negative and positive memories. Tests of indirect effects indicated that depressive symptoms were indirectly related to lower affect fade for negative (but not positive) autobiographical memories via the heightened tendency to think about negative (but not positive) memories. Anxiety was unrelated to affect fade both directly and indirectly. These results suggest that people higher in depressive symptoms retain more negative affect due to an increased likelihood of thinking about negative autobiographical events.
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Affiliation(s)
- Claire Marsh
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Matthew D. Hammond
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Matthew T. Crawford
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
- * E-mail:
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Weber-Goericke F, Muehlhan M. A quantitative meta-analysis of fMRI studies investigating emotional processing in excessive worriers: Application of activation likelihood estimation analysis. J Affect Disord 2019; 243:348-359. [PMID: 30266026 DOI: 10.1016/j.jad.2018.09.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/27/2018] [Accepted: 09/15/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Excessive worry is a highly impairing cognitive activity which features a range of psychological disorders. Investigations of its disturbed underlying neural mechanisms have presented largely heterogeneous results. This quantitative neuroimaging meta-analysis aims to identify consistent functional disturbances in emotional processing associated with excessive worry across previously published studies. METHODS We used the activation likelihood estimation (ALE) method to test for significant convergence across findings of 16 neuroimaging experiments reporting functional aberrations during emotional processing between individuals experiencing high versus normal levels of worry. RESULTS Results demonstrated convergent aberrations in high compared to normal worriers mainly in a left-hemispheric cluster comprising parts of the middle frontal gyrus, inferior frontal gyrus and anterior insula. Behavioral characterization indicated the identified cluster to be associated with language processing and memory, while meta-analytic connectivity mapping yielded strong functional connections between the observed convergent regions and parts of the salience network as well as the default mode network. LIMITATIONS The ALE method cannot consider findings based on regions of interest analyses and studies without significant group differences. CONCLUSION Our results indicate that in response to emotional contexts worry prone individuals exhibit disturbed functioning in brain areas which are possibly associated with deviant inner speech processes experienced by these individuals. The observed clusters may further constitute key nodes within interacting neural networks that support internally and externally oriented cognition and control the dynamic interplay among these processes.
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Affiliation(s)
- Fanny Weber-Goericke
- Institute of Clinical Psychology and Psychotherapy, Faculty of Psychology, School of Science, Technische Universität Dresden, Dresden Germany
| | - Markus Muehlhan
- Department of Psychology, Faculty of Human Science, Medical School Hamburg, Hamburg, Germany; Institute of Clinical Psychology and Psychotherapy, Faculty of Psychology, School of Science, Technische Universität Dresden, Dresden Germany.
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Examining characteristics of worry in relation to depression, anxiety, and suicidal ideation and attempts. J Psychiatr Res 2018; 107:97-103. [PMID: 30384092 DOI: 10.1016/j.jpsychires.2018.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/20/2018] [Accepted: 10/03/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pathological worry is defined as worry that is excessive, pervasive, and uncontrollable. Although pathological worry is related to depression, anxiety, and suicidal ideation, less is understood about what specific features of worry confer risk for these mental health conditions. The current study examined associations between four characteristics of worry-frequency, duration, controllability, and content-and self-reported symptoms of depression, anxiety, suicidal ideation, and lifetime suicide attempts. METHODS A sample of 548 community participants (53.6% female, 45.4% male, 0.5% transgender male, 0.2% transgender female, and 0.2% gender non-binary), aged 19-98 years (M = 36.54, SD = 12.33), was recruited via Amazon's MTurk and completed a battery of self-report questionnaires online. RESULTS Results indicated that controllability of worry was uniquely associated with depression, anxiety, and suicidal ideation above and beyond other characteristics of worry, demographic variables, negative affect, and future-oriented repetitive thinking. Lifetime suicide attempts were found non-significant to these mental health outcomes. Frequency of worry was also positively related to depression. LIMITATIONS This study utilized a cross-sectional design with exclusive self-report measures. CONCLUSIONS Overall, these findings suggest that controllability of one's thoughts may be a key transdiagnostic factor that confers risk for a variety of psychopathology-related concerns. Clinical relevance includes identifying potential risk factors for varying psychopathology. Future research should examine relationships between worry controllability and anxiety, depression, suicidal ideation, and attempts, within clinical samples and utilizing a variety of methodologies.
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Wilson GA, Koerner N, Antony MM. An Examination of Feedback Seeking in Individuals With Social Anxiety Disorder, Generalized Anxiety Disorder, or No History of Mental Disorder Using a Daily Diary Method. J Cogn Psychother 2018; 32:15-37. [DOI: 10.1891/0889-8391.32.1.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined excessive reassurance seeking (or positive feedback seeking; PFS) and negative feedback seeking (NFS) in individuals with social anxiety disorder (SAD), generalized anxiety disorder (GAD), or no history of mental health difficulties. A 2-week daily diary method was used to examine potential group differences in the frequency, topics, and targets of PFS and NFS. The SAD and GAD groups reported significantly higher feedback seeking (FS) than the healthy group on self-report questionnaires. The most common targets of FS in each group were other people (e.g., romantic partner, family members). According to diary data, there were no significant group differences in the frequency of PFS, NFS, overall FS, or overall FS adjusted for self-reported compliance with diary completion (after applying Bonferroni correction). There were also no significant group differences in FS topics according to diary data. Future research directions and potential implications of these findings are discussed.
