1
|
Virgilsen LF, Jensen H, Falborg AZ, Prior A, Pedersen AF, Vedsted P. Psychiatric disorders and the cancer diagnostic process in general practice: a combined questionnaire and register study exploring the patients' experiences in Denmark. Scand J Prim Health Care 2024; 42:156-169. [PMID: 38149909 PMCID: PMC10851816 DOI: 10.1080/02813432.2023.2296944] [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: 06/29/2023] [Accepted: 12/14/2023] [Indexed: 12/28/2023] Open
Abstract
OBJECTIVE Patients with psychiatric disorders are at risk of experiencing suboptimal cancer diagnostics and treatment. This study investigates how this patient group perceives the cancer diagnostic process in general practice. DESIGN Cross-sectional study using questionnaire and register data. SETTING General practice in Denmark. SUBJECTS Patients diagnosed with cancer in late 2016 completed a questionnaire about their experiences with their general practitioner (GP) in the cancer diagnostic process (n = 3411). Information on pre-existing psychiatric disorders was obtained from register data on psychiatric hospital contacts and primary care treated psychiatric disorders through psychotropic medications. Logistic regression was used to analyse the association between psychiatric disorders and the patients' experiences. MAIN OUTCOME MEASURES Patients' experiences, including cancer worry, feeling being taken seriously, and the perceived time between booking an appointment and the first GP consultation.[Box: see text]. RESULTS A total of 13% of patients had an indication of a psychiatric disorder. This group more often perceived the time interval as too short between the first booking of a consultation and the first GP consultation. Patients with primary care treated psychiatric disorders were more likely to worry about cancer at the first presentation and to share this concern with their GP compared with patients without psychiatric disorders. We observed no statistically significant association between patients with psychiatric disorders and perceiving the waiting time to referral from general practice, being taken seriously, trust in the GP's abilities, and the patients' knowledge of the process following the GP referral. CONCLUSION The patients' experiences with the cancer diagnostic process in general practice did not vary largely between patients with and without psychiatric disorders. Worrying about cancer may be a particular concern for patients with primary care treated psychiatric disorders.
Collapse
Affiliation(s)
| | - Henry Jensen
- Research Unit for General Practice, Aarhus C, Denmark
| | | | - Anders Prior
- Research Unit for General Practice, Aarhus C, Denmark
| | - Anette Fischer Pedersen
- Research Unit for General Practice, Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
| |
Collapse
|
2
|
Li J, Jin Y, Xu S, Luo X, Wilson A, Li H, Wang X, Sun X, Wang Y. Anxiety and Depression Symptoms among Youth Survivors of Childhood Sexual Abuse: A Network Analysis. BMC Psychol 2023; 11:278. [PMID: 37717011 PMCID: PMC10504753 DOI: 10.1186/s40359-023-01275-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 08/08/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Previous studies have frequently reported a high prevalence of co-occurring anxiety and depression among people who experienced stressful events in childhood. However, few have noted the symptomatic relationship of this comorbidity among childhood sexual abuse (CSA) survivors. Therefore, this study's objectives were as follows: (1) to examine the relationship across symptoms between anxiety and depression among CSA survivors; (2) to compare differences between male and female network structures among CSA survivors. METHODS A total of 63 Universities and Colleges in Jilin Province, China, covered 96,218 participants in this study, a sub-set data of which met the criteria of CSA was analyzed with the network analysis. The Childhood Trauma Questionnaire-Short Form (CTQ-SF), measured CSA. Anxiety was measured by the seven-item Generalized Anxiety Disorder Scale (GAD-7), and depression was measured by the Patient Health Questionnaire (PHQ-9). The sex difference between anxiety and depression among CSA survivors was compared. RESULTS 3,479 college students reported the experience of CSA (CTQ-SF total scores ≥ 8), with a prevalence of 3.62% (95% CI: 3.50-3.73%). Among CSA survivors, control worry, sad mood, and energy were central and bridge symptoms of the anxiety and depression network. Meanwhile, male CSA survivors appeared to have a stronger correlation between guilt and suicide, but female CSA survivors seemed to have a stronger correlation between control worry and suicide. Moreover, the edge of control worry-relax-afraid was stronger in the male network, while the edge of restless-relax was stronger in the female network. CONCLUSION Control worry, sad mood, and energy are crucial to offer targeted treatment and to relieve anxiety and depression symptoms for CSA survivors. Guilt needs more attention for male CSA survivors, while control worry remains more important for female CSA survivors to reduce suicidal ideation and suicide attempts.
Collapse
Affiliation(s)
- Jiaqi Li
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Yu Jin
- College of Education for the Future, Beijing Normal University, Beijing, China
| | - Shicun Xu
- Northeast Asian Research Center, Jilin University, Changchun, China.
- Department of Population, Resources, and Environment, Northeast Asian Studies College, Jilin University, Changchun, China.
- China Center for Aging Studies and Social-Economic Development, Jilin University, Changchun, China.
| | - Xianyu Luo
- College of Education for the Future, Beijing Normal University, Beijing, China
| | - Amanda Wilson
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Hui Li
- School of Public Health, Jilin University, Changchun, China
| | - Xiaofeng Wang
- Northeast Asian Research Center, Jilin University, Changchun, China
| | - Xi Sun
- Department of Population, Resources, and Environment, Northeast Asian Studies College, Jilin University, Changchun, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China.
| |
Collapse
|
3
|
Tourreix E, Besançon M, Gonthier C. Non-Cognitive Specificities of Intellectually Gifted Children and Adolescents: A Systematic Review of the Literature. J Intell 2023; 11:141. [PMID: 37504784 PMCID: PMC10382067 DOI: 10.3390/jintelligence11070141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/02/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023] Open
Abstract
For several years, there was a growing interest in intellectual giftedness and in particular in the non-cognitive specificities of gifted individuals. This topic attracted much public attention and sometimes led to contradictions with the scientific literature. The current review synthesizes a broad set of results related to non-cognitive specificities of intellectual gifted in children and adolescents. This synthesis of scientific research on giftedness and its associated non-cognitive features does not support the conclusion that there is a stable profile across gifted individuals that would consistently separate them from non-gifted individuals. A few specificities in some areas are noted, but they are not necessarily being systematic. These specificities often turn out to be in favor of gifted youth, contrary to the view sometimes defended in the general public that gifted individuals suffer from major everyday difficulties. Finally, methodological issues are listed regarding the designs of existing studies, with recommendations for future research in the field.
Collapse
Affiliation(s)
- Emma Tourreix
- DysCo Lab, Paris Nanterre University, 92000 Nanterre, France
- LP3C, University of Rennes, 35000 Rennes, France
| | | | - Corentin Gonthier
- Laboratoire de Psychologie des Pays de la Loire (LPPL UR 4638), Nantes Université, Chemin de la Censive du Tertre, 44312 Nantes, France
| |
Collapse
|
4
|
Mordeno IG, Gallemit IMJS, Dinding DLL. To Leave is to Die a Little: Assessing the Symptom Structure of Separation Anxiety Disorder in Left-Behind Emerging Adults. Psychiatr Q 2023:10.1007/s11126-023-10024-z. [PMID: 37058269 DOI: 10.1007/s11126-023-10024-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 04/15/2023]
Abstract
The literature on separation anxiety disorder (SAD) presented two contentious issues relating to its assessment. First, studies are scarce in assessing the symptom structure of DSM-5 SAD among the adult population. Second, the accuracy in assessing the severity of SAD through measuring the intensity of disturbance and the frequency of occurrence of symptoms is yet to be studied. To address these limitations, the present study aimed to: (1) examine the latent factor structure of the newly developed separation anxiety disorder symptom severity inventory (SADSSI); (2) evaluate the necessity of using frequency or intensity formats through comparison of differences in the latent level; and (3) investigate SAD latent class analysis. Utilizing 425 left-behind emerging adults (LBA), the findings showed that a general factor with two dimensions (i.e., response formats) measuring frequency and intensity symptom severity separately has excellent fit and good reliability. Finally, the latent class analysis yielded a three-class solution best fitting to the data. Overall, the data provided evidence for the psychometric soundness of SADSSI as an assessment tool for separation anxiety symptoms among LBA.
Collapse
Affiliation(s)
- Imelu G Mordeno
- Department of Professional Education, Mindanao State University, Iligan Institute of Technology, Iligan City, Philippines.
