Excessive reassurance seeking and anxiety pathology: tests of incremental associations and directionality

The influence of attachment style on support and feedback seeking and depression severity among mothers during the COVID-19 pandemic

OBJECTIVES

The ways that people seek support during times of stress influence their mental health outcomes, including depression. Insecure attachment is a risk factor for depression and may also interfere with adaptive support and feedback-seeking behaviour during stress. The purpose of the present study was to test theorized associations between insecure attachment, support and feedback seeking, and changes in depression symptoms over 1 year, in a sample of mothers of school-age children in the context of stress elicited by the COVID-19 pandemic.

METHODS

Participants (N = 70 mothers) completed self-report measures of anxious and avoidant attachment and depression severity at baseline in spring 2020 and then completed measures of past-year engagement in direct and indirect support seeking and excessive reassurance seeking (ERS), preference for negative feedback, and depression severity at a follow-up assessment in summer 2021.

RESULTS

Greater attachment anxiety at baseline predicted more frequent direct support seeking, indirect support seeking, and ERS during the 1-year follow-up period. In turn, greater indirect support seeking predicted greater increases in depression from baseline to follow-up. Greater attachment avoidance at baseline predicted less direct support seeking during the 1-year follow-up period. Greater attachment avoidance at baseline also predicted depression severity at follow-up, particularly among mothers with moderate to high levels of attachment anxiety, although none of the examined support and feedback-seeking behaviours mediated this association.

CONCLUSIONS

These results provide support for the role of activated attachment systems in determining support and feedback-seeking behaviour during stress, as well as the role of support and feedback-seeking behaviour in the maintenance and exacerbation of depression.

Care trajectories of individuals with anxiety disorders: A retrospective cohort study

BACKGROUND

Anxiety disorders (ADs) are associated with increased healthcare use (HCU), and individuals may seek healthcare through various pathways according to clinical and individual characteristics. This study aimed to characterize care trajectories (CTs) of individuals with ADs.

METHODS

This is a retrospective cohort study using the Care Trajectories - Enriched Data cohort, a linkage between the Canadian Community Health Surveys (CCHS), and health administrative data from Quebec. The cohort included 5143 respondents reporting ADs to the CCHS between 2009 and 2016. We measured CTs over 5 years before CCHS using a state sequence analysis.

RESULTS

The cohort was categorized into five types of CTs. Type 1 (52.7 %) was the lowest care-seeking group, with fewer comorbidities. Type 2 (24.0 %) had higher levels of physical and mental health comorbidities and moderate HCU, mainly ambulatory visits to general practitioners. Type 3 (13.1 %) represented older patients with the highest level of physical illnesses and high HCU, predominantly ambulatory consultation of specialists other than psychiatrists. Types 4 and 5 combined young and middle-aged patients suffering from severe psychological distress. HCU of type 4 (6.7 %) was high, mainly consultations of ambulatory psychiatrists, and HCU of type 5 (3.5 %), was the highest and mostly in acute care.

LIMITATIONS

Administrative and survey data may have coding errors, missing data and self-report biases.

CONCLUSION

Five types of CTs showed distinct patterns of HCU often modulated by physical and mental health comorbidities, which emphasizes the importance of considering ADs when individuals seek care for other mental health conditions or physical illness.

Elevated depression and anxiety predict future patterns of individualistic and collectivistic cultural values: A cross-lagged longitudinal network analysis

BACKGROUND

Specific components of independent and interdependent self-construal have been associated with psychopathology. However, most studies on this topic have been cross-sectional, precluding causal inferences. We used contemporaneous and temporal cross-lagged network analysis to establish weak causal effects in understanding the association between self-construal and psychopathology components.

METHODS

Middle-aged and older community-dwelling adults (n = 3294) participated in the Midlife Development in the United States study across two time-points, spaced nine years apart. Six self-construal (interdependence: connection to others, commitment to others, receptiveness to influence; independence: behavioral consistency, sense of difference from others, self-reliance) and three psychopathology nodes (major depressive disorder (MDD), generalized anxiety disorder (GAD), and panic disorder (PD) symptom severity) were examined. All network analyses controlled for age, sex, race, and number of chronic illnesses as covariates.

RESULTS

Contemporaneous and temporal networks yielded relations between elevated MDD and PD and increased receptiveness to influence. Heightened GAD symptom severity was associated with future increased difference from others and decreased connection to others, commitment to others, and receptiveness to influence. Higher MDD, GAD, and PD severity were associated with future lower self-reliance. Network comparison tests revealed no consistent network differences across sex and race.

LIMITATIONS

DSM-III-R measures of MDD, GAD, and PD were used. Results may not generalize to culturally diverse racial groups.

CONCLUSIONS

Changes in self-construal may result from increased MDD, GAD, and PD severity. Findings suggest the importance of targeting common mental health symptoms to positively influence how individuals view the self and others in various social contexts.

Investigating psychological and motivational predictors of problematic smartphone use among Smartphone-based Social Networking Service (SNS) users

Given that the active use of certain smartphone applications is associate with problematic smartphone use, it has been proposed that certain smartphone applications are more addictive than others, such as Social Networking Services (SNS). Still, studies that consider smartphone users' main usage application which are known to influence the users' problematic smartphone use, such as SNS, remain to be explored. Thus, the current study aims to investigate the psychological and motivational predictors of problematic smartphone use in a sample of smartphone-based SNS users whose main device usage is SNS. A series of mean comparison tests and binary logistic regression were performed in this study. Of the 433 smartphone-based SNS users, 218 were male (50.3%) and 215 were female (49.7%). Age of 433 participants ranged from 20 to 40, and mean age was 30.75 (SD = 7.84). 73 participants (16.9%) were sorted into the high-risk problematic smartphone use group and 360 participants (83.1%) were categorized as the normal user group. The finding from binary regression analysis showed that reward responsiveness from the Behavioral Activation System (BAS), a lack of self-control, and anxiety significantly increased the odds of problematic smartphone use of the smartphone-based SNS users. Reward responsiveness was found to be the most powerful predictor. Our findings broaden the existing literature and provide implications to reduce addictive smartphone use relating to smartphone-based SNS usage.

Is everything really okay?: Using ecological momentary assessment to evaluate daily co-fluctuations in anxiety and reassurance seeking

OBJECTIVE

Reassurance seeking, a behavior prominent in anxiety disorders and depression, is associated with poorer quality of interpersonal relationships and acts as a mechanism of stress generation. However, little research has elucidated momentary associations between state anxiety and reassurance seeking behaviors.