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Silva S, Janeiro L, Brás M, Carmo C, Martins AT, Jiménez-Ros A. Paradoxical Effects of Worrisome Thoughts Suppression: the Influence of Depressive Mood. CURRENT PSYCHOLOGY 2018. [DOI: 10.1007/s12144-016-9493-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Hearn CS, Donovan CL, Spence SH, March S. Do worry and its associated cognitive variables alter following CBT treatment in a youth population with Social Anxiety Disorder? Results from a randomized controlled trial. J Anxiety Disord 2018; 53:46-57. [PMID: 29195187 DOI: 10.1016/j.janxdis.2017.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 08/10/2017] [Accepted: 11/22/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Cate S Hearn
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, Mount Gravatt, QLD, 4122, Australia.
| | - Caroline L Donovan
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, Mount Gravatt, QLD, 4122, Australia.
| | - Susan H Spence
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, Mount Gravatt, QLD, 4122, Australia.
| | - Sonja March
- Institute for Resilient Regions & School of Psychology and Counselling, University of Southern Queensland, Springfield, QLD, 4300, Australia.
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Intolerance of uncertainty, depression, and anxiety: Examining the indirect and moderating effects of worry. Asian J Psychiatr 2017; 29:129-133. [PMID: 29061409 DOI: 10.1016/j.ajp.2017.04.017] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/22/2017] [Accepted: 04/25/2017] [Indexed: 11/23/2022]
Abstract
The present study sought to examine the indirect and moderating effects of worry between intolerance of uncertainty (IU) and symptoms of depression and anxiety. The study was a cross sectional study. Data were collected from 120 psychiatric patients, aged 22 to 37 years. A battery of self-report questionnaires was administered for tapping IU, worry, depression and anxiety symptoms. Results from indirect effects analyses revealed that even though IU, worry, depression, and anxiety symptoms correlated moderately with each other, worry carried a substantial proportion of variance in predicting symptoms of depression and anxiety. However, the relative effect was more pronounced for anxiety compared to depression symptoms. The results from hierarchical analyses supported the moderator role of worry. More specifically, a high level of worry enhanced the association between IU and symptoms of depression and anxiety. Given the potential for worry as a mechanism, and/or moderator between IU and symptoms of depression and anxiety, adults with a tendency to use this negative repetitive thought process (e.g. worry) may be at higher risk to develop psychological symptoms.
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Counsell A, Furtado M, Iorio C, Anand L, Canzonieri A, Fine A, Fotinos K, Epstein I, Katzman MA. Intolerance of uncertainty, social anxiety, and generalized anxiety: Differences by diagnosis and symptoms. Psychiatry Res 2017; 252:63-69. [PMID: 28254577 DOI: 10.1016/j.psychres.2017.02.046] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 12/10/2016] [Accepted: 02/19/2017] [Indexed: 11/27/2022]
Abstract
Research suggests that Intolerance of Uncertainty (IU) is related to the severity of suffering in Generalized Anxiety Disorder (GAD). However, its role in Social Anxiety Disorder (SAD) has not been extensively studied. This study examines IU in a clinical sample of 248 individuals referred to a tertiary care clinic. Few individuals had a diagnosis of pure SAD or pure GAD, but we examined differences of IU scores by diagnostic category. We further examined the relationships between IU scores, social anxiety scores, and worry through a structural equation model. We found that diagnostic category (SAD versus GAD) accounted for little variability in IU scores, but IU scores were strongly related to symptoms of both GAD and SAD. Results highlight that IU is related to both social anxiety and worry; however aspects of IU associated with being unable to act or avoiding uncertainty are more strongly associated with SAD symptoms, whereas aspects of IU more associated with general stress and perceiving uncertainty as unfair are more strongly associated with GAD symptoms. Our results suggest that IU is an important concept for both social anxiety and generalized anxiety, however the relationship between IU and symptoms of these disorders manifests differently.
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Affiliation(s)
- Alyssa Counsell
- Department of Psychology, York University, Toronto, ON, Canada
| | - Melissa Furtado
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
| | - Christina Iorio
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada; Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
| | - Leena Anand
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
| | | | - Alexa Fine
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
| | - Kathryn Fotinos
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
| | - Irvin Epstein
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
| | - Martin A Katzman
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada; Department of Psychology, Lakehead University, Thunder Bay, ON, Canada; The Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Adler Graduate Professional School, Toronto, ON, Canada.
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Andersson E, Hedman E, Wadström O, Boberg J, Andersson EY, Axelsson E, Bjureberg J, Hursti T, Ljótsson B. Internet-Based Extinction Therapy for Worry: A Randomized Controlled Trial. Behav Ther 2017; 48:391-402. [PMID: 28390501 DOI: 10.1016/j.beth.2016.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 07/11/2016] [Accepted: 07/17/2016] [Indexed: 11/26/2022]
Abstract
Worry is a common phenotype in both psychiatric patients and the normal population. Worry can be seen as a covert behavior with primary function to avoid aversive emotional experiences. Our research group has developed a treatment protocol based on an operant model of worry, where we use exposure-based strategies to extinguish the catastrophic worry thoughts. The aim of this study was to test this treatment delivered via the Internet in a large-scale randomized controlled trial. We randomized 140 high-worriers (defined as > 56 on the Penn State Worry Questionnaire [PSWQ]) to either Internet-based extinction therapy (IbET) or to a waiting-list condition (WL). Results showed that IbET was superior to WL with an overall large between-group effect size of d = 1.39 (95% confidence interval [1.04,1.73]) on the PSWQ. In the IbET group, 58% were classified as responders. The corresponding figure for WL participants was 7%. IbET was also superior to the WL on secondary outcome measures of anxiety, depression, meta-cognitions, cognitive avoidance, and quality of life. Overall treatment results were maintained for the IbET group at 4- and 12-month follow-up. The results from this trial are encouraging as they indicate that worry can be targeted with an accessible and novel intervention for worry. Replication trials with active control group are needed.
