Does the Beck Anxiety Inventory measure anything beyond panic attack symptoms?

Associations between Sleep Disturbance and Suicidal Ideation Severity in Iranian University Students: Evaluating Emotion Regulation Difficulties and Distress Tolerance

AIM

Although sleep disturbance is associated with suicide ideation, underlying cognitive-affective mechanisms that may explain this association are not well understood. The aim of the present study was to concurrently evaluate whether emotion regulation difficulties and distress tolerance explain this association among Iranian university students.

METHOD

A total of 679 Iranian university students (66.42% females; Mage = 24.34 years, SD = 4.86) completed a battery of online self-report questionnaire. Structural equation modeling was used to empirically explore the relations among variables.

RESULTS

Sleep disturbance was positively associated with suicide ideation. Higher sleep disturbance symptoms were associated with higher levels of suicide ideation. Sleep disturbance was indirectly related to suicide ideation through both emotion regulation difficulties and distress tolerance.

CONCLUSION

Findings expand knowledge of cognitive-emotional processes that may explain the sleep disturbance-suicide ideation association among Iranian university students. Iranian students experiencing sleep disturbance may benefit from intervention strategies targeting emotion regulation skills and distress tolerance to reduce suicide ideation.

Reduction of anxiety symptoms during systemic family therapy results in a concurrent improvement of cognitive performance: a study on people with high anxiety

Difficulties in various cognitive functions are common observations in people experiencing anxiety. However, limited research has investigated the effects of psychotherapy on abnormal cognitive functioning. This study assessed whether psychotherapy-related reductions of anxiety result in improvements of cognitive functioning as well. Fifty-four participants with high self-reported anxiety, divided into two experimental groups (N = 28 and N = 26), and 27 non-anxious control participants (N = 27) completed a battery of memory tasks and anxiety questionnaires in three consecutive time points. In experimental group 1, participants started systemic family therapy immediately after the first time point, while, in experimental group 2, participants begun the same type of therapy three months later at the second time point. The results showed that, compared to control participants, at the beginning of the experiment, participants in the experimental groups had significantly lower memory performance, along with higher anxiety. Psychotherapy had a beneficial effect on anxiety symptoms and cognitive performance, with significant changes occurring only after intervals of treatments. These results show that psychotherapy is effective not only in reducing anxiety symptoms but on cognitive functioning as well. This improvement might be linked to the release of cognitive resources previously absorbed by worrisome thoughts, facilitated by a heightened protection from interference.

Anxiety during the long-term course of obsessive-compulsive disorder

OBJECTIVE

The study aimed to investigate anxiety and its relation with obsessive-compulsive symptoms during the long-term course of obsessive-compulsive disorder (OCD).

METHODS

We used data from the Netherlands OCD Association (NOCDA) study, which included 419 participants with OCD (aged 18-79 years). Severity of obsessive-compulsive symptoms and anxiety at baseline and after two, four, and six years were entered into three models, which were analyzed using structural equation modeling: 1) the cross-lagged model, which assumes that anxiety and obsessive-compulsive symptoms are two distinct groups of symptoms interacting directly on the long-term; 2) the stable traits model, which assumes that anxiety and obsessive-compulsive symptoms result from two distinct latent factors, which are stable over the time and interact with each other; and 3) the common factor model, which assumes that anxiety and obsessive-compulsive symptoms are presentations of the same latent factor.

RESULTS

The cross-lagged model and the stable traits model both were valid models with a good model fit. The common factor model had a poor model fit and was rejected.

LIMITATIONS

The duration of OCD varied widely between the participants (0-64 years). The majority experienced obsessive-compulsive symptoms since several years, which may have affected results on the course of anxiety and the interaction between anxiety and obsessive-compulsive symptoms.

CONCLUSIONS

Anxiety and obsessive-compulsive symptoms in OCD patients do not result from a shared underlying factor but are distinct, interacting symptom groups, probably interacting by distinct latent factors.

Reducing safety behaviors to prevent anxious symptoms: a pre-registered prevention intervention study

The purpose of this pre-registered study was to test the efficacy of a simple, low-impact safety behavior prevention intervention for anxiety. The intervention was delivered online using a 4-week workbook format. Participants (n = 130) were a non-clinical sample of American college students; they were randomly assigned to one of two intervention conditions: safety-behavior reduction or active control condition (academic skills). Results showed that participants in the safety behavior workbook condition did not report fewer safety behaviors or lower levels of anxiety compared to the active control condition post-intervention. Exploratory analyses found that fidelity mattered; participants who completed all the workbook activities reported a significant decrease in the safety-behaviors relative to the control condition. However, those who reduced their use of safety behaviors reported greater levels of anxiety compared to participants in the control condition who reduced their safety behaviors. These results suggest that encouraging safety behavior reduction in non-clinical samples may have the unintended consequence of maintaining anxiety.

Efficacy of combined subanesthetic ketamine infusion and cervical sympathetic blockade as a symptomatic treatment of PTSD/TBI in a special forces patient with a 1-year follow-up: A case report

Co-occurrence of posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) symptoms are particularly prevalent in the special operations forces' community, along with other related conditions (e.g., endocrine dysregulation, sleep disorders, chronic pain). Ketamine infusion (KI) has been shown to increase neuroplasticity as well as memory improvement and cervical sympathetic block (CSB) has been shown to improve cognitive function, reduce sympathetic overactivity, and improve other symptoms of PTSD. We want to report the efficacious use of a single intervention consisting of bilateral CSB technique with subanesthetic KI X5 in a Special Operations Forces patient, diagnosed with PTSD with comorbid TBI, evaluated during treatment and at 1-year follow-up. We postulated KI and CSB would have a synergistic effect. Our patient received KI starting at 0.5 mg/kg, which was escalated daily. KI was combined with right-sided ultrasound-guided CSB (C6 and C4 levels). This was followed the next day by left-sided CSB and KI. Patient's PTSD symptoms were evaluated using the Posttraumatic Stress Disorder Checklist (PCL-5), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), suicidal ideation and other related factors by Concise Health Risk Tracking Self Report (CHRTSR). All measures were assessed prior to treatment, during treatment, and 394 days after. KI combined with CSB showed immediate and prolonged benefits 394 days later regarding the symptoms of PTSD, anxiety, depression, suicidal ideation, and cognitive deterioration (patient report). KI combined with CSB can markedly reduce symptoms of PTSD, psychiatric comorbidities, and cognitive dysfunction.

