Journal of Anxiety Disorders最新文献_第2页

Climate anxiety scholarship: A global bibliometric synthesis (2000–2024) 气候焦虑研究：全球文献计量综合（2000-2024）

IF 4.5 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2026-01-06 DOI: 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。

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引用次数: 0

Social anxiety in online social interactions: Examining the effects of self and audience images on anxiety, self-awareness and performance evaluations 网络社交中的社交焦虑：自我和受众形象对焦虑、自我意识和绩效评估的影响

IF 4.5 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2026-01-06 DOI: 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.

很少有研究调查在线社交互动中的社交焦虑症状。我们研究了在有/没有虚拟观众图像和有/没有自我直播视频的情况下，在线互动中社交焦虑升高的个体的自我报告症状。方法非寻求治疗的社交焦虑升高的参与者通过在线社交交流平台进行简短的即兴演讲。参与者被随机分配到开着或关着相机，向观众展示可见或不可见的图像。我们记录了参与者自我报告的焦虑、所采取的观点、对演讲表现的评估和事后处理。结果网络社交过程中焦虑程度增加。此外，与其他条件相比，开着摄像机但看不到观众的参与者对自己的表现的评价更差，并且参与了更严重的负面事后处理。在线视频会议任务会引起焦虑，激活消极的自我形象和事后对社会表现的评价。我们的研究结果支持使用在线社交互动来研究社交焦虑、适应不良的认知行为偏见，并开发新的干预措施。

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引用次数: 0

Behavioural experiments for intolerance of uncertainty: A brief intervention delivered via videoconference for adults with generalised anxiety disorder 对不确定性不耐受的行为实验：通过视频会议对成人广泛性焦虑症的简短干预。

IF 4.5 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2026-01-06 DOI: 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.

获得心理治疗常常遇到时间、费用和可获得性的障碍。通过视频会议提供的有重点的简短干预措施可以克服其中一些障碍。我们试图评估有效性和可行性，以及基于暴露的学习过程的短暂干预治疗广泛性焦虑症（GAD），利用视频会议提供的行为实验。初步诊断为GAD的参与者（N = 40）通过临床访谈进行评估，并随机分为治疗组（N = 20）或候补组（N = 20）。治疗包括每周两次1小时的会议，参与者利用行为实验来测试对不确定性的负面信念。主要结局为担忧、安全行为、回避、抑郁、焦虑、生理紧张和不确定性不耐受（IU）。线性混合模型显示，治疗组仅在焦虑从治疗前到治疗后的变化上优于候补组。联合组（一旦候补参与者接受治疗）证明，除焦虑外，治疗前和治疗后的所有结果都显著减少。此外，有证据表明期望违反和习惯化发生了，这表明行为实验促进了不同的基于暴露的学习过程。对于患有广泛性焦虑症的成年人来说，这种干预也被认为是可接受的、适当的和可行的。因此，远程提供的简短干预有望成为广泛性焦虑症患者的有效选择。

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引用次数: 0

Development and validation of the eight item contrast avoidance questionnaire-general emotion scale (CAQ-GE-8): An item-response theory analysis 八项对比回避问卷-一般情绪量表（CAQ-GE-8）的编制与验证：项目反应理论分析

IF 4.5 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2026-01-06 DOI: 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.

目的：我们开发并验证了25项对比回避问卷-一般情绪量表（CAQ-GE）的8项版本，命名为CAQ-GE-8。方法以未入选的大学生（N = 8432）为研究对象，采用验证性分级反应模型进行项目反应理论（IRT）分析。然后，我们检查了CAQ-GE-8预测可能的广泛性焦虑症（GAD）和重度抑郁症（MDD）的能力。与其他两个学生样本，我们检查了量表的收敛/判别效度（N = 410）以及重测信度（N = 124）。结果CAQ-GE-8量表包含与CAQ-GE相同的2个因素（F1：创造和维持负面情绪以避免负面对比[SNE]， 5项；F2：情绪转移不适[DES]， 3项）。这两个因素都表现出很强的内部一致性。简要量表预测可能的广泛性焦虑症，临界值≥ 15（受试者工作特征曲线下面积[AUC]:）。794)，使用cut point评分≥ 13 （AUC:.782）判断可能的重度抑郁症。CAQ-GE-8及其两个子量表也表现出良好的收敛效度和判别效度，1周重测信度良好至优异（r = .737 -.879）。结论本研究结果支持CAQ-GE-8在研究和治疗中用于评估对比回避的构建。

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引用次数: 0

Efficacy of combined low-frequency rTMS and cognitive behavioral therapy for unmedicated panic disorder: A randomized controlled trial 低频rTMS联合认知行为疗法治疗非药物性恐慌症的疗效：一项随机对照试验。

IF 4.5 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2026-01-05 DOI: 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.