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Rabner J, Mian ND, Langer DA, Comer JS, Pincus D. The Relationship Between Worry and Dimensions of Anxiety Symptoms in Children and Adolescents. Behav Cogn Psychother 2017; 45:124-138. [PMID: 27852349 PMCID: PMC5405454 DOI: 10.1017/s1352465816000448] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Worry is a common feature across many anxiety disorders. It is important to understand how and when worry presents from childhood to adolescence to prevent long-term negative outcomes. However, most of the existing studies that examine the relationship between worry and anxiety disorders utilize adult samples. AIMS The present study aimed to assess the level of worry in children and adolescents and how relationships between worry and symptoms of separation anxiety disorder (SAD) and social anxiety disorder (Soc) may present differently at different ages. METHOD 127 children (age 8-12 years) and adolescents (age 13-18 years), diagnosed with any anxiety disorder, presenting at a child anxiety out-patient clinic, completed measures of worry, anxiety and depression. RESULTS Worry scores did not differ by age group. Soc symptoms were significantly correlated with worry in both age groups; however, SAD symptoms were only significantly correlated with worry in younger participants. After the inclusion of covariates, SAD symptoms but not Soc symptoms remained significant in the regression model with younger children, and Soc symptoms remained significant in the regression model with older children. CONCLUSIONS The finding that worry was comparable in both groups lends support for worry as a stable construct associated with anxiety disorders throughout late childhood and early adolescence.
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Affiliation(s)
- Jonathan Rabner
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
| | - Nicholas D. Mian
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
- University of New Hampshire, Manchester, NH
| | - David A. Langer
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
| | - Jonathan S. Comer
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
- Department of Psychology, Florida International University, Miami, Florida
| | - Donna Pincus
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
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Hearn CS, Donovan CL, Spence SH, March S. A worrying trend in Social Anxiety: To what degree are worry and its cognitive factors associated with youth Social Anxiety Disorder? J Affect Disord 2017; 208:33-40. [PMID: 27744124 DOI: 10.1016/j.jad.2016.09.052] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/27/2016] [Accepted: 09/30/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Comorbidity between Social Anxiety Disorder (SAD) and Generalized Anxiety Disorder (GAD) is extremely common. This study investigated whether factors commonly associated with GAD, including worry, intolerance of uncertainty (IU), positive and negative beliefs about worry (PBW, NBW), negative problem orientation (NPO) and cognitive avoidance (CA) were associated with SAD severity, symptoms and overall functioning. METHOD Participants included 126 youth aged 8-17 years (M=11.29, SD=2.67, Males n=50) with a primary diagnosis of SAD. Participants and a parent underwent a diagnostic interview and completed questionnaires at pre- and 12-week post assessment, and 6-month follow-up. Correlations and hierarchical multiple regression analyses were conducted. RESULTS Each of the cognitive variables, with the exception of PBW, was found to correlate with SAD symptoms, SAD severity and overall functioning. NPO emerged as an important predictor of SAD severity, self-reported ratings of SAD symptoms, and poorer levels of overall functioning. IU and worry also predicted self-rated SAD symptoms. LIMITATIONS Measures were chosen on the basis of their sound psychometrics however some were yet to undergo rigorous testing with youth populations. The study design is cross-sectional, which restricts firm conclusions regarding causal and temporal associations between the variables. CONCLUSIONS Findings from this study have implications for the specificity of GAD and SAD in youth. Further research is required to understand whether these cognitive variables play a maintaining role in youth SAD and the extent to which they might influence treatment.
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Affiliation(s)
- Cate S Hearn
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, Mount Gravatt, QLD 4122, Australia.
| | - Caroline L Donovan
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, Mount Gravatt, QLD 4122, Australia.
| | - Susan H Spence
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, Mount Gravatt, QLD 4122, Australia.
| | - Sonja March
- School of Psychology, Institute for Resilient Regions & School of Psychology and Counselling, University of Southern Queensland, Springfield, QLD 4300, Australia.
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LaFreniere LS, Newman MG. A BRIEF ECOLOGICAL MOMENTARY INTERVENTION FOR GENERALIZED ANXIETY DISORDER: A RANDOMIZED CONTROLLED TRIAL OF THE WORRY OUTCOME JOURNAL. Depress Anxiety 2016; 33:829-39. [PMID: 27062682 DOI: 10.1002/da.22507] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 03/14/2016] [Accepted: 03/15/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The efficacy of many cognitive behavioral component interventions has not been examined, with worry outcome monitoring among them. METHODS To address this issue, 51 participants with clinical levels of generalized anxiety disorder were randomly assigned to a treatment or control condition for 10 days. The treatment condition consisted of a brief ecological momentary intervention termed the Worry Outcome Journal (WOJ). WOJ participants recorded worries and tracked their outcomes, rating worry distress, interference, and expected outcome probabilities. Thought log (TL) control participants completed a record of their everyday thoughts and rated associated distress. All participants made four entries on paper each day when randomly prompted by text message. They then entered their paper contents online each night. After 30 days they reviewed their contents electronically and completed follow-up measures. RESULTS Primary results revealed significant reductions in worry for WOJ users compared to TL users at postintervention. A marginally significant difference was found at 20-day follow-up and treatment gains were maintained. Secondary analyses showed no harmful increases in worry beliefs for WOJ users, as well as preliminary evidence for decreases in beliefs about the uncontrollability of thoughts in both groups. CONCLUSION The WOJ may be a viable therapist-independent treatment for reducing worry, even after only 10 days of use.