METHOD

In a sample of 104 university-affiliated young adults, we sought to replicate cross-sectional associations of reassurance seeking with trait anxiety (Aim 1) and intolerance of uncertainty (Aim 2). We then used ecological momentary assessment (EMA) to evaluate concurrent fluctuations in daily anxiety and reassurance seeking across 14 consecutive days (Aim 3). Hierarchical multi-level models for intensive longitudinal data were used to evaluate the relationship between state anxiety and daily reassurance seeking.

RESULTS

In baseline analyses, trait anxiety and intolerance of uncertainty were significantly associated with greater trait reassurance seeking, controlling for depression. Analyses of the EMA data showed that daily reassurance seeking behaviors fluctuated concurrently with daily anxiety during the 14 days, while controlling for trait anxiety and depression.

CONCLUSION

Given evidence of concurrent fluctuations between state anxiety and reassurance seeking, the behavior should be considered as a potential target in treatment for anxiety disorders.

Adolescents' Hormonal Responses to Social Stress and Associations with Adolescent Social Anxiety and Maternal Comfort: A Preliminary Study

Both social support and social stress can impact adolescent physiology including hormonal responses during the sensitive transition to adolescence. Social support from parents continues to play an important role in socioemotional development during adolescence. Sources of social support and stress may be particularly impactful for adolescents with social anxiety symptoms. The goal of the current study was to examine whether adolescent social anxiety symptoms and maternal comfort moderated adolescents' hormonal response to social stress and support. We evaluated 47 emotionally healthy 11- to 14-year-old adolescents' cortisol and oxytocin reactivity to social stress and support using a modified version of the Trier Social Stress Test for Adolescents that included a maternal comfort paradigm. Findings demonstrated that adolescents showed significant increases in cortisol and significant decreases in oxytocin following the social stress task. Subsequently, we found that adolescents showed significant decreases in cortisol and increases in oxytocin following the maternal comfort paradigm. Adolescents with greater social anxiety symptoms showed higher levels of cortisol at baseline but greater declines in cortisol response following maternal social support. Social anxiety symptoms were unrelated to oxytocin response to social stress or support. Our findings provide further evidence that mothers play a key role in adolescent regulation of physiological response, particularly if the stressor is consistent with adolescents' anxiety. More specifically, our findings suggest that adolescents with higher social anxiety symptoms show greater sensitivity to maternal social support following social stressors. Encouraging parents to continue to serve as a supportive presence during adolescent distress may be helpful for promoting stress recovery during the vulnerable transition to adolescence.

Intolerance of uncertainty and emotion regulation: A meta-analytic and systematic review

Intolerance of uncertainty, a transdiagnostic factor manifested across emotional disorders, has been associated with difficulties in regulating emotions. This meta-analysis addresses the lack of synthesis of this relationship. PsycInfo, PubMed, Scopus, and ProQuest were systematically searched for relevant articles published up to and during November 2022. We combined 161 effect sizes from 91 studies (N = 30,239), separating the analysis into maladaptive and adaptive emotion regulation strategies and their association with intolerance of uncertainty. We found a moderate positive relationship between maladaptive, and a moderate inverse relationship between adaptive emotion regulation and intolerance of uncertainty. Analysing the magnitude of relationships revealed that cognitive avoidance and mindfulness were the maladaptive and adaptive strategies respectively which had the largest effect sizes and thus strongest relationships with intolerance of uncertainty. Combining all strategies, cognitive avoidance remained the largest effect size, while expressive suppression had the smallest effect size and was non-significant in its relationship. Further analyses testing study sample, design, and age as moderators found no significant moderator for the relationships between intolerance of uncertainty and emotion regulation strategies. These findings have implications for future intolerance of uncertainty interventions, with emotion regulation as a potential target of change.

Stress can lead to an increase in smartphone use in the context of texting while walking

Texting while walking (TWW) is a dangerous behavior that can lead to injury and even death. While several studies have examined the relationship between smartphone use and stress, to our knowledge no studies have yet investigated the relationship between stress and TWW. The objective of the present study was to investigate this relationship by examining the effects of stress on TWW, the effects of TWW on subsequent stress, and the effect of stress on multitasking performance. A total of 80 participants completed two sequential tasks in a laboratory while they walked on a treadmill and responded to a biological motion stimulus imitating the movement of another pedestrian. In the unrestricted task, participants were given the choice to use their personal phones. In the controlled task, they carried a text conversation with a research assistant while they walked and responded to the stimulus. Stress was measured via questionnaire and saliva collection for measure of cortisol (a stress hormone) before and after each task. Results show that greater psychological stress and cortisol variations were associated with a greater number of phone uses during the unrestricted task. Greater phone use during the unrestricted task was associated with lower subsequent psychological stress in women and total time of phone use was correlated with subsequent cortisol levels. Stress measured before the controlled task had no effect on multitasking performance, but participants with moderate performance were those with the highest cortisol levels. Our results suggest that stress could be a precursor to TWW and that it could affect a pedestrian’s ability to stay safe when using their smartphone.

Difficulties in interpersonal regulation of emotions (DIRE) questionnaire: Psychometric Properties of the Italian Version and Associations with psychopathological symptoms

The goal of this research was to validate an Italian adaptation of the questionnaire Difficulties in Interpersonal Regulation of Emotions (DIRE) and to investigate its associations with psychopathology. An Italian sample (N = 630) completed the DIRE and the Symptom Checklist-90 (SCL-90). We tested the factorial structure of the DIRE using explorative and confirmatory factorial analyses; we analysed the convergent validity in terms of zero-order correlations with SCL-90 dimensions; and, we conducted multiple regressions to test the predictivity of DIRE factors on specific SCL-90 dimensions. The Italian DIRE replicated the four-factor structure of the original measure, with two interpersonal (Vent and Reassurance-seek) and two intrapersonal (Accept and Avoid) factors. Interpersonal factors resulted correlated with SCL-90 global indexes of psychopathology. Moreover, specific association between DIRE factors and SCL-90 dimensions were found. The Italian DIRE is a reliable and valid measure to evaluate clinically-relevant forms of emotion dysregulation.

