Content of worry in the community: what do people with generalized anxiety disorder or other disorders worry about?

Specific topics, specific symptoms: linking the content of recurrent involuntary memories to mental health using computational text analysis

Researchers debate whether recurrent involuntary autobiographical memories (IAMs; memories of one's personal past retrieved unintentionally and repetitively) are pathological or ordinary. While some argue that these memories contribute to clinical disorders, recurrent IAMs are also common in everyday life. Here, we examined how the content of recurrent IAMs might distinguish between those that are maladaptive (related to worse mental health) versus benign (unrelated to mental health). Over two years, 6187 undergraduates completed online surveys about recurrent IAMs; those who experienced recurrent IAMs within the past year were asked to describe their memories, resulting in 3624 text descriptions. Using a previously validated computational approach (structural topic modeling), we identified coherent topics (e.g., "Conversations", "Experiences with family members") in recurrent IAMs. Specific topics (e.g., "Negative past relationships", "Abuse and trauma") were uniquely related to symptoms of mental health disorders (e.g., depression, PTSD), above and beyond the self-reported valence of these memories. Importantly, we also found that content in recurrent IAMs was distinct across symptom types (e.g., "Communication and miscommunication" was related to social anxiety, but not symptoms of other disorders), suggesting that while negative recurrent IAMs are transdiagnostic, their content remains unique across different types of mental health concerns. Our work shows that topics in recurrent IAMs-and their links to mental health-are identifiable, distinguishable, and quantifiable.

The Moderating Role of the Hostile-World Scenario in the Connections Between COVID-19 Worries, Loneliness, and Anxiety

The COVID-19 pandemic has had pronounced effects on individuals' psychological well-being around the world. Concerns regarding the consequences of infection, as well as the general uncertainty and governmental regulations have resulted in increased psychological distress among many populations and cultures. In this regard, research has shown that the manner by which individuals perceive such large-scale threats and appraise them significantly contributes to the psychological consequences of such events. According to the Hostile-World Scenario (HWS) model, negative engagement (NE) with such threats weakens one's competence and coping abilities, whereas positive engagement (PE) facilitates resilience and enhances psychological adjustment. Accordingly, the current study examines the moderating role of both NE and PE in the connections of two main features of the current pandemic, COVID-19-related worries and loneliness, with anxiety. Data were collected between March 16 and April 14, 2020, from 1,112 Israelis (age range 17-92, M = 46.90, SD = 16.46), who provided information regarding COVID-19 health worries, loneliness, and anxiety. A special measure assembled items pertinent to the HWS-NE and HWS-PE throughout the survey. Results demonstrated that both HWS-NE and HWS-PE were significant moderators. COVID-19-related health worries/loneliness were linked with anxiety only among individuals with high HWS-NE, and were non-significant among those with low HWS-NE. Moreover, the positive association between loneliness and anxiety was significantly mitigated by high HWS-PE. The discussion highlights the importance of the HWS for understanding the psychological consequences of COVID-19 and offers practical suggestions, which may aid mental health practitioners in providing assistance and support to the general population.

Longitudinal prediction of positive and negative mental health in Germany, Russia, and China

The present study examines a broad range of longitudinal predictors of dimensional positive mental health (PMH) and negative mental health (NMH), using data from the BOOM study. Participants were drawn from university student samples in Germany (1,608), Russia (677) and China (12,057). A structural equation model was conducted with four groups of predictors and PMH/NMH as criteria (outcomes). Five of the six salutogenic predictors were predictive of both positive mental health (positively) and negative mental health, as measured by depression (negatively). Pathogenic predictors anxiety and depression were related to future depression, but not to positive mental health. Stress at baseline was related to both future positive mental health (negatively) and future depression (positively). Being male in this study was associated with increased future depression. Results hold across Germany, Russia, and China. Results support the conceptualization of positive and negative mental health as related, but independent dimensions across three cultures.

An Examination of Feedback Seeking in Individuals With Social Anxiety Disorder, Generalized Anxiety Disorder, or No History of Mental Disorder Using a Daily Diary Method

This study examined excessive reassurance seeking (or positive feedback seeking; PFS) and negative feedback seeking (NFS) in individuals with social anxiety disorder (SAD), generalized anxiety disorder (GAD), or no history of mental health difficulties. A 2-week daily diary method was used to examine potential group differences in the frequency, topics, and targets of PFS and NFS. The SAD and GAD groups reported significantly higher feedback seeking (FS) than the healthy group on self-report questionnaires. The most common targets of FS in each group were other people (e.g., romantic partner, family members). According to diary data, there were no significant group differences in the frequency of PFS, NFS, overall FS, or overall FS adjusted for self-reported compliance with diary completion (after applying Bonferroni correction). There were also no significant group differences in FS topics according to diary data. Future research directions and potential implications of these findings are discussed.