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Affiliation(s)
- Lucas S LaFreniere
- Department of Psychology, The Pennsylvania State University, Pennsylvania.
| | - Michelle G Newman
- Department of Psychology, The Pennsylvania State University, Pennsylvania
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Spinhoven P, Drost J, van Hemert B, Penninx BW. Common rather than unique aspects of repetitive negative thinking are related to depressive and anxiety disorders and symptoms. J Anxiety Disord 2015; 33:45-52. [PMID: 26004746 DOI: 10.1016/j.janxdis.2015.05.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 05/01/2015] [Accepted: 05/01/2015] [Indexed: 10/23/2022]
Abstract
Repetitive Negative Thinking (RNT) is assumed to be a transdiagnostic factor in depressive and anxiety disorders. We hypothesized that an underlying common dimension of RNT will be more strongly associated with each of the anxiety and depressive disorders, with comorbidity among disorders and with symptom severity than unique aspects of rumination and worry. In a cross-sectional study, 2143 adults diagnosed according to DSM-IV criteria completed questionnaires for content-independent RNT, rumination and worry. 84% of the shared variance of worry and rumination overlapped with content-independent RNT. The common dimension of RNT was significantly associated with each of the depressive and anxiety disorders, comorbidity among emotional disorders and the common core of depressive, anxiety and avoidance symptoms. The unique portion of rumination showed a significant relationship with Major Depressive Disorder and depressive comorbidity and the unique portion of worry with Generalized Anxiety Disorder. These findings are particularly relevant for clinical practice as generic interventions to reduce RNT are currently being tested.
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Affiliation(s)
- Philip Spinhoven
- Leiden University, Institute of Psychology, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands; Leiden University Medical Center, Department of Psychiatry, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Jolijn Drost
- Leiden University, Institute of Psychology, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands.
| | - Bert van Hemert
- Leiden University Medical Center, Department of Psychiatry, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Brenda W Penninx
- Leiden University Medical Center, Department of Psychiatry, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; VU University Medical Center, Department of Psychiatry, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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26
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Pretorius C, Walker SP, Esterhuyse KG. The applicability of the metacognitive model of worry and generalized anxiety disorder in a non-clinical multi-ethnic sample of university students. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2015. [DOI: 10.1177/0081246314567890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This study explored the applicability of the metacognitive model of excessive worry and generalized anxiety disorder to the understanding of worry in a multi-ethnic context. A convenience sample of 1224 university students (female = 57.9%; Black = 49.9%) with a mean age of 19.77 years (standard deviation = 2.323) participated in the study. Following exploratory factor analysis, hierarchical regression analyses were employed to analyse the data. In combination, positive beliefs about worry, negative beliefs about worry, and cognitive control strategies emerged as significant predictors of worry intensity for the sample as a whole. However, only positive and negative beliefs about worry made independent contributions to the explanation of the variance in worry scores. Gender moderated the relationship between metacognition and worry. Viewing worry as a source of motivation was a unique predictor of worry intensity among women, while considering worry to be a positive personality trait emerged a distinctive predictor among males. The metacognitive model demonstrates cross-ethnic utility in understanding worry in a non-clinical population. The implications for theory and practice are discussed.
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Affiliation(s)
- Chrisma Pretorius
- Department of Psychology, University of the Free State, South Africa
| | - Stephen P Walker
- Unit for Professional Training and Services in the Behavioural Sciences, University of the Free State, South Africa
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27
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Relationship between trait repetitive negative thinking styles and symptoms of psychopathology. PERSONALITY AND INDIVIDUAL DIFFERENCES 2014. [DOI: 10.1016/j.paid.2014.07.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hendriks SM, Licht CMM, Spijker J, Beekman ATF, Hardeveld F, de Graaf R, Penninx BWJH. Disorder-specific cognitive profiles in major depressive disorder and generalized anxiety disorder. BMC Psychiatry 2014; 14:96. [PMID: 24690413 PMCID: PMC3975137 DOI: 10.1186/1471-244x-14-96] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 03/25/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This investigation examines differences in cognitive profiles in subjects with major depressive disorder (MDD) and generalized anxiety disorder (GAD). METHODS Data were used from subjects with current MDD (n = 655), GAD (n = 107) and comorbid MDD/GAD (n = 266) diagnosis from the Netherlands Study of Depression and Anxiety (NESDA). The Composite Interview Diagnostic Instrument was used to diagnose MDD and GAD. Cognitive profiles were measured using the Leiden Index of Depression Sensitivity, the Anxiety Sensitivity Index, and the Penn State Worry Questionnaire. RESULTS Results showed that differences in cognitive profiles between single MDD and single GAD subjects were present: scores on hopelessness/suicidality and rumination were significantly higher in MDD than GAD, whereas anxiety sensitivity for physical concerns and pathological worry were higher in GAD than MDD. The cognitive profile of comorbid MDD/GAD showed more extreme depression cognitions compared to single disorders, and a similar anxiety profile compared to single GAD subjects. CONCLUSIONS Despite the commonalities in cognitive profiles in MDD and GAD, there are differences suggesting that MDD and GAD have disorder-specific cognitive profiles. Findings of this investigation give support for models like the cognitive content-specificity model and the tripartite model and could provide useful handles for treatment focus.