Resting-State Functional Connectivity Differences Following Experimental Manipulation of the Orbitofrontal Cortex in Two Directions via Theta-Burst Stimulation

Compulsive behaviors (CBs) have been linked to orbitofrontal cortex (OFC) function in animal and human studies. However, brain regions function not in isolation but as components of widely distributed brain networks—such as those indexed via resting-state functional connectivity (RSFC). Sixty-nine individuals with CB disorders were randomized to receive a single session of neuromodulation targeting the left OFC—intermittent theta-burst stimulation (iTBS) or continuous TBS (cTBS)—followed immediately by computer-based behavioral “habit override” training. OFC seeds were used to quantify RSFC following iTBS and following cTBS. Relative to cTBS, iTBS showed increased RSFC between right OFC (Brodmann’s area 47) and other areas, including dorsomedial prefrontal cortex (dmPFC), occipital cortex, and a priori dorsal and ventral striatal regions. RSFC connectivity effects were correlated with OFC/frontopolar target engagement and with subjective difficulty during habit-override training. Findings help reveal neural network-level impacts of neuromodulation paired with a specific behavioral context, informing mechanistic intervention development.

Excessive-reassurance seeking and mental health: Interpersonal networks for emotion regulation

In the context of research on depression, previous studies have explained relationships between excessive-reassurance seeking and mental health from the perspective of interpersonal rejection by significant others. The present study examined the mechanisms underlying these relationships from the perspective of “emotionships”, which indicates the diversity of interpersonal networks for emotion regulation. We also examined how the most significant other’s interpersonal acceptance plays a role in processes that underlie the relationship between excessive-reassurance seeking and mental health as mediated through emotionships. 118 students completed three questionnaires. First, they completed measures of excessive-reassurance seeking, depression and well-being. Second, to assess emotionships, participants nominated individuals they seek in different emotion regulation scenarios. Third, participants selected the most significant other that they nominated previously and answered questions about this individual’s acceptance tendency. Moderated mediation analysis results indicated that in a case that the most significant other did not tend to accept others, those who engaged in excessive-reassurance seeking had fewer emotionships, and fewer emotionships predicted deterioration of well-being. In contrast, when the most significant other tended to accept others, these negative effects of ERS behavior on well-being via emotionships were not found. These findings suggest that maintaining interpersonal networks for emotion regulation and the most significant other’s interpersonal acceptance may be important for preventing deterioration of mental health among excessive-reassurance seekers.

Validation of the Korean Version of the Coronavirus Reassurance-Seeking Behaviors Scale During the COVID-19 Pandemic

OBJECTIVE

In this study, we aimed to develop a Korean version of the Coronavirus Reassurance-Seeking Behaviors Scale (CRBS) and to explore its reliability and validity among the general population in South Korea.

METHODS

Using an online survey conducted during November 9-15, 2021, we collected the demographic data of 400 individuals and their responses to rating scales such as the CRBS, the Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), the Generalized Anxiety Disorder-7 items (GAD-7), and the Patient Health Questionnaire-9 items (PHQ-9). We conducted factor analyses and utilized item response theory to confirm the validity and reliability of the Korean version of the CRBS.

RESULTS

Factor analyses revealed that the single factor model of the Korean version of the CRBS showed a good fit with the CRBS (χ2=5.475, df=5, p value=0.361, χ2/df=1.095, CFI=0.999, TLI=0.998, RMSEA=0.015). Multigroup CFA results indicated that the CRBS measures reassurance-seeking behaviors consistently across variables of sex, depression, general anxiety, and viral anxiety. The CRBS also exhibited good convergent validity with the SAVE-6 (r=0.431, p<0.001), GAD-7 (r=0.574, p<0.001), and PHQ-9 (r=0.575, p<0.001).

CONCLUSION

The CRBS is a reliable and valid rating scale that measures reassurance-seeking behavior in relation to viral epidemics.

COVID-19 News and Its Association with the Mental Health of Sexual and Gender Minority Adults: A Cross-Sectional Study

Background

Sexual and gender minority (SGM; people whose sexual orientation is not heterosexual or whose gender identity varies from what is traditionally associated with the sex assigned to them at birth) people experience high rates of trauma and substantial disparities in anxiety and posttraumatic stress disorder (PTSD). Exposure to traumatic stressors such as news related to COVID-19 may be associated with symptoms of anxiety and PTSD.

Objective

This study aims to evaluate the relationship of COVID-19 news exposure with anxiety and PTSD symptoms in a sample of SGM adults in the United States.

Methods

Data were collected between March 23 and August 2, 2020, from The PRIDE Study, a national longitudinal cohort study of SGM people. Regression analyses were used to analyze the relationship between self-reported news exposure and symptoms of anxiety using the Generalized Anxiety Disorder-7 and symptoms of COVID-19–related PTSD using the Impact of Events Scale-Revised.

Results

Our sample included a total of 3079 SGM participants. Each unit increase in COVID-19–related news exposure was associated with greater anxiety symptoms (odds ratio 1.77, 95% CI 1.63-1.93; P<.001) and 1.93 greater odds of PTSD (95% CI 1.74-2.14; P<.001).

Conclusions

Our study found that COVID-19 news exposure was positively associated with greater symptoms of anxiety and PTSD among SGM people. This supports previous literature in other populations where greater news exposure was associated with poorer mental health. Further research is needed to determine the direction of this relationship and to evaluate for differences among SGM subgroups with multiple marginalized identities.

The contribution of attachment styles and reassurance seeking to trust in romantic couples

The current daily diary study examined the moderating impact of attachment style on the association between excessive reassurance seeking (ERS) behavior and trust in romantic dyads. A sample of 110 heterosexual couples completed measures of attachment, ERS, and relationship trust. In line with prior research, an anxious attachment style was associated with higher daily ERS, and an avoidant attachment style with lower daily ERS. Lower levels of trust were also associated with greater daily ERS. Moreover, analyses remained significant while controlling for symptoms of depression. This study extended the literature by demonstrating that for women with an anxious attachment style, and men with an avoidant attachment style, ERS was related to lower next day trust. In contrast, the partners of men with an avoidant attachment style, who also engaged in ERS, reported higher levels of next day trust. This study was also the first to examine how individual attachment styles influenced the perception of, and reactions to, ERS. Women with an anxious attachment style liked when their male partners engaged in ERS, as illustrated by higher levels of reported trust. These results support the idea that attachment styles play an important role in determining whether or not ERS leads to negative interpersonal consequences. They also suggest that it is the combination of relationship insecurities and ERS that leads to negative interpersonal consequences.