- Department of Professional Education, College of Education, MSU-Iligan Institute of Technology, Andres Bonifacio Ave, Tibanga, Iligan City, 9200, Philippines.
| | - I Marie Joy S Gallemit
- School of Graduate Studies, College of Education, Mindanao State University, Iligan Institute of Technology, Iligan City, Philippines
| | - Dame Lent L Dinding
- Department of Psychology, Mindanao State University, Marawi City, Philippines
| |
Collapse
|
5
|
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.
Collapse
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.
| |
Collapse
|
6
|
Miao X, Wang W, Chen Y, Huang X, Wang R. Psychological stress and influencing factors of hospital workers in different periods under the public health background of infectious disease outbreak: A cross‐sectional study. Health Sci Rep 2022; 5:e834. [PMID: 36177398 PMCID: PMC9476554 DOI: 10.1002/hsr2.834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Xing Miao
- Department of Cardiology Fujian Provincial Hospital Fuzhou China
- Department of Cardiology Shengli Clinical Medical College of Fujian Medical University Fuzhou China
| | - Wei Wang
- Department of Psychiatry Fuzhou Neuropsychiatric Hospital Affiliated to Fujian Medical University Fuzhou China
| | - Yongli Chen
- Department of Cardiology Shengli Clinical Medical College of Fujian Medical University Fuzhou China
| | - Xiufang Huang
- Department of Cardiology Fujian Provincial Hospital Fuzhou China
| | - Rehua Wang
- Department of Cardiology Fujian Provincial Hospital Fuzhou China
- Department of Cardiology Shengli Clinical Medical College of Fujian Medical University Fuzhou China
| |
Collapse
|
7
|
Yao N, Yang Y, Huang S. Validation of the Chinese Version of the Perseverative Thinking Questionnaire. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2022. [DOI: 10.1007/s10942-022-00470-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
8
|
Martins DS, Sampaio TPDA, Lotufo Neto F. Relationships between worry and depressive symptoms during two group therapies for generalized anxiety disorder. JORNAL BRASILEIRO DE PSIQUIATRIA 2022. [DOI: 10.1590/0047-2085000000361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Objective: Generalized anxiety disorder (GAD) is a chronic and disabling disorder associated with various impairments and shows a significant prevalence in the worldwide and Brazilian populations. This study aimed to investigate the longitudinal relationship of two symptoms relevant to the disorder (worry and depressive symptoms) in the context of a randomized clinical trial (RCT) by using a cross-lagged panel model (CLPM) analysis. Methods: A total of 92 adult patients with GAD were randomized to receive ten sessions of either acceptance‐based group behavioral therapy (ABBT) or nondirective supportive group therapy (NDST). Treatment had four time-point measures. Worries were measured using the Penn State Worry Questionnaire (PSWQ), and depression was measured using the Depression Anxiety Stress Scales (DASS-D). Results: The NDST model revealed significant paths from worry to depression (first wave) and from depression to worry (second wave). There was no other significant cross-lagged effect. These data show that there was an influence between symptoms only during one of the treatment groups, and without a homogeneous and constant pattern in any of the cross-lagged routes. Conclusion: A supportive group psychotherapy potentially interferes with the pattern of the direct relationship between worries and depressive symptoms in adults with GAD.
Collapse
|
9
|
Warren R, Yu E. Positive beliefs about worry: An evaluation of the Why Worry-II questionnaire in patients with anxiety and mood disorders: Implications for theory and treatment. Clin Psychol Psychother 2022; 29:1457-1462. [PMID: 34984752 DOI: 10.1002/cpp.2705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/08/2022]
Abstract
Positive beliefs about worry are an important factor that has been shown to be associated with the reduction of worry severity with cognitive behavioural therapy. The present study evaluated the psychometric properties of a measure of positive beliefs about worry, the Why Worry Questionnaire II (WW-II; Hebert et al., 2014, 0.1016/j.paid.2013.08.009) with a clinical sample. The present study also compared mean scores on the WW-II in the present clinical sample with scores found in non-clinical samples. Finally, the study compared mean scores on the WW-II between groups with primary diagnoses of generalized anxiety disorder (GAD), major depressive disorder (MDD) and anxiety disorder not otherwise specified (NOS). The confirmatory factor analysis found the five-factor model an adequate to good fit to the data, and the WW-II demonstrated excellent internal consistency within this clinical sample. Additionally, scores on the WW-II in the present sample were significantly higher than scores found by in their non-clinical sample. Finally, no significant mean differences were found between primary diagnoses of GAD, anxiety disorder NOS or MDD. Important theoretical and clinical implications and suggestions for future research are discussed.
Collapse
Affiliation(s)
- Ricks Warren
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth Yu
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
10
|
Gerlach AR, Karim HT, Kazan J, Aizenstein HJ, Krafty RT, Andreescu C. Networks of worry-towards a connectivity-based signature of late-life worry using higher criticism. Transl Psychiatry 2021; 11:550. [PMID: 34711810 PMCID: PMC8553743 DOI: 10.1038/s41398-021-01648-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/16/2021] [Accepted: 09/27/2021] [Indexed: 01/14/2023] Open
Abstract
Severe worry is a complex transdiagnostic phenotype independently associated with increased morbidity, including cognitive impairment and cardiovascular diseases. We investigated the neurobiological basis of worry in older adults by analyzing resting state fMRI using a large-scale network-based approach. We collected resting fMRI on 77 participants (>50 years old) with varying worry severity. We computed region-wise connectivity across the default mode network (DMN), anterior salience network, and left executive control network. All 22,366 correlations were regressed on worry severity and adjusted for age, sex, race, education, disease burden, depression, anxiety, rumination, and neuroticism. We employed higher criticism, a second-level method of significance testing for rare and weak features, to reveal the functional connectivity patterns associated with worry. The analysis suggests that worry has a complex, yet distinct signature associated with resting state functional connectivity. Intra-connectivities and inter-connectivities of the DMN comprise the dominant contribution. The anterior cingulate, temporal lobe, and thalamus are heavily represented with overwhelmingly negative association with worry. The prefrontal regions are also strongly represented with a mix of positive and negative associations with worry. Identifying the most salient connections may be useful for targeted interventions for reducing morbidity associated with severe worry in older adults.
Collapse
Affiliation(s)
- Andrew R. Gerlach
- grid.21925.3d0000 0004 1936 9000Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA USA
| | - Helmet T. Karim
- grid.21925.3d0000 0004 1936 9000Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA USA ,grid.21925.3d0000 0004 1936 9000Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA USA
| | - Joseph Kazan
- grid.21925.3d0000 0004 1936 9000Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA USA
| | - Howard J. Aizenstein
- grid.21925.3d0000 0004 1936 9000Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA USA ,grid.21925.3d0000 0004 1936 9000Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA USA
| | - Robert T. Krafty
- grid.189967.80000 0001 0941 6502Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA USA
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
11
|
Batmaz S, Altinoz AE, Sonkurt HO. Cognitive attentional syndrome and metacognitive beliefs as potential treatment targets for metacognitive therapy in bipolar disorder. World J Psychiatry 2021; 11:589-604. [PMID: 34631463 PMCID: PMC8474997 DOI: 10.5498/wjp.v11.i9.589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/16/2021] [Accepted: 08/13/2021] [Indexed: 02/06/2023] Open
Abstract
Most treatment guidelines emphasize the use of psychotropic drugs for both the acute and maintenance treatment of bipolar disorder (BD). However, relying only on psychotropics without adjunctive psychosocial interventions may be insufficient in treating patients with BD. Given its unique view in the explanation of psychopathological states, metacognitive therapy (MCT) might be helpful for BD. Metacognitive theory posits that psychopathology is a result of the cognitive attentional syndrome (CAS) and that it is influenced and maintained by dysfunctional metacognitive beliefs, perseverative thinking, attentional biases, and dysfunctional coping strategies. In this review, literature data regarding these areas in BD are examined. Studies suggest that perseverative thinking might be among the emotion regulation strategies endorsed in individuals with BD. Regarding attentional biases, literature data show that state-dependent, mood-changing attentional biases and a ruminative self-focused attention are present. Studies also suggest that cognitive self-consciousness is higher in BD compared to controls. It is seen that maladaptive coping strategies are frequently reported in BD, and that these strategies are associated with depression severity, negative affect and relapse risk. Studies focusing on dysfunctional metacognitive beliefs in BD reported that individuals with BD had higher scores for negative metacognitive beliefs, self-consciousness, need to control thoughts, and a lack of cognitive confidence. Also, dysfunctional metacognitive beliefs were associated with depressive symptomatology. These findings suggest that the components of CAS and dysfunctional metacognitive beliefs are evident in BD. For a subgroup of patients with BD who fail to respond to evidence-based psychopharmacological and adjunctive psychotherapeutic interventions, MCT might be an alternative way to consider as a treatment option. In conclusion, taken the available data together, we propose a sequential treatment protocol for BD, mainly based on the MCT treatment plan of depressive disorders.