背景：认知行为疗法（CBT）是治疗惊恐障碍（PD）的一线干预手段，但有一部分患者表现出不理想的反应。这项随机对照试验研究了低频重复经颅磁刺激（rTMS）是否能增强未用药PD患者CBT的疗效。方法：50例PD患者随机分为主动或假性rTMS联合标准化CBT两组。采用惊恐障碍严重程度量表（PDSS）、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD-17）、临床总体印象严重程度量表（CGI-S）、症状量表-90 （SCL-90）和个人与社会表现量表（PSP）对结果进行评估。采用贝叶斯线性混合效应模型（LMM）分析临床评分随时间的变化，考虑重复测量和基线严重程度。还进行敏感性分析以评估研究结果的稳健性。结果：LMM分析显示PDSS和HAMA评分之间存在显著的组× 时间交互作用。从第2周开始，与假手术组相比，活跃的rTMS组在恐慌和焦虑症状方面表现出更大的减少。在12周的终点，两组均表现出总体精神病理症状（SCL-90）、抑郁症状（HAMD-17）、疾病严重程度（CGI-S）和社会心理功能（PSP）的显著改善。然而，与假对照组相比，活跃rTMS组在PSP评分上表现出更大的改善，而在SCL-90、CGI-S或HAMD-17评分上没有明显的改善。两种治疗方法均耐受良好。结论：与CBT联合使用时，主动rTMS可显著加速和增强早期焦虑和恐慌症状的减轻，显示其作为治疗初期有效辅助策略的潜力。该组合安全可行，支持进一步研究优化测序和PD治疗的长期结果。

{"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}

引用次数: 0

The exposure continuum model: A theoretical framework for understanding exposure across trauma-centered psychotherapies 暴露连续体模型：理解以创伤为中心的心理治疗中暴露的理论框架。

IF 4.5 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-12-08 DOI: 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.

暴露技术是创伤治疗的基础，但其应用在不同的心理治疗中差异很大。这篇理论论文介绍了暴露连续模型（ECM），这是一个新的综合框架，它根据两个关键维度对创伤为中心的治疗方法进行分类：暴露的接近度（隐性暴露到显性暴露或间接暴露到直接暴露）和标准累积剂量（暴露的重复和持续时间）。这些维度提供了一个跨越以证据为基础的以创伤为重点的治疗（例如，长时间暴露[PE]，认知加工治疗[CPT]，眼动脱敏和再加工[EMDR]）和其他创伤知情模式（例如，人际心理治疗[IPT]，躯体体验[SE]）的地图。本文回顾了暴露疗法的临床、认知和神经生物学机制，强调了暴露疗法在不同治疗方式下应用的多样性。它还详细描述了这些疗法如何结合暴露成分并在模型中定位它们。通过提供一个结构化的框架来理解跨疗法的暴露成分矩阵，这篇基石论文为未来的研究和实践奠定了基础。这些未来数据驱动的探索将帮助临床医生根据创伤类型、创伤时间、症状严重程度以及患者、治疗师和治疗环境之间的个体差异等变量改进治疗方法。

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引用次数: 0

Prospective predictors of posttraumatic stress symptoms following two “armed and dangerous person” campus lockdowns 两次“武装和危险人物”校园封锁后创伤后应激症状的前瞻性预测因素

IF 4.5 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-12-02 DOI: 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.

目前的研究调查了北卡罗来纳大学教堂山分校两次校园范围内的“武装和危险人物”封锁后创伤后应激（PTS）和一般痛苦症状的预测因素。参与者（N = 287）在封锁后四周完成了基线调查，其中115人参加了为期7个月的随访。利用创伤后应激障碍的认知模型，我们研究了创伤后认知、焦虑敏感性（AS）和既往创伤作为PTS和一般痛苦的预测因子。结果显示，较高的初始创伤后认知和AS与较高的PTS和痛苦症状严重程度相关。有趣的是，随着时间的推移，创伤后认知的提高预示着PTS症状的更快减轻，而AS的影响保持稳定。先前的创伤不能显著预测预后。这些发现强调了特定认知因素在形成创伤反应中的作用，并强调了有针对性的干预措施减轻集体压力事件后症状的潜力。

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引用次数: 0

Social anxiety in the context of the alternative DSM-5 model of personality disorder 社会焦虑的背景下的另类DSM-5型人格障碍模型

IF 4.5 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-12-02 DOI: 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.