Efficacy of aripiprazole as adjunctive therapy in major depressive disorder with somatic symptoms: A randomized, double-blind, placebo-controlled trial with clinical and electroencephalography evidence

BACKGROUND

Somatic symptoms, which are common in major depressive disorder (MDD), are associated with a worse prognosis and increased health costs.

AIMS

This randomized, double-blind, placebo-controlled study evaluated the efficacy of aripiprazole augmentation in MDD patients with somatic symptoms.

METHODS

In all, 41 MDD patients with somatic symptoms completed the study. Participants who had been on a stable dose of antidepressants for at least 1 month were randomly assigned to receive an 8-week adjunctive treatment with either aripiprazole or placebo. The initiation dose of aripiprazole was 2 mg/day, which was later adjusted to 1-10 mg/day. The primary endpoint was the change in the Symptom Checklist-90-Revised-Somatization (SCL-90-R-SOM) score. We collected quantitative electroencephalogram data and performed spectral analyses to obtain the absolute power of frequency bands.

RESULTS/OUTCOMES

The aripiprazole group (n = 20; 2.98 ± 1.75 mg/day) showed a significant improvement in SCL-90-R-SOM scores compared to the placebo group (n = 21; F = 8.56, p = 0.006), without significant differences in changes in depression and anxiety symptoms. Compared to the control, the aripiprazole group showed a greater decrease in total alpha power (F = 7.03, p = 0.01). Changes in frontal alpha power were positively correlated with changes in SCL-90-R-SOM scores in the aripiprazole group (r = 0.53, p = 0.014).

CONCLUSIONS/INTERPRETATION

Aripiprazole adjunctive to antidepressants in patients with MDD and somatic symptoms improved somatic symptom severity without significant safety concerns, and this improvement correlated with a decrease in total and frontal alpha power.Trial Registration: https://cris.nih.go.kr; identifier: KCT0004607.

Reliability and validity of the traditional Chinese version of the GAD-7 in Taiwanese patients with epilepsy

BACKGROUND

Generalized anxiety disorder (GAD) is the second most common psychiatric comorbidity of epilepsy. GAD has a negative impact on seizure control, and it is underrecognized. The Generalized Anxiety Disorder 7-item (GAD-7) questionnaire is useful for screening GAD in patients with epilepsy (PWE). This study aimed to validate the traditional Chinese version of the GAD-7 for Taiwanese patients by obtaining data on adult PWE from our hospital.

METHOD

PWE were recruited from the Taipei Veterans General Hospital from April 2017 to January 2020. The mood disorder module of the Mini International Neuropsychiatric Interview (MINI) was used for the psychiatric assessment. The traditional Chinese version of the GAD-7 and the Beck Anxiety Inventory were included as self-rated psychiatric evaluation. To investigate the psychometric properties, internal consistency, external validation, and receiver operator characteristic (ROC) curve analysis were conducted to assess the utility of the Taiwanese version of the GAD-7.

RESULTS

We recruited 109 patients in the present study. Seventeen patients (15.9%) had GAD according to the MINI. The mean GAD-7 score was 10.28 ± 10.68. All the GAD-7 items were significantly and positively associated with the corrected overall GAD-7 score (Cronbach's alpha = 0.928, p < 0.0001). The cut-off point for the GAD-7 in ROC curve analysis was 7. The patients with GAD were more likely to be female and single.

CONCLUSION

The traditional Chinese version of the GAD-7 is a reliable and valid self-report questionnaire for detecting GAD in Taiwanese PWE.

Emotion and Emotion Preferences in Daily Life: The Role of Anxiety

People vary in their emotion preferences (i.e., desired emotional states). No study, however, has examined the nature of emotion preferences in anxiety. The current study utilized a 14-day ecological momentary assessment (EMA) paradigm to investigate the daily dynamics of emotion preferences and state emotion as they relate to individual differences in trait anxiety and anxiety symptom severity. Individuals with higher levels of trait anxiety and with more severe anxiety symptoms report greater preferences for state anxiety compared to their low anxiety counterparts. Relations between anxiety preferences and subsequent anxiety vary as a function of trait anxiety and symptom severity, and different associations are observed between the two measures of anxiety. The current findings suggest that aberrant emotion preferences may contribute to emotion dysfunction in anxiety, and highlight emotion preferences as a novel treatment target for interventions that aim to improve emotion functioning among people with elevated levels of anxiety.

Anxiety Symptoms and Disorders in College Students With ADHD

Objective: This study examined anxiety symptoms and disorders in college students with ADHD. Method: Forty-six college students with ADHD and a matched group of students without ADHD participated. Participants completed self-report measures of anxiety symptoms and associated features, including worry, maladaptive beliefs about worry, panic symptoms, social anxiety, obsessive-compulsive symptoms, and self-efficacy. Participants also completed a diagnostic interview to assess lifetime and current anxiety disorders. Results: Participants with ADHD endorsed more maladaptive beliefs about worry, more obsessive-compulsive symptoms, and poorer self-efficacy compared with comparison participants. There were no group differences in rates of current anxiety disorders. Participants with ADHD were over 2 times more likely than comparison participants to endorse this lifetime history. Conclusion: College students with ADHD are more likely to have a lifetime history of an anxiety disorder and are at greater risk for some anxiety symptoms and associated features.

