Pub Date : 2025-11-13DOI: 10.1016/j.janxdis.2025.103094
Cornelia Exner , Alexandra Kleiman , Anke Haberkamp , Jana Hansmeier , Christopher Milde , Julia Anna Glombiewski
{"title":"On the non-inferiority of metacognitive therapy for OCD: Clarifying the methodology and rationale","authors":"Cornelia Exner , Alexandra Kleiman , Anke Haberkamp , Jana Hansmeier , Christopher Milde , Julia Anna Glombiewski","doi":"10.1016/j.janxdis.2025.103094","DOIUrl":"10.1016/j.janxdis.2025.103094","url":null,"abstract":"","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"116 ","pages":"Article 103094"},"PeriodicalIF":4.5,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528789","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 : 2025-11-13DOI: 10.1016/j.janxdis.2025.103092
Stefania Sette , Robert J. Coplan , Laura L. Ooi , Antonio Zuffianò , Bowen Xiao , Quincy J.J. Wong , Ronald M. Rapee , Wonjung Oh , Junsheng Liu , Yunhee Kim , Hyoun K. Kim , Shanmukh Kamble , Carolina Greco , Aysun Dogan , Karen Noel Castillo , Nora Braathu , Evalill Bølstad , Sevgi Bayram-Ozdemir , Julie C. Bowker
The aim of the present study was to assess the measurement invariance of the long version of the straightforwardly-worded Social Interaction Anxiety Scale (S-SIAS) across 10 countries and explore links with life satisfaction in a large sample of emerging adults attending university. Participants were N = 4284 university students (Mage = 19.89 years, SD = 1.83; 65 % females) from 10 countries (i.e., Argentina, Australia, Canada, China, India, Italy, South Korea, Norway, Turkey, and the United States), who completed self-report assessments of social anxiety and life satisfaction. Findings from a multiple-group factor analysis alignment method indicated approximate measurement invariance for the S-SIAS across the 10 country sites. University students from Norway reported the highest mean level of social anxiety of all groups, whereas participants from Argentina reported the lowest social anxiety. Results from multigroup regression analysis indicated that social anxiety was negatively associated with life satisfaction in all samples (except for Argentina and Australia, where the life satisfaction measure was not collected), but the strength of the association was stronger in Norway compared to samples from other countries. Results are discussed in terms of the meaning and implication of social anxiety across cultures.
{"title":"Measurement invariance of the Straightforwardly-Worded Social Interaction Anxiety Scale and Associations with life satisfaction among emerging adults attending University in 10 countries","authors":"Stefania Sette , Robert J. Coplan , Laura L. Ooi , Antonio Zuffianò , Bowen Xiao , Quincy J.J. Wong , Ronald M. Rapee , Wonjung Oh , Junsheng Liu , Yunhee Kim , Hyoun K. Kim , Shanmukh Kamble , Carolina Greco , Aysun Dogan , Karen Noel Castillo , Nora Braathu , Evalill Bølstad , Sevgi Bayram-Ozdemir , Julie C. Bowker","doi":"10.1016/j.janxdis.2025.103092","DOIUrl":"10.1016/j.janxdis.2025.103092","url":null,"abstract":"<div><div>The aim of the present study was to assess the measurement invariance of the long version of the straightforwardly-worded <em>Social Interaction Anxiety Scale</em> (S-SIAS) across 10 countries and explore links with life satisfaction in a large sample of emerging adults attending university. Participants were <em>N</em> = 4284 university students (<em>M</em><sub>age</sub> = 19.89 years, <em>SD</em> = 1.83; 65 % females) from 10 countries (i.e., Argentina, Australia, Canada, China, India, Italy, South Korea, Norway, Turkey, and the United States), who completed self-report assessments of social anxiety and life satisfaction. Findings from a multiple-group factor analysis alignment method indicated approximate measurement invariance for the S-SIAS across the 10 country sites. University students from Norway reported the highest mean level of social anxiety of all groups, whereas participants from Argentina reported the lowest social anxiety. Results from multigroup regression analysis indicated that social anxiety was negatively associated with life satisfaction in all samples (except for Argentina and Australia, where the life satisfaction measure was not collected), but the strength of the association was stronger in Norway compared to samples from other countries. Results are discussed in terms of the meaning and implication of social anxiety across cultures.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"116 ","pages":"Article 103092"},"PeriodicalIF":4.5,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551727","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 : 2025-11-12DOI: 10.1016/j.janxdis.2025.103093
Lucie Da Costa Silva , Peggy Quinette , Jacques Dayan , Florence Fraisse , Denis Peschanski , Vincent de La Sayette , Pierre Gagnepain , Francis Eustache , Mickaël Laisney
Individuals with Posttraumatic Stress Disorder (PTSD) exhibit symptoms that affect their responsiveness to negative information. Specifically, hypervigilance heightens attention toward negative stimuli, whereas dissociation diverts attention away from it (Chiba et al., 2021), potentially leading to differential effects on memory encoding. This study investigated the influence of prominent hypervigilant and dissociative symptomatology on the memorization of negative emotional and contextual information in individuals exposed to the November 13, 2015, Paris terrorist attacks. Participants included individuals who had been exposed to the traumatic event (N = 99; 26 met full diagnostic criteria for PTSD, 28 showed subthreshold symptoms, and 45 had no symptoms) and non-exposed individuals (N = 65). They were asked to memorize faces displaying positive, neutral, and sad emotions, each paired with a word representing a profession, which served as a non-emotional contextual cue. This task was administered at two time points: ∼1.5 years and ∼3.5 years after the attacks. An emotion-profession recognition task was used, with an index measuring whether the emotional expression or the profession was better recognized. At the first time point, among exposed individuals, a relationship was observed between the prominence of hypervigilant or dissociative symptoms and enhanced recognition of either the emotional expression or the profession, respectively, in the context of sad facial expressions. Furthermore, changes in the prominence of these symptoms between the two time points were associated with shifts in the type of content that was better recognized.