Collapse
Affiliation(s)
- Sedat Batmaz
- Department of Psychiatry, School of Medicine, Tokat Gaziosmanpasa University, Tokat 60100, Turkey
| | - Ali Ercan Altinoz
- Department of Psychiatry, School of Medicine, Eskisehir Osmangazi University, Eskisehir 26000, Turkey
| | | |
Collapse
|
12
|
Pilot study of a group worry intervention for recent onset psychosis. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x21000106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Worry is common among individuals with psychosis and has been found to be a causal factor in the development of paranoia. Previous research has shown that a cognitive behavioural therapy protocol targeting worry helps to reduce persecutory delusions and associated distress in a population experiencing longstanding psychotic symptoms. However, there has yet to be a published adaptation of the protocol for individuals experiencing a recent onset of psychosis. The current study aims to examine the feasibility of adapting the worry intervention for recent onset psychosis in a group setting. Six young adults with a recent onset of psychosis, aged 18–32 years, participated in a pilot study of an 8-week group intervention covering cognitive behavioural strategies for managing worry, including worry periods, worry postponement techniques, mindfulness and relaxation, and problem solving. Pre- and post-intervention data were collected on worry, anxiety, depressive symptoms, psychotic symptoms, and perceived recovery from psychosis. In addition, qualitative feedback from group members was gathered during a post-intervention focus group. Feasibility of the group appeared promising, despite high participant attrition. All components of the intervention were successfully implemented, and group members provided positive feedback regarding acceptability of the group. Contrary to prediction, there was not a consistent decrease in worry from pre- to post-intervention. Findings from secondary symptom measures were mixed and may have been related to participants’ subjective experience of the group. Specifically, participants who experienced high levels of group cohesion seemed to benefit more from the intervention.
Key learning aims
(1)
To gain awareness of the gaps in treatment for early psychosis.
(2)
To understand the role of worry in psychosis.
(3)
To learn about the feasibility of implementing a group worry intervention for recent onset psychosis.
(4)
To consider the impact of group cohesion and symptom severity on treatment engagement.
Collapse
|
13
|
Livingston JD, Youssef GJ, StGeorge J, Wynter K, Dowse E, Francis LM, Di Manno L, Teague S, Demmer D, Collins S, Wilford E, Leach L, Melvin GA, Macdonald JA. Paternal coping and psychopathology during the perinatal period: A mixed studies systematic review and meta-analysis. Clin Psychol Rev 2021; 86:102028. [PMID: 33975226 DOI: 10.1016/j.cpr.2021.102028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 03/10/2021] [Accepted: 03/30/2021] [Indexed: 12/25/2022]
Abstract
How fathers cope with stress may be critical to their mental health during the perinatal period. Using a sequential explanatory design for systematic review and meta-analysis, we aimed to identify associations and causal relations between higher- and lower-order avoidant and approach coping strategies and paternal psychopathology. We searched five electronic databases and grey literature, and used random-effects models to calculate pooled effects from 11 quantitative studies. Meta-analytic results were integrated with findings from 18 qualitative studies. Fathers' avoidant coping was positively associated with global psychopathology and depression. Approach-oriented coping, particularly problem-solving, was associated with positive affect but not psychopathology. Qualitative findings indicate distressed fathers employ avoidant coping strategies such as suppression, distraction, and social withdrawal. Approach-oriented coping strategies such as problem-solving and cognitive reappraisals appeared to be constructive components of men's coping repertoires supporting adaptation to fatherhood. Different coping strategies and approaches may reflect enactment of constrictive, moderate, or reinterpreted masculine norms. Study designs did not allow conclusions about causal relations between coping and psychopathology. Screening for, and targeting of, high avoidant coping among expectant and new fathers may help detect men at risk of or experiencing mental health difficulties and inform clinical response to psychopathology. Research examining whether different patterns of avoidant and approach coping are associated with psychopathology over time could inform interventions to support men's mental health and adaptation to fatherhood.
Collapse
Affiliation(s)
- Julianne D Livingston
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia
| | - George J Youssef
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Melbourne, Australia
| | | | - Karen Wynter
- Deakin University, School of Nursing and Midwifery, Faculty of Health, Geelong, Australia; Deakin University, Centre for Quality and Patient Safety Research - Western Health Partnership, St Albans, Australia
| | - Eileen Dowse
- University of Newcastle, School of Nursing and Midwifery, Newcastle, Australia
| | - Lauren M Francis
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia
| | - Laura Di Manno
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia
| | - Samantha Teague
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia
| | - David Demmer
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia
| | - Sam Collins
- Deakin University, Food & Mood Centre, IMPACT SRC, School of Medicine, Faculty of Health, Geelong, Australia
| | - Emily Wilford
- Australian National University, National Centre for Epidemiology and Population Health, Canberra, Australia
| | - Liana Leach
- Australian National University, National Centre for Epidemiology and Population Health, Canberra, Australia
| | - Glenn A Melvin
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia; Centre for Educational Development, Appraisal & Research, University of Warwick, Coventry, UK
| | - Jacqui A Macdonald
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Melbourne, Australia; University of Melbourne, Department of Paediatrics, Royal Children's Hospital, Melbourne, Australia.
| |
Collapse
|
14
|
Schroder HS, Duda JM, Christensen K, Beard C, Björgvinsson T. Stressors and chemical imbalances: Beliefs about the causes of depression in an acute psychiatric treatment sample. J Affect Disord 2020; 276:537-545. [PMID: 32807732 DOI: 10.1016/j.jad.2020.07.061] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/05/2020] [Accepted: 07/05/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Public perceptions of mental illness are increasingly construed in neurobiological and genetic terms. Accumulating evidence suggests there are some unintended consequences of these explanations, including reduced optimism for recovery among individuals with depression. However, little is known about how these beliefs relate to treatment process and outcomes in a psychiatric treatment setting, a gap this study aimed to fill. METHODS We examined etiological beliefs about depression in a sample of patients (N = 279) seeking acute treatment in a behaviorally-based therapy program at a psychiatric hospital and examined relations with treatment expectations and outcomes. RESULTS We found that although psychosocial explanations of depression were most popular, biogenetic beliefs, particularly the belief that depression is caused by a chemical imbalance, were prevalent in this sample. Further, the chemical imbalance belief related to poorer treatment expectations. This relationship was moderated by symptoms of depression, with more depressed individuals showing a stronger relationship between chemical imbalance beliefs and lower treatment expectations. Finally, the chemical imbalance belief predicted more depressive symptoms after the treatment program ended for a 2-week measure of depression (but not for a 24-hour measure of depression), controlling for psychiatric symptoms at admission, inpatient hospitalizations, and treatment expectations. LIMITATIONS The sample was homogenous in terms of race and ethnicity and we did not assess how patients came to their beliefs. CONCLUSIONS Together, the results illustrate the correlates and possible impacts of etiological beliefs in a real-world clinical setting and invite a critical discussion about predominant messages about the etiology of depression.