Disorder-specific cognitive profiles in major depressive disorder and generalized anxiety disorder

BACKGROUND

This investigation examines differences in cognitive profiles in subjects with major depressive disorder (MDD) and generalized anxiety disorder (GAD).

METHODS

Data were used from subjects with current MDD (n = 655), GAD (n = 107) and comorbid MDD/GAD (n = 266) diagnosis from the Netherlands Study of Depression and Anxiety (NESDA). The Composite Interview Diagnostic Instrument was used to diagnose MDD and GAD. Cognitive profiles were measured using the Leiden Index of Depression Sensitivity, the Anxiety Sensitivity Index, and the Penn State Worry Questionnaire.

RESULTS

Results showed that differences in cognitive profiles between single MDD and single GAD subjects were present: scores on hopelessness/suicidality and rumination were significantly higher in MDD than GAD, whereas anxiety sensitivity for physical concerns and pathological worry were higher in GAD than MDD. The cognitive profile of comorbid MDD/GAD showed more extreme depression cognitions compared to single disorders, and a similar anxiety profile compared to single GAD subjects.

CONCLUSIONS

Despite the commonalities in cognitive profiles in MDD and GAD, there are differences suggesting that MDD and GAD have disorder-specific cognitive profiles. Findings of this investigation give support for models like the cognitive content-specificity model and the tripartite model and could provide useful handles for treatment focus.

The impact of stressful life events on relapse of generalized anxiety disorder

BACKGROUND

Stressful life events (SLEs) are associated with the onset of psychiatric disorders but little is known about the effects of SLEs on individuals already diagnosed with an anxiety disorder, particularly generalized anxiety disorder (GAD) in which worry about life events is a defining characteristic. This study examined the impact of SLEs on relapse in adults already diagnosed with GAD.

METHODS

Data are obtained from the Harvard/Brown Anxiety Research Project (HARP), a naturalistic longitudinal study of adults with a current or past history of anxiety disorders. One hundred and twelve adults recovered from an episode of GAD and 27 subsequently relapsed during the study. Eight categories of SLEs were assessed via interview and were examined as predictors of GAD relapse.

RESULTS

An increased total number of SLEs was associated with a higher cumulative probability of relapse into episode of GAD and there was a nonsignificant statistical trend indicating specific categories of SLEs including health, death, and family/friends/household were related to an increased probability of relapse into episodes of GAD.

CONCLUSIONS

SLEs impact the course of GAD and certain types of stressors may be more relevant to symptomatology than others. The change and uncertainty associated with SLEs may exacerbate existing worry tendencies even among those who have recovered from GAD.

The importance of worry across diagnostic presentations: prevalence, severity and associated symptoms in a partial hospital setting

Although excessive worry has been linked primarily with Generalized Anxiety Disorder (GAD), recent work suggests worry is dimensional, with potential relevance to a range of psychiatric disorders. The current study examined associations between worry and psychological symptoms across several primary diagnoses and tested worry's hypothesized unique relation to GAD in an acute psychiatric setting. Participants were 568 patients with primary diagnoses of Major Depression, Bipolar Disorder-Depressed, Bipolar Disorder-Manic, and Psychosis. Participants completed a structured diagnostic interview and questionnaires at admission. Partial correlations controlling for GAD diagnosis indicated that worry correlated with higher depression and poorer overall well-being in the Depressed, Bipolar-Depressed, and Psychosis groups and decreased functioning in the Depressed, Bipolar-Manic, and Psychosis groups. Depressed and Bipolar-Depressed groups endorsed the highest level of worry. A comorbid anxiety disorder was associated with higher worry across primary diagnoses, even after controlling for GAD. Of the anxiety disorders, GAD and Panic Disorder diagnoses predicted higher worry scores. Results discussed in terms of conceptual implications for worry as a transdiagnostic concept and clinical interventions.

Efficacy of duloxetine for the treatment of generalized anxiety disorder: implications for primary care physicians

OBJECTIVE

This study examined the efficacy and tolerability of duloxetine, a dual reuptake inhibitor of serotonin and norepinephrine, for the treatment of patients with generalized anxiety disorder (GAD).

METHOD

Patients were ≥ 18 years old and recruited from 5 European countries, the United States, and South Africa. The study had a 9-week, multicenter, randomized, double-blind, fixed-dose, placebo-controlled, parallel-group design. A total of 513 patients (mean age = 43.8 years; 67.8% female) with a DSM-IV-defined GAD diagnosis received treatment with duloxetine 60 mg/day (N = 168), duloxetine 120 mg/day (N = 170), or placebo (N = 175). The primary efficacy measure was the Hamilton Rating Scale for Anxiety (HAM-A) total score. Secondary measures included the Sheehan Disability Scale, HAM-A psychic and somatic anxiety factor scores, and HAM-A response, remission, and sustained improvement rates. The study was conducted from July 2004 to September 2005.