Role of panic appraisal in predicting the severity of panic and agoraphobic symptoms

OBJECTIVE

The present study examined the contribution of panic appraisal (PA) dimensions to the prediction of panic and agoraphobic symptoms, above and beyond anxiety sensitivity (AS), among patients with panic disorder. PA dimensions consist of anticipated panic, perceived panic consequences, and panic coping efficacy.

METHOD

Panic disorder patients (N = 84, 60.7% female, M = 38 years) completed self-report measures of panic and agoraphobic symptoms, three dimensions of PA, AS, anxiety, and depression symptoms.

RESULTS

PA dimensions significantly contributed to the prediction of overall and all facets of panic and agoraphobic symptoms, as well as anxiety symptoms, but not depressive symptoms, above and beyond AS. Of the three PA dimensions, both anticipated panic and panic coping efficacy uniquely contributed to agoraphobic avoidance after controlling for AS and the other dimensions of PA.

CONCLUSION

PA dimensions may emerge as an important predictor of panic and agoraphobic or anxiety symptoms.

Transdiagnostic Dimensions of Psychiatric Comorbidity in Individuals at Clinical High Risk for Psychosis: A Preliminary Study Informed by HiTOP

Background: Although psychiatric comorbidity is the norm among individuals at clinical high risk for psychotic disorders (CHR), research has yet to examine transdiagnostic dimensional models of comorbidity in this critical population. Methods: This study analyzed quantitative measures of eleven psychiatric syndromes in a group at CHR (n = 71) and a matched healthy comparison group (n = 73) to determine these syndromes' dimensional structure and relationships to cognition, functioning, and risk of conversion to psychotic disorders. Results: Relative to the comparison group, the CHR group was elevated on all eleven psychiatric syndromes. Exploratory factor analysis found three psychopathology dimensions: internalizing, negative symptoms, and positive symptoms. Depression cross-loaded onto the internalizing and negative symptom dimensions. Hypomania loaded positively on positive symptoms but negatively on negative symptoms. The negative symptom factor was associated with poorer cognition and functioning and a higher risk of conversion to psychosis. Conclusions: These dimensions align with internalizing, detachment, and thought disorder, three of the five spectra in higher-order models such as the Hierarchical Taxonomy of Psychopathology (HiTOP). In the CHR state, detachment appears to be particularly insidious and predictive of psychosis. Further research is required to distinguish depression and hypomania from attenuated psychotic symptoms in this population.

Anxiety Symptoms Questionnaire (ASQ): development and validation

Background

The Anxiety Symptoms Questionnaire (ASQ) is a brief self-report questionnaire which measures frequency and intensity of symptoms and was developed to improve assessment of anxiety symptoms in a clinical setting. We examined the reliability and validity of the ASQ in patients with anxiety disorders and/or depression, non-clinical control subjects and college students.

Methods

240 outpatients with generalised anxiety disorder, social anxiety disorder, panic disorder or major depressive disorder were administered the ASQ and additional questionnaires measuring depression and anxiety, as were 111 non-clinical control subjects and 487 college students. Factor analysis, Pearson's correlation coefficients and logistic regression were used to assess reliability and validity. Test-retest reliability of the ASQ was measured using a subset who were re-administered the ASQ after 4 weeks.

Results

Factor analysis revealed measurement of a single dimension by the ASQ. Internal consistency and test-retest reliability were strong. The ASQ total score also significantly distinguished patients with an anxiety disorder from the clinical controls above and beyond the clinician-rated Hamilton Anxiety Scale.

Conclusions

The ASQ is a valid, reliable and effective self-rated measure of anxiety and may be a useful tool for screening and assessing anxiety symptoms in psychiatric as well as college settings.

Association of recommended food score with depression, anxiety, and quality of life in Korean adults: the 2014-2015 National Fitness Award Project

BACKGROUND

A healthy diet is a key determinant of an individual's health status and is closely related to mental health and quality of life (QoL); however, the exact nature of the relationship is unknown. This study hypothesized that a higher diet quality score is associated with a lower observance of symptoms of depression and anxiety and a higher QoL.

METHODS

This study evaluated 1,295 adults (521 men; 774 women) aged 19-64 years, who participated in the 2014-2015 National Fitness Award Project. Diet quality was measured by the recommended food score (RFS), and mental health and QoL were assessed by the beck depression inventory (BDI), beck anxiety inventory (BAI), and the World Health Organization QoL-Brief (WHOQoL-BREF).

RESULTS

After adjusting for covariates, the individuals with depression had a significantly lower RFS value compared to those without depression, and the group with a QoL score above the median had a higher RFS value than the group with a QoL score below the median. These trends occurred in both men and women. Subjects in the highest tertile of RFS showed a lower odds of depression (OR = 0.51, 95% CI = 0.32-0.81, p-trend = 0.0043) and a QoL score below the median (OR = 0.40, 95% CI = 0.30-0.54, p-trend < 0.0001) compared with those in the lowest tertile. The RFS was not associated with anxiety.

CONCLUSIONS

Our data suggest that higher diet quality may be associated with lower depressive symptoms and a better QoL in Korean adults.

