Pub Date : 2026-01-10DOI: 10.1016/j.janxdis.2026.103114
Camille Mouguiama-Daouda , Richard J. McNally , Alexandre Heeren
Recent evidence indicates that sizeable segments of the global population experience marked anxiety about climate change. Yet important questions remain about the psychological processes that sustain climate anxiety and about how this anxiety can translate into adaptive responses (i.e., pro-environmental behaviors) versus maladaptive outcomes (i.e., impairments in daily functioning). In the present study, we explicitly build on decades of basic research identifying intolerance of uncertainty—a dispositional difficulty in tolerating the unknown—as a decisive mechanism in the emergence and maintenance of anxiety-related dysfunction. Accordingly, we investigated how intolerance of uncertainty, the experience of climate change, and climate anxiety are interconnected, along with climate anxiety’s (mal)adaptive outcomes. We analyzed data from an international unselected sample (n = 728) using computational tools from the network analytical framework. Specifically, we estimated a Gaussian Graphical Model (GGM) to characterize the network’s structure, identify potential clusters of variables, and detect influential nodes, and we estimated a directed acyclic graph (DAG) to examine the probabilistic dependencies among variables. Our results indicate that both intolerance of uncertainty and the experience of climate change function as driving forces within the overall network structure.
{"title":"Intolerance of uncertainty and climate change experience as driving forces of climate anxiety: Insights from a network perspective","authors":"Camille Mouguiama-Daouda , Richard J. McNally , Alexandre Heeren","doi":"10.1016/j.janxdis.2026.103114","DOIUrl":"10.1016/j.janxdis.2026.103114","url":null,"abstract":"<div><div>Recent evidence indicates that sizeable segments of the global population experience marked anxiety about climate change. Yet important questions remain about the psychological processes that sustain climate anxiety and about how this anxiety can translate into adaptive responses (i.e., pro-environmental behaviors) versus maladaptive outcomes (i.e., impairments in daily functioning). In the present study, we explicitly build on decades of basic research identifying intolerance of uncertainty—a dispositional difficulty in tolerating the unknown—as a decisive mechanism in the emergence and maintenance of anxiety-related dysfunction. Accordingly, we investigated how intolerance of uncertainty, the experience of climate change, and climate anxiety are interconnected, along with climate anxiety’s (mal)adaptive outcomes. We analyzed data from an international unselected sample (<em>n</em> = 728) using computational tools from the network analytical framework. Specifically, we estimated a Gaussian Graphical Model (GGM) to characterize the network’s structure, identify potential clusters of variables, and detect influential nodes, and we estimated a directed acyclic graph (DAG) to examine the probabilistic dependencies among variables. Our results indicate that both intolerance of uncertainty and the experience of climate change function as driving forces within the overall network structure.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"118 ","pages":"Article 103114"},"PeriodicalIF":4.5,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981013","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 : 2026-01-07DOI: 10.1016/j.janxdis.2026.103113
Dawne Vogt , Shaina A. Kumar , Eric D. Caine , Stephanie Gamble , Elizabeth Karras , Shelby Borowski
Trauma exposure is widespread within the U.S. and around the world. Although researchers have examined the mental health and functional challenges that can result from these experiences, knowledge regarding which symptoms and domains of functioning are most central in maintaining poor mental health and functioning is limited. Using data from The Veterans Metrics Initiative (TVMI) study, we conducted a series of network analyses to identify factors that are most central to mental health (depression, posttraumatic stress disorder [PTSD], anxiety, and suicidal ideation) and functional challenges (health, social, vocational, and financial) experienced by U.S. military veterans (N = 2150). Depression symptoms and health functioning were most strongly linked to other factors in the network of associations among and between mental health and functioning domains, with similar associations observed for those with minimal versus elevated symptom levels. Collectively, these findings suggest that interventions targeting depression, alongside efforts to increase engagement in health-promoting behaviors, may have greatest potential to disrupt these networks. Future research is needed to confirm the causal impact that these factors have on other aspects of mental health and functioning, and to evaluate whether interventions that target these factors can improve the mental health and well-being of military veterans and other trauma-exposed populations.