RESULTS

Both groups of duloxetine-treated patients demonstrated significantly greater improvements in anxiety symptom severity compared with placebo-treated patients as measured by HAM-A total score and HAM-A psychic and somatic anxiety factor scores (p values ranged from ≤ .01 to ≤ .001). Duloxetine-treated patients had greater functional improvements in Sheehan Disability Scale global and specific domain scores (p ≤ .001) than placebo-treated patients. Both duloxetine doses also resulted in significantly greater HAM-A response, remission, and sustained improvement rates compared with placebo (p values ranged from ≤ .01 to ≤ .001). The rate of study discontinuation due to adverse events was 11.3% for duloxetine 60 mg and 15.3% for duloxetine 120 mg versus 2.3% for placebo (p ≤ .001).

CONCLUSION

The results of this study demonstrate that duloxetine 60 mg/day and 120 mg/day were efficacious and well tolerated and thus may provide primary care physicians with a useful pharmacologic intervention for GAD.

CLINICAL TRIALS REGISTRATION

ClinicalTrials.gov identifier NCT00122824.

Contextual conditioning in rats as an animal model for generalized anxiety disorder

Animal models of psychiatric disorders are important translational tools for exploring new treatment options and gaining more insight into the disease. Thus far, there is no systematically validated animal model for generalized anxiety disorder (GAD), a severely impairing and difficult-to-treat disease. In this review, we propose contextual conditioning (CC) as an animal model for GAD. We argue that this model has sufficient face validity (there are several symptom similarities), predictive validity (it responds to clinically effective treatments), and construct validity (the underlying mechanisms are comparable). Although the refinement and validation of an animal model is a never-ending process, we want to give a concise overview of the currently available evidence. We suggest that the CC model might be a valuable preclinical tool to enhance the development of new treatment strategies and our understanding of GAD.

Specificity of interpersonal problems in generalized anxiety disorder versus other anxiety disorders and depression

We examined the diagnostic specificity of interpersonal problems (IP) in generalized anxiety disorder (GAD). We expected generally higher interpersonal distress, and specifically higher levels of nonassertive, exploitable, overly nurturant, and intrusive behavior in n = 58 patients with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition GAD compared with patients with post-traumatic stress disorder (n = 46), other anxiety disorders (n = 47), and unipolar depressive disorders (n = 47). IP were assessed with the Inventory of Interpersonal Problems. Specificity in the sense of heightened interpersonal distress for GAD was not supported in any of the aforementioned scales, neither for pure nor for comorbid GAD. This finding persisted after accounting for the degree of depressiveness (Beck Depression Inventory). GAD patients are rather not characterized by more self-ascribed IPs although they may worry more about interpersonal issues in general.

Generalized implicit fear associations in generalized anxiety disorder

BACKGROUND

Cognitive schema theories of anxiety postulate that higher-level cognitive processes such as attention and memory are guided by underlying distorted fear associations. While numerous studies investigated these disorder-specific, biased processes, hardly any research addressed the underlying schemata themselves. In particular, no study has ever addressed implicit fear associations in Generalized Anxiety Disorder (GAD). In addition, no study has ever experimentally investigated the clinical observation that in GAD, patients' worry processes seem to be triggered by a broad range of materials, even by neutral or positive stimuli.

METHODS

We used a Single Target Implicit Association Task (STIAT) to investigate implicit associations and stimulus generalization with clearly negative worry-related words (e.g., cancer, bankruptcy) and neutral words that are only indirectly related to worry topics (e.g., doctor, bank). Participants were 39 GAD patients and 23 healthy controls.

RESULTS

In line with our expectations, both groups showed negative implicit associations with negative target words, and only GAD patients also associated neutral words with negative attributes.

CONCLUSIONS

These results support the hypothesis that GAD patients' fear associations generalize to stimuli that are only peripherally related to the core of their worries.

Is worry different from rumination? Yes, it is more predictive of psychopathology!

OBJECTIVE

Although worry and rumination are everyday phenomena as well as common symptoms across numerous psychopathological disorders, the theoretical and clinical delineations of both concepts need more clarification. This study explored the degree of overlap between worry and rumination on the levels of standardized questionnaires and a priori lay concepts.

METHOD

The subjective conceptualization of worry and of rumination of 221 undergraduate and graduate students was assessed with the semantic differential technique, together with the frequency and intensity with which they experienced worry and rumination (based on their lay concepts). Standardized self-report measures for worry, rumination, depression, and anxiety were also administered.

RESULTS

Worry was viewed as more negative than rumination and was more predictive of anxiety as well as of depression than rumination, especially when the assessment was based on the subjective lay concepts. The different measures of worry and rumination were only moderately correlated with each other.

CONCLUSION

It is concluded that the lay concepts worry and rumination and the hypothetical constructs worry and rumination should not be confused in personality and clinical research.