Evidence for Transdiagnostic Repetitive Negative Thinking and Its Association with Rumination, Worry, and Depression and Anxiety Symptoms: A Commonality Analysis

Recent theoretical advances have emphasized the commonality between rumination and worry, often referred to as repetitive negative thinking. Although not studied extensively, repetitive negative thinking may not only account for a substantial overlap between depression and anxiety symptoms but also encapsulate other constructs including one's tendency to experience unwanted intrusive thoughts or have low levels of mindfulness. In this study, 643 college students completed self-report questionnaire measures of repetitive negative thinking (the Habit Index of Negative Thinking) and other relevant constructs including rumination, worry, depression and anxiety symptoms, intrusive thoughts, and mindfulness. To analyze the data, we conducted systematic commonality analyses, which algebraically decomposed shared variances among these measures into various unique components. Results in Study 1 indicated that individual differences in repetitive negative thinking were explained largely by the overlap between rumination and worry, but also by some rumination-specific and worry-specific variance. Moreover, the shared variation in rumination and worry explained the frequencies of depression and anxiety symptoms and their overlap. We also found in Study 2 that repetitive negative thinking was positively related to intrusive thoughts and negatively related to mindfulness. These associations were mostly explained by shared variance with rumination and worry, but there was also some mindfulness-specific variance. These results suggest that repetitive negative thinking may indeed lie at the core of the comorbidity between depression and anxiety symptoms, but that it is also a broader construct that encompasses intrusive thoughts and low levels of mindfulness.

Clinical Utility of Beck Anxiety Inventory in Clinical and Nonclinical Korean Samples

Despite the prominent use of the Beck Anxiety Inventory (BAI) in primary healthcare systems, few studies have confirmed its diagnostic utility and psychometric properties in non-Western countries. This study aims to clarify the clinical utility of the BAI as a screening tool for anxiety disorders according to DSM-IV criteria, based on blind recruitment and diagnostic interviews of both clinical and non-clinical participants in the Korean population. A total of 1,157 participants were involved in the final psychometric analysis, which included correlational analysis with other anxiety and depression self-report measures and mean score comparison with the Beck Depression Inventory (BDI). ROC analysis and calculation of positive and negative predictive values were conducted to examine diagnostic utility. The BAI was found to have high correlations with depression-related self-report measures (0.747-0.796) and moderate to high correlations with anxiety-related self-report measures (0.518-0.776). The ROC analysis failed to provide cutoff scores with adequate sensitivity and specificity for identifying participants with anxiety disorders (85.0% sensitivity, 88.1% specificity, and 92.8% AUC). The comparison of BAI and BDI mean scores for different diagnostic groups revealed that BAI and BDI scores were higher in the depressive or anxiety disorders group than in the non-clinical group. However, BAI mean score was not higher for the anxiety-only group than the depression-only group. Our data supports the BAI reliability and validity as a tool to measure the severity of general anxiety in clinical and non-clinical populations; however, it fails to capture the unique characteristics of anxiety disorders that distinguish them from depressive disorders. Further clinical implications of the BAI based on these results and some limitations of the study are discussed.

Self-report indicators of negative valence constructs within the research domain criteria (RDoC): A critical review

BACKGROUND

In 2010, the National Institute of Mental Health (NIMH) created the Research Domain Criteria (RDoC), a research framework for integrating multiple units of information to explicate basic dimensions of functioning underlying both adaptive and maladaptive behavior. Our goal in this review is to evaluate self-report indicators of negative valence systems constructs within RDoC.

METHODS

We review the content and correlates of several of the most popular self-report measures currently classified within the negative valence systems in the RDoC matrix, using both our own data and previously published results. We use these data to evaluate whether these measures are appropriately placed; in addition, wherever possible, we recommend better alternatives to assess key RDoC constructs.

RESULTS

Our findings indicate that many of the currently listed self-report measures are misplaced. Specifically, our data reveal that some of the purported fear scales are better conceptualized as measures of anxiety and/or anxious arousal. In addition, none of the currently listed measures of frustrative nonreward is a clear, unambiguous indicator of that construct.

LIMITATIONS

The RDoC matrix currently does not list any specific measures of either loss or sustained threat, which makes it difficult to identify appropriate measures of these constructs. In many cases, the specificity/discriminant validity of proposed measures remains uncertain.

CONCLUSIONS

Researchers wanting to include self-report measures of negative valence constructs currently receive little guidance from the RDoC matrix. Future assessment work should be oriented toward the development of measures that are explicitly designed to assess these RDoC constructs.

CRHR1 promoter hypomethylation: An epigenetic readout of panic disorder?

The corticotropin releasing hormone receptor 1 (CRHR1) is crucially involved in the hypothalamic-pituitary-adrenal axis and thus a major regulator of the stress response. CRHR1 gene variation is associated with several mental disorders including anxiety disorders. Studies in rodents have demonstrated epigenetic regulation of CRHR1 gene expression to moderate response to stressful environment. In the present study, we investigated CRHR1 promoter methylation for the first time regarding its role in panic disorder applying a case-control approach (N=131 patients, N=131 controls). In an independent sample of healthy volunteers (N=255), CRHR1 methylation was additionally analyzed for association with the Beck Anxiety Inventory (BAI) score as a dimensional panic-related intermediate phenotype. The functional relevance of altered CRHR1 promoter methylation was investigated by means of luciferase-based reporter gene assays. In panic disorder patients, a significantly decreased CRHR1 methylation was discerned (p<0.001). Accordingly, healthy controls with high BAI scores showed significantly decreased CRHR1 methylation. Functional analyses revealed an increased gene expression in presence of unmethylated as compared to methylated pCpGl_CRHR1 reporter gene vectors. The present study identified a potential role of CRHR1 hypomethylation - conferring increased CRHR1 expression - in panic disorder and a related dimensional intermediate phenotype. This up-regulation of CRHR1 gene expression driven by de-methylation might constitute a link between the stress response and panic disorder risk.