{"title":"Disrupting posttrauma networks: Identifying candidate intervention targets to improve military veterans’ mental health and well-being","authors":"Dawne Vogt , Shaina A. Kumar , Eric D. Caine , Stephanie Gamble , Elizabeth Karras , Shelby Borowski","doi":"10.1016/j.janxdis.2026.103113","DOIUrl":"10.1016/j.janxdis.2026.103113","url":null,"abstract":"<div><div>Trauma exposure is widespread within the U.S. and around the world. Although researchers have examined the mental health and functional challenges that can result from these experiences, knowledge regarding which symptoms and domains of functioning are most central in maintaining poor mental health and functioning is limited. Using data from The Veterans Metrics Initiative (TVMI) study, we conducted a series of network analyses to identify factors that are most central to mental health (depression, posttraumatic stress disorder [PTSD], anxiety, and suicidal ideation) and functional challenges (health, social, vocational, and financial) experienced by U.S. military veterans (<em>N</em> = 2150). Depression symptoms and health functioning were most strongly linked to other factors in the network of associations among and between mental health and functioning domains, with similar associations observed for those with minimal versus elevated symptom levels. Collectively, these findings suggest that interventions targeting depression, alongside efforts to increase engagement in health-promoting behaviors, may have greatest potential to disrupt these networks. Future research is needed to confirm the causal impact that these factors have on other aspects of mental health and functioning, and to evaluate whether interventions that target these factors can improve the mental health and well-being of military veterans and other trauma-exposed populations.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"118 ","pages":"Article 103113"},"PeriodicalIF":4.5,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980415","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 : 2026-01-06DOI: 10.1016/j.janxdis.2026.103110
Gulnaz Anjum , Mudassar Aziz , Abdul Rehman Nawaz
Climate anxiety research has emerged as a significant interdisciplinary scholarship linking mental health, environmental science, and social justice. Despite its growing prominence, no comprehensive bibliometric analysis has systematically mapped its intellectual structure and global dynamics. This study presents a bibliometric synthesis of 579 publications on climate anxiety indexed in Scopus and Web of Science from 2000 to 2024. Using Biblioshiny (the graphical interface for the R package "bibliometrix") and VOSviewer, we analyzed co-authorship, co-citation, and keyword co-occurrence networks to examine patterns in scientific production, thematic development, and institutional and geographic distribution. Citation trend analysis and keyword mapping traced thematic evolution across three phases: 2003–2015, 2016–2020, and 2021–2024. Results indicate exponential growth in climate anxiety research since 2019, with 242 publications in 2024 alone. The field is largely shaped by prominent scholars from the Global North and over the years thematic clusters have expanded from foundational constructs such as solastalgia and eco-anxiety to broader concerns including ecological grief, place attachment, and pro-environmental behavior. However, research remains geographically concentrated in high-income countries, with limited representation from climate-vulnerable regions, underscoring persistent epistemic disparities. Overall, the field demonstrates rapid development and growing interdisciplinary reach, yet continues to reflect inequities in global authorship and knowledge production. Advancing a more inclusive and context-sensitive climate anxiety scholarship requires centering Global South perspectives, decolonizing research agendas, and promoting equitable collaboration.