The Mediating Effect of Reassurance-Seeking Behavior on the Influence of Viral Anxiety and Depression on COVID-19 Obsession Among Medical Students

OBJECTIVES

Healthcare workers experienced great psychological burden due to the continuation of the COVID-19 pandemic. During the pandemic, medical healthcare workers experienced greater instances of insomnia, anxiety, depression, somatization, and obsessive-compulsive symptoms than the general population. This study aimed to explore the association between viral anxiety and obsession with COVID-19 among medical students with reassurance-seeking behavior as a mediator.

METHODS

In October 2021, an online survey was conducted among medical students at the University of Ulsan College of Medicine. The clinical characteristics of 162 participants and their responses to rating scales, including stress and anxiety to viral Epidemics-6 items (SAVE-6), Coronavirus Reassurance-Seeking Behaviors Scale (CRBS), Patient Health Questionnaire-9 items (PHQ-9), and Obsession with COVID-19 scale were collected.

RESULTS

Medical students' obsession with COVID-19 was based on the PHQ-9 (β = 0.15, p = 0.01), SAVE-6 (β = 0.43, p < 0.001), and CRBS (β = 0.38, p < 0.001) scores (adjusted R² = 0.49, F = 39.9, p < 0.001). Mediation analysis showed that medical students' viral anxiety and depression directly influenced their obsession with COVID-19, and their reassurance-seeking behavior partially mediated the effects of depression or viral anxiety on obsession with COVID-19.

CONCLUSIONS

Medical students' viral anxiety and depression may affect their obsession with COVID-19, and reassurance-seeking behaviors may mediate this. Therefore, medical students should adopt adaptive coping strategies to prevent high levels of viral anxiety and recurrent reassurance-seeking behavior.

Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder

Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.

The Relationship between Social Anxiety, Smartphone Use, Dispositional Trust, and Problematic Smartphone Use: A Moderated Mediation Model

BACKGROUND

The pervasiveness of smartphones has raised concerns about an increase in the prevalence of problematic smartphone use (PSU), which depends on a set of psychological and behavioral risk factors. Previous research has yielded mixed results on factors predicting PSU, including social anxiety and trust. In particular, the role of trust remained largely unexplored. In the present study, we aimed to investigate the relationship between social anxiety and PSU, via the mediating role of time spent on the phone, and to explore the moderating role of dispositional trust toward others, by using a moderated mediation model with PSU as the outcome.

METHODS

A total of 240 young adults (M_age = 23.33, SD = 3.90, 50% male) answered an online questionnaire, which included the 12-item Social Anxiety Scale, a question on the daily duration of smartphone use, a single-item measure of dispositional trust, and the 10-item Smartphone Addiction Scale Short Version. Gender and occupational status were included as covariates.

RESULTS

Social anxiety was significantly and positively related to PSU; however, smartphone use did not mediate this relationship. Although the relationship between smartphone use and PSU was significant and positive, the link between social anxiety and smartphone use was not. Dispositional trust moderated and strengthened the direct relationships between social anxiety and PSU as well as smartphone use and PSU.

CONCLUSIONS

Heavy smartphone users as well as socially anxious individuals, with the tendency of trusting others, are more at risk of PSU, which can be explained by their preference and search for online connections.

Intrapersonal Emotion Regulation Difficulties and Maladaptive Interpersonal Behavior in Adolescence

Although most research conceptualizes emotion regulation as an internal process (i.e., intrapersonal), emotions are frequently regulated in an interpersonal context. Adolescents may be particularly prone to turn to peers for assistance, given that honing emotion regulation abilities is a key task and peers become increasingly important at this stage. Adolescents each participated with a self-nominated same-gender friend (total N = 186; M age = 15.68 years). All participants provided self-reports of their own emotion regulation difficulties and their engagement in interpersonal behaviors (excessive reassurance seeking, negative feedback seeking, conversational self-focus, self-disclosure) as well as their perceptions of their friends' engagement in excessive reassurance seeking and conversational self-focus. Using a cross-lagged panel model design, the current study tested associations between adolescents' intrapersonal emotion regulation difficulties and engagement in self- and friend-reported interpersonal emotion regulation behaviors at 3 time points over 6 months. Gender and age group differences were considered. Results evidenced concurrent and longitudinal associations between emotion regulation difficulties and self-reported maladaptive (excessive reassurance seeking, conversational self-focus, negative feedback seeking), but not adaptive (self-disclosure), interpersonal regulatory behaviors. Friends' reports of adolescents' excessive reassurance seeking and conversational self-focus were associated concurrently, but not longitudinally, with self-reported emotion regulation difficulties. Implications for clinical intervention with adolescents struggling to regulate emotions are discussed.

Associations Between Social Anxiety, Depression, and Use of Mobile Dating Applications

This study explores associations between symptoms of social anxiety (SA) and depression with participants' extent of dating app use, self-reported motivations for dating app use, and likelihood of initiating interaction with dating app matches. Three-hundred seventy-four participants completed an online battery of surveys that examined psychopathology and dating app use. SA and depression symptoms were positively associated with participants' extent of dating app use, and symptoms of psychopathology and gender interacted to predict various dating app use motivations. Symptoms of SA and depression predicted lower likelihood of initiating contact with a dating app match among men but not women. This study provides an initial step toward understanding the relationship between SA, depression, and use of dating apps.

Depression and anxiety symptoms are associated with problematic smartphone use under the COVID-19 epidemic: The mediation models

COVID-19 epidemic has brought wide psychological impacts on the young adults. To investigate the depression and anxiety symptoms and their associations with problematic smartphone use under the COVID-19 epidemic, a total of 847 Chinese undergraduate students joined in this study and were measured with their levels of depression and anxiety symptoms, resilience, perceived social support, the sense of school belonging and problematic smartphone use. Results showed that among the Chinese undergraduate students, the disorder rates of depression and anxiety symptoms were 29.16% and 46.64% respectively, and their symptoms ranged from mild to extreme severe. Depression and anxiety symptoms both positively predicted problematic smartphone use. Resilience, perceived social support and the sense of school belonging partially mediated both associations; resilience and the sense of school belonging exerted buffering effects, while perceived social support exacerbated the impacts. The current study advanced our understanding of the COVID-19 impacts and furthermore, suggested the protective factors for mitigating these impacts.