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Affiliation(s)
- Sanne M Hendriks
- Department of Psychiatry, Pro Persona Mental Health Care, Willy Brandtlaan 20, Ede 6717 RR, The Netherlands.
| | - Carmilla MM Licht
- Department of Psychiatry, VU University Amsterdam, A.J. Ernststraat 887, Amsterdam 1081 HL, The Netherlands
| | - Jan Spijker
- Pro Persona Mental Health Care, Radboud University Nijmegen, Reinier Postlaan 6, 6525 GC Nijmegen, The Netherlands,Netherlands Institute of Mental Health and Addiction, Da Costakade 45, Utrecht 3521 VS, The Netherlands
| | - Aartjan TF Beekman
- Department of Psychiatry, VU University Amsterdam, A.J. Ernststraat 887, Amsterdam 1081 HL, The Netherlands
| | - Florian Hardeveld
- Department of Psychiatry, Pro Persona Mental Health Care, Willy Brandtlaan 20, Ede 6717 RR, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Da Costakade 45, Utrecht 3521 VS, The Netherlands
| | - Brenda WJH Penninx
- Department of Psychiatry, VU University Amsterdam, A.J. Ernststraat 887, Amsterdam 1081 HL, The Netherlands,Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands,Department of Psychiatry, University Medical Center Groningen, Hanzeplein 1, Groningen 9713 GZ, The Netherlands
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Abstract
Worry, characterized by repetitive and involuntary aversive thoughts about perceived concerns, is a central mental health complaint known to negatively impact quality of life of individuals facing perceived threats to health or well-being. Although empirical focus on worry has escalated over the past three decades, there has been less attention to current research trends and knowledge development related to this important phenomenon in nursing. This article presents a biobehavioral conceptual framework of worry for nursing application that is derived from a concept synthesis of biological, behavioral, clinical, and cognitive psychology sources.Databases including CINAHL, EBM Review, Health & Wellness Resource Center, PsycINFO, and PubMed were systematically reviewed for the years 2000–2012. The adapted conceptual framework describes relationships among perceived threat; process, structure, and content worry attributes; and outcomes of worry. The framework may be applied in clinical environments as a resource to better understand and care for patients facing perceived threats to health and well-being. The framework contributes a foundation to build empirical knowledge for nursing practice, theory, and research that has potential to improve patient well-being and health-related quality of life outcomes.
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30
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Kertz SJ, McHugh RK, Lee J, Björgvinsson T. Examining the latent structure of worry and generalized anxiety in a clinical sample. J Anxiety Disord 2014; 28:8-15. [PMID: 24334160 DOI: 10.1016/j.janxdis.2013.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 11/14/2013] [Accepted: 11/16/2013] [Indexed: 11/17/2022]
Abstract
Generalized anxiety disorder (GAD) is characterized by "pathological" worry, suggesting that GAD worriers differ qualitatively from non-GAD worriers. However, results from taxometric studies of worry in undergraduate and community samples have been mixed and to date, no studies have utilized clinical samples. The current study examined the latent structure of worry and GAD symptoms in a diagnostically heterogeneous clinical sample. Indicators were selected from the Penn State Worry Questionnaire-Abbreviated (n=1175) and the GAD-7 (n=638) and submitted to three taxometric procedures: MAXCOV, MAMBAC, and L-Mode. Results from all three procedures suggested that both worry and generalized anxiety are best conceptualized as dimensional constructs. Findings also indicated that ongoing conceptualization, assessment, and treatment of worry and GAD may be hampered by the application of a categorical framework.
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Affiliation(s)
- Sarah J Kertz
- McLean Hospital, Harvard Medical School, United States; Southern Illinois University, United States.
| | | | - Josephine Lee
- McLean Hospital, Harvard Medical School, United States
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Rudy BM, May AC, Whiting SE, Davis TE, Jenkins WS, Reuther ET. Differentiating Among Singular and Comorbid Obsessive–Compulsive Disorder and Social Phobia Symptomology. Cogn Behav Ther 2013; 43:111-21. [DOI: 10.1080/16506073.2013.859170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Starcevic V, Portman ME. The status quo as a good outcome: How the DSM-5 diagnostic criteria for generalized anxiety disorder remained unchanged from the DSM-IV criteria. Aust N Z J Psychiatry 2013; 47:995-7. [PMID: 24027082 DOI: 10.1177/0004867413503719] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Vladan Starcevic
- 1University of Sydney, Sydney Medical School - Nepean, Discipline of Psychiatry
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Asberg K. Hostility/anger as a mediator between college students' emotion regulation abilities and symptoms of depression, social anxiety, and generalized anxiety. THE JOURNAL OF PSYCHOLOGY 2013; 147:469-90. [PMID: 24003591 DOI: 10.1080/00223980.2012.715601] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Internalizing problems are common among college students and have been linked consistently to deficits in emotion regulation (ER). Also, hostility/anger (animosity toward others, phenomenological aspect of anger) is an important feature of internalizing problems, but has received limited attention as a mediator between ER and outcomes. Results (N = 160) indicated that although college students' ER abilities corresponded with all three types of internalizing symptoms, hostility/anger mediated fully the relationship for symptoms of depression and social anxiety, but not generalized anxiety (GAD). The stronger interpersonal aspect inherent in depression and social anxiety relative to GAD may in part explain findings, but findings must be viewed in lieu of limitations, which include self-report, a non-clinical sample, and a cross-sectional design. Overall, hostility/anger may be important to address in interventions and programs aimed at reducing internalizing problems, especially among those who demonstrate ER deficits and are prone to depression and social anxiety.
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Affiliation(s)
- Kia Asberg
- Western Carolina University, 91 Killian Building Lane, Room 302B, Cullowhee, NC 28723, USA.
