Pub Date : 2025-01-25DOI: 10.1016/j.janxdis.2025.102978
Candice Basterfield, Michelle G. Newman
Background
Generalized Anxiety Disorder (GAD) is a chronic condition. Enabling the prediction of individual trajectories would facilitate tailored management approaches for these individuals. This study used machine learning techniques to predict the recovery of GAD at a nine-year follow-up.
Method
The study involved 126 participants with GAD. Various baseline predictors from psychological, social, biological, sociodemographic and health variables were used. Two machine learning models, gradient boosted trees, and elastic nets were compared to predict the clinical course in participants with GAD.
Results
At nine-year follow-up, 95 participants (75.40 %) recovered. Elastic nets achieved a cross-validated area-under-the-receiving-operator-characteristic-curve (AUC) of .81 and a balanced accuracy of 72 % (sensitivity of .70 and specificity of .76). The elastic net algorithm revealed that the following factors were highly predictive of nonrecovery at follow-up: higher depressed affect, experiencing daily discrimination, more mental health professional visits, and more medical professional visits. The following variables predicted recovery: having some college education or higher, older age, more friend support, higher waist-to-hip ratio, and higher positive affect.
Conclusions
There was acceptable performance in predicting recovery or nonrecovery at a nine-year follow-up. This study advances research on GAD outcomes by understanding predictors associated with recovery or nonrecovery. Findings can potentially inform more targeted preventive interventions, ultimately improving care for individuals with GAD. This work is a critical first step toward developing reliable and feasible machine learning-based predictions for applications to GAD.
{"title":"Development of a machine learning-based multivariable prediction model for the naturalistic course of generalized anxiety disorder","authors":"Candice Basterfield, Michelle G. Newman","doi":"10.1016/j.janxdis.2025.102978","DOIUrl":"10.1016/j.janxdis.2025.102978","url":null,"abstract":"<div><h3>Background</h3><div>Generalized Anxiety Disorder (GAD) is a chronic condition. Enabling the prediction of individual trajectories would facilitate tailored management approaches for these individuals. This study used machine learning techniques to predict the recovery of GAD at a nine-year follow-up.</div></div><div><h3>Method</h3><div>The study involved 126 participants with GAD. Various baseline predictors from psychological, social, biological, sociodemographic and health variables were used. Two machine learning models, gradient boosted trees, and elastic nets were compared to predict the clinical course in participants with GAD.</div></div><div><h3>Results</h3><div>At nine-year follow-up, 95 participants (75.40 %) recovered. Elastic nets achieved a cross-validated area-under-the-receiving-operator-characteristic-curve (AUC) of .81 and a balanced accuracy of 72 % (sensitivity of .70 and specificity of .76). The elastic net algorithm revealed that the following factors were highly predictive of nonrecovery at follow-up: higher depressed affect, experiencing daily discrimination, more mental health professional visits, and more medical professional visits. The following variables predicted recovery: having some college education or higher, older age, more friend support, higher waist-to-hip ratio, and higher positive affect.</div></div><div><h3>Conclusions</h3><div>There was acceptable performance in predicting recovery or nonrecovery at a nine-year follow-up. This study advances research on GAD outcomes by understanding predictors associated with recovery or nonrecovery. Findings can potentially inform more targeted preventive interventions, ultimately improving care for individuals with GAD. This work is a critical first step toward developing reliable and feasible machine learning-based predictions for applications to GAD.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"110 ","pages":"Article 102978"},"PeriodicalIF":4.8,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143096802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-22DOI: 10.1016/j.janxdis.2025.102974
Bridget K. Biggs , Stephen P.H. Whiteside , Matthew Knutson , Sara Seifert , Deanna R. Hofschulte , Jennifer R. Geske , Alisson N. Lass , Kristin S. Vickers , Lilianne M. Gloe , Stephanie T. Reneson-Feeder
Virtual reality is a promising tool for improving efficacy of exposure therapy for childhood anxiety disorders (CADs), particularly for exposures that are challenging to orchestrate in vivo. The present study compared virtual reality exposure (VRE) to verbal imaginal exposure (IE) on anxiety elicited, homework completion, and preparation for subsequent exposures. Forty-five youth with CADs completed both types of exposure in session (order randomly assigned), practiced one form of exposure as homework (randomly assigned), and returned a week later to repeat both exposures (in randomized order), provide user feedback, and complete a related in vivo exposure. Both VRE and IE elicited moderate anxiety that decreased to mild during the exposure and were associated with lower initial anxiety ratings in subsequent exposures. These patterns did not differ across exposure type. The two techniques did not differ on homework completion. VRE was associated with greater simulator (motion) sickness symptoms. Participants rated VRE as more realistic than IE and noted pros and cons for both approaches. The present study supported use of VRE and IE in treatment of CADs without demonstrating superiority of either technique in effectiveness or homework completion.