NEGATIVE FEEDBACK SEEKING AND EXCESSIVE REASSURANCE SEEKING BEHAVIOR AND DEPRESSION: A META-ANALYTIC REVIEW

Introduction: Negative feedback seeking and excessive reassurance seeking behaviors in interpersonal relationships have been shown to frequently occur in conjunction with levels of depression.

Method: We used meta-analysis to examine 102 studies (134 effects), relating depression with negative feedback seeking (k = 31) and/or excessive reassurance seeking (k = 103).

Results: Depression had positive, moderate effect sizes with both negative feedback seeking (r = .26, 95% CI [.21, .32], p < .001, k = 31) and excessive reassurance seeking (r = .33, 95% CI [.31, .36] p < .001, k = 103). Subgroup analysis revealed the effect size for negative feedback seeking was smaller in romantic relationships compared to other relationship types. Effect sizes for excessive reassurance seeking did not differ for romantic and other relationships but were smaller in romantic relationships of a longer duration. Participant gender and symptom severity did not moderate effect sizes. Studies with child and adolescent samples had larger effects for negative feedback seeking and smaller effects for excessive reassurance seeking, relative to adult samples.

Discussion: Longer closer relationships may protect against maladaptive interpersonal behaviors in individuals with depression.

The Covert and Overt Reassurance Seeking Inventory (CORSI): Development, validation and psychometric analyses

BACKGROUND

Reassurance seeking (RS) is motivated by perceived general and social/relational threats across disorders, yet is often under-recognized because it occurs in covert (i.e. subtle) and overt forms. Covert safety-seeking behaviour may maintain disorders by preventing corrective learning and is therefore important to identify effectively.

AIMS

This study presents the validation and psychometric analyses of a novel measure of covert and overt, general and social/relational threat-related interpersonal RS.

METHOD

An initial 30-item measure was administered to an undergraduate sample (N = 1626), as well as to samples of individuals diagnosed with obsessive compulsive disorder (OCD; n = 50), anxiety disorders (n = 60) and depression (n = 30). The data were subjected to exploratory and confirmatory factor analyses, and validation analyses.

RESULTS

An exploratory factor analysis using principal axis factoring with oblique rotation yielded five interpretable factors, after removing four complex items. The resulting 26-item measure, the Covert and Overt Reassurance Seeking Inventory (CORSI), evidenced good convergent and divergent validity and accounted for 54.99% of the total variance after extraction. Factor correlations ranged from r = .268 to .736, suggesting that they may be tapping into unique facets of RS behaviour. In comparison with undergraduate participants, all clinical groups had significantly higher total scores [t (51.80-840) = 3.92-5.84, p < .001]. The CFA confirmed the five-factor model with good fit following the addition of four covariance terms (goodness of fit index = .897, comparative fit index = .918, Tucker-Lewis index = .907, root mean square error approximation = .061).

CONCLUSION

The CORSI is a brief, yet comprehensive and psychometrically strong measure of problematic RS. With further validation, the CORSI has potential for use within clinical and research contexts.

Excessive reassurance seeking in depression versus obsessive-compulsive disorder: Cross-sectional and cognitive behavioural therapy treatment comparisons

Excessive reassurance seeking (ERS) has been hypothesized as an important maintenance factor in depression and obsessive compulsive disorder (OCD). The present study examined the types of ERS in depression and OCD, the effects of CBT on ERS, predictors of ERS reduction, and the relation between ERS reduction and symptom change.

METHOD

Treatment-seeking participants diagnosed with a depressive disorder (N = 361) or OCD (N = 156) completed the Reassurance Seeking Scale (RSS) and symptom measures before and following CBT treatment. Measures of intolerance of uncertainty and distress tolerance were completed pre-treatment as potential predictors of ERS change.

RESULTS

Individuals with depression demonstrated higher pre-treatment ERS related to social attachment compared to those with OCD. ERS significantly decreased over treatment in both groups and change in ERS predicted symptom change among both OCD and depression groups. Higher pre-treatment intolerance of uncertainty significantly predicted less ERS change regardless of diagnosis. Distress tolerance was not associated with ERS changes.

CONCLUSION

ERS is significantly related to symptom severity cross-sectionally as well as over treatment in depression and OCD, though types of ERS may differ. Higher intolerance of uncertainty may impede the reduction of ERS in CBT.

An examination of the relationship of patient modifiable and non-modifiable characteristics with fear of cancer recurrence among colorectal cancer survivors

PURPOSE

Fear of cancer recurrence (FCR) is one of the most common and distressing issues affecting cancer survivors. This study examined (1) the association between modifiable cognitive, behavioral, and social characteristics and FCR, (2) the association between non-modifiable characteristics and FCR, and (3) the relative contributions of modifiable and non-modifiable characteristics to FCR.

METHODS

Participants (n = 120) had been diagnosed with colorectal cancer and completed cancer treatment in the past 6 to 36 months. Participants completed self-report measures of modifiable cognitive (e.g., beliefs about worry), behavioral (e.g., health-related reassurance seeking), and social (e.g., social constraints) characteristics. Non-modifiable characteristics (e.g., age, disease severity) were assessed via self-report and medical record review.

FINDINGS

Modifiable (i.e., perceived risk, self-efficacy, positive beliefs about worry, negative beliefs about worry, intolerance of uncertainty, rumination, reassurance seeking, health-related reassurance seeking, social constraints) and non-modifiable (i.e., age, gender, disease severity, neuroticism, conscientiousness) characteristics were associated with FCR (p's < .05). Hierarchical linear regression analyses demonstrated that modifiable characteristics accounted for an additional 15% of the variance (p < .001) beyond that accounted for by non-modifiable characteristics (R² = .45, p < .001), with perceived risk (B = .35) and health-related reassurance seeking (B = .22) emerging as significant predictors of FCR (p's < .05).

IMPLICATIONS

Results identify non-modifiable characteristics that may serve as risk factors for greater FCR and identify specific modifiable characteristics (i.e., perceived risk, health-related reassurance seeking) to be targeted by interventions to reduce FCR among cancer survivors.

Increased problematic smartphone use among children with attention-deficit/hyperactivity disorder in the community: The utility of Chinese version of Smartphone Addiction Proneness Scale

BACKGROUND

Problematic smartphone use is more prevalent in children than before. This study aimed to evaluate the reliability and validity of the Chinese version of the Smartphone Addiction Proneness Scale (SAPS).