Is worry different from rumination? Yes, it is more predictive of psychopathology!

Objective: Although worry and rumination are everyday phenomena as well as common symptoms across numerous psychopathological disorders, the theoretical and clinical delineations of both concepts need more clarification. This study explored the degree of overlap between worry and rumination on the levels of standardized questionnaires and a priori lay concepts.

Method: The subjective conceptualization of worry and of rumination of 221 undergraduate and graduate students was assessed with the semantic differential technique, together with the frequency and intensity with which they experienced worry and rumination (based on their lay concepts). Standardized self-report measures for worry, rumination, depression, and anxiety were also administered.

Results: Worry was viewed as more negative than rumination and was more predictive of anxiety as well as of depression than rumination, especially when the assessment was based on the subjective lay concepts. The different measures of worry and rumination were only moderately correlated with each other.

Conclusion: It is concluded that the lay concepts worry and rumination and the hypothetical constructs worry and rumination should not be confused in personality and clinical research.

Improvement of psychic and somatic symptoms in adult patients with generalized anxiety disorder: examination from a duloxetine, venlafaxine extended-release and placebo-controlled trial

BACKGROUND

This study examined the efficacy and tolerability of duloxetine and venlafaxine extended-release (XR) treatment for generalized anxiety disorder (GAD), with a secondary focus on psychic and somatic symptoms within GAD.

METHOD

The design was a 10-week, multi-center, double-blind placebo-controlled study of duloxetine (20 mg or 60-120 mg once daily) and venlafaxine XR (75-225 mg once daily) treatment. Efficacy was measured using the Hamilton Anxiety Rating Scale (HAMA), which includes psychic and somatic factor scores. Tolerability was measured by occurrence of treatment-emergent adverse events (TEAEs) and discontinuation rates.

RESULTS

Adult out-patients (mean age 42.8 years; 57.1% women) with DSM-IV-defined GAD were randomly assigned to placebo (n=170), duloxetine 20 mg (n=84), duloxetine 60-120 mg (n=158) or venlafaxine XR 75-225 mg (n=169) treatment. Each of the three active treatment groups had significantly greater improvements on HAMA total score from baseline to endpoint compared with placebo (p=0.01-0.001). For the HAMA psychic factor score, both duloxetine treatment arms and venlafaxine XR demonstrated significantly greater improvement compared with placebo (p=0.01-0.001). For the HAMA somatic factor score, the mean improvement in the duloxetine 60-120 mg and venlafaxine XR groups was significantly greater than placebo (p0.05 and p0.01 respectively), whose mean improvement did not differ from the duloxetine 20 mg group (p=0.07). Groups did not differ in study discontinuation rate due to adverse events.

CONCLUSIONS

Duloxetine and venlafaxine treatment were each efficacious for improvement of core psychic anxiety symptoms and associated somatic symptoms for adults with GAD.

Pathological worry, anxiety disorders and the impact of co-occurrence with depressive and other anxiety disorders

The Penn State Worry Questionnaire (PSWQ) was administered to 123 outpatients with principal diagnoses of generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder with agoraphobia, and panic disorder without agoraphobia (PD) to examine the specificity of pathological worry for GAD. The mean PSWQ scores in patients with GAD and SAD were significantly higher than the mean PSWQ scores in patients with PD, while not differing significantly in the subgroups without any co-occurring depressive or anxiety disorders. Patients with any co-occurring depressive or anxiety disorder scored significantly higher on the PSWQ. In a logistic regression analysis, high PSWQ scores independently predicted only GAD and SAD diagnoses. The study suggests that pathological worry is specific not only for GAD, and indicates that a significant relationship exists between pathological worry, GAD and SAD, and that depressive and anxiety disorders co-occurrence increases levels of pathological worry in patients with anxiety disorders.

Cognitive specificity of anxiety disorders: a review of selected key constructs

Cognitive models of anxiety disorders propose that certain cognitive constructs, that is, underlying beliefs and cognitive processes, may be specific for particular disorders. In this article, we review the specificity of four representative cognitive constructs-anxiety sensitivity, pathological worry, intolerance of uncertainty, and thought-action fusion-for particular disorders. Conceptual overlap, inconsistent definitions, and insufficient consideration of the components of these constructs are limitations of the existing literature. We suggest that the constructs are unlikely to be pathognomonic for any given disorder or to occur in isolation. Rather, the association of each cognitive construct is evident, to varying degrees, with different disorders. Relative to other disorders, anxiety sensitivity is to a certain extent specific for panic disorder, as are pathological worry for generalized anxiety disorder, intolerance of uncertainty for generalized anxiety disorder and obsessive-compulsive disorder, and thought-action fusion for obsessive-compulsive disorder. We discuss the implications of these findings for diagnostic systems and treatment, and suggest areas for further research.