{"title":"A comparison of virtual reality and verbal imaginal exposure for childhood anxiety disorders","authors":"Bridget K. Biggs , Stephen P.H. Whiteside , Matthew Knutson , Sara Seifert , Deanna R. Hofschulte , Jennifer R. Geske , Alisson N. Lass , Kristin S. Vickers , Lilianne M. Gloe , Stephanie T. Reneson-Feeder","doi":"10.1016/j.janxdis.2025.102974","DOIUrl":"10.1016/j.janxdis.2025.102974","url":null,"abstract":"<div><div>Virtual reality is a promising tool for improving efficacy of exposure therapy for childhood anxiety disorders (CADs), particularly for exposures that are challenging to orchestrate <em>in vivo</em>. The present study compared virtual reality exposure (VRE) to verbal imaginal exposure (IE) on anxiety elicited, homework completion, and preparation for subsequent exposures. Forty-five youth with CADs completed both types of exposure in session (order randomly assigned), practiced one form of exposure as homework (randomly assigned), and returned a week later to repeat both exposures (in randomized order), provide user feedback, and complete a related <em>in vivo</em> exposure. Both VRE and IE elicited moderate anxiety that decreased to mild during the exposure and were associated with lower initial anxiety ratings in subsequent exposures. These patterns did not differ across exposure type. The two techniques did not differ on homework completion. VRE was associated with greater simulator (motion) sickness symptoms. Participants rated VRE as more realistic than IE and noted pros and cons for both approaches. The present study supported use of VRE and IE in treatment of CADs without demonstrating superiority of either technique in effectiveness or homework completion.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"110 ","pages":"Article 102974"},"PeriodicalIF":4.8,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although intolerance of uncertainty (IU) is associated with negative outcomes, studies focusing on older adults are still emerging. Specifically, the relationship between IU and psychological health in this population remains unclear. Moreover, no review has focused on understanding the unique contributions of IU and aging to anxiety and mental health in older adults. This scoping review and meta-analysis addressed this gap and provided a comprehensive understanding of the relationship between IU, aging, and mental health. Among 45 studies reviewed, 37 were included in the meta-analysis using mixed effect analysis to examine the relationship between IU and age across adulthood. The remaining eight studies, along with seven selected from the meta-analysis, were included in the scoping review to evaluate the relationship between IU, anxiety, and mental health. Among these, 12 studies focused on late adulthood, two on overall adulthood, and one included both late and overall adulthood. Results of the meta-analysis revealed an overall significant age difference in IU throughout adulthood. Moreover, results of the scoping review indicated a direct correlation between IU and anxiety, and other psychological issues in elderly. These findings provide insights for future research and interventions aimed at reducing IU and improving mental health among older adults.