气候焦虑研究已经成为一项重要的跨学科研究，将心理健康、环境科学和社会正义联系起来。尽管它日益突出，但没有全面的文献计量分析系统地描绘了它的知识结构和全球动态。本研究对2000年至2024年Scopus和Web of Science收录的579篇关于气候焦虑的出版物进行了文献计量综合分析。使用Biblioshiny （R软件包“bibliometrix”的图形界面）和VOSviewer，我们分析了共同作者、共同被引和关键词共现网络，以检查科学生产、专题发展、机构和地理分布的模式。引文趋势分析和关键词映射追踪了2003-2015年、2016-2020年和2021-2024年三个阶段的主题演变。结果表明，自2019年以来，气候焦虑研究呈指数级增长，仅在2024年就发表了242篇论文。该领域在很大程度上是由来自全球北方的杰出学者塑造的，多年来，主题集群已经从太阳痛和生态焦虑等基础结构扩展到更广泛的关注，包括生态悲伤、地方依恋和亲环境行为。然而，研究在地理上仍然集中在高收入国家，来自气候脆弱地区的代表性有限，这突显了持续存在的认知差异。总体而言，该领域发展迅速，跨学科范围不断扩大，但仍反映出全球作者身份和知识生产的不平等。推动更具包容性和环境敏感性的气候焦虑研究需要以全球南方视角为中心，非殖民化研究议程，促进公平合作。
{"title":"Climate anxiety scholarship: A global bibliometric synthesis (2000–2024)","authors":"Gulnaz Anjum , Mudassar Aziz , Abdul Rehman Nawaz","doi":"10.1016/j.janxdis.2026.103110","DOIUrl":"10.1016/j.janxdis.2026.103110","url":null,"abstract":"<div><div>Climate anxiety research has emerged as a significant interdisciplinary scholarship linking mental health, environmental science, and social justice. Despite its growing prominence, no comprehensive bibliometric analysis has systematically mapped its intellectual structure and global dynamics. This study presents a bibliometric synthesis of 579 publications on climate anxiety indexed in Scopus and Web of Science from 2000 to 2024. Using Biblioshiny (the graphical interface for the R package \"bibliometrix\") and VOSviewer, we analyzed co-authorship, co-citation, and keyword co-occurrence networks to examine patterns in scientific production, thematic development, and institutional and geographic distribution. Citation trend analysis and keyword mapping traced thematic evolution across three phases: 2003–2015, 2016–2020, and 2021–2024. Results indicate exponential growth in climate anxiety research since 2019, with 242 publications in 2024 alone. The field is largely shaped by prominent scholars from the Global North and over the years thematic clusters have expanded from foundational constructs such as solastalgia and eco-anxiety to broader concerns including ecological grief, place attachment, and pro-environmental behavior. However, research remains geographically concentrated in high-income countries, with limited representation from climate-vulnerable regions, underscoring persistent epistemic disparities. Overall, the field demonstrates rapid development and growing interdisciplinary reach, yet continues to reflect inequities in global authorship and knowledge production. Advancing a more inclusive and context-sensitive climate anxiety scholarship requires centering Global South perspectives, decolonizing research agendas, and promoting equitable collaboration.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"118 ","pages":"Article 103110"},"PeriodicalIF":4.5,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145929041","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 : 2026-01-06DOI: 10.1016/j.janxdis.2026.103111
Neslihan Özhan , Erich W. Graf , Matthew Garner
Background
Few studies have examined social anxiety symptoms during online social interactions. We examined self-report symptoms in individuals with elevated social anxiety in online interactions in the presence/absence of virtual audience images and the presence/absence of live videos of the self.
Method
Participants with elevated social anxiety who were not treatment-seeking gave a short impromptu talk via an online social communication platform. Participants were randomised to present with their camera on or off, and to audience images that were visible or not. We recorded participants’ self-reported anxiety, perspective taken, evaluations of speech performance, and post-event processing.
Results
Anxiety increased during the online social interaction. Furthermore, participants whose camera was on, but the audience was not visible, evaluated their own performance as worse and engaged in more severe negative post-event processing compared with the other conditions.
Discussion
Online videoconferencing tasks can induce anxiety and activate negative self-images and post-event evaluations of social performance. Our findings support the use of online social interactions to research social anxiety, maladaptive cognitive-behavioural biases and to develop novel interventions.