METHODS

We recruited 319 students aged 9 to 12 years including 70 attention-deficit/hyperactivity disorder subjects at a university hospital and 249 controls from elementary school. Finally, 164 males and 138 females were collected for data analysis with mean age of 10.99 ± 0.88 years. Item analysis, exploratory factor analysis, internal consistency test, and t test were performed to verify the reliability and validity of the SAPS-Chinese version. Correlations were examined for relation between the score in the SAPS-Chinese version and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnostic criteria.

RESULTS

Factor analysis showed two factors: problematic use-associated behaviors and impaired daily functions. Item analysis for every item in the SAPS-Chinese version showed significant differences in t values (p < 0.001) and high correlation in all items (r = 0.37-0.79). The Kaiser-Meyer-Olkin (KMO) was equal to 0.94 and Bartlett's test of Sphericity was significant (p < 0.001). Cronbach's α for the SAPS-Chinese version was 0.93. It revealed high reliability and validity.

CONCLUSION

The SAPS-Chinese version is reliable, valid, and suitable for clinical and research uses with satisfactory properties. Applying the modified SAPS-Chinese version offers early detection of problematic smartphone use.

Tolerating Uncertainty in the Dark: Insomnia Symptoms, Distress, and Well-Being Among Parents of Adolescents and Young Adults with Cancer

BACKGROUND

Given the need to better understand mechanisms linking poor sleep and psychological distress in the context of chronic illness, we explored a novel factor, intolerance of uncertainty (IU), in relation to insomnia among parents of adolescents and young adults (AYAs) with cancer. We hypothesized that parents with higher IU would report greater insomnia symptoms, which would be associated with higher anxiety and depressive symptoms. These greater levels of anxiety and depressive symptoms are hypothesized to mediate the relationship between insomnia symptoms and subjective well-being (SWB).

METHOD

Surveying 59 parents of AYAs with cancer, we computed a parallel-serial mediational analysis using bootstrapping techniques for ordinary least squares regression to test two pathways (adjusting for whether the AYA currently resided with the parent). The first serial pathway was IU→insomnia symptoms→anxiety symptoms→SWB. The second pathway was IU→insomnia symptoms→depressive symptoms→SWB.

RESULTS

Although the first pathway involving sleep and anxiety as serial mediators was nonsignificant, the second pathway with sleep and depressive symptoms was significant. The relationship between IU and SWB was mediated through insomnia and depressive symptoms. An alternative serial mediation analysis wherein depressive symptoms preceded sleep was not significant, lending support to study findings.

CONCLUSION

This study provides preliminary evidence that IU's detrimental influence on depression and SWB may operate through its influence on insomnia symptoms. Given implications for parents' well-being and, likely, their subsequent capacity to care for the AYA with cancer, interventions addressing IU and disturbed sleep among this underserved population deserve attention.

Excessive reassurance seeking mediates relations between rumination and problematic smartphone use

Aside from depression and anxiety, less is known about the relationship of problematic smartphone use (PSU) to other psychopathology- related variables. The authors' aim was to test previously neglected variables in relation to PSU: rumination and excessive reassurance seeking behavior (ERSB). The authors recruited 295 college students for a web-based survey of smartphone use frequency, PSU, depression and anxiety, ruminative thinking, and ERSB. The authors tested linear regression and mediation models, assessing rumination and ERSB as mediating associations between depression/anxiety severity with PSU, adjusting for age, sex, and smartphone use frequency. Results demonstrate that ERSB was significantly related to PSU severity, and ERSB mediated the association between rumination and PSU. Furthermore, the combination of rumination and ERSB mediated relations between both depression and anxiety severity with PSU. Results provide evidence for ERSB as an important variable in understanding relationships between psychopathology symptoms and PSU severity among college students.

Reassurance seeking in the anxiety disorders and OCD: Construct validation, clinical correlates and CBT treatment response

BACKGROUND

Reassurance seeking has been hypothesized to be a key factor in the maintenance of anxiety and obsessive-compulsive disorders according to contemporary cognitive-behavioural therapy (CBT) approaches. The present study sought to examine the structure, clinical correlates, and malleability of reassurance seeking in the context of CBT treatment.

METHODS

Treatment-seeking participants (N = 738) with DSM-IV-TR (American Psychiatric Association, 2000) panic disorder with agoraphobia (PD/A), social anxiety disorder (SAD), generalized anxiety disorder (GAD), and obsessive compulsive disorder (OCD) completed the Reassurance Seeking Scale (RSS) with other symptom measures prior to and following CBT treatment.

RESULTS

A confirmatory factor analysis supported a three factor solution: the need to seek excessive reassurance regarding decisions, attachment and the security of relationships, and perceived general threat and anxiety. The RSS was moderately correlated with general measures of anxiety and depression as well as disorder-specific symptom scales. Further, CBT was found to produce changes in reassurance seeking across CBT treatments and these reductions were significantly associated with disorder-specific clinical improvement.

CONCLUSION

Reassurance seeking appears to be a common factor across anxiety disorders and its reduction in CBT treatment is associated with improved clinical outcomes.

Individuals Intolerant of Uncertainty: The Maintenance of Worry and Distress Despite Reduced Uncertainty

The intolerance of uncertainty model of worry posits that individuals worry as a means to cope with the discomfort they feel when outcomes are uncertain, but few experimental studies have investigated the causal relationships between intolerance of uncertainty, situational uncertainty, and state worry. Furthermore, existing studies have failed to control for the likelihood of future negative events occurring, introducing an important rival hypothesis to explain past findings. In the present study, we examined how individuals with high and low trait intolerance of uncertainty differ in their behavioral, cognitive, and emotional reactions to situational uncertainty about an upcoming negative event (watching emotionally upsetting film clips), holding constant the likelihood of that negative event taking place. We found that although individuals high in trait prospective intolerance of uncertainty reported a higher degree of belief that being provided with detailed information about the upcoming stressor would make them feel more at ease, they did not experience an actual decrease in distress or state worry upon being provided with more information, during anticipation of the film clips, or during the film clips themselves. Our results suggest that heightened distress regarding negative events may be more central than intolerance of uncertainty to the maintenance of worry.