Depressive Symptoms and the Anticipation and Experience of Uplifting Events in Everyday Life

OBJECTIVE

Despite proliferation of laboratory-based studies examining reward functioning in depression, few studies have examined these processes in everyday life. We addressed this shortcoming by exploring experience and anticipation of uplifting experiences under ecologically valid conditions METHOD: One hundred fifty-seven young adults, oversampled for depressive symptoms, completed a 14-day diary tracking mood in relation to recent and anticipated positive events RESULTS: Consistent with studies supporting "mood-brightening" effects in depression, participants with greater baseline dysphoria showed stronger associations between elevated daily uplifts and lower daily depressive symptoms, particularly when events were interpersonal in nature. Baseline dysphoria was associated with lower daily anticipation of positive next-day experiences; however, when dysphoric individuals did anticipate positive experiences, they experienced greater reductions in depressed mood CONCLUSION: Results suggest that despite reward processing deficits found in laboratory studies, dysphoric individuals show improvements in mood in conjunction with anticipation and consumption of uplifting events in daily life.

Relative effects of cognitive and behavioral therapies on generalized anxiety disorder, social anxiety disorder and panic disorder: A meta-analysis

Although cognitive and behavioral therapies are effective in the treatment of anxiety disorders, it is not clear what the relative effects of these treatments are. We conducted a meta-analysis of trials comparing cognitive and behavioral therapies with a control condition, in patients with social anxiety disorder (SAD), generalized anxiety disorder (GAD) and panic disorder. We included 42 studies in which generic measures of anxiety were used (BAI, HAMA, STAI-State and Trait). Only the effects of treatment for panic disorder as measured on the BAI (13.33 points; 95% CI: 10.58-16.07) were significantly (p=0.001) larger than the effect sizes on GAD (6.06 points; 95% CI: 3.96-8.16) and SAD (5.92 points; 95% CI: 4.64-7.20). The effects remained significant after adjusting for baseline severity and other major characteristics of the trials. The results should be considered with caution because of the small number of studies in many subgroups and the high risk of bias in most studies.

Reduced power spectra of heart rate variability are correlated with anxiety in patients with mild traumatic brain injury

Anxiety is one of the most frequently diagnosed emotional disorders after a mild traumatic brain injury (mTBI); however, predictors of anxiety after an mTBI remain uncertain. Recent research indicated that anxiety is associated with abnormalities in the autonomic nervous system (ANS) which can be evaluated by a power spectral analysis of heart rate variability (HRV). In this study, we investigated whether a frequency-domain analysis of HRV could correlate with the occurrence of anxiety in mTBI patients. We recruited 165 Taiwanese patients diagnosed with an mTBI and 82 volunteer healthy controls from three affiliated hospitals of Taipei Medical University during 2010-2014. The Beck Anxiety Inventory (BAI) was assessed at the 1st, 6th, and 12th weeks. We found that mTBI patients were more vulnerable to anxiety compared to healthy controls. The power spectral density of HRV was significantly lower in mTBI patients than in healthy controls. A correlation analysis indicated that anxiety was negatively significantly correlated with low- and high-frequency power at the 6th week. Our study suggests the clinical usefulness of HRV as a potential noninvasive tool for evaluating later anxiety in mTBI patients.

Intolerance of uncertainty and transdiagnostic group cognitive behavioral therapy for anxiety

BACKGROUND

Recent evidence suggests intolerance of uncertainty (IU) is a transdiagnostic variable elevated across anxiety disorders. No studies have investigated IU's response to transdiagnostic group CBT for anxiety (TGCBT). This study evaluated IU outcomes following TGCBT across anxiety disorders.

METHODS

151 treatment-seekers with primary diagnoses of social anxiety disorder, panic disorder, or GAD were evaluated before and after 12 weeks of TGCBT and completed self-report questionnaires at pre-, mid-, and post-treatment.

RESULTS

IU decreased significantly following treatment. Decreases in IU predicted improvements in clinical presentation across diagnoses. IU interacted with time to predict improvement in clinical presentation irrespective of primary diagnosis. IU also interacted with time to predict improvement in clinical presentation although interactions of time with diagnosis-specific measures did not. IUS interacted with time to predict reduction in anxiety and fear symptoms, and inhibitory IU interacted with time to predicted reductions in anxiety symptoms but prospective IU did not.

CONCLUSION

IU appears to be an important transdiagnostic variable in CBT implicated in both initial presentation and treatment change. Further implications are discussed.

Cardiac Denial and Psychological Predictors of Cardiac Care Adherence in Adults With Congenital Heart Disease

The current study examined cardiac denial and psychological predictors (i.e., depression, anxiety) of health outcomes including medical nonadherence and physical health in a sample of 80 adults with congenital heart disease (ACHD). Results indicated that denial of impact was elevated in this patient group compared with reference groups, and denial was negatively associated with depression and anxiety at ps < .01. Results indicated that depression, anxiety, and denial predicted unique variance in medical nonadherence, and gender moderated the relationships between these psychological factors and nonadherence. For depression, men and women showed similar relationships between depression and nonadherence at high levels of depression; however, at low levels of depression (i.e., a more normal mood state), men were less adherent compared with women. For anxiety, men and women did not differ in adherence at low levels of anxiety; however, men experiencing high anxiety were less adherent compared with women experiencing high anxiety. Implications of this study are discussed including the role of gender and denial and the impact of denial functioning to reduce negative affect. Depression was the only significant predictor of physical functioning. Results of this study suggest that psychological interventions aimed at depression and anxiety may function differently across gender to improve patient medical adherence and improve physical functioning in ACHD.

Heart rate variability and serum level of insulin-like growth factor-1 are correlated with symptoms of emotional disorders in patients suffering a mild traumatic brain injury

OBJECTIVE

Patients who have experienced a mild traumatic brain injury (mTBI) are susceptible to symptoms of anxiety or depression. To explore the potential biomarkers for emotional disorders in mTBI patients, we analyzed the frequency domain of heart rate variability (HRV) and serum concentrations of four neurohormones.

METHODS

We assessed mTBI patients on their first visit and follow-up. Symptoms were evaluated by the Beck Anxiety Inventory and the Beck Depression Inventory, respectively. Serum levels of adrenocorticotropic hormone (ACTH), melatonin, cortisol, and insulin-like growth factor (IGF)-1 and HRV follow-ups were measured and compared.