{"title":"Intolerance of uncertainty, aging, and anxiety and mental health concerns: A scoping review and meta-analysis","authors":"Mandy H.M. Yu , Yuan Cao , Sylvia S.Y. Fung , Gerald S.Y. Kwan , Zita C.K. Tse , David H.K. Shum","doi":"10.1016/j.janxdis.2025.102975","DOIUrl":"10.1016/j.janxdis.2025.102975","url":null,"abstract":"<div><div>Although intolerance of uncertainty (IU) is associated with negative outcomes, studies focusing on older adults are still emerging. Specifically, the relationship between IU and psychological health in this population remains unclear. Moreover, no review has focused on understanding the unique contributions of IU and aging to anxiety and mental health in older adults. This scoping review and meta-analysis addressed this gap and provided a comprehensive understanding of the relationship between IU, aging, and mental health. Among 45 studies reviewed, 37 were included in the meta-analysis using mixed effect analysis to examine the relationship between IU and age across adulthood. The remaining eight studies, along with seven selected from the meta-analysis, were included in the scoping review to evaluate the relationship between IU, anxiety, and mental health. Among these, 12 studies focused on late adulthood, two on overall adulthood, and one included both late and overall adulthood. Results of the meta-analysis revealed an overall significant age difference in IU throughout adulthood. Moreover, results of the scoping review indicated a direct correlation between IU and anxiety, and other psychological issues in elderly. These findings provide insights for future research and interventions aimed at reducing IU and improving mental health among older adults.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"110 ","pages":"Article 102975"},"PeriodicalIF":4.8,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-17DOI: 10.1016/j.janxdis.2025.102976
Julia C. Sager , Christopher R. DeJesus , Jaclyn C. Kearns , Johanna Thompson-Hollands , Stephanie L. Trendel , Brian P. Marx , Denise M. Sloan
There are two versions of the Cognitive Processing Therapy (CPT) protocol: one that includes a trauma narrative and one that does not. Despite both versions being used in clinical practice, to date, there has not been a comprehensive comparison of posttraumatic stress disorder (PTSD) treatment outcomes associated with these two protocols. The current study is a meta-analytic review of 29 randomized controlled trials of CPT+A (k = 13) and CPT-C (k = 16) in which we investigated whether there are differences in treatment outcome effect sizes and treatment dropout between the two protocol versions. Sample type (military/veteran versus non-military/non-veteran) as a moderator was examined, given that less robust PTSD treatment outcomes have been typically observed in military and veteran samples. Meta-regression analyses revealed that there were no significant differences between the two CPT protocol versions in pre-post PTSD treatment effect sizes, t(26) = -0.743, p = .463. As expected, studies that enrolled a military or veteran sample reported an average smaller symptom reduction (g = 0.95) than studies that enrolled a non-military or non-veteran sample (g = 1.41), t(26) = 2.48, p = .019. There were also no significant differences between the two CPT protocols for treatment dropout, t(26) = 1.69, p = .104, or between studies enrolling military/veteran and non-military/non-veteran samples t(26) = -1.10, p = .282. The findings support the use of either CPT protocol in practice, but also demonstrate that veterans and service members may be less responsive to either CPT protocol than other trauma samples.
{"title":"A meta-analytic review of cognitive processing therapy with and without the written account","authors":"Julia C. Sager , Christopher R. DeJesus , Jaclyn C. Kearns , Johanna Thompson-Hollands , Stephanie L. Trendel , Brian P. Marx , Denise M. Sloan","doi":"10.1016/j.janxdis.2025.102976","DOIUrl":"10.1016/j.janxdis.2025.102976","url":null,"abstract":"<div><div>There are two versions of the Cognitive Processing Therapy (CPT) protocol: one that includes a trauma narrative and one that does not. Despite both versions being used in clinical practice, to date, there has not been a comprehensive comparison of posttraumatic stress disorder (PTSD) treatment outcomes associated with these two protocols. The current study is a meta-analytic review of 29 randomized controlled trials of CPT+A (<em>k</em> = 13) and CPT-C (<em>k</em> = 16) in which we investigated whether there are differences in treatment outcome effect sizes and treatment dropout between the two protocol versions. Sample type (military/veteran versus non-military/non-veteran) as a moderator was examined, given that less robust PTSD treatment outcomes have been typically observed in military and veteran samples. Meta-regression analyses revealed that there were no significant differences between the two CPT protocol versions in pre-post PTSD treatment effect sizes, <em>t</em>(26) = -0.743, <em>p</em> = .463. As expected, studies that enrolled a military or veteran sample reported an average smaller symptom reduction (<em>g</em> = 0.95) than studies that enrolled a non-military or non-veteran sample (<em>g</em> = 1.41), <em>t</em>(26) = 2.48, <em>p</em> = .019. There were also no significant differences between the two CPT protocols for treatment dropout, <em>t</em>(26) = 1.69, <em>p</em> = .104, or between studies enrolling military/veteran and non-military/non-veteran samples <em>t</em>(26) <em>=</em> -1.10, <em>p</em> = .282. The findings support the use of either CPT protocol in practice, but also demonstrate that veterans and service members may be less responsive to either CPT protocol than other trauma samples.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"110 ","pages":"Article 102976"},"PeriodicalIF":4.8,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143349075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-17DOI: 10.1016/j.janxdis.2025.102977
Johannes J. Bürkle , Stefan Schmidt , Johannes C. Fendel
Mindfulness- and acceptance-based programmes (MABPs) in the treatment of obsessive-compulsive disorder (OCD) are increasingly gaining research interest, yet a comprehensive systematic review and meta-analysis is missing. To fill this gap, we analysed 46 trials involving 2221 patients. Two independent reviewers screened records, extracted data, assessed risk of bias, and rated overall quality of evidence. MABPs were associated with large reductions in OCD-severity in between-group analysis in randomised controlled trials (k = 33; g = -.87; CI = -1.13,-.60) and within-group pre-post analysis in all MABPs (k = 49; g = -1.72; CI = -2.00,-1.44). Depressive symptoms decreased between- and within-group with a small to moderate effect, with maintained reductions at follow-up for both OCD and depression. Moderate to large pre-post improvements were also observed in anxiety, obsessive beliefs, and quality of life. MABPs did not differ from cognitive behavioural therapy and exposure and response prevention (k = 9; g=.02; CI = -.23,.26) but were superior to medication (k = 5; g = -.77; CI = -1.44,-.11) and waitlist (k = 16; g = -1.66; CI = -2.1,-1.24). Symptom reductions were observed across world regions, but to varying degrees. When combined, increases in mindfulness and psychological flexibility predicted reductions in OCD symptoms. Outcomes were not moderated by treatment duration, samples’, and therapists’ characteristics. MABPs can reduce OCD-severity, but further high-quality trials with long-term follow-ups are needed to confirm results.