{"title":"Social anxiety in online social interactions: Examining the effects of self and audience images on anxiety, self-awareness and performance evaluations","authors":"Neslihan Özhan , Erich W. Graf , Matthew Garner","doi":"10.1016/j.janxdis.2026.103111","DOIUrl":"10.1016/j.janxdis.2026.103111","url":null,"abstract":"<div><h3>Background</h3><div>Few studies have examined social anxiety symptoms during online social interactions. We examined self-report symptoms in individuals with elevated social anxiety in online interactions in the presence/absence of virtual audience images and the presence/absence of live videos of the self.</div></div><div><h3>Method</h3><div>Participants with elevated social anxiety who were not treatment-seeking gave a short impromptu talk via an online social communication platform. Participants were randomised to present with their camera on or off, and to audience images that were visible or not. We recorded participants’ self-reported anxiety, perspective taken, evaluations of speech performance, and post-event processing.</div></div><div><h3>Results</h3><div>Anxiety increased during the online social interaction. Furthermore, participants whose camera was on, but the audience was not visible, evaluated their own performance as worse and engaged in more severe negative post-event processing compared with the other conditions.</div></div><div><h3>Discussion</h3><div>Online videoconferencing tasks can induce anxiety and activate negative self-images and post-event evaluations of social performance. Our findings support the use of online social interactions to research social anxiety, maladaptive cognitive-behavioural biases and to develop novel interventions.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"118 ","pages":"Article 103111"},"PeriodicalIF":4.5,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145929040","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 : 2026-01-06DOI: 10.1016/j.janxdis.2026.103112
Emily J. Wilson , Maree J. Abbott , Alice R. Norton , Jessica Riley , David Berle
Accessing psychological treatment is often met with barriers of time, cost, and availability. Focused brief interventions delivered via videoconference can overcome some of these barriers. We sought to evaluate the efficacy and feasibility, as well as processes of exposure-based learning for a brief intervention for treating generalised anxiety disorder (GAD), utilising behavioural experiments delivered via videoconference. Participants (N = 40) with a primary diagnosis of GAD were assessed via clinical interview and randomised to either the treatment condition (n = 20) or waitlist condition (n = 20). Treatment consisted of two weekly 1-hour sessions where participants utilised behavioural experiments to test negative beliefs about uncertainty. The primary outcomes were worry, safety behaviours, avoidance, depression, anxiety, physiological tension, and intolerance of uncertainty (IU). Linear mixed models indicated that the treatment group was only superior to the waitlist group on change from pre- to post-treatment for worry. The combined group (once waitlisted participants received treatment) evidenced significant reduction across all outcomes from pre- to post-treatment, except for anxiety. Additionally, there was evidence that expectancy violation and habituation occurred, suggesting that behavioural experiments facilitate different processes of exposure-based learning. The intervention was also found to be acceptable, appropriate, and feasible by adults with GAD. Thus, the remotely delivered brief intervention shows promise as an effective option for individuals with GAD.
{"title":"Behavioural experiments for intolerance of uncertainty: A brief intervention delivered via videoconference for adults with generalised anxiety disorder","authors":"Emily J. Wilson , Maree J. Abbott , Alice R. Norton , Jessica Riley , David Berle","doi":"10.1016/j.janxdis.2026.103112","DOIUrl":"10.1016/j.janxdis.2026.103112","url":null,"abstract":"<div><div>Accessing psychological treatment is often met with barriers of time, cost, and availability. Focused brief interventions delivered via videoconference can overcome some of these barriers. We sought to evaluate the efficacy and feasibility, as well as processes of exposure-based learning for a brief intervention for treating generalised anxiety disorder (GAD), utilising behavioural experiments delivered via videoconference. Participants (<em>N</em> = 40) with a primary diagnosis of GAD were assessed via clinical interview and randomised to either the treatment condition (<em>n</em> = 20) or waitlist condition (<em>n</em> = 20). Treatment consisted of two weekly 1-hour sessions where participants utilised behavioural experiments to test negative beliefs about uncertainty. The primary outcomes were worry, safety behaviours, avoidance, depression, anxiety, physiological tension, and intolerance of uncertainty (IU). Linear mixed models indicated that the treatment group was only superior to the waitlist group on change from pre- to post-treatment for worry. The combined group (once waitlisted participants received treatment) evidenced significant reduction across all outcomes from pre- to post-treatment, except for anxiety. Additionally, there was evidence that expectancy violation and habituation occurred, suggesting that behavioural experiments facilitate different processes of exposure-based learning. The intervention was also found to be acceptable, appropriate, and feasible by adults with GAD. Thus, the remotely delivered brief intervention shows promise as an effective option for individuals with GAD.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"118 ","pages":"Article 103112"},"PeriodicalIF":4.5,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012954","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 : 2026-01-06DOI: 10.1016/j.janxdis.2026.103109
Sandra J. Llera , Nur Hani Zainal , Michelle G. Newman
Goal
We developed and validated an 8-item version of the 25-item Contrast Avoidance Questionnaire-General Emotion (CAQ-GE) scale, named the CAQ-GE-8.