RESULTS

mTBI patients were more vulnerable to symptoms of anxiety or depression than healthy controls. Reduced HRV was noted in mTBI patients compared to healthy controls. The mTBI patients demonstrated higher serum levels of ACTH, lower IGF-1 compared to healthy controls. In correlation analysis, only IGF-1 was positively correlated with HRV in mTBI patients. Both HRV and IGF-1 were correlated with symptom of depression while only HRV was correlated with symptom of anxiety in mTBI patients.

CONCLUSIONS

We infer that HRV may be more significantly correlated with emotional disorders than is IGF-1 in mTBI patients.

SIGNIFICANCE

The study is relevant for specific diagnostic markers in mTBI patients.

Safety Behavior Increases Obsession-Related Cognitions About the Severity of Threat

This study investigated whether checking behavior, the most common safety behavior in obsessive-compulsive disorder (OCD), contributes to the development of OCD symptoms. Ninety healthy undergraduates spent a week between a pre- and posttest either actively engaging in clinically representative checking behavior on a daily basis (experimental group, n=30), monitoring their normal checking behavior (monitor group, n=30), or received no instructions on checking behavior (control group, n=30). Cognitions about the severity of threat increased from pre- to posttest in the experimental group, but not in the monitor and control groups. Cognitions about the importance of checking decreased in the monitor group. The results indicate that checking behavior contributes directly to the exacerbation of OCD symptoms. Together with the findings of previous studies, this suggests that safety behavior may be involved in the development of anxiety disorders and OCD. Potential mechanisms of how engaging in safety behavior increases threat perception are discussed.

IDENTIFYING PANIC DISORDER SUBTYPES USING FACTOR MIXTURE MODELING

BACKGROUND

The clinical presentation of panic disorder (PD) is known to be highly heterogeneous, complicating research on its etiology, neurobiological pathways, and treatment. None of the attempts to identify PD subtypes have been independently reproduced, rendering the current literature inconclusive.

METHODS

Using a data-driven, case-centered approach (factor mixture modeling) on a broad range of anxiety symptoms assessed with the Beck anxiety inventory, the present study identifies PD disorder subtypes in a large (n = 658), well-documented mixed-population sample from the Netherlands Study of Depression and Anxiety (NESDA), with subtypes being validated and detailed using a variety of clinical characteristics.

RESULTS

A three-class, one-factor model proved superior to all other possible models (Bayesian information criterion = 13,200; Lo-Mendel-Rubin = 0.0295; bootstrapped likelihood ratio test ≤ 0.0001), with the first class, a cognitive-autonomic subtype, accounting for 29.8%, the second class, the autonomic subtype, for 29.9%, and a third class, the aspecific subtype, for 40.3% of the population. The cognitive-autonomic and autonomic subtypes showed significant differences compared to the aspecific subtype (e.g., comorbidity and suicide attempts) but on severity differed between themselves only.

CONCLUSION

Three qualitatively different PD subtypes were identified: a severe cognitive-autonomic subtype, a moderate autonomic subtype, and a mild aspecific subtype. Qualitative and quantitative differences were related to severity and clinical properties such as comorbidity, suicide attempts, sleep, and sense of mastery.

The effect of maternal psychopathology on parent-child agreement of child anxiety symptoms: A hierarchical linear modeling approach

The current study examined the effects of maternal anxiety, worry, depression, child age and gender on mother and child reports of child anxiety using hierarchical linear modeling. Participants were 73 mother-child dyads with children between the ages of 7 and 10 years. Reports of child anxiety symptoms, including symptoms of specific disorders (e.g., social phobia) were obtained using concordant versions of the Screen for Anxiety and Related Emotional Disorders (SCARED). Children reported significantly higher levels of anxiety symptoms relative to their mothers. Maternal worry and depression predicted for significantly lower levels of maternal-reported child anxiety and increasing discrepant reports. Maternal anxiety predicted for higher levels of maternal-reported child anxiety and decreasing discrepant reports. Maternal depression was associated with increased child-reported child anxiety symptoms. No significant effect of child age or gender was observed. Findings may inform inconsistencies in previous studies on reporter discrepancies. Implications and future directions are discussed.

The Indirect Effect of Anxiety Sensitivity in the Relationship Between Panic Symptoms and Panic Severity

The cognitive model of panic (Clark, 1988) suggests that panic attacks result from the catastrophic misinterpretation of bodily sensations rather than the sensations themselves. Anxiety sensitivity (AS) is fear of anxious bodily sensations (Reiss, 1991) and has implications in panic development, maintenance, and severity. Although previous work has demonstrated that AS amplifies symptoms in response to provocations, few have analyzed the role of AS in the relationship between panic symptoms and panic disorder severity. The purpose of this investigation was to determine if AS, a cognitive risk for panic, has an indirect effect on the association between self-reported panic symptoms and panic severity, both self-reported and clinician-assessed, among 67 treatment-seeking individuals with a primary diagnosis of panic disorder with or without agoraphobia. Data were analyzed using the bootstrapped conditional process indirect effects model. Results indicated that the overall total mediational effect on Panic Disorder Severity Scale (PDSS) was significant with evidence of partial mediation. The direct effect of Beck Anxiety Inventory (BAI) on PDSS remained significant although there was also a significant indirect effect of BAI via AS. Results showed a similar relationship when Clinician Severity Rating was the outcome. Moderation analyses were not significant. Therefore, AS was a significant partial mediator of the relationship between symptom intensity and panic severity, whether clinician-rated or self-reported. This investigation provides support for the importance of AS in panic, highlighting its importance but suggesting that it is not sufficient to explain panic disorder.