Collapse
Affiliation(s)
| | - Jessica M Duda
- McLean Hospital and Harvard Medical School, United States
| | | | - Courtney Beard
- McLean Hospital and Harvard Medical School, United States
| | | |
Collapse
|
15
|
Correa JK, Brown TA. Expression of Generalized Anxiety Disorder Across the Lifespan. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2020; 41:53-59. [PMID: 31938010 DOI: 10.1007/s10862-018-9697-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In generalized anxiety disorder (GAD), both the associated symptoms and worry content have been shown to vary as a function of age (Jeste et al., 2005; Portman et al., 2011). However, few studies have conducted analyses beyond mean comparisons and no studies have examined whether the observed differences in worry content and the associated symptoms are due to the lack of measurement invariance across age groups. The current study evaluated whether the measurement and expression of GAD in adults varied as a function of age, using a clinical sample of 375 participants and dimensional measures of GAD. The sample was divided into three age groups (OLDER = 60+, MID = 40-59, YOUNG = 20-39), matched by sex and GAD status. Two associated symptoms were found to exhibit differential item functioning, overall distress/interference as well as fatigue, with higher levels distress/interference and lower levels of fatigue found in the OLDER age group despite equivalent GAD severity levels across groups. When examining the content of reported worries, differential item functioning was found in four worry domains. Holding the latent dimension of worry severity constant: (a) the YOUNG age group was found to have higher reported rate of social worries, and (b) the OLDER age group was found to have higher levels of reported worries about community/world affairs and health of self. The OLDER age group also exhibited lower levels of worry about work and school. These results are discussed with regard to the assessment of GAD across the lifespan.
Collapse
|
16
|
Wu M, Mennin DS, Ly M, Karim HT, Banihashemi L, Tudorascu DL, Aizenstein HJ, Andreescu C. When worry may be good for you: Worry severity and limbic-prefrontal functional connectivity in late-life generalized anxiety disorder. J Affect Disord 2019; 257:650-657. [PMID: 31357162 PMCID: PMC6711791 DOI: 10.1016/j.jad.2019.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 05/31/2019] [Accepted: 07/04/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Late-life generalized anxiety disorder (GAD) is one of the most common anxiety disorders in older adults. However, its neural markers have received relatively little attention. In this study, we explored the association between worry severity and limbic-prefrontal connectivity during emotional reactivity in late-life GAD. METHODS We recruited 16 anxious (GAD) and 20 non-anxious (HC) older adults to perform the faces/shapes emotional reactivity task during functional magnetic resonance imaging (fMRI). We investigated the functional connectivity of both the amygdala and the bed nucleus of stria terminalis (BNST) with the prefrontal cortex (PFC) using generalized psychophysiological interaction (gPPI) analysis. We tested for (1) group differences in connectivity, (2) association between worry severity and connectivity, and (3) interaction between group and worry severity and its association with connectivity. RESULTS Amygdala-PFC and BNST-PFC functional connectivity were associated with worry severity in an inverse U-shape, and was independent of depression severity, global anxiety, neuroticism, and general cognitive function. LIMITATIONS Our limitations include slightly skewed PSWQ distributions, lack of non-anxious individuals with high worry, small sample size, and low depression comorbidity in a sample of late-life GAD that may not generalize to GAD in younger populations. CONCLUSIONS This suggests that moderate worry is associated with maximum engagement of the limbic-PFC connectivity, while severe worry is associated with failure of the limbic-PFC emotional regulation circuit. This may explain the aberrant and exaggerated responses to negative stimuli observed in participants with pathological worry.
Collapse
Affiliation(s)
- M Wu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - DS Mennin
- Teachers college, Columbia University, New York City, NY
| | - M Ly
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - HT Karim
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - L Banihashemi
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - DL Tudorascu
- Department of Internal Medicine, Graduate School of Public health, Pittsburgh, PA,Department of Biostatistics, Graduate School of Public Health, Pittsburgh, PA
| | - HJ Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - C Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| |
Collapse
|
17
|
Jacques MC, St-Cyr Tribble D, Bonin JP. Filters in the coping process of people with schizophrenia: A constructivist grounded theory study. J Psychiatr Ment Health Nurs 2019; 26:142-152. [PMID: 30825402 DOI: 10.1111/jpm.12515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/06/2019] [Accepted: 02/27/2019] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: In the nursing perspective of Roy's adaptation model, to be adapted means to have positive interactions with one's environment. The ability to use effective coping strategies is an essential ingredient of mental health recovery. However, coping difficulties are often a problem for people with a diagnosis of schizophrenia spectrum disorder, especially those who have inadequate social support. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: "Filters in the coping process" is a grounded theory of coping in people with a diagnosis of schizophrenia spectrum disorder. A filter effect impairs their ability and limits their opportunities to use effective coping strategies. These filters are as follows: to have been helped, to understand in one's own way, to act despite limited freedom and to modulate the process of self-disclosure. "Surface coping" is the product of the effect of these filters on coping attempts and possibilities. It does not reflect the person's real potential. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: By offering an alternative, holistic nursing perspective, the filter model provides the nurse with factors to consider when assessing clients with a diagnosis of schizophrenia spectrum disorder, so as to plan interventions towards improving their coping capacity. By allowing for the presence of surface coping, the nurse will have less tendency to form negative judgments about clients with a diagnosis of schizophrenia spectrum disorder. ABSTRACT: Introduction Numerous studies confirm the coping difficulties of people diagnosed with schizophrenia spectrum disorder, especially those with limited social support. Further, the coping process is itself poorly understood. Aim Starting from a conceptualization of the adaptation of Roy's model, the aim of this study was to describe the coping process of people with schizophrenia spectrum disorder in the context of an inadequate social support. Method A constructivist grounded theorization was performed with a sample of 30 persons with schizophrenia spectrum disorder. Results The results are a model named: "Filters in the coping process of people with a diagnosis of schizophrenia spectrum disorder who have inadequate social support." The type of coping strategies used evolves over time and in accordance with the filters. The consequence of the process is "surface coping." Discussion The coping potential of people with schizophrenia spectrum disorder is affected by environmental factors as well as factors inherent to the disorder itself. The filter model provides a holistic perspective, as opposed to merely focusing on behaviours. Implication for practice The findings of this study could improve nursing interventions through a better understanding of impediments to coping: what they are, how they arise and the nature of their effects.
Collapse
Affiliation(s)
- Marie-Claude Jacques
- School of Nursing, Faculty of Medicine and Health Sciences, Université of Montreal, Montreal, Québec, Canada.,Institut universitaire de première ligne en santé et services sociaux, Sherbrooke, Québec, Canada
| | - Denise St-Cyr Tribble
- École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Jean-Pierre Bonin
- Faculté des sciences infirmières, Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|
18
|
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.
Collapse
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.
| |
Collapse
|
19
|
Abstract
This study examined the role of social support in managing worry among a sample of Malaysian adults. An online questionnaire was completed by 136 participants (age M = 34, SD = 7.65; 71% female, 29% male). Each wrote open-ended, essay-type descriptions of their experiences with social support in relation to worry, as well as completing measures of pathological worry (Penn State Worry Questionnaire), normal worry (Worry Domains Questionnaire), and perceived social support (Multidimensional Scale of Perceived Social Support). Results indicated that young adults experienced a higher degree of normal worry compared to older adults, but pathological worry was not significantly different between the two groups. No significant differences in worry were found in relation to gender, ethnicity or marital status. Perceived social support was negatively related to levels of both normal and pathological worry. Qualitative analyses pointed towards four important roles for social support: providing a sense of belonging and security, providing emotional relief or catharsis, helping to reappraise situations, and facilitating problem-solving and decision-making. The role of social support as a secure base that facilitates emotion management and helps to ground thinking is discussed.
Collapse
|
20
|
Kumar V, Avasthi A, Grover S. Correlates of worry and functional somatic symptoms in generalized anxiety disorder. Ind Psychiatry J 2019; 28:29-36. [PMID: 31879444 PMCID: PMC6929227 DOI: 10.4103/ipj.ipj_31_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/11/2019] [Accepted: 10/23/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Worry and functional somatic symptoms (FSS) are important clinical features of generalized anxiety disorder (GAD). Although there is literature on the prevalence of worry and FSS in GAD, there is limited data on psychological correlates of worry and somatic symptoms in patients with GAD. OBJECTIVE The purpose of this research was to evaluate the relationship of worry and FSS with somatosensory amplification, health anxiety (hypochondriasis), and alexithymia in patients with GAD. METHODS Forty patients with the diagnosis of GAD were assessed with Penn State Worry Questionnaire, Bradford Somatic Inventory (BSI), GAD-7 Scale, somatosensory amplification Scale (SSAS), Whiteley Index (WI), and Toronto Alexithymia Scale-20 Hindi version (TAS-H-20). RESULTS Worry had significant positive correlation with total scores of BSI, GAD-7 scale, TAS-H-20 subscale 1, SSAS, and WI. Younger age of onset was associated with higher FSS as assessed on BSI. BSI total score had positive correlation with total scores of GAD-7 scale, TAS-H-20 and its subscales, SSAS, WI, and with the severity grades of BSI and GAD. CONCLUSION Worry and FSS are associated with somatosensory amplification and hypochondriasis. In addition, somatic symptoms are associated with alexithymia.