{"title":"Mindfulness- and acceptance-based programmes for obsessive-compulsive disorder: A systematic review and meta-analysis","authors":"Johannes J. Bürkle , Stefan Schmidt , Johannes C. Fendel","doi":"10.1016/j.janxdis.2025.102977","DOIUrl":"10.1016/j.janxdis.2025.102977","url":null,"abstract":"<div><div>Mindfulness- and acceptance-based programmes (MABPs) in the treatment of obsessive-compulsive disorder (OCD) are increasingly gaining research interest, yet a comprehensive systematic review and meta-analysis is missing. To fill this gap, we analysed 46 trials involving 2221 patients. Two independent reviewers screened records, extracted data, assessed risk of bias, and rated overall quality of evidence. MABPs were associated with large reductions in OCD-severity in between-group analysis in randomised controlled trials (<em>k</em> = 33; <em>g</em> = -.87; CI = -1.13,-.60) and within-group pre-post analysis in all MABPs (<em>k</em> = 49; <em>g</em> = -1.72; CI = -2.00,-1.44). Depressive symptoms decreased between- and within-group with a small to moderate effect, with maintained reductions at follow-up for both OCD and depression. Moderate to large pre-post improvements were also observed in anxiety, obsessive beliefs, and quality of life. MABPs did not differ from cognitive behavioural therapy and exposure and response prevention (<em>k</em> = 9; <em>g</em>=.02; CI = -.23,.26) but were superior to medication (<em>k</em> = 5; <em>g</em> = -.77; CI = -1.44,-.11) and waitlist (<em>k</em> = 16; <em>g</em> = -1.66; CI = -2.1,-1.24). Symptom reductions were observed across world regions, but to varying degrees. When combined, increases in mindfulness and psychological flexibility predicted reductions in OCD symptoms. Outcomes were not moderated by treatment duration, samples’, and therapists’ characteristics. MABPs can reduce OCD-severity, but further high-quality trials with long-term follow-ups are needed to confirm results.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"110 ","pages":"Article 102977"},"PeriodicalIF":4.8,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-03DOI: 10.1016/j.janxdis.2024.102964
Jinmeng Liu, Jun Hu, Yuxue Qi, Xuebing Wu, Yiqun Gan
Anxiety symptoms are among the most prevalent mental health disorders in adolescents, highlighting the need for scalable and accessible interventions. As anxiety often co-occurs with perceived stress during adolescence, stress interventions may offer a promising approach to reducing anxiety. Previous stress interventions have largely focused on the view that stress is harmful, aiming to manage and mitigate its negative effects. Stress optimization presents a novel intervention perspective, suggesting that stress can also lead to positive outcomes. However, it remains unclear whether stress optimization can effectively reduce anxiety symptoms in adolescents. We developed a single-session stress optimization intervention and investigated the conditions under which it was most effective. A large-scale randomized controlled trial was conducted (N = 1779, aged 12–18 years), with participants reporting their perceived stress, stress mindset, and anxiety over a two-month follow-up period. Machine learning is a promising approach for assessing personalized intervention effects. Conservative Bayesian causal forest analysis was employed to detect both treatment and heterogeneous intervention effects. The findings revealed that the intervention effectively reduced anxiety symptoms in the school context over a two-month follow-up (0.87 posterior probability). Furthermore, adolescents with higher anxiety and perceived stress at baseline experienced the most significant reductions in anxiety outcomes (standard deviations of −0.18 and −0.11 respectively). The single-session stress optimization intervention demonstrated potential for cost-effective scaling.