Case-Series Evaluating a Transdiagnostic Cognitive-Behavioural Treatment for Co-occurring Anxiety Disorders

BACKGROUND

Patients with anxiety disorder diagnoses commonly have more than one anxiety diagnosis. While cognitive-behavioural interventions have proven efficacy in treating single anxiety disorder diagnoses, there has been little investigation of their efficacy in treating co-occurring anxiety disorders.

AIMS

To evaluate the efficacy of a transdiagnostic cognitive-behavioural intervention for treating co-occurring anxiety disorders.

METHOD

An A-B single case study design (N = 6) was used to evaluate the efficacy of a 12 to 13-session modular transdiagnostic cognitive-behavioural intervention for treating co-occurring anxiety disorders across patients with at least two of the following diagnoses: GAD, Social Phobia, Panic Disorder and/or OCD.

RESULTS

Five of the six participants completed treatment. At posttreatment assessment the five treatment completers achieved diagnostic and symptomatic change, with three participants being diagnosis free. All participants who completed treatment no longer met criteria for any DSM-IV-TR Axis-I diagnosis at the 3-month follow-up assessment, and demonstrated reliable and clinically-significant improvements in symptoms. Across the participants, statistically significant improvements from pre to postintervention were found on measures of anxiety, depression and general well-being, and all improvements were maintained at 3-month follow-up.

CONCLUSIONS

Results suggest that transdiagnostic cognitive behavioural interventions can be of benefit to patients with co-occurring anxiety disorders.

Beck Anxiety Inventory: psychometric characteristics in a sample from the clinical Spanish population

Even though the Beck Anxiety Inventory (BAI) is one of the most popular instruments to assess anxiety today, only limited data is available about its psychometric characteristics and normative values in clinical Spanish populations. A study was conducted to test the psychometric characteristics of a Spanish adaptation of the Beck Anxiety Inventory (BAI) in a sample of 918 outpatients being treated at a community mental health center in Spain. Results confirmed the adaptation's high internal consistency (∝ = .91), substantial test-retest reliability at 8-10 weeks (r = .84, p < .01), and satisfactory convergent validity with the Anxiety (r = .86, p < .01), Somatization (r = .81, p < .01), Obsessive-compulsive (r = .60, p < .01), and Phobic Anxiety (r = .63, p < .01) dimensions of the SCL-90-R, and with the Anxious Thoughts Inventory (r = .57, p < .01). Gender differences in BAI scores did occur, so normative values appear separately for each gender.

An examination of generalized anxiety disorder and dysthymic disorder by latent class analysis

BACKGROUND

The nosological status of generalized anxiety disorder (GAD) versus dysthymic disorder (DD) has been questioned. The aim of this study was to examine qualitative differences within (co-morbid) GAD and DD symptomatology.

METHOD

Latent class analysis was applied to anxious and depressive symptomatology of respondents from three population-based studies (2007 Australian National Survey of Mental Health and Wellbeing; National Comorbidity Survey Replication; and Netherlands Mental Health Survey and Incidence Study-2; together known as the Triple study) and respondents from a multi-site naturalistic cohort [Netherlands Study of Depression and Anxiety (NESDA)]. Sociodemographics and clinical characteristics of each class were examined.

RESULTS

A three-class (Triple study) and two-class (NESDA) model best fitted the data, reflecting mainly different levels of severity of symptoms. In the Triple study, no division into a predominantly GAD or DD co-morbidity subtype emerged. Likewise, in spite of the presence of pure GAD and DD cases in the NESDA sample, latent class analysis did not identify specific anxiety or depressive profiles in the NESDA study. Next, sociodemographics and clinical characteristics of each class were examined. Classes only differed in levels of severity.

CONCLUSIONS

The absence of qualitative differences in anxious or depressive symptomatology in empirically derived classes questions the differentiation between GAD and DD.

The latent structure of generalized anxiety disorder in midlife adults

Generalized anxiety disorder (GAD) is identified as a discrete disorder in the DSM-5, but evidence suggests that GAD and the related construct of pathological worry possesses a dimensional latent structure. The objective of this study was to ascertain the latent structure of GAD using taxometric methods. A subsample of adults (N=2061) from the Midlife in the United States Study, a national sample of Americans, provided the data. Additional data from individuals who were re-interviewed 10 year later (n=1228) were also analyzed. Items corresponding to the DSM-IV-TR diagnostic criteria for GAD were used to generate indicators for the taxometric analyses. Multiple taxometric procedures provided no evidence that GAD has a categorical or taxonic latent structure. Instead, the results were more consistent with the proposition that GAD exists on a continuum. Evidence that GAD is dimensional suggests that dichotomizing individuals into GAD versus non-GAD groups will typically result in decreased statistical power. They also suggest that any diagnostic thresholds for identifying GAD are likely to be arbitrary. The findings are consistent with models that locate GAD within the framework of extant dimensional models of personality and with research that emphasizes a multifactorial etiology for GAD.

Distress tolerance and anxiety sensitivity cognitive concerns: testing the incremental contributions of affect dysregulation constructs on suicidal ideation and suicide attempt

Empirical work has suggested relationships among suicide-related outcomes and several constructs related to affect dysregulation, notably anxiety sensitivity (AS) and distress tolerance (DT). However, important questions remain, including the relative contributions of these affect regulation variables as well as the direct contribution of DT on suicidal ideation and prior attempts. The current study sought to better elucidate the nature of these relationships by examining AS, DT, and suicidal ideation and attempt in a clinical sample (N=192). Consistent with prior work and prediction, findings revealed a significant relationship between the AS cognitive concerns subfactor and suicidal ideation and suicide attempt history after accounting for the effects of DT, gender, and depressive symptoms. In addition, depressive symptoms significantly moderated the relationship between the AS cognitive concerns subfactor and suicidal ideation. After accounting for the influence of AS, analyses revealed that DT approached significance in predicting suicidal ideation, but did not significantly predict suicide attempt history. These results suggest that elevated AS cognitive concerns are particularly relevant to suicide in the context of depressive symptoms. Clinicians may benefit from implementing AS reduction strategies with individuals who endorse elevated suicide risk as well as elevated AS cognitive concerns.