Method
Using unselected university undergraduates (N = 8432), we conducted item-response theory (IRT) analyses with a confirmatory graded response model. We then examined the ability of the CAQ-GE-8 to predict probable generalized anxiety disorder (GAD) and major depressive disorder (MDD). With two other student samples, we examined the scale’s convergent/discriminant validity (N = 410) as well as retest reliability (N = 124).
Results
The CAQ-GE-8 contained the same 2 factors as the CAQ-GE (F1: Create and Sustain Negative Emotions to Avoid Negative Contrasts [SNE], 5 items; and F2: Discomfort with Emotional Shifts [DES], 3 items). Both factors demonstrated strong internal consistency. The brief scale predicted probable GAD using a cut-point score of ≥ 15 (area under the receiver operating characteristic curve [AUC]:.794), and probable MDD using a cut-point score of ≥ 13 (AUC:.782). The CAQ-GE-8 and its two subscales also demonstrated good convergent and discriminant validity, and good to excellent retest reliability over 1 week (r = .737–.879).
Conclusion
These findings support the use of the CAQ-GE-8, both in research and in treatment, to assess the construct of contrast avoidance.
{"title":"Development and validation of the eight item contrast avoidance questionnaire-general emotion scale (CAQ-GE-8): An item-response theory analysis","authors":"Sandra J. Llera , Nur Hani Zainal , Michelle G. Newman","doi":"10.1016/j.janxdis.2026.103109","DOIUrl":"10.1016/j.janxdis.2026.103109","url":null,"abstract":"<div><h3>Goal</h3><div>We developed and validated an 8-item version of the 25-item Contrast Avoidance Questionnaire-General Emotion (CAQ-GE) scale, named the CAQ-GE-8.</div></div><div><h3>Method</h3><div>Using unselected university undergraduates (<em>N</em> = 8432), we conducted item-response theory (IRT) analyses with a confirmatory graded response model. We then examined the ability of the CAQ-GE-8 to predict probable generalized anxiety disorder (GAD) and major depressive disorder (MDD). With two other student samples, we examined the scale’s convergent/discriminant validity (<em>N</em> = 410) as well as retest reliability (<em>N</em> = 124).</div></div><div><h3>Results</h3><div>The CAQ-GE-8 contained the same 2 factors as the CAQ-GE (F1: Create and Sustain Negative Emotions to Avoid Negative Contrasts [SNE], 5 items; and F2: Discomfort with Emotional Shifts [DES], 3 items). Both factors demonstrated strong internal consistency. The brief scale predicted probable GAD using a cut-point score of ≥ 15 (area under the receiver operating characteristic curve [AUC]:.794), and probable MDD using a cut-point score of ≥ 13 (AUC:.782). The CAQ-GE-8 and its two subscales also demonstrated good convergent and discriminant validity, and good to excellent retest reliability over 1 week (<em>r</em> = .737–.879).</div></div><div><h3>Conclusion</h3><div>These findings support the use of the CAQ-GE-8, both in research and in treatment, to assess the construct of contrast avoidance.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"118 ","pages":"Article 103109"},"PeriodicalIF":4.5,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145915382","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 : 2026-01-05DOI: 10.1016/j.janxdis.2025.103108
Xiaojie Yang , Xiaodong Zhang , Jia Luo , Pengchong Wang , Fang He , Limin Meng , Qin Qin , Tong Wu , Xiangyun Yang
Background
Cognitive behavioral therapy (CBT) is a first-line intervention for panic disorder (PD), yet a subset of patients exhibits suboptimal response. This randomized controlled trial investigated whether low-frequency repetitive transcranial magnetic stimulation (rTMS) augments the efficacy of CBT in unmedicated PD patients.