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Merino H, Ferreiro F, Senra C. Cognitive Vulnerability to Emotional Symptoms: Reconsidering the Role of Worry and Rumination. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2013. [DOI: 10.1007/s10862-013-9374-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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35
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Rodríguez-Biglieri R, Vetere GL. Psychometric Characteristics of the Penn State Worry Questionnaire in an Argentinean Sample: A Cross-Cultural Contribution. SPANISH JOURNAL OF PSYCHOLOGY 2013; 14:452-63. [DOI: 10.5209/rev_sjop.2011.v14.n1.41] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although studies in several populations have provided support for Penn State Worry Questionnaire (PSQW) reliability and validity, factor analysis studies carried out on different populations show divergent results. The aim of this article is to contribute with the cross-cultural literature on PSWQ. This report describes two studies examining the psychometric characteristics of a revised Argentinean version of the PSWQ. In the first study, items of original PSWQ were translated into Spanish and then back-translated into English. Then, in order to examine its reliability and factorial structure, the instrument was completed by 400 community participants. The second study included two groups of participants as follows: patients with generalized anxiety disorder (GAD), and patients with other anxiety disorders (AC). Results revealed appropriated test-retest reliability over a four-week period, high internal consistency, and good convergent and discriminant validity for PSWQ. In concordance with some results reported in previous studies, a single factorial structure was confirmed for the Argentinean version of PSWQ. By the other hand, a receiver operating characteristic analysis was made to evaluate the ability of PSWQ to discriminate GAD from individuals with others anxiety disorders. A total score of 63 simultaneously optimized sensitivity and specificity in discriminating GAD patients from patients with others anxiety disorders.
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Assunção MC, Costa DLDC, de Mathis MA, Shavitt RG, Ferrão YA, do Rosário MC, Miguel EC, Torres AR. Social phobia in obsessive-compulsive disorder: prevalence and correlates. J Affect Disord 2012; 143:138-47. [PMID: 22858214 DOI: 10.1016/j.jad.2012.05.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 05/05/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Social Phobia (SP) is an anxiety disorder that frequently co-occurs with obsessive-compulsive disorder (OCD); however, studies that evaluate clinical factors associated with this specific comorbidity are rare. The aim was to estimate the prevalence of SP in a large multicenter sample of OCD patients and compare the characteristics of individuals with and without SP. METHOD A cross-sectional study with 1001 patients of the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders using several assessment instruments, including the Dimensional Yale-Brown Obsessive-Compulsive Scale and the Structured Clinical Interview for DSM-IV Axis I Disorders. Univariate analyses were followed by logistic regression. RESULTS Lifetime prevalence of SP was 34.6% (N=346). The following variables remained associated with SP comorbidity after logistic regression: male sex, lower socioeconomic status, body dysmorphic disorder, specific phobia, dysthymia, generalized anxiety disorder, agoraphobia, Tourette syndrome and binge eating disorder. LIMITATIONS The cross-sectional design does not permit the inference of causal relationships; some retrospective information may have been subject to recall bias; all patients were being treated in tertiary services, therefore generalization of the results to other samples of OCD sufferers should be cautious. Despite the large sample size, some hypotheses may not have been confirmed due to the small number of cases with these characteristics (type 2 error). CONCLUSION SP is frequent among OCD patients and co-occurs with other disorders that have common phenomenological features. These findings have important implications for clinical practice, indicating the need for broader treatment approaches for individuals with this profile.
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Affiliation(s)
- Melissa Chagas Assunção
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Univ. Estadual Paulista, SP, Brazil.
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Abstract
This article reviews the main issues associated with the concept and the diagnosis of generalized anxiety disorder (GAD) and examines the proposed DSM-5 diagnostic criteria for GAD. The lack of specific features, which is the primary issue for GAD, will not be addressed in DSM-5. The hallmark of the condition will remain pathological worry, although it also characterizes other disorders. Likewise, the proposed behavioral diagnostic criteria lack specificity for GAD, and it is not clear how these will be assessed. The proposed changes will lower the diagnostic threshold for GAD in DSM-5. Although this will not necessarily lead to a better recognition of GAD and an improvement in the perception of its relevance and clinical utility, many currently subthreshold cases will qualify for this diagnosis. The likely inclusion of many such "false-positives" will result in an artificial increase in the prevalence of GAD and will have further negative consequences.
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Kertz SJ, Bigda-Peyton JS, Rosmarin DH, Björgvinsson T. The importance of worry across diagnostic presentations: prevalence, severity and associated symptoms in a partial hospital setting. J Anxiety Disord 2012; 26:126-33. [PMID: 22078242 DOI: 10.1016/j.janxdis.2011.10.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 10/07/2011] [Accepted: 10/09/2011] [Indexed: 01/19/2023]
Abstract
Although excessive worry has been linked primarily with Generalized Anxiety Disorder (GAD), recent work suggests worry is dimensional, with potential relevance to a range of psychiatric disorders. The current study examined associations between worry and psychological symptoms across several primary diagnoses and tested worry's hypothesized unique relation to GAD in an acute psychiatric setting. Participants were 568 patients with primary diagnoses of Major Depression, Bipolar Disorder-Depressed, Bipolar Disorder-Manic, and Psychosis. Participants completed a structured diagnostic interview and questionnaires at admission. Partial correlations controlling for GAD diagnosis indicated that worry correlated with higher depression and poorer overall well-being in the Depressed, Bipolar-Depressed, and Psychosis groups and decreased functioning in the Depressed, Bipolar-Manic, and Psychosis groups. Depressed and Bipolar-Depressed groups endorsed the highest level of worry. A comorbid anxiety disorder was associated with higher worry across primary diagnoses, even after controlling for GAD. Of the anxiety disorders, GAD and Panic Disorder diagnoses predicted higher worry scores. Results discussed in terms of conceptual implications for worry as a transdiagnostic concept and clinical interventions.