DSM-5第三部分介绍了一种人格障碍（AMPD）的替代模型，包括人格功能障碍和适应范围不良特征。本研究阐明了社交焦虑症状、社交焦虑障碍（social anxiety disorder， SAD）、回避型人格障碍（Section-II avoidance personality disorder， APD）与AMPD人格病理的关系。方法成人（N = 600；包括心理健康门诊患者和有人格病理学风险的非患者）完成了自我报告和访谈者评定的社会焦虑和AMPD结构的测量，包括自我和人际功能以及特质负性情感、超脱、去抑制、对抗和精神病。大多数参与者（n = 497）在平均8个月后完成了重新评估。我们研究了社交焦虑与人格病理学的趋同，以及预测社交焦虑与基线人格的纵向变化，反之亦然。我们关注的是自我报告的社交焦虑症状、面试官评定的SAD和APD标准计数，以及自我和面试官评定的人格的重复性结果。结果社交焦虑与高负性情感、超然、自我功能障碍和人际功能障碍相关。其中，后三个维度纵向预测了社交焦虑的增加。社交焦虑并不能预测人格病理的纵向变化。研究结果能否推广到其他人群、环境和方法（如青少年、初级保健或直接观察）尚不确定。纵向分析表明有因果关系，但无法确定。结论AMPD丰富了对当前社交焦虑的描述和对社交焦虑变化的预测。人格病理学的评估，包括人格功能障碍和适应范围不良特征，可以确定预防或治疗社交焦虑的目标，在未来的研究中进行测试。

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引用次数: 0

A review of the relationship between changes in trauma-related cognitions and PTSD outcome in response to trauma-focused psychotherapy: A three-level meta-analysis 创伤相关认知改变与创伤后应激障碍治疗结果的关系：三水平荟萃分析

IF 4.5 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-11-21 DOI: 10.1016/j.janxdis.2025.103096

Dharani Keyan , Nadine Garland , Polly Rise , Hana McMahon , Richard Bryant

Prevailing models of posttraumatic stress disorder (PTSD) suggest that trauma-related cognitions have a critical role in influencing the persistence of posttraumatic stress symptoms. This study aimed to quantitatively synthesise the strength of the relationship between changes in trauma-related cognitions and PTSD severity in response to trauma-focused psychotherapy (T-F psychotherapy). We also sought to explore potential moderators of this relationship. Four databases (PubMed (includes MEDLINE), PsycINFO, PTSDpubs (formerly PILOTS), and Cochrane library) were searched for relevant studies. Additional ‘hand search’ strategies were conducted to obtain relevant articles that may have been missed in the original database searches. A total of 44 studies reporting 95 effect sizes with data from 5102 participants were extracted. Primary analyses indicated that pre-post reductions in trauma-related cognitions were significantly related to pre-post reductions in PTSD severity, r = .45 (95 %CI [.40,.49], p < .0001). Additionally, mid-treatment reductions in trauma-related cognitions were significantly associated with mid-treatment reductions in PTSD severity, r = .42 (95 %CI [.34,.50], p < .0001). Exploratory moderator analyses did not yield any significant findings of this relationship between changes in trauma-related cognitions and PTSD severity. Secondary analyses revealed that reductions in trauma-related cognitions after T-F psychotherapy were similalry related to reduced PTSD severity after treatment, r = .49 (95 %CI [.40,.57], p < .0001). These findings underscore the importance of reductions in trauma-related cognitions as a potential key indicator of PTSD symptom reduction throughout varied points of T-F psychotherapy. The implications for augmenting outcomes of T-F psychotherapy are discussed.