Methods
Fifty patients with PD were randomly assigned to receive either active or sham rTMS combined with standardized CBT. Outcomes were assessed using the Panic Disorder Severity Scale (PDSS), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD-17), Clinical Global Impression-Severity (CGI-S), Symptom Checklist-90 (SCL-90), and Personal and Social Performance scale (PSP). Bayesian linear mixed-effects model (LMM) was employed to analyze changes in clinical scores over time, accounting for repeated measures and baseline severity. Sensitivity analysis was also performed to evaluate the robustness of the findings.
Results
LMM analysis revealed a significant group × time interaction for both PDSS and HAMA scores. The active rTMS group showed significantly greater reduction in panic and anxiety symptoms compared to the sham group from week 2 onward. At the 12-week endpoint, both groups demonstrated significant improvements in overall psychopathological symptoms (SCL-90), depressive symptoms (HAMD-17), illness severity (CGI-S), and psychosocial functioning (PSP). However, the active rTMS group demonstrated significantly greater improvement in PSP scores compared to the sham control group, while no superior improvement was observed in SCL-90, CGI-S, or HAMD-17 scores. Both treatments were well tolerated.
Conclusions
Active rTMS significantly accelerated and enhanced early anxiety and panic symptom reduction when combined with CBT, demonstrating its potential as an effective adjunctive strategy in the initial phase of treatment. The combination was safe and feasible, supporting further investigation into optimized sequencing and long-term outcomes in PD management.
{"title":"Efficacy of combined low-frequency rTMS and cognitive behavioral therapy for unmedicated panic disorder: A randomized controlled trial","authors":"Xiaojie Yang , Xiaodong Zhang , Jia Luo , Pengchong Wang , Fang He , Limin Meng , Qin Qin , Tong Wu , Xiangyun Yang","doi":"10.1016/j.janxdis.2025.103108","DOIUrl":"10.1016/j.janxdis.2025.103108","url":null,"abstract":"<div><h3>Background</h3><div>Cognitive behavioral therapy (CBT) is a first-line intervention for panic disorder (PD), yet a subset of patients exhibits suboptimal response. This randomized controlled trial investigated whether low-frequency repetitive transcranial magnetic stimulation (rTMS) augments the efficacy of CBT in unmedicated PD patients.</div></div><div><h3>Methods</h3><div>Fifty patients with PD were randomly assigned to receive either active or sham rTMS combined with standardized CBT. Outcomes were assessed using the Panic Disorder Severity Scale (PDSS), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD-17), Clinical Global Impression-Severity (CGI-S), Symptom Checklist-90 (SCL-90), and Personal and Social Performance scale (PSP). Bayesian linear mixed-effects model (LMM) was employed to analyze changes in clinical scores over time, accounting for repeated measures and baseline severity. Sensitivity analysis was also performed to evaluate the robustness of the findings.</div></div><div><h3>Results</h3><div>LMM analysis revealed a significant group × time interaction for both PDSS and HAMA scores. The active rTMS group showed significantly greater reduction in panic and anxiety symptoms compared to the sham group from week 2 onward. At the 12-week endpoint, both groups demonstrated significant improvements in overall psychopathological symptoms (SCL-90), depressive symptoms (HAMD-17), illness severity (CGI-S), and psychosocial functioning (PSP). However, the active rTMS group demonstrated significantly greater improvement in PSP scores compared to the sham control group, while no superior improvement was observed in SCL-90, CGI-S, or HAMD-17 scores. Both treatments were well tolerated.</div></div><div><h3>Conclusions</h3><div>Active rTMS significantly accelerated and enhanced early anxiety and panic symptom reduction when combined with CBT, demonstrating its potential as an effective adjunctive strategy in the initial phase of treatment. The combination was safe and feasible, supporting further investigation into optimized sequencing and long-term outcomes in PD management.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"118 ","pages":"Article 103108"},"PeriodicalIF":4.5,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967436","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 : 2025-12-08DOI: 10.1016/j.janxdis.2025.103107
Dori Rubinstein , Nachshon Korem , David G. Bullard , Ilan Harpaz-Rotem