{"title":"Personalized stress optimization intervention to reduce adolescents’ anxiety: A randomized controlled trial leveraging machine learning","authors":"Jinmeng Liu, Jun Hu, Yuxue Qi, Xuebing Wu, Yiqun Gan","doi":"10.1016/j.janxdis.2024.102964","DOIUrl":"10.1016/j.janxdis.2024.102964","url":null,"abstract":"<div><div>Anxiety symptoms are among the most prevalent mental health disorders in adolescents, highlighting the need for scalable and accessible interventions. As anxiety often co-occurs with perceived stress during adolescence, stress interventions may offer a promising approach to reducing anxiety. Previous stress interventions have largely focused on the view that stress is harmful, aiming to manage and mitigate its negative effects. Stress optimization presents a novel intervention perspective, suggesting that stress can also lead to positive outcomes. However, it remains unclear whether stress optimization can effectively reduce anxiety symptoms in adolescents. We developed a single-session stress optimization intervention and investigated the conditions under which it was most effective. A large-scale randomized controlled trial was conducted (<em>N</em> = 1779, aged 12–18 years), with participants reporting their perceived stress, stress mindset, and anxiety over a two-month follow-up period. Machine learning is a promising approach for assessing personalized intervention effects. Conservative Bayesian causal forest analysis was employed to detect both treatment and heterogeneous intervention effects. The findings revealed that the intervention effectively reduced anxiety symptoms in the school context over a two-month follow-up (0.87 posterior probability). Furthermore, adolescents with higher anxiety and perceived stress at baseline experienced the most significant reductions in anxiety outcomes (standard deviations of −0.18 and −0.11 respectively). The single-session stress optimization intervention demonstrated potential for cost-effective scaling.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"110 ","pages":"Article 102964"},"PeriodicalIF":4.8,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-02DOI: 10.1016/j.janxdis.2024.102963
Chris M. Hoeboer , Federica Nava , Joris F.G. Haagen , Birit F.P. Broekman , Rutger-Jan van der Gaag , Miranda Olff
Introduction
Information regarding the prevalence of potentially traumatic events (PTEs), DSM-5 posttraumatic stress disorder (PTSD) and ICD-11 complex PTSD (CPTSD) in the Netherlands is currently lacking, as is data on treatment uptake and treatment barriers. We aimed to provide prevalence estimates for potentially traumatic events, PTSD and CPTSD in the Netherlands, describe treatment seeking behavior and explore associated risk factors.
Method
We included a sample of 1690 participants aged 16 years and older across the Netherlands via the Longitudinal Internet studies for the Social Sciences panel, a true probability sample of households drawn from the population register by Statistics Netherlands. We recruited participants between September 1st, 2023, and November 1st 2023. All participants completed online self-report questionnaires, and a subset consented to an interview (n = 204). Instruments included the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), the PTSD Checklist for DSM-5 (PCL-5) and the International Trauma Questionnaire (ITQ).
Results
The lifetime prevalence of any PTE was 81.5 %. The estimated lifetime prevalence of DSM-5 PTSD was 11.1 % and current prevalence 1.3 %. The estimated current prevalence of ICD-11 PTSD was 1.0 % and ICD-11 complex PTSD was 1.6 %. Especially females, younger adults, those with a lower education and those with a non-Dutch cultural background were at risk for PTSD. About half of the people with probable lifetime PTSD sought professional help and one-third received first-line PTSD treatment. Common reasons for refraining from seeking professional support included a lack of knowledge, shame and avoidance.
Conclusions
PTEs, PTSD and CPTSD are common in the Netherlands and disproportionately distributed in society. Although evidence-based treatments for PTSD are available, only about one-third of those with lifetime PTSD receive first-line treatment. Findings underscore the need for targeted screening and preventative interventions, alongside public health campaigns aimed at enhancing knowledge and mitigating stigma about PTSD.