创伤后应激障碍（PTSD）的主流模型表明，创伤相关认知在影响创伤后应激症状的持续方面起着关键作用。本研究旨在定量综合创伤相关认知变化与创伤后应激障碍严重程度在创伤聚焦心理治疗（T-F心理治疗）中的关系强度。我们还试图探索这种关系的潜在调节因素。检索了四个数据库（PubMed（包括MEDLINE）、PsycINFO、ptsdbars（以前的PILOTS）和Cochrane图书馆）以查找相关研究。额外的“手动检索”策略是为了获得在原始数据库检索中可能丢失的相关文章。共有44项研究报告了来自5102名参与者的95个效应值。初步分析表明，创伤相关认知的降低与创伤后应激障碍严重程度的降低显著相关，r = .45(95 % CI(.40,。49], p & lt; 。)。此外，治疗中期创伤相关认知的降低与治疗中期创伤后应激障碍严重程度的降低显著相关，r = .42(95 % CI(点,。50], p & lt; 。)。探索性调节分析没有发现创伤相关认知变化与创伤后应激障碍严重程度之间的关系。二次分析显示，T-F心理治疗后创伤相关认知的降低与治疗后创伤后应激障碍严重程度的降低相似，r = .49(95 % CI(.40,。57], p & lt; 。)。这些发现强调了创伤相关认知的减少作为创伤后应激障碍症状减轻的潜在关键指标的重要性，贯穿于T-F心理治疗的各个方面。本文还讨论了T-F心理治疗对增强治疗效果的影响。

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引用次数: 0

Actigraphy and subjective sleep predictors of nine-year generalized anxiety disorder 9年广泛性焦虑障碍的活动描记和主观睡眠预测因子

IF 4.5 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-11-19 DOI: 10.1016/j.janxdis.2025.103095

Nur Hani Zainal , Natalia Van Doren

Background

Sleep disturbances have been linked to generalized anxiety disorder (GAD) symptoms. However, cross-sectional studies, linearity assumptions, and limited predictor sets preclude identifying which unique sleep disturbance markers precede GAD symptoms. We thus harnessed machine learning (ML) to determine objective and subjective sleep disturbance predictors of nine-year GAD symptoms.

Methods

Community adults (N = 1054) underwent baseline surveys, clinical interviews, and seven-day sleep actigraphy protocols. GAD symptoms were reassessed nine years later. Seven ML models were examined with 44 baseline predictors. Partial dependence and Shapley additive explanation plots were created as interpretable ML approaches with the best-performing random forest model using nested cross-validation. Sensitivity analyses included and excluded GAD sleep items.

Results

The final multivariable predictive algorithm performed well (R² = 69.7 %, 95 % confidence interval [67.3 %–71.9 %]), thus explaining over half the variance in the outcome. These self-reported sleep disturbances predicted GAD symptoms in descending order of relative importance: sleep disturbances, poorer sleep quality, longer sleep onset latency, daytime dysfunction, habitual sleep inefficiency, and sleep medication use. These rest-phase actigraphy markers predicted nine-year GAD symptoms: higher maximum and total activity counts. Longer total sleep time during the sleep phase and higher average sleep bouts during the active phase also predicted nine-year GAD severity.

Conclusions

Outcomes highlight the importance of combining actigraphy and self-report sleep assessments. Future studies should determine the degree to which these patterns extend to the within-person level to develop early prevention, treatment, and precision mental health strategies for individuals at risk of, or with, increased GAD severity.

背景：睡眠障碍与广泛性焦虑症（GAD）症状有关。然而，横断面研究、线性假设和有限的预测集排除了确定哪些独特的睡眠障碍标记先于广泛性焦虑症症状。因此，我们利用机器学习（ML）来确定9年广泛性焦虑症症状的客观和主观睡眠障碍预测因素。方法社区成人（N = 1054）接受基线调查、临床访谈和7天睡眠活动记录仪方案。9年后重新评估广泛性焦虑症的症状。用44个基线预测因子检查了7个ML模型。部分依赖和Shapley加性解释图被创建为可解释的ML方法，使用嵌套交叉验证的最佳随机森林模型。敏感性分析包括和排除广泛性焦虑症睡眠项目。结果最终的多变量预测算法表现良好（R2 = 69.7 %，95% %置信区间[67.3% % -71.9 %]），可以解释结果中一半以上的方差。这些自我报告的睡眠障碍预示着广泛性焦虑症的症状，其相对重要性依次递减：睡眠障碍、较差的睡眠质量、较长的睡眠潜伏期、白天功能障碍、习惯性睡眠效率低下和睡眠药物使用。这些休息期活动描记标记物预测了9年的广泛性焦虑症症状：较高的最大和总活动计数。睡眠阶段较长的总睡眠时间和活跃阶段较高的平均睡眠次数也预示着9年广泛性焦虑症的严重程度。结论：结果强调了结合活动描记和自我报告睡眠评估的重要性。未来的研究应该确定这些模式扩展到个人层面的程度，以制定早期预防、治疗和精确的心理健康策略，用于有GAD风险或严重程度增加的个体。

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引用次数: 0