Exposure techniques are foundational in trauma treatment, yet their application varies significantly across psychotherapies. This theoretical paper introduces the Exposure Continuum Model (ECM), a novel comprehensive framework that classifies trauma-centered therapeutic approaches along two key dimensions: Closeness (implicit to explicit or indirect to direct exposure) and Standardized Cumulative Dose (repetition and duration) of exposure. These dimensions provide a map that spans across evidence-based trauma-focused therapies (e.g., Prolonged Exposure [PE], Cognitive Processing Therapy [CPT], Eye Movement Desensitization and Reprocessing [EMDR]) and other, trauma-informed modalities (e.g., Interpersonal Psychotherapy [IPT], Somatic Experiencing [SE]). The paper reviews the clinical, cognitive, and neurobiological mechanisms that underpin exposure therapy, highlighting the diversity of its application across different therapeutic modalities. It also offers a detailed description of how these therapies incorporate exposure components and locate them within the model. By offering a structured framework for understanding the exposure component matrix across therapies, this cornerstone paper lays the foundation for future research and practice. These future data-driven explorations will help clinicians refine treatment approaches based on variables such as trauma type, time from trauma, symptom severity, and individual differences among patients, therapists, and therapeutic settings.
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Pub Date : 2025-12-02DOI: 10.1016/j.janxdis.2025.103105
Joseph B. Friedman , Tate F. Halverson , Emily K. Juel , Nicholas S. Myers , Mujgan Inozu , Jonathan S. Abramowitz
The current study examined predictors of posttraumatic stress (PTS) and general distress symptoms following two campus-wide “armed and dangerous person” lockdowns at the University of North Carolina at Chapel Hill. Participants (N = 287) completed baseline surveys four weeks post-lockdowns, with 115 participating in follow-ups over seven months. Utilizing the cognitive model of PTSD, we investigated posttraumatic cognitions, anxiety sensitivity (AS), and prior trauma as predictors of PTS and general distress. Results revealed that higher initial posttraumatic cognitions and AS were associated with greater PTS and distress symptom severity. Interestingly, elevated posttraumatic cognitions predicted a faster reduction in PTS symptoms over time, while AS effects remained stable. Prior trauma did not significantly predict outcomes. These findings highlight the roles of specific cognitive factors in shaping responses to trauma and emphasize the potential for targeted interventions to mitigate symptoms following collective stressful events.
{"title":"Prospective predictors of posttraumatic stress symptoms following two “armed and dangerous person” campus lockdowns","authors":"Joseph B. Friedman , Tate F. Halverson , Emily K. Juel , Nicholas S. Myers , Mujgan Inozu , Jonathan S. Abramowitz","doi":"10.1016/j.janxdis.2025.103105","DOIUrl":"10.1016/j.janxdis.2025.103105","url":null,"abstract":"<div><div>The current study examined predictors of posttraumatic stress (PTS) and general distress symptoms following two campus-wide “armed and dangerous person” lockdowns at the University of North Carolina at Chapel Hill. Participants (<em>N</em> = 287) completed baseline surveys four weeks post-lockdowns, with 115 participating in follow-ups over seven months. Utilizing the cognitive model of PTSD, we investigated posttraumatic cognitions, anxiety sensitivity (AS), and prior trauma as predictors of PTS and general distress. Results revealed that higher initial posttraumatic cognitions and AS were associated with greater PTS and distress symptom severity. Interestingly, elevated posttraumatic cognitions predicted a faster reduction in PTS symptoms over time, while AS effects remained stable. Prior trauma did not significantly predict outcomes. These findings highlight the roles of specific cognitive factors in shaping responses to trauma and emphasize the potential for targeted interventions to mitigate symptoms following collective stressful events.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"117 ","pages":"Article 103105"},"PeriodicalIF":4.5,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726804","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 : 2025-12-02DOI: 10.1016/j.janxdis.2025.103104
Jeffrey R. Vittengl , Eunyoe Ro , Robin B. Jarrett , Lee Anna Clark
Background
Section-III of DSM-5 introduced an alternative model of personality disorder (AMPD) including both personality dysfunction and maladaptive-range traits. This study clarified relations of social anxiety symptoms, social anxiety disorder (SAD), and Section-II avoidant personality disorder (APD) with AMPD personality pathology.