A dimensional approach to the phantom vibration and ringing syndrome during medical internship

Phantom vibrations and ringing of mobile phones are prevalent hallucinations in the general population. They might be considered as a "normal" brain mechanism. The aim of this study was to determine if a dimensional approach to identify individuals suffering from these hallucinations was more important than a categorical approach. A prospective longitudinal study of 74 medical interns (male: 46, mean age: 24.8 ± 1.2) was carried out using repeated investigations of the severity of phantom vibrations and ringing, as well as accompanying symptoms of anxiety and depression as measured by Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI) before, at the 3rd, 6th, and 12th month during internship, and 2 weeks after internship. We utilized the cognitive and somatic subscales of the BDI, as well as the subjective, somatic and panic subscales of the BAI. The correlation between phantom vibration and ringing was lowest before the internship but became moderate during the internship and high 2 weeks after it. Compared to interns with subclinical phantom ringing and vibrations, interns with severe phantom vibrations and ringing had higher subjective and somatic anxiety and somatic depressive scores at any time point throughout the internship. Only interns with severe phantom ringing had more cognitive/affective depression. A dimensional approach to the phantom vibration and ringing syndrome is a powerful way to identify their correlation, as well as their association with anxiety and depression.

Comparing physical exercise in groups to group cognitive behaviour therapy for the treatment of panic disorder in a randomized controlled trial

BACKGROUND

Previous studies have suggested that physical exercise can reduce symptoms for subjects suffering from panic disorder (PD). The efficacy of this intervention has so far not been compared to an established psychotherapy, such as cognitive behaviour therapy (CBT). Assessment of controlled long-term effects and the clinical significance of the treatment are also lacking.

AIM

To compare physical exercise to CBT as treatment for PD, and assess controlled long-term and clinically significant effects.

METHOD

PD-patients were randomized to either three weekly sessions of physical exercise (n = 17), or one weekly session of CBT (n = 19). Both treatments ran for 12 weeks, were manualized and administered in groups. Patients were assessed twice before the start of treatment, at post-treatment and at 6 and 12 months thereafter. Primary outcome-measures consisted of the Mobility Inventory (MI), the Agoraphobia Cognitions Questionnaire (ACQ) and the Body Sensations Questionnaire (BSQ).

RESULTS

A two-way repeated measures MANOVA of these measures demonstrated a significant effect of time, F(16, 544) = 7.28, p < .01, as well as a significant interaction effect, F(16, 544) = 1.71, p < .05, in favour of CBT. This finding was supported by the assessment of clinically significant changes of avoidant behaviour and of treatment-seeking one year later.

CONCLUSION

Group CBT is more effective than group physical exercise as treatment of panic disorder, both immediately following treatment and at follow-up assessments.

Psychometric properties of the Turkish version of the 42 item Depression Anxiety Stress Scale (DASS-42) in a clinical sample

OBJECTIVE

To study the psychometric properties of the Turkish translation of the Depression Anxiety and Stress Scale (DASS-42) in a clinical group.

METHODS

Outpatients diagnosed with anxiety (n = 138; mean age = 44.5 years; 74.6% female) or depression (n = 112; mean age = 46.2 years; 77.7% female) from the psychiatric outpatient clinic of a public hospital were evaluated. A group of non-clinical volunteers (n = 250; mean age = 37 years; 68% female) served as a community group for comparison. The participants completed the Turkish versions of the DASS-42, the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI).

RESULTS

The structure of the DASS-42 was analyzed in the clinical sample using principal components extraction. The three-factor solution accounted for 56% of the total variance, with eigenvalues of 17.6, 3.0, and 2.6. The range of factor loadings was 0.55-0.85 for depression, 0.47-0.62 for anxiety, and 0.49-0.74 for stress. The Cronbach alpha values for the DASS depression, anxiety, and stress subscales were 0.94, 0.88, 0.94 respectively. The concurrent validity of the DASS was satisfactory. The non-clincal participants scored lower on all three subscales than the individuals in all of the clinical groups.

CONCLUSION

The Turkish version of the DASS-42 appears to be an excellent instrument for measuring features of depression, hyperarousal, and tension in clinical groups.

Pretreatment anxiety predicts patterns of change in cognitive behavioral therapy and medications for depression

OBJECTIVE

Some studies report that initial anxiety is associated with equivocal or negative effects in depression treatment. In contrast, at least 4 studies of cognitive behavioral therapy (CBT) report that anxiety predicts greater or more rapid change in depression. Further exploration is needed to clarify the relationship between initial anxiety and depression change. Questions include the relationship between anxiety and patterns of change and time to relapse, as well as the specificity effects to CBT.

METHOD

The study assessed the relation of Beck Anxiety Inventory anxiety scores to early rapid change and overall change in Beck Depression Inventory-II depression scores during acute depression treatment. Participants were 178 individuals enrolled in a randomized controlled trial of CBT versus antidepressant medications (ADMs) for moderate to severe depression. They were 58% female and 83% Caucasian, with an average age of 40 (SD = 11.5). Thirty-four percent (34%) were married or cohabitating. Hierarchical linear models, including quadratic growth parameters, were used to model change. The relation of anxiety to the probability of posttreatment relapse was also examined.

RESULTS

Findings indicate that higher levels of anxiety predict early rapid change, but not overall change, in both CBT and ADM. However, patients with higher levels of intake anxiety evidenced increased risk for relapse after CBT.

CONCLUSIONS

Early rapid change predicted by anxiety occurs across different treatment conditions, but this early rapid response is not indicative of positive overall outcome in all cases. These findings might indicate that anxiety predicts a response to nonspecific "common factors" of treatment.