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Affiliation(s)
- Sarah J Kertz
- McLean Hospital/Harvard Medical School, 115 Mill St., Belmont, MA 02478, USA.
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Drost J, Van der Does AJW, Antypa N, Zitman FG, Van Dyck R, Spinhoven P. General, Specific and Unique Cognitive Factors Involved in Anxiety and Depressive Disorders. COGNITIVE THERAPY AND RESEARCH 2011; 36:621-633. [PMID: 23144515 PMCID: PMC3490077 DOI: 10.1007/s10608-011-9401-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Comorbidity among anxiety and depressive disorders is the rule rather than the exception. The Integrative Hierarchical Model proposes that each of these disorders contains general (common to all), specific (common to some) and unique components. However, research into this model is limited and hampered by small (clinical) sample sizes. The aim of the present study is to investigate the incremental validity of the cognitive constructs Anxiety Sensitivity, Pathological Worry and Cognitive Reactivity to sad mood over and above the personality traits neuroticism and extraversion. Symptomatic (N = 1,111) and remitted (N = 834) patients were selected from the 2,981 participants of the Netherlands Study of Depression and Anxiety (NESDA). Results revealed both specific and unique cognitive components of anxiety and depression. Across symptomatic and remitted groups, Anxiety Sensitivity was specific to social anxiety disorder and panic disorder, Aggression Reactivity was a unique component of dysthymia, and Rumination on Sadness was unique to major depressive disorder. We conclude that cognitive constructs have additional value in understanding anxiety and depressive disorders. Moreover, they prove to be more than mere epiphenomena of current disorders.
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Affiliation(s)
- J Drost
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
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Do beliefs about the utility of worry facilitate worry? J Anxiety Disord 2011; 25:217-23. [PMID: 20956065 DOI: 10.1016/j.janxdis.2010.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 08/27/2010] [Accepted: 09/09/2010] [Indexed: 11/24/2022]
Abstract
Various theoretical models have pointed out the role of positive beliefs in the worry process (Dugas, Gagnon, Ladouceur, & Freeston, 1998; Wells, 1995). Two studies were conducted to search for experimental support for this possibility. After trait worry was controlled, a persuasion procedure was used to induce diverse beliefs about worry (positive, negative, or neutral). It was hypothesized that participants persuaded of the usefulness of worry would be more worried and more anxious after listening to a worrisome message. In the first study, 90 participants (62 females and 28 males) were exposed to a novel worrisome message, and in the second study, 60 participants (34 females and 26 males) were exposed to a more personally relevant worry. Results indicate that persuasion about the utility of worry does not trigger worry, and when prior positive beliefs about worry were controlled, they do not correlate with the change in anxiety after worrisome induction.
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Berle D, Starcevic V, Moses K, Hannan A, Milicevic D, Sammut P. Preliminary validation of an ultra-brief version of the Penn State Worry Questionnaire. Clin Psychol Psychother 2010; 18:339-46. [DOI: 10.1002/cpp.724] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
OBJECTIVES This study examined the factor structure of the adapted Ruminative Response Scale in a large Australian older adult sample. Previously, the factor structure has only been explored in small UK sample and thus remains tentative. A further objective was to explore overlapping and distinct characteristics of worry, brooding and reflection in relation to coping behaviour which has not previously been examined in older adults. METHOD A total of 138 older adults aged between 65 and 97 years (M = 77, SD = 7.9) completed a number of instruments to measure worry, rumination, anxiety and coping behaviour. RESULTS A three-factor structure comprised of worry, brooding and reflection emerged. However, no unique relationship was found between the rumination components (brooding and reflection) and worry and coping pathways. CONCLUSION The factor structure supports the idea that worry, brooding and reflection are distinguishable constructs in the elderly. However, the lack of differential associations between the rumination components and worry in relation to coping strategies provided evidence that rumination and worry are part of the same theoretical construct of repetitive thought. The implications of these findings for the management of anxiety and depression in the elderly are discussed.
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A taxometric investigation of the latent structure of worry: dimensionality and associations with depression, anxiety, and stress. Behav Ther 2010; 41:212-28. [PMID: 20412886 DOI: 10.1016/j.beth.2009.03.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 02/25/2009] [Accepted: 03/08/2009] [Indexed: 11/24/2022]
Abstract
Worry has been described as a core feature of several disorders, particularly generalized anxiety disorder (GAD). The present study examined the latent structure of worry by applying 3 taxometric procedures (MAXEIG, MAMBAC, and L-Mode) to data collected from 2 large samples. Worry in the first sample (Study 1) of community participants (n=1,355) was operationalized by worry engagement, absence of worry, and the worry feature of trait anxiety. Worry in the second sample (Study 2) of undergraduate participants (n=1,171) was operationalized by the tendency to experience worry, intolerance of uncertainty, beliefs about worry, and symptoms of GAD. Results across both samples provided converging evidence that worry is best conceptualized as a dimensional construct, present to a greater or lesser extent in all individuals. Findings from Study 2 also indicated that the latent dimension of worry generally has an equal association with symptoms of depression, anxiety, and stress across the entire continuum. These findings are discussed in relation to the conceptualization and assessment of worry in GAD and related disorders.