Collapse
Affiliation(s)
- Vijaya Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
21
|
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.
Collapse
|
22
|
Schroder HS, Kneeland ET, Silverman AL, Beard C, Björgvinsson T. Beliefs About the Malleability of Anxiety and General Emotions and Their Relation to Treatment Outcomes in Acute Psychiatric Treatment. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9985-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
23
|
Forgeard M, Herzhoff K, Jayawickreme E, Tsukayama E, Beard C, Björgvinsson T. Changes in daily manifestations of Openness to Experience during intensive cognitive-behavioral treatment. J Pers 2018; 87:856-870. [PMID: 30317642 DOI: 10.1111/jopy.12438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 08/10/2018] [Accepted: 09/16/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Research examining relationships between trait Openness to Experience, psychopathology, and well-being has produced contradictory findings. Examining temporary manifestations of Openness may provide further insight into the interplay between Openness and symptoms in clinical populations. METHOD The present study validated a brief new measure to assess daily Openness in 271 adults (Mage = 34 years, 52% women, 83% White) taking part in 7 days of intensive treatment for acute psychopathology. Participants also completed a daily measure of depressive symptoms. RESULTS Participants overall experienced a significant but small increase in daily Openness during treatment. Two latent classes best characterized initial levels and trajectories of Openness in this sample: medium/increase (86% of sample) and low/decrease (14%). Daily Openness negatively related to depressive symptoms over the entire course of treatment and at the daily level. Daily Openness, however, did not predict depressive symptoms from one day to the next (or vice versa). CONCLUSIONS Results of this study contribute to the scientific understanding of positive personality change during challenging life circumstances. Future research could examine whether targeting Openness as part of treatment holds clinical value. Findings are limited by this study's short time frame and the lack of ethnoracial diversity in this sample.
Collapse
Affiliation(s)
- Marie Forgeard
- Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts.,Department of Clinical Psychology, William James College
| | - Kathrin Herzhoff
- Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts.,Department of Psychology, Northwestern University, Evanston, Illinois
| | - Eranda Jayawickreme
- Department of Psychology, Wake Forest University, Winston-Salem, North Carolina
| | - Eli Tsukayama
- Department of Business Administration and Marketing, University of Hawaii West Oahu, Kapolei, Hawaii
| | - Courtney Beard
- Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Thröstur Björgvinsson
- Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| |
Collapse
|
24
|
The relationship between personal growth and psychological functioning in individuals treated in a partial hospital setting. J Clin Psychol 2018; 74:1759-1774. [DOI: 10.1002/jclp.22627] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 01/26/2018] [Accepted: 02/17/2018] [Indexed: 11/07/2022]
|
25
|
Difficulty concentrating in generalized anxiety disorder: An evaluation of incremental utility and relationship to worry. J Anxiety Disord 2018; 53:39-45. [PMID: 29175616 PMCID: PMC5748347 DOI: 10.1016/j.janxdis.2017.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/28/2017] [Accepted: 10/25/2017] [Indexed: 10/18/2022]
Abstract
Difficulty concentrating is one of the most common diagnostic criteria across DSM-5 categories, especially within the emotional (mood- and anxiety-related) disorders. A substantial literature has characterized cognitive functioning in emotional disorders using objective (behavioral) computerized cognitive tasks. However, diagnoses are typically formed on the basis of subjective (self-reported; clinician-rated) assessments of symptoms, and little is known about difficulty concentrating as a symptom. These questions are particularly important for generalized anxiety disorder (GAD), which has long been the subject of nosological debates, and for which several theoretical models that suggest a central role for cognitive impairments (including difficulty concentrating) in the maintenance of psychopathology have been proposed. The present study evaluated the incremental utility of difficulty concentrating and its relationship to worry and other symptoms in 175 GAD-diagnosed adults. Clinician-assessed difficulty concentrating incrementally predicted clinician-rated GAD, anxiety, and depression severity even after other GAD symptoms were controlled. Consistent with theoretical models of GAD that propose a direct relationship between worry and cognitive impairment, difficulty concentrating mediated the relationship between trait worry and clinical severity. These findings suggest that difficulty concentrating has value as a diagnostic criterion and is a potential mechanism by which worry increases distress and impairment.
Collapse
|
26
|
Parsing sensitivity to negative affect in borderline personality disorder: A comparison of anxiety and disgust. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2017.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
27
|
Sellers R, Wells A, Morrison AP. Are experiences of psychosis associated with unhelpful metacognitive coping strategies? A systematic review of the evidence. Clin Psychol Psychother 2017; 25:31-49. [DOI: 10.1002/cpp.2132] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/09/2017] [Accepted: 07/28/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Rachel Sellers
- Division of Psychology and Mental Health, School of Health Sciences; University of Manchester; Manchester UK
- Psychosis Research Unit; Greater Manchester West Mental Health Foundation NHS Trust; Manchester UK
| | - Adrian Wells
- Division of Psychology and Mental Health, School of Health Sciences; University of Manchester; Manchester UK
| | - Anthony P. Morrison
- Division of Psychology and Mental Health, School of Health Sciences; University of Manchester; Manchester UK
- Psychosis Research Unit; Greater Manchester West Mental Health Foundation NHS Trust; Manchester UK
| |
Collapse
|
28
|
Lee KH, Jun JS, Kim YJ, Roh S, Moon SS, Bukonda N, Hines L. Mental Health, Substance Abuse, and Suicide Among Homeless Adults. ACTA ACUST UNITED AC 2017; 14:229-242. [DOI: 10.1080/23761407.2017.1316221] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Kyoung Hag Lee
- School of Social Work, Wichita State University, Wichita, Kansas, USA
| | - Jung Sim Jun
- School of Social Work, Wichita State University, Wichita, Kansas, USA
| | - Yi Jin Kim
- Department of Social Work, University of Mississippi, Oxford, Mississippi, USA
| | - Soonhee Roh
- Department of Social Work, University of South Dakota, Sioux Falls, South Dakota, USA
| | - Sung Seek Moon
- College of Social Work, University of South Carolina, Columbia, South Carolina, USA
| | - Ngoyi Bukonda
- Department of Public Health Sciences, Wichita State University, Wichita, Kansas, USA
| | - Lisa Hines
- School of Social Work, Wichita State University, Wichita, Kansas, USA
| |
Collapse
|
29
|
Abstract
The Penn State Worry Questionnaire for Children (PSWQ-C) is one of the most frequently used instruments to assess worry in children. The current study examines the measurement invariance of the PSWQ-C in a Romanian sample. Participants (n = 759) were recruited from both community and clinical populations. Our findings have replicated the good psychometric properties of the PSWQ-C and of the short PSWQ-C (the original scale with the negative items deleted). Multigroup confirmatory factor analysis has supported measurement invariance (configural, metric, scalar) across gender, age and clinical diagnosis. Convergent validity with other assessment measures has also been established. Finally, the implications of the use of the PSWQ-C in the assessment of anxiety in children and adolescents are discussed.
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
Beard C, Millner AJ, Forgeard MJC, Fried EI, Hsu KJ, Treadway M, Leonard CV, Kertz S, Björgvinsson T. Network analysis of depression and anxiety symptom relationships in a psychiatric sample. Psychol Med 2016; 46:3359-3369. [PMID: 27623748 PMCID: PMC5430082 DOI: 10.1017/s0033291716002300] [Citation(s) in RCA: 397] [Impact Index Per Article: 49.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Researchers have studied psychological disorders extensively from a common cause perspective, in which symptoms are treated as independent indicators of an underlying disease. In contrast, the causal systems perspective seeks to understand the importance of individual symptoms and symptom-to-symptom relationships. In the current study, we used network analysis to examine the relationships between and among depression and anxiety symptoms from the causal systems perspective. METHOD We utilized data from a large psychiatric sample at admission and discharge from a partial hospital program (N = 1029, mean treatment duration = 8 days). We investigated features of the depression/anxiety network including topology, network centrality, stability of the network at admission and discharge, as well as change in the network over the course of treatment. RESULTS Individual symptoms of depression and anxiety were more related to other symptoms within each disorder than to symptoms between disorders. Sad mood and worry were among the most central symptoms in the network. The network structure was stable both at admission and between admission and discharge, although the overall strength of symptom relationships increased as symptom severity decreased over the course of treatment. CONCLUSIONS Examining depression and anxiety symptoms as dynamic systems may provide novel insights into the maintenance of these mental health problems.