The role of excessive reassurance seeking: An eye tracking study of the indirect effect of social anxiety symptoms on attention bias

High social anxiety is associated with increased attentional bias, and difficulties disengaging from relevant threat information, though social anxiety may also be associated with avoidance of threat. Few mechanisms of this relationship have been empirically evaluated, whereas theories and treatment manuals implicate avoidance and/or safety behaviors as significant agents of negative reinforcement for anxiety symptoms and search for threat. The current study sought to investigate one safety behavior, excessive reassurance seeking, as a mediator of the relationship between social anxiety and attention bias to disgust facial stimuli. Support was found for our hypotheses, such that social anxiety symptoms had an indirect effect on attention bias to disgust faces through increased reassurance seeking. These results suggest that reassurance seeking may result in disengagement of attention to threat stimuli. Specifically, social anxiety may result in a decreased threshold for negative social cues and therefore seek out reassurance feedback and avoid threatening stimuli. Future studies should test these directly and utilize a prospective design. The current study suggests that reassurance seeking may be involved in the attention bias process, providing additional data for current cognitive theories of social anxiety and additional support for reinforcement patterns of anxiety symptoms.

Is Reassurance Seeking Specific to OCD? Adaptation Study of the Turkish Version of Reassurance Seeking Questionnaire in Clinical and Non-Clinical Samples

BACKGROUND

Reassurance seeking in obsessive compulsive disorder (OCD) is a kind of neutralization behaviour that causes considerable interpersonal conflicts.

AIMS

The purpose of this study was to conduct the adaptation of the Reassurance Seeking Questionnaire (ReSQ; Kobori and Salkovskis, 2013) into the Turkish language, and to examine its psychometric properties. Moreover, we aimed to identify the specificity of reassurance seeking to OCD, as opposed to other anxiety disorders and depression.

METHOD

Five groups of participants (OCD, anxiety disorders, depression, healthy control groups, and a university student sample) were administered ReSQ, Obsessive Beliefs Questionnaire, Obsessive-Compulsive Inventory-Revised Form, State and Trait Anger Expression Inventory, Guilt Inventory, Beck Depression Inventory and State Trait Anxiety Inventory-Trait Form.

RESULTS

The findings revealed acceptable test-retest and internal consistency coefficients, and also good construct, convergent, discriminant and criterion validity information for the Turkish version of the ReSQ scales. Results also revealed some aspects of reassurance seeking specific to OCD as opposed to other anxiety disorders and depression.

CONCLUSION

The results of the present study indicated a good reliability and validity information for the Turkish version of the ReSQ, supporting the cross-cultural nature of the scale.

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

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.

Smartphone use and smartphone addiction in middle school students in Korea: Prevalence, social networking service, and game use

This study aimed to examine smartphone use patterns, smartphone addiction characteristics, and the predictive factors of the smartphone addiction in middle school students in South Korea. According to the Smartphone Addiction Proneness Scale scores, 563 (30.9%) were classified as a risk group for smartphone addiction and 1261 (69.1%) were identified as a normal user group. The adolescents used mobile messengers for the longest, followed by Internet surfing, gaming, and social networking service use. The two groups showed significant differences in smartphone use duration, awareness of game overuse, and purposes of playing games. The predictive factors of smartphone addiction were daily smartphone and social networking service use duration, and the awareness of game overuse.

Psychometric Properties of the Worry Behaviors Inventory: Replication and Extension in a Large Clinical and Community Sample

BACKGROUND

The use of maladaptive behaviors by individuals with generalized anxiety disorder (GAD) is theoretically important and clinically meaningful. However, little is known about the specificity of avoidant behaviors to GAD and how these behaviors can be reliably assessed.

AIMS

This study replicated and extended the psychometric evaluation of the Worry Behaviors Inventory (WBI), a brief self-report measure of avoidant behaviors associated with GAD.

METHOD

The WBI was administered to a hospital-based sample of adults seeking treatment for symptoms of anxiety and/or depression (n = 639) and to a community sample (n = 55). Participants completed measures of symptom severity (GAD, depression, panic disorder, health anxiety, and personality disorder), and measures of checking, reassurance-seeking and behavioral inhibition. Analyses evaluated the factor structure, convergent, divergent, incremental, and discriminant validity, as well the temporal stability and treatment sensitivity of the WBI.

RESULTS

The two-factor structure found in the preliminary psychometric evaluation of the WBI was replicated. The WBI was sensitive to changes across treatment and correlated well with measures of GAD symptom severity and maladaptive behaviors. The WBI was more strongly related to GAD symptom severity than other disorders. The WBI discriminated between clinical and community samples.

CONCLUSIONS

The WBI provides clinicians and researchers with a brief, clinically meaningful index of problematic behaviors that may guide treatment decisions and contribute to our understanding of maintaining factors in GAD.

Contagion of Anxiety Symptoms Among Adolescent Siblings: A Twin Study

This study examined whether social contagion of anxiety symptoms is present between siblings during early adolescence and whether this process is moderated by sex, relationship quality, and zygosity. Based on 634 monozygotic and dizygotic twins (336 females) assessed in Grades 6 and 7, anxiety symptoms and sibling relationship quality were measured with self-report questionnaires. The predictive association of the co-twin's level of anxiety with adolescents' own increased anxiety 1 year later was only observed in same-sex twin dyads (monozygotic and dizygotic) and was higher for those who perceived a higher level of relationship quality with their co-twin. Raising awareness of a possible sibling contagion of anxiety may be useful for preventing the development of anxiety symptoms in youth.

Distinguishing Fear Versus Distress Symptomatology in Pediatric OCD

Prior research has identified OCD subtypes or "clusters" of symptoms that differentially relate to clinical features of the disorder. Given the high comorbidity between OCD and anxiety, OCD symptom clusters may more broadly associate with fear and/or distress internalizing constructs. This study examines fear and distress dimensions, including physical concerns (fear), separation anxiety (fear), perfectionism (distress), and anxious coping (distress), as predictors of previously empirically-derived OCD symptom clusters in a sample of 215 youth diagnosed with primary OCD (ages 7-17, mean age = 12.25). Self-reported separation fears predicted membership in Cluster 1 (aggressive, sexual, religious, somatic obsessions, and checking compulsions) while somatic/autonomic fears predicted membership in Cluster 2 (symmetry obsessions and ordering, counting, repeating compulsions). Results highlight the diversity of pediatric OCD symptoms and their differential association with fear, suggesting the need to carefully assess both OCD and global fear constructs that might be directly targeted in treatment.