{"title":"Epidemiology of DSM-5 PTSD and ICD-11 PTSD and complex PTSD in the Netherlands","authors":"Chris M. Hoeboer , Federica Nava , Joris F.G. Haagen , Birit F.P. Broekman , Rutger-Jan van der Gaag , Miranda Olff","doi":"10.1016/j.janxdis.2024.102963","DOIUrl":"10.1016/j.janxdis.2024.102963","url":null,"abstract":"<div><h3>Introduction</h3><div>Information regarding the prevalence of potentially traumatic events (PTEs), DSM-5 posttraumatic stress disorder (PTSD) and ICD-11 complex PTSD (CPTSD) in the Netherlands is currently lacking, as is data on treatment uptake and treatment barriers. We aimed to provide prevalence estimates for potentially traumatic events, PTSD and CPTSD in the Netherlands, describe treatment seeking behavior and explore associated risk factors.</div></div><div><h3>Method</h3><div>We included a sample of 1690 participants aged 16 years and older across the Netherlands via the Longitudinal Internet studies for the Social Sciences panel, a true probability sample of households drawn from the population register by Statistics Netherlands. We recruited participants between September 1st, 2023, and November 1st 2023. All participants completed online self-report questionnaires, and a subset consented to an interview (<em>n</em> = 204). Instruments included the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), the PTSD Checklist for DSM-5 (PCL-5) and the International Trauma Questionnaire (ITQ).</div></div><div><h3>Results</h3><div>The lifetime prevalence of any PTE was 81.5 %. The estimated lifetime prevalence of DSM-5 PTSD was 11.1 % and current prevalence 1.3 %. The estimated current prevalence of ICD-11 PTSD was 1.0 % and ICD-11 complex PTSD was 1.6 %. Especially females, younger adults, those with a lower education and those with a non-Dutch cultural background were at risk for PTSD. About half of the people with probable lifetime PTSD sought professional help and one-third received first-line PTSD treatment. Common reasons for refraining from seeking professional support included a lack of knowledge, shame and avoidance.</div></div><div><h3>Conclusions</h3><div>PTEs, PTSD and CPTSD are common in the Netherlands and disproportionately distributed in society. Although evidence-based treatments for PTSD are available, only about one-third of those with lifetime PTSD receive first-line treatment. Findings underscore the need for targeted screening and preventative interventions, alongside public health campaigns aimed at enhancing knowledge and mitigating stigma about PTSD.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"110 ","pages":"Article 102963"},"PeriodicalIF":4.8,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.janxdis.2024.102947
Aidan J. Flynn, K. Lira Yoon
Graded exposure successfully reduces fear in specific phobias and anxiety disorders, yet social exposure in daily life often fails to mitigate social anxiety. Post-event processing, perseverative, negative, self-referential thinking that occurs following a social-evaluative event, may partly explain inhibited desensitization to social fears. Post-event processing has been studied extensively since its first description by Clark and Wells (1995) and previously reviewed (e.g., Brozovich & Heimberg, 2008; Wong, 2016). However, these reviews are now dated or limited in scope. In the present scoping review, we pay particular attention to contemporary research that addresses unanswered questions raised in past reviews (e.g., Brozovich & Heimberg, 2008), synthesizing existing knowledge. Specifically, we discuss post-event processing’s evolving role in cognitive models of social anxiety disorder, its core features, its eliciting situations (e.g., performance vs. social interactions), its relation to other cognitive and affective constructs (e.g., memory, performance appraisal, self-focused attention), and its assessment. Our findings indicate that post-event processing is more frequent after performance situations than social interactions, is related to negative memory biases, is bi-directionally related to worsening performance appraisals, and may be precipitated by self-focused attention. Future research directions include elucidating post-event processing’s course, clarifying post-event processing’s potential causal role in the development of social anxiety disorder, and identifying factors that underlie post-event processing’s deleterious nature.