Collapse
Affiliation(s)
| | | | | | | | - Kean J. Hsu
- McLean Hospital/Harvard Medical School
- University of California, Los Angeles
| | | | | | | | | |
Collapse
|
32
|
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.
Collapse
Affiliation(s)
- Lucas S LaFreniere
- Department of Psychology, The Pennsylvania State University, Pennsylvania.
| | - Michelle G Newman
- Department of Psychology, The Pennsylvania State University, Pennsylvania
| |
Collapse
|
33
|
Sugiura T, Sugiura Y. Relationships Between Refraining From Catastrophic Thinking, Repetitive Negative Thinking, and Psychological Distress. Psychol Rep 2016; 119:374-94. [DOI: 10.1177/0033294116663511] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Skills to refrain from catastrophic thinking were negatively related to worry and a wide range of psychological distress. Repetitive negative thinking (including worry) is proposed as a common etiological factor for a wide range of psychological distress. Therefore, reduced repetitive negative thinking would mediate the negative relation between refraining from catastrophic thinking and psychological distress (depression, social anxiety, phobia, generalized anxiety, and obsessions and compulsions). As an overlap between five indices of psychological distress was expected, we first computed latent factors underlying them, which were then predicted by refraining from catastrophic thinking and repetitive negative thinking. Cross-sectional questionnaire data from 125 nonclinical voluntarily participating students ( M age = 19.0 years, SD = 3.6; 54% women) supported the predictions: refraining from catastrophic thinking was negatively correlated with depression, social anxiety, phobia, generalized anxiety, and obsession and compulsion. Repetitive negative thinking mediated the negative relationship between refraining from catastrophic thinking and latent factors underlying psychological distress (Fear and Distress). Refraining from catastrophic thinking may be negatively correlated with psychological distress due to its negative relation to repetitive negative thinking.
Collapse
Affiliation(s)
- Tomoko Sugiura
- Graduate School of Integrated Arts and Sciences, Hiroshima University, Higashi-Hiroshima, Japan
| | - Yoshinori Sugiura
- Graduate School of Integrated Arts and Sciences, Hiroshima University, Higashi-Hiroshima, Japan
| |
Collapse
|
34
|
Prevalence and Characteristics of Body Dysmorphic Disorder Among Patients in a Partial Hospital Program. J Nerv Ment Dis 2016; 204:554-7. [PMID: 27362701 DOI: 10.1097/nmd.0000000000000543] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Body dysmorphic disorder (BDD) is a common disorder that is usually associated with impaired functioning and high levels of suicidality. The current study is the first to assess prevalence of BDD among patients in a partial hospital program and compare patients with and without BDD on demographic and clinical variables. Participants were 207 patients with a variety of Axis I diagnoses. Prevalence of current BDD was 7.2%, and a diagnosis of BDD did not predict worse treatment outcome in the program. Patients with current BDD were more likely to be female and younger and have more comorbid diagnoses than patients without current BDD. No other significant differences were found at baseline between patients with and without current BDD. Results indicate that BDD is relatively common among patients in partial hospital programs and that such programs may be as beneficial to patients with BDD as to other patients.
Collapse
|
35
|
Webb CA, Beard C, Kertz SJ, Hsu KJ, Björgvinsson T. Differential role of CBT skills, DBT skills and psychological flexibility in predicting depressive versus anxiety symptom improvement. Behav Res Ther 2016; 81:12-20. [PMID: 27057997 DOI: 10.1016/j.brat.2016.03.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 03/24/2016] [Accepted: 03/27/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Studies have reported associations between cognitive behavioral therapy (CBT) skill use and symptom improvement in depressed outpatient samples. However, little is known regarding the temporal relationship between different subsets of therapeutic skills and symptom change among relatively severely depressed patients receiving treatment in psychiatric hospital settings. METHOD Adult patients with major depression (N = 173) receiving combined psychotherapeutic and pharmacological treatment at a psychiatric hospital completed repeated assessments of traditional CBT skills, DBT skills and psychological flexibility, as well as depressive and anxiety symptoms. RESULTS Results indicated that only use of behavioral activation (BA) strategies significantly predicted depressive symptom improvement in this sample; whereas DBT skills and psychological flexibility predicted anxiety symptom change. In addition, a baseline symptom severity X BA strategies interaction emerged indicating that those patients with higher pretreatment depression severity exhibited the strongest association between use of BA strategies and depressive symptom improvement. CONCLUSIONS Findings suggest the importance of emphasizing the acquisition and regular use of BA strategies with severely depressed patients in short-term psychiatric settings. In contrast, an emphasis on the development of DBT skills and the cultivation of psychological flexibility may prove beneficial for the amelioration of anxiety symptoms.
Collapse
Affiliation(s)
- Christian A Webb
- Department of Psychiatry, Harvard Medical School and Center for Depression, Anxiety and Stress Research, McLean Hospital.
| | - Courtney Beard
- Behavioral Health Partial Program, McLean Hospital, Harvard Medical School, 115 Mill Street, Belmont, MA 02478, USA
| | - Sarah J Kertz
- Department of Psychology, Southern Illinois University, Carbondale, IL, USA
| | - Kean J Hsu
- Behavioral Health Partial Program, McLean Hospital, Harvard Medical School, 115 Mill Street, Belmont, MA 02478, USA
| | - Thröstur Björgvinsson
- Behavioral Health Partial Program, McLean Hospital, Harvard Medical School, 115 Mill Street, Belmont, MA 02478, USA
| |
Collapse
|
36
|
Beard C, Stein AT, Hearon BA, Lee J, Hsu KJ, Björgvinsson T. Predictors of Depression Treatment Response in an Intensive CBT Partial Hospital. J Clin Psychol 2016; 72:297-310. [DOI: 10.1002/jclp.22269] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 10/26/2015] [Accepted: 12/31/2015] [Indexed: 11/12/2022]
|
37
|
Leidenfrost CM, Calabrese W, Schoelerman RM, Coggins E, Ranney M, Sinclair SJ, Antonius D. Changes in Psychological Health and Subjective Well-Being Among Incarcerated Individuals With Serious Mental Illness. JOURNAL OF CORRECTIONAL HEALTH CARE 2016; 22:12-20. [DOI: 10.1177/1078345815618200] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Corey M. Leidenfrost
- University at Buffalo, State University of New York, Buffalo, NY, USA
- Erie County Forensic Mental Health Services, Buffalo, NY, USA
| | - William Calabrese
- University at Buffalo, State University of New York, Buffalo, NY, USA
| | | | - Evelyn Coggins
- University at Buffalo, State University of New York, Buffalo, NY, USA
- Erie County Forensic Mental Health Services, Buffalo, NY, USA
| | - Michael Ranney
- Erie County Forensic Mental Health Services, Buffalo, NY, USA
| | | | - Daniel Antonius
- University at Buffalo, State University of New York, Buffalo, NY, USA
- Erie County Forensic Mental Health Services, Buffalo, NY, USA
- New York University School of Medicine, New York, NY, USA
| |
Collapse
|
38
|
Seeley SH, Mennin DS, Aldao A, McLaughlin KA, Rottenberg J, Fresco DM. Impact of Comorbid Depressive Disorders on Subjective and Physiological Responses to Emotion in Generalized Anxiety Disorder. COGNITIVE THERAPY AND RESEARCH 2015; 40:290-303. [PMID: 27660375 DOI: 10.1007/s10608-015-9744-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Generalized anxiety disorder (GAD) and unipolar depressive disorders (UDD) have been shown to differ from each other in dimensions of affective functioning despite their high rates of comorbidity. We showed emotional film clips to a community sample (n = 170) with GAD, GAD with secondary UDD, or no diagnosis. Groups had comparable subjective responses to the clips, but the GAD group had significantly lower heart rate variability (HRV) during fear and after sadness, compared to controls. While HRV in the GAD and control groups rose in response to the sadness and happiness clips, it returned to baseline levels afterwards in the GAD group, potentially indicating lesser ability to sustain attention on emotional stimuli. HRV in the GAD + UDD group changed only in response to sadness, but was otherwise unvarying between timepoints. Though preliminary, these findings suggest comorbid UDD as a potential moderator of emotional responding in GAD.