Method
Adults (N = 600; including mental-health outpatients and non-patients at risk for personality pathology) completed self-report and interviewer-rated measures of social anxiety and AMPD constructs, including self and interpersonal functioning and trait negative affectivity, detachment, disinhibition, antagonism, and psychoticism. Most participants (n = 497) completed reassessment, on average 8 months later. We examined convergence of social anxiety with personality pathology, as well as prediction of longitudinal changes in social anxiety from baseline personality and vice versa. We focused on results replicating across self-reported social anxiety symptoms, interviewer-rated SAD and APD criterion counts, and self- and interviewer-rated personality.
Results
Concurrently, social anxiety related to higher negative affectivity, detachment, self dysfunction, and interpersonal dysfunction. Of these, the latter three dimensions predicted increases in social anxiety longitudinally. Social anxiety did not predict longitudinal changes in personality pathology as consistently.
Limitations
Generalization of findings to other populations, settings, and methods, such as adolescents, primary care, or direct observation, is uncertain. Longitudinal analyses suggested causality but could not establish it.
Conclusions
The AMPD enriches description of current social anxiety and prediction of changes in social anxiety. Assessment of personality pathology, including both personality dysfunction and maladaptive-range traits, may identify targets for prevention or treatment of social anxiety, to be tested in future research.
{"title":"Social anxiety in the context of the alternative DSM-5 model of personality disorder","authors":"Jeffrey R. Vittengl , Eunyoe Ro , Robin B. Jarrett , Lee Anna Clark","doi":"10.1016/j.janxdis.2025.103104","DOIUrl":"10.1016/j.janxdis.2025.103104","url":null,"abstract":"<div><h3>Background</h3><div>Section-III of <em>DSM-5</em> introduced an alternative model of personality disorder (AMPD) including both personality dysfunction and maladaptive-range traits. This study clarified relations of social anxiety symptoms, social anxiety disorder (SAD), and Section-II avoidant personality disorder (APD) with AMPD personality pathology.</div></div><div><h3>Method</h3><div>Adults (<em>N</em> = 600; including mental-health outpatients and non-patients at risk for personality pathology) completed self-report and interviewer-rated measures of social anxiety and AMPD constructs, including self and interpersonal functioning and trait negative affectivity, detachment, disinhibition, antagonism, and psychoticism. Most participants (<em>n</em> = 497) completed reassessment, on average 8 months later. We examined convergence of social anxiety with personality pathology, as well as prediction of longitudinal changes in social anxiety from baseline personality and vice versa. We focused on results replicating across self-reported social anxiety symptoms, interviewer-rated SAD and APD criterion counts, and self- and interviewer-rated personality.</div></div><div><h3>Results</h3><div>Concurrently, social anxiety related to higher negative affectivity, detachment, self dysfunction, and interpersonal dysfunction. Of these, the latter three dimensions predicted increases in social anxiety longitudinally. Social anxiety did not predict longitudinal changes in personality pathology as consistently.</div></div><div><h3>Limitations</h3><div>Generalization of findings to other populations, settings, and methods, such as adolescents, primary care, or direct observation, is uncertain. Longitudinal analyses suggested causality but could not establish it.</div></div><div><h3>Conclusions</h3><div>The AMPD enriches description of current social anxiety and prediction of changes in social anxiety. Assessment of personality pathology, including both personality dysfunction and maladaptive-range traits, may identify targets for prevention or treatment of social anxiety, to be tested in future research.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"117 ","pages":"Article 103104"},"PeriodicalIF":4.5,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684944","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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