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Pub Date : 2025-01-01DOI: 10.1016/j.janxdis.2024.102959
Benjamin M. Rosenberg , Nora M. Barnes-Horowitz , Tomislav D. Zbozinek , Michelle G. Craske
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Pub Date : 2025-01-01DOI: 10.1016/j.janxdis.2024.102962
Jasper A.J. Smits , Jonathan S. Abramowitz , Rebecca A. Anderson , Joanna J. Arch , Daniel Badeja , Snir Barzilay , Amanda N. Belanger , Thomas Borchert , Emma Bryant , Alane S. Burger , Laura J. Dixon , Christina D. Dutcher , Hayley E. Fitzgerald , Bronwyn M. Graham , Anke Haberkamp , Stefan G. Hofmann , Jürgen Hoyer , Jonathan D. Huppert , David Johnson , Baraa Q. Kabha , Cornelia Weise
Background
This paper reports on the outcomes of a proof-of-principle study for the Exposure Therapy Consortium, a global network of researchers and clinicians who work to improve the effectiveness and uptake of exposure therapy. The study aimed to test the feasibility of the consortium’s big-team science approach and test the hypothesis that adding post-exposure processing focused on enhancing threat reappraisal would enhance the efficacy of a one-session large-group interoceptive exposure therapy protocol for reducing anxiety sensitivity.
Methods
The study involved a multi-site cluster-randomized controlled trial comparing exposure with post-processing (ENHANCED), exposure without post-processing (STANDARD), and a stress management intervention (CONTROL) in students with elevated anxiety sensitivity. Feasibility was assessed using site performance metrics (e.g., timeline, sample size, missing data). Efficacy was assessed up to 1-month follow-up using the Anxiety Sensitivity Index-3.
Results
Despite challenges posed by unforeseen global crises, a standardized protocol for screening, assessment, and treatment at 12 research sites across four continents was successfully implemented, resulting in a total sample size of 400 with minimal missing data. Challenges in recruitment and adherence to the projected timelines were encountered. Significant reductions in anxiety sensitivity were observed in all conditions. Contrary to hypotheses, group differences were only observed at post-treatment, when ENHANCED and CONTROL outperformed STANDARD but were not significantly different from each other.
Conclusions
This study demonstrates the feasibility of the Exposure Therapy Consortium. Findings raise questions regarding the efficacy of large group exposure interventions and underscore the importance of careful research site selection and an iterative approach to treatment development.
{"title":"Exposure therapy consortium: Outcomes of the proof-of-principle study","authors":"Jasper A.J. Smits , Jonathan S. Abramowitz , Rebecca A. Anderson , Joanna J. Arch , Daniel Badeja , Snir Barzilay , Amanda N. Belanger , Thomas Borchert , Emma Bryant , Alane S. Burger , Laura J. Dixon , Christina D. Dutcher , Hayley E. Fitzgerald , Bronwyn M. Graham , Anke Haberkamp , Stefan G. Hofmann , Jürgen Hoyer , Jonathan D. Huppert , David Johnson , Baraa Q. Kabha , Cornelia Weise","doi":"10.1016/j.janxdis.2024.102962","DOIUrl":"10.1016/j.janxdis.2024.102962","url":null,"abstract":"<div><h3>Background</h3><div>This paper reports on the outcomes of a proof-of-principle study for the Exposure Therapy Consortium, a global network of researchers and clinicians who work to improve the effectiveness and uptake of exposure therapy. The study aimed to test the feasibility of the consortium’s big-team science approach and test the hypothesis that adding post-exposure processing focused on enhancing threat reappraisal would enhance the efficacy of a one-session large-group interoceptive exposure therapy protocol for reducing anxiety sensitivity.</div></div><div><h3>Methods</h3><div>The study involved a multi-site cluster-randomized controlled trial comparing exposure with post-processing (ENHANCED), exposure without post-processing (STANDARD), and a stress management intervention (CONTROL) in students with elevated anxiety sensitivity. Feasibility was assessed using site performance metrics (e.g., timeline, sample size, missing data). Efficacy was assessed up to 1-month follow-up using the Anxiety Sensitivity Index-3.</div></div><div><h3>Results</h3><div>Despite challenges posed by unforeseen global crises, a standardized protocol for screening, assessment, and treatment at 12 research sites across four continents was successfully implemented, resulting in a total sample size of 400 with minimal missing data. Challenges in recruitment and adherence to the projected timelines were encountered. Significant reductions in anxiety sensitivity were observed in all conditions. Contrary to hypotheses, group differences were only observed at post-treatment, when ENHANCED and CONTROL outperformed STANDARD but were not significantly different from each other.</div></div><div><h3>Conclusions</h3><div>This study demonstrates the feasibility of the Exposure Therapy Consortium. Findings raise questions regarding the efficacy of large group exposure interventions and underscore the importance of careful research site selection and an iterative approach to treatment development.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"109 ","pages":"Article 102962"},"PeriodicalIF":4.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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