Collapse
Affiliation(s)
- Saren H Seeley
- The University of Arizona, 1503 East University Boulevard, Tucson, AZ 85721, USA
| | - Douglas S Mennin
- Department of Psychology, Hunter College, City University of New York, 695 Park Avenue, HN742, New York, NY 10065, USA; The Graduate Center, City University of New York, 365 5th Avenue, New York, NY 10016, USA
| | - Amelia Aldao
- Ohio State University, 1835 Neil Avenue, Columbus, OH 43210, USA
| | - Katie A McLaughlin
- University of Washington, 3939 University Way NE, Seattle, WA 98105, USA
| | | | - David M Fresco
- Kent State University, 226 Kent Hall Annex, Kent, OH 44242, USA
| |
Collapse
|
39
|
Transdiagnostic mechanisms in depression and anxiety: The role of rumination and attentional control. J Affect Disord 2015; 188:22-7. [PMID: 26340079 PMCID: PMC4765997 DOI: 10.1016/j.jad.2015.08.008] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/03/2015] [Accepted: 08/04/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Deficits in attentional control have been hypothesized to cause rumination, suggesting that the relationships between attentional control and clinical symptoms may be mediated in part by rumination. However, to date, no clinical study has examined these constructs transdiagnostically in a path analysis model. METHODS Fifty-one adults presenting for treatment completed measures of self-reported attentional control, rumination, and depression and anxiety symptoms. A bias-corrected path analysis-based approach was employed to test whether indirect (i.e., mediating) effects of rumination were significantly associated with the direct effects of attentional control on depression and anxiety symptoms. Separate models for depression and anxiety symptoms were tested along with reverse models using attentional control as a proposed mediator. RESULTS The relationship between attentional control and clinical symptomatology (i.e., both depression and anxiety symptoms) was mediated by rumination. Poor attentional control was associated with more rumination and consequently more severe symptoms of depression and anxiety. The reverse relationship (i.e., attentional control mediating the relationship between rumination and depression or anxiety symptoms) was not significant. LIMITATIONS Study design did not allow testing of temporal precedence for the mediation models. All constructs were assessed via self-report. CONCLUSIONS Attentional control appears to impact depression and anxiety symptoms through rumination. The pathway between poor attentional control and emotion dysregulation via rumination suggests that interventions targeting attentional control may decrease maladaptive ruminative processes, leading to improved emotion regulation and reduced clinical symptomatology. Future studies should examine the stability of this mediational relationship over time (and in the face of targeted interventions).
Collapse
|
40
|
Is post-event processing a social anxiety specific or transdiagnostic cognitive process in the anxiety spectrum? Behav Cogn Psychother 2015; 42:706-17. [PMID: 25413026 DOI: 10.1017/s135246581300074x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Research on post-event processing (PEP), where individuals conduct a post-mortem evaluation of a social situation, has focused primarily on its relationship with social anxiety. AIMS The current study examined: 1) levels of PEP for a standardized event in different anxiety disorders; 2) the relationship between peak anxiety levels during this event and subsequent PEP; and 3) the relationship between PEP and disorder-specific symptom severity. METHOD Participants with primary DSM-IV diagnoses of social anxiety disorder (SAD), obsessive compulsive disorder (OCD), panic disorder with/without agoraphobia (PD/A), or generalized anxiety disorder (GAD) completed diagnosis specific symptom measures before attending group cognitive behavioural therapy (CBT) specific to their diagnosis. Participants rated their peak anxiety level during the first group therapy session, and one week later rated PEP in the context of CBT. RESULTS The results indicated that all anxiety disorder groups showed heightened and equivalent PEP ratings. Peak state anxiety during the first CBT session predicted subsequent level of PEP, irrespective of diagnostic group. PEP ratings were found to be associated with disorder-specific symptom severity in SAD, GAD, and PD/A, but not in OCD. CONCLUSIONS PEP may be a transdiagnostic process with relevance to a broad range of anxiety disorders, not just SAD.
Collapse
|
41
|
Kertz SJ, Bakhti R, Stevens KT, Curewitz A. Testing Cognitive and Emotion-Focused Models of Worry in Black and White Samples. Cogn Behav Ther 2015; 44:353-64. [PMID: 25730261 DOI: 10.1080/16506073.2015.1013055] [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: 10/23/2022]
Abstract
Several models have been proposed to conceptualize worry. Broadly, the models can be classified as cognitive (including the Avoidance Model, the Intolerance of Uncertainty Model, and the Metacognitive Model) and emotion-focused (including Emotion Dysregulation and Acceptance-Based models). Although these models have received strong empirical investigation in primarily non-Hispanic White samples, no known study has examined the applicability to racial and ethnic minority groups. The current study compared the proportion of variance explained by cognitive and emotion-focused models of worry in White and Black samples. Results indicated that cognitive and emotion-focused models significantly predicted worry in both Black and White samples. However, the overall amount of variance in worry explained by the models was less for Black samples. Specifically, controlling for gender, the cognitive models explained 53% of the variance in worry in the White sample compared with 19% in the Black sample. Similarly, the emotion-focused models explained 34% of the variance in worry in the White sample but only 13% in the Black sample. These findings suggest that well-established conceptual frameworks for worry failed to explain the bulk of the variance in worry in Black samples, leaving much unknown. Additional research is needed to identify key variables that may further explain worry in ethnic minority samples.
Collapse
Affiliation(s)
- Sarah J Kertz
- a Department of Psychology, Southern Illinois University , Life Science II 6502, Carbondale , IL 62901 , USA
| | - Rinad Bakhti
- a Department of Psychology, Southern Illinois University , Life Science II 6502, Carbondale , IL 62901 , USA
| | - Kimberly T Stevens
- a Department of Psychology, Southern Illinois University , Life Science II 6502, Carbondale , IL 62901 , USA
| | - Alana Curewitz
- a Department of Psychology, Southern Illinois University , Life Science II 6502, Carbondale , IL 62901 , USA
| |
Collapse
|
42
|
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.
Collapse
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
| | | |
Collapse
|
43
|
Kertz SJ, Stevens KT, McHugh RK, Björgvinsson T. Distress intolerance and worry: the mediating role of cognitive variables. ANXIETY STRESS AND COPING 2014; 28:408-24. [PMID: 25314145 DOI: 10.1080/10615806.2014.974571] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Distress intolerance (DI) has been identified as a potential risk factor for a variety of maladaptive avoidance behaviors, including worry. However, mechanisms linking DI to specific behaviors remain poorly understood. One hypothesis is that DI is a general vulnerability that confers risk of particular avoidance behaviors via more specific, lower-order vulnerabilities. The current study examined associations between DI and worry-related cognitions. DESIGN A multiple mediator model tested the hypothesis that worry-related variables (intolerance of uncertainty [IU], cognitive avoidance, beliefs about worry, and negative problem orientation) mediated the association between DI and worry. METHODS An undergraduate student (n = 281) and a clinical (n = 123) sample completed self-report measures. RESULTS Across samples, worry was associated with higher levels of DI, IU, cognitive avoidance, beliefs about worry, and negative problem orientation. Mediation results differed somewhat between the two samples. In the undergraduate sample, IU, negative beliefs about worry, and positive beliefs about worry mediated the association between DI and worry. In the clinical sample, negative problem orientation and negative beliefs about worry mediated the association between DI and worry. CONCLUSIONS Results provide initial evidence that DI may be associated with worry via unique risk factors.
Collapse
Affiliation(s)
- Sarah J Kertz
- a Psychology Department , Southern Illinois University , Carbondale , IL , USA
| | | | | | | |
Collapse
|
44
|
Wuthrich VM, Johnco C, Knight A. Comparison of the Penn State Worry Questionnaire (PSWQ) and abbreviated version (PSWQ-A) in a clinical and non-clinical population of older adults. J Anxiety Disord 2014; 28:657-63. [PMID: 25124502 DOI: 10.1016/j.janxdis.2014.07.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/24/2014] [Accepted: 07/04/2014] [Indexed: 10/25/2022]
Abstract
The Penn State Worry Questionnaire (PSWQ) is a widely used measure of worry severity. An 8-item abbreviated version (PSWQ-A) has been developed as a brief screening measure, although there are limited studies assessing the psychometric properties of this measure in a large geriatric population. The aim of this study was to assess the utility of the PSWQ-A compared to the full PSWQ, to identify pathological worry in an older adult sample (N=108) of clinically anxious and depressed older adults, compared to a non-clinical sample (N=53). The PSWQ and PSWQ-A were found to have similarly adequate reliability and validity. The factor structure of the PSWQ-A was replicated, but not for the PSWQ. Both measures accurately distinguished between clinical and non-clinical status with similar sensitivity and specificity. These findings indicate the PSWQ-A is a useful measure for screening or epidemiological studies assessing worry in geriatric populations.