Negative emotions in veterans relate to suicide risk through feelings of perceived burdensomeness and thwarted belongingness

BACKGROUND

Suicide rates among veterans are disproportionately high compared to rates among the general population. Veterans may experience a number of negative emotions (e.g., anger, self-directed hostility, shame, guilt) during periods of postwar adjustment and reintegration into civilian life that may uniquely confer risk for suicide. Mechanisms of these associations, however, are less well studied. The purpose of the present study was to examine the relationship between negative emotions and suicide risk in veterans through the theoretical framework of the interpersonal theory of suicide.

METHODS

A large sample of veterans (N = 541) completed measures assessing their negative emotions, perceived burdensomeness, thwarted belongingness, and suicide risk.

RESULTS

Self-directed hostility and shame related indirectly to suicide risk through both perceived burdensomeness and thwarted belongingness. Thwarted belongingness accounted for the association between anger and suicide risk, whereas perceived burdensomeness accounted for the relationship between guilt and suicide risk.

LIMITATIONS

This study had a cross-sectional design and relied solely on self-report measures.

CONCLUSIONS

These findings provide evidence for the role of negative emotions in conferring risk for suicide in veterans. Clinical implications, limitations, and future research directions are discussed.

Problematic smartphone use: A conceptual overview and systematic review of relations with anxiety and depression psychopathology

BACKGROUND

Research literature on problematic smartphone use, or smartphone addiction, has proliferated. However, relationships with existing categories of psychopathology are not well defined. We discuss the concept of problematic smartphone use, including possible causal pathways to such use.

METHOD

We conducted a systematic review of the relationship between problematic use with psychopathology. Using scholarly bibliographic databases, we screened 117 total citations, resulting in 23 peer-reviewer papers examining statistical relations between standardized measures of problematic smartphone use/use severity and the severity of psychopathology.

RESULTS

Most papers examined problematic use in relation to depression, anxiety, chronic stress and/or low self-esteem. Across this literature, without statistically adjusting for other relevant variables, depression severity was consistently related to problematic smartphone use, demonstrating at least medium effect sizes. Anxiety was also consistently related to problem use, but with small effect sizes. Stress was somewhat consistently related, with small to medium effects. Self-esteem was inconsistently related, with small to medium effects when found. Statistically adjusting for other relevant variables yielded similar but somewhat smaller effects.

LIMITATIONS

We only included correlational studies in our systematic review, but address the few relevant experimental studies also.

CONCLUSIONS

We discuss causal explanations for relationships between problem smartphone use and psychopathology.

A novel cognitive intervention for compulsive checking: Targeting maladaptive beliefs about memory

BACKGROUND AND OBJECTIVES

Compulsive checking is one of the most common symptoms of obsessive-compulsive disorder (OCD). Recently it has been proposed that those who check compulsively may believe their memory is poor, rather than having an actual memory impairment. The current study sought to develop and assess a brief cognitive intervention focused on improving maladaptive beliefs about memory, as they pertain to both checking symptoms and memory performance.

METHODS

Participants (N = 24) with a diagnosis of OCD and clinical levels of checking symptomatology were randomly assigned either to receive two weekly 1-hour therapy sessions or to self-monitor during a similar waitlist period. Time spent checking, checking symptoms, maladaptive beliefs about memory, and visuospatial memory were assessed both pre- and post-treatment/waitlist.

RESULTS

Results showed that compared to the waitlist condition, individuals in the treatment condition displayed significant decreases in their maladaptive beliefs about memory and checking symptoms from pre- to post-intervention. They also exhibited increased recall performance on a measure of visuospatial memory. Changes in beliefs about memory were predictors of reduced post-intervention checking, but were not predictive of increased post-intervention memory scores.

LIMITATIONS

The lack of long term follow-up data and use of a waitlist control leave questions about the stability and specificity of the intervention.

CONCLUSIONS

Findings provide preliminary evidence that strategies targeting beliefs about memory may be worthy of inclusion in cognitive-behavioural approaches to treating compulsive checking.

The Worry Behaviors Inventory: Assessing the behavioral avoidance associated with generalized anxiety disorder

BACKGROUND

Understanding behavioral avoidance associated with generalized anxiety disorder (GAD) has implications for the classification, theoretical conceptualization, and clinical management of the disorder. This study describes the development and preliminary psychometric evaluation of a self-report measure of avoidant behaviors associated with GAD: the Worry Behaviors Inventory (WBI).

METHODS

The WBI was administered to treatment-seeking patients (N=1201). Convergent validity was assessed by correlating the WBI with measures of GAD symptom severity. Divergent validity was assessed by correlating the WBI with measures of general disability and measures of depression, social anxiety and panic disorder symptom severity.

RESULTS

Exploratory and confirmatory factor analyses supported a two-factor structure (Safety Behaviors and Avoidance). Internal reliability was acceptable for the 10-item WBI scale (α=.86), Safety Behaviors (α=.85) and Avoidance subscales (α=.75). Evidence of convergent, divergent, and discriminant validity is reported. WBI subscales demonstrated differential associations with measures of symptom severity. The Safety Behaviors subscale was more strongly associated with GAD symptoms than symptoms of other disorders, whereas the Avoidance subscale was as strongly correlated with GAD severity as it was with depression, social anxiety and panic disorder severity.

LIMITATIONS

Structured diagnostic interviews were not conducted therefor validity analyses are limited to probable diagnoses based on self-report. The cross-sectional design precluded examination of the WBI's temporal stability and treatment sensitivity.

CONCLUSIONS

Preliminary evidence supports the use of the WBI in research and clinical settings and may assist clinicians to identify behaviors that are theorized to maintain GAD and that can be targeted during psychological treatment.

Intolerance of uncertainty in body dysmorphic disorder

Intolerance of uncertainty (IU) is a transdiagnostic construct associated with several anxiety and related disorders. Three studies were conducted to explore the potential relationship between IU and body dysmorphic disorder (BDD). Study 1 revealed a positive relationship between IU and BDD symptoms above symptoms of anxiety and depression in an unselected student sample (N=88). Study 2 demonstrated a similar relationship between IU and BDD symptoms above negative affectivity and intolerance of ambiguity in a community sample (N=116). Study 3 found that a clinical BDD sample (N=23) reported greater IU than healthy controls (N=20), though this relationship was accounted for by symptoms of anxiety and depression. Greater IU predicted functional impairment in the clinical sample above BDD symptoms and past-week anxiety and depression. The observed relationship between IU and BDD symptoms provides preliminary support for the relevance of IU to this population.