Collectively, these findings suggest the presence of a memory bias—either toward or away from emotional content—among individuals exposed to traumatic events, and particularly those with full diagnostic criteria for PTSD.
{"title":"Relationships between symptom profiles and memory in posttraumatic stress disorder","authors":"Lucie Da Costa Silva , Peggy Quinette , Jacques Dayan , Florence Fraisse , Denis Peschanski , Vincent de La Sayette , Pierre Gagnepain , Francis Eustache , Mickaël Laisney","doi":"10.1016/j.janxdis.2025.103093","DOIUrl":"10.1016/j.janxdis.2025.103093","url":null,"abstract":"<div><div>Individuals with Posttraumatic Stress Disorder (PTSD) exhibit symptoms that affect their responsiveness to negative information. Specifically, hypervigilance heightens attention toward negative stimuli, whereas dissociation diverts attention away from it (Chiba et al., 2021), potentially leading to differential effects on memory encoding. This study investigated the influence of prominent hypervigilant and dissociative symptomatology on the memorization of negative emotional and contextual information in individuals exposed to the November 13, 2015, Paris terrorist attacks. Participants included individuals who had been exposed to the traumatic event (N = 99; 26 met full diagnostic criteria for PTSD, 28 showed subthreshold symptoms, and 45 had no symptoms) and non-exposed individuals (N = 65). They were asked to memorize faces displaying positive, neutral, and sad emotions, each paired with a word representing a profession, which served as a non-emotional contextual cue. This task was administered at two time points: ∼1.5 years and ∼3.5 years after the attacks. An emotion-profession recognition task was used, with an index measuring whether the emotional expression or the profession was better recognized. At the first time point, among exposed individuals, a relationship was observed between the prominence of hypervigilant or dissociative symptoms and enhanced recognition of either the emotional expression or the profession, respectively, in the context of sad facial expressions. Furthermore, changes in the prominence of these symptoms between the two time points were associated with shifts in the type of content that was better recognized.</div><div>Collectively, these findings suggest the presence of a memory bias—either toward or away from emotional content—among individuals exposed to traumatic events, and particularly those with full diagnostic criteria for PTSD.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"117 ","pages":"Article 103093"},"PeriodicalIF":4.5,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625357","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 : 2025-11-08DOI: 10.1016/j.janxdis.2025.103091
Georgia Socratous , Senta M. Haussler , Katie Finning , David M. Howard , Richard D. Hayes , Johnny Downs , Alice Wickersham
Background
Academic achievement is an important predictor of later life outcomes, yet its relationship with anxiety disorders and obsessive-compulsive disorder (OCD) remains unclear. This systematic review and meta-analysis aimed to clarify the direction and strength of these associations and is the first to synthesise evidence on moderators and mediators.
Method
We searched Embase, PsycINFO, and PubMed from inception to 12 March 2025 for observational studies of anxiety disorders or OCD (exposure variables) and academic achievement (outcome) at any age. Study quality was assessed using the Newcastle-Ottawa Scale. Crude effects were pooled using random-effects meta-analyses, and study-level moderators explored using subgroup analyses. Evidence on confounders, within-study moderators and mediators was synthesised narratively. PROSPERO: CRD42023393935.
Results
Of 7610 studies screened, 23 were included. Study quality was generally low for anxiety disorders but higher for OCD. Meta-analysis of 15 studies (n = 864,729) showed a small negative association between anxiety disorders and academic achievement, Hedges’ g = -0.31, 95 % CI [-0.46, −0.16], p < .001, I² = 98.1 %. All four studies examining sex/gender reported stronger negative effects among females. Adjusted estimates varied. Meta-analysis of four studies (n = 809,598) showed no evidence of an association between OCD and academic achievement, Hedges’ g = -0.21, 95 % CI [-0.56, 0.14], p = .25, I² = 97.9 %.
Conclusions
Anxiety disorders, but not OCD, were negatively associated with academic achievement in meta-analysis. High meta-analytic heterogeneity and inconsistent adjusted findings suggest context-dependent effects, underscoring the need for more moderation studies. Nonetheless, our findings highlight the need for coordinated efforts between educational and mental health services to better identify and support affected students.
学习成绩是日后生活的重要预测指标，但其与焦虑障碍和强迫症（OCD）的关系尚不清楚。本系统综述和荟萃分析旨在阐明这些关联的方向和强度，并首次综合了调节因子和中介因子的证据。方法我们检索Embase、PsycINFO和PubMed从成立到2025年3月12日的所有年龄段的焦虑障碍或强迫症（暴露变量）和学业成就（结果）的观察性研究。使用纽卡斯尔-渥太华量表评估研究质量。使用随机效应荟萃分析汇总粗效应，并使用亚组分析探索研究水平的调节因子。关于混杂因素、研究内调节因子和调节因子的证据被叙述地综合起来。普洛斯彼罗:CRD42023393935。结果在筛选的7610项研究中，纳入23项。焦虑障碍的研究质量一般较低，但强迫症的研究质量较高。对15项研究的荟萃分析（n = 864,729）显示，焦虑障碍与学业成绩之间存在较小的负相关，Hedges的g = -0.31,95 % CI [-0.46, - 0.16], p <； 。001, i²= 98.1 %。所有四项关于性/性别的研究都表明，女性的负面影响更大。调整后的估计各不相同。四项研究的荟萃分析（n = 809,598）显示，没有证据表明强迫症与学业成绩之间存在关联，Hedges的g = -0.21,95 % CI [-0.56, 0.14], p = 。25、i²= 97.9 %。结论在meta分析中，焦虑障碍与学业成绩呈负相关，而非强迫症。高荟萃分析异质性和不一致的调整结果表明，环境依赖效应，强调需要更多的适度研究。尽管如此，我们的研究结果强调了教育和心理健康服务之间协调努力的必要性，以更好地识别和支持受影响的学生。
{"title":"Exploring contradicting associations between anxiety disorders, obsessive-compulsive disorder, and academic achievement: A meta-analysis","authors":"Georgia Socratous , Senta M. Haussler , Katie Finning , David M. Howard , Richard D. Hayes , Johnny Downs , Alice Wickersham","doi":"10.1016/j.janxdis.2025.103091","DOIUrl":"10.1016/j.janxdis.2025.103091","url":null,"abstract":"<div><h3>Background</h3><div>Academic achievement is an important predictor of later life outcomes, yet its relationship with anxiety disorders and obsessive-compulsive disorder (OCD) remains unclear. This systematic review and meta-analysis aimed to clarify the direction and strength of these associations and is the first to synthesise evidence on moderators and mediators.</div></div><div><h3>Method</h3><div>We searched Embase, PsycINFO, and PubMed from inception to 12 March 2025 for observational studies of anxiety disorders or OCD (exposure variables) and academic achievement (outcome) at any age. Study quality was assessed using the Newcastle-Ottawa Scale. Crude effects were pooled using random-effects meta-analyses, and study-level moderators explored using subgroup analyses. Evidence on confounders, within-study moderators and mediators was synthesised narratively. PROSPERO: CRD42023393935.</div></div><div><h3>Results</h3><div>Of 7610 studies screened, 23 were included. Study quality was generally low for anxiety disorders but higher for OCD. Meta-analysis of 15 studies (<em>n</em> = 864,729) showed a small negative association between anxiety disorders and academic achievement, Hedges’ <em>g</em> = -0.31, 95 % CI [-0.46, −0.16], <em>p</em> < .001, I² = 98.1 %. All four studies examining sex/gender reported stronger negative effects among females. Adjusted estimates varied. Meta-analysis of four studies (<em>n</em> = 809,598) showed no evidence of an association between OCD and academic achievement, Hedges’ <em>g</em> = -0.21, 95 % CI [-0.56, 0.14], <em>p</em> = .25, I² = 97.9 %.</div></div><div><h3>Conclusions</h3><div>Anxiety disorders, but not OCD, were negatively associated with academic achievement in meta-analysis. High meta-analytic heterogeneity and inconsistent adjusted findings suggest context-dependent effects, underscoring the need for more moderation studies. Nonetheless, our findings highlight the need for coordinated efforts between educational and mental health services to better identify and support affected students.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"117 ","pages":"Article 103091"},"PeriodicalIF":4.5,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555349","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 : 2025-11-01DOI: 10.1016/j.janxdis.2025.103090
Shota Noda , Chantal Kasch , Cameron E. Lindsay , Stefan G. Hofmann
Social anxiety disorder (SAD), body dysmorphic disorder (BDD), and major depressive disorder (MDD) are highly comorbid, which may be influenced by cultural variables associated with individualism vs. collectivism with particular emphasis on shame. This study investigated the network structures comprising symptoms of SAD, BDD, MDD, and shame across three countries typically associated with either a high tendency of collectivism (Japan), a high tendency of individualism (USA), or in between (Germany). Participants included 319 Japanese, 440 US Americans, and 308 Germans from the general populations of their respective countries, who completed questionnaires assessing the aforementioned symptoms as well as individualistic and collectivistic tendencies. Psychometric network analyses were conducted using Gaussian Graphical Models to separately examine the network structures of (a) individualistic and collectivistic tendencies and (b) symptoms of SAD, BDD, MDD, and shame. A Network Comparison Test (NCT) was used to assess the overall consistency of these networks across countries. The NCT revealed significant cross-cultural differences in the network structures of individualistic and collectivistic tendencies across countries, as well as in the networks of symptoms of SAD, BDD, MDD, and shame between Japan and Germany and between Japan and the USA. Although certain central symptoms were shared across all countries, others differed. These findings underscore the coexistence of cultural homogeneity and heterogeneity in the manifestation and organization of SAD, BDD, and MDD symptoms, emphasizing the importance of culturally sensitive, targeted interventions.
{"title":"Cross-cultural network structures of social anxiety, body dysmorphic, and major depressive disorder symptoms in individualistic vs. collectivistic societies: A comparison between American, German, and Japanese populations","authors":"Shota Noda , Chantal Kasch , Cameron E. Lindsay , Stefan G. Hofmann","doi":"10.1016/j.janxdis.2025.103090","DOIUrl":"10.1016/j.janxdis.2025.103090","url":null,"abstract":"<div><div>Social anxiety disorder (SAD), body dysmorphic disorder (BDD), and major depressive disorder (MDD) are highly comorbid, which may be influenced by cultural variables associated with individualism vs. collectivism with particular emphasis on shame. This study investigated the network structures comprising symptoms of SAD, BDD, MDD, and shame across three countries typically associated with either a high tendency of collectivism (Japan), a high tendency of individualism (USA), or in between (Germany). Participants included 319 Japanese, 440 US Americans, and 308 Germans from the general populations of their respective countries, who completed questionnaires assessing the aforementioned symptoms as well as individualistic and collectivistic tendencies. Psychometric network analyses were conducted using Gaussian Graphical Models to separately examine the network structures of (a) individualistic and collectivistic tendencies and (b) symptoms of SAD, BDD, MDD, and shame. A Network Comparison Test (NCT) was used to assess the overall consistency of these networks across countries. The NCT revealed significant cross-cultural differences in the network structures of individualistic and collectivistic tendencies across countries, as well as in the networks of symptoms of SAD, BDD, MDD, and shame between Japan and Germany and between Japan and the USA. Although certain central symptoms were shared across all countries, others differed. These findings underscore the coexistence of cultural homogeneity and heterogeneity in the manifestation and organization of SAD, BDD, and MDD symptoms, emphasizing the importance of culturally sensitive, targeted interventions.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"116 ","pages":"Article 103090"},"PeriodicalIF":4.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460281","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 : 2025-10-25DOI: 10.1016/j.janxdis.2025.103089
Michael J. Mason , J. Douglas Coatsworth , Aaron Brown , Nikola Zaharakis , Michael Russell , Jeremy Mennis
Approximately one in five (19.5 %) young adults have experienced generalized anxiety disorder (GAD) in the past year. Compared with other age groups, they are least likely to receive mental health treatment despite reporting greater need for these services. To address these issues, we conducted a randomized clinical trial with 102 young adults using an 8-week, automated text-message delivered cognitive behavioral therapy (CBT-txt-A) to treat GAD. We examined treatment engagement, tested treatment efficacy, and tested 3 clinical mechanisms of change. Participants were from 33 states, recruited from Instagram and Facebook who presented with at least moderate GAD symptomatology. Assessments occurred at baseline prior to randomization and at 1, 2, and 3 months after enrollment. The primary outcome, severity of GAD symptoms, was assessed using the GAD-7 measure. Behavioral activation, perseverative thinking, and cognitive distortions were hypothesized clinical mechanisms. Participants were randomized to CBT-txt-A or a waitlist control condition. Results