Collapse
Affiliation(s)
- Viviana M Wuthrich
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
| | - Carly Johnco
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Ashleigh Knight
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| |
Collapse
|
45
|
Weiss RB, Aderka IM, Lee J, Beard C, Björgvinsson T. A Comparison of Three Brief Depression Measures in an Acute Psychiatric Population: CES-D-10, QIDS-SR, and DASS-21-DEP. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2014. [DOI: 10.1007/s10862-014-9461-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
46
|
Stout DM, Shackman AJ, Johnson JS, Larson CL. Worry is associated with impaired gating of threat from working memory. ACTA ACUST UNITED AC 2014; 15:6-11. [PMID: 25151519 DOI: 10.1037/emo0000015] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Dispositional anxiety is a well-established risk factor for the development of anxiety and other emotional disorders. These disorders are common, debilitating, and challenging to treat, pointing to the need to understand the more elementary neurocognitive mechanisms that confer elevated risk. Importantly, many of the maladaptive behaviors characteristic of anxiety, such as worry, occur when threat is absent. This raises the possibility that worry reflects difficulties gating threat-related information from working memory--a limited capacity workspace that supports the maintenance, recall, and manipulation of information--and facilitates goal-directed thoughts and actions. Here, we tested, for the first time, whether trait-like individual differences in worry, a key facet of the anxious phenotype, reflect difficulties gating threat and neutral-related distracters from working memory. Results indicated that both dispositional worry and anxiety individually predicted the combined filtering cost of threat and neutral distracters. Importantly, worry was associated with inefficient filtering of threat-related, but not neutral, distracters from working memory. In contrast, dispositional anxiety was related to a similar level of threat and neutral filtering cost. Furthermore, dispositional anxiety's relationship to filtering of threat was predominantly driven by differences in worry. These results suggest that the propensity to worry is characterized by a failure to gate task-irrelevant threat from working memory. These results provide a framework for understanding the mechanisms underlying chronic worry and, more broadly, the cognitive architecture of dispositional anxiety.
Collapse
|
47
|
The therapeutic alliance in a naturalistic psychiatric setting: temporal relations with depressive symptom change. Behav Res Ther 2014; 61:70-7. [PMID: 25156322 DOI: 10.1016/j.brat.2014.07.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 07/24/2014] [Accepted: 07/25/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Numerous studies have reported associations between the therapeutic alliance and depressive symptom improvement in outpatient samples. However, little is known regarding the temporal relationship between the alliance and symptom change among relatively severely depressed patients receiving treatment in naturalistic, psychiatric hospital settings. METHOD Adult patients with major depression (n = 103) receiving combined cognitive behavioral therapy and pharmacological treatment at a psychiatric hospital completed repeated assessments of the therapeutic alliance and depressive symptoms, as well as a pretreatment assessment of their expectation of symptom improvement. RESULTS Results indicated that the alliance and treatment outcome expectancies significantly predicted subsequent depressive symptom change. However, in a model in which prior symptom change and treatment outcome expectancies were statistically controlled, the alliance-outcome association was rendered nonsignificant. The alliance was significantly associated with prior symptom improvement. CONCLUSIONS Findings highlight the importance of controlling for plausible third variable and temporal confounds to minimize biased estimates of alliance-outcome associations in future studies. Overall, results were more consistent with the alliance being a consequence, rather than a cause, of symptom change. Finally, findings contribute to a growing body of evidence supporting the role of treatment outcome expectancies in predicting symptom improvement, even within our relatively severely depressed sample.
Collapse
|
48
|
Topper M, Emmelkamp PMG, Watkins E, Ehring T. Development and assessment of brief versions of the Penn State Worry Questionnaire and the Ruminative Response Scale. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2014; 53:402-21. [DOI: 10.1111/bjc.12052] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 03/17/2014] [Indexed: 01/09/2023]
Affiliation(s)
- Maurice Topper
- Department of Clinical Psychology; University of Amsterdam; The Netherlands
- Cognitive Science Center Amsterdam; University of Amsterdam; The Netherlands
| | - Paul M. G. Emmelkamp
- Department of Clinical Psychology; University of Amsterdam; The Netherlands
- Cognitive Science Center Amsterdam; University of Amsterdam; The Netherlands
- The Center for Social and Humanities Research; King AbdulAziz University; Jeddah Saudi Arabia
| | - Ed Watkins
- School of Psychology; Mood Disorders Centre; University of Exeter; UK
| | - Thomas Ehring
- Department of Clinical Psychology and Psychotherapy; University of Münster; Germany
| |
Collapse
|
49
|
Bredemeier K, Beevers CG, McGeary JE. Serotonin transporter and BDNF polymorphisms interact to predict trait worry. ANXIETY STRESS AND COPING 2014; 27:712-21. [PMID: 24679122 DOI: 10.1080/10615806.2014.909928] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Excessive worry is associated with a range of psychological disorders. While previous studies have examined genes associated with a range of different anxiety phenotypes, none have explored genes specifically associated with the general tendency to worry. DESIGN The present study tested associations between trait worry and functional polymorphisms of three candidate genes: the serotonin transporter-linked polymorphic region (5-HTTLPR) of the SLC6A4 gene, the Val66Met region of the brain-derived neurotrophic factor (BDNF) gene, and the Val158Met region of the catechol-O-methyltransferase (COMT) gene. METHODS A heterogeneous sample of adult participants (n=173) completed the Penn State Worry Questionnaire (PSWQ) and provided DNA samples for genotyping. RESULTS Results revealed a significant interaction between 5-HTTLPR and BDNF genotypes predicting levels of worry. Specifically, there was a significant positive association between 5-HTTLPR short alleles and PSWQ scores, but only in BDNF met allele carriers. COMT genotype was not significantly associated levels of worry, nor did COMT interact with 5-HTTLPR or BDNF genotypes to predict PSWQ scores. CONCLUSIONS These findings provide preliminary evidence about the putative genetic etiology of worrying. Key limitations of the present study and corresponding directions for future research on this topic are discussed.
Collapse
Affiliation(s)
- Keith Bredemeier
- a Providence Veterans Affairs Medical Center , Providence , RI , USA
| | | | | |
Collapse
|
50
|
Björgvinsson T, Kertz SJ, Bigda-Peyton JS, Rosmarin DH, Aderka IM, Neuhaus EC. Effectiveness of cognitive behavior therapy for severe mood disorders in an acute psychiatric naturalistic setting: a benchmarking study. Cogn Behav Ther 2014; 43:209-20. [PMID: 24679127 DOI: 10.1080/16506073.2014.901988] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The current study examined the effectiveness of brief cognitive behavior therapy (CBT) for severe mood disorders in an acute naturalistic setting. The sample included 951 individuals with either major depressive disorder (n = 857) or bipolar disorder with depressed mood (n = 94). Participants completed a battery of self-report measures assessing depression, overall well-being, and a range of secondary outcomes both before and after treatment. We found significant reductions in depressive symptoms, worry, self-harm, emotional lability, and substance abuse, as well as significant improvements in well-being and interpersonal relationships, post-treatment. Comparable to outpatient studies, 30% of the sample evidenced recovery from depression. Comparison of findings to benchmark studies indicated that, although the current sample started treatment with severe depressive symptoms and were in treatment for average of only 10 days, the overall magnitude of symptom improvement was similar to that of randomized controlled trials. Limitations of the study include a lack of control group, a limitation of most naturalistic studies. These findings indicate that interventions developed in controlled research settings on the efficacy of CBT can be transported to naturalistic, "real world" settings, and that brief CBT delivered in a partial hospital program is effective for many patients with severe depressive symptoms.
Collapse
|