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Olatunji BO, Wolitzky-Taylor KB, Sawchuk CN, Ciesielski BG. Worry and the anxiety disorders: A meta-analytic synthesis of specificity to GAD. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.appsy.2011.03.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Scott SL, Carper TM, Middleton M, White R, Renk K, Grills-Taquechel A. Relationships Among Locus of Control, Coping Behaviors, and Levels of Worry Following Exposure to Hurricanes. JOURNAL OF LOSS & TRAUMA 2010. [DOI: 10.1080/15325020902925985] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Salzer S, Stiller C, Tacke-Pook A, Jacobi C, Leibing E. Screening for Generalized Anxiety Disorder in inpatient psychosomatic rehabilitation: pathological worry and the impact of depressive symptoms. PSYCHO-SOCIAL MEDICINE 2009; 6:Doc02. [PMID: 19742048 PMCID: PMC2736478 DOI: 10.3205/psm000058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Pathological worry is considered to be a defining feature for Generalized Anxiety Disorder (GAD). The Penn State Worry Questionnaire (PSWQ) is an instrument for assessing pathological worry. Two earlier studies demonstrated the suitability of the PSWQ as screening instrument for GAD in outpatient and non-clinical samples. This study examined the suitability of the PSWQ as a screening instrument for GAD in a German inpatient sample (N=237). Furthermore, a comparison of patients with GAD and patients with depression and other anxiety disorders regarding pathological worry and depression was carried out in a sub-sample of N=118 patients. METHOD Cut-off scores optimizing sensitivity, optimizing specificity and simultaneously optimizing both sensitivity and specificity were calculated for the PSWQ score by receiver operating characteristic analysis (ROC). Differences regarding pathological worry and depression measured by the PSWQ and the Beck Depression Inventory (BDI) across five diagnostic subgroups were examined by conducting one-way ANOVAs. The influence of depression on pathological worry was controlled by conducting an ANCOVA with BDI score as a covariate. RESULTS The ROC analysis showed an area under the curve of AUC=.67 (p=0.02) with only 54.4% of the patients correctly classified. Comparison of diagnostic subgroups showed that after controlling the influence of depression, differences referring to pathological worry between diagnostic subgroups no longer existed. CONCLUSIONS Contrary to the earlier results we found that the use of the PSWQ as a screening instrument for GAD at least in a sample of psychotherapy inpatients is not meaningful. Instead of that, the PSWQ can be used to discriminate high from low worriers in clinical samples. Thus, the instrument can be useful in establishing e.g. symptom-oriented group interventions as they are established in behavioural-medicine inpatient settings. Furthermore, our findings stress the influence of (comorbid) depressive symptoms on the process of worrying.
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Affiliation(s)
- Simone Salzer
- Clinic of Psychosomatic Medicine and Psychotherapy, Georg-August University Goettingen, Germany
| | - Christian Stiller
- Clinic of Psychosomatic Medicine and Psychotherapy, Georg-August University Goettingen, Germany
| | | | - Claus Jacobi
- Paracelsus-Roswitha-Klinik, Bad Gandersheim, Germany
| | - Eric Leibing
- Clinic of Psychosomatic Medicine and Psychotherapy, Georg-August University Goettingen, Germany
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Intolerance of uncertainty and social anxiety. J Anxiety Disord 2009; 23:130-5. [PMID: 18565725 DOI: 10.1016/j.janxdis.2008.04.007] [Citation(s) in RCA: 237] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 04/29/2008] [Accepted: 04/29/2008] [Indexed: 11/23/2022]
Abstract
Research has shown that intolerance of uncertainty (IU)--the tendency to react negatively to situations that are uncertain--is involved in generalized anxiety disorder (GAD). There is uncertainty about the specificity of IU. Some studies have shown that IU is specific for GAD. Other studies have shown that IU is also involved in obsessive compulsive disorder (OCD). No studies have yet examined IU in social anxiety, although it is possible that IU plays a role in anxiety responses that can be experienced in social-evaluative situations. This study examined the relationship between IU and social anxiety among 126 adults. Findings revealed that IU explained a significant amount of variance in social anxiety severity when controlling for established cognitive correlates of social anxiety (e.g., fear of negative evaluation) and for neuroticism. Furthermore, it was found that IU was related with symptom levels of GAD, OCD, and social anxiety, but not depression, when controlling the shared variance among these symptoms.
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Hendriks GJ, Oude Voshaar RC, Keijsers GPJ, Hoogduin CAL, van Balkom AJLM. Cognitive-behavioural therapy for late-life anxiety disorders: a systematic review and meta-analysis. Acta Psychiatr Scand 2008; 117:403-11. [PMID: 18479316 DOI: 10.1111/j.1600-0447.2008.01190.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine and estimate the efficacy of cognitive-behavioural therapy (CBT) for late-life anxiety disorders. METHOD A systematic review and meta-analysis of randomized controlled trials comparing CBT with i) a waiting-list control condition and ii) an active control condition controlling for non-specific effects in patients aged over 60 years and suffering from an anxiety disorder. The main outcome parameter of individual studies, i.e. effect on anxiety, was pooled using the standardized mean difference (SMD). RESULTS Seven papers fulfilled the inclusion criteria, including nine randomized controlled comparisons for 297 patients. Anxiety symptoms were significantly more reduced following CBT than after either a waiting-list control condition [SMD = -0.44 (95 CI: -0.84 -0.04), P = 0.03] or an active control condition [SMD = -0.51 (95 CI: -0.81, -0.21), P<0.001]. Additionally, CBT significantly alleviated accompanying symptoms of worrying and depression. CONCLUSION Cognitive-behavioural therapy is efficacious for the treatment of late-life anxiety disorders.
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Affiliation(s)
- G J Hendriks
- Department for Anxiety Disorders Overwaal, Forum GGz Nijmegen, Nijmegen, The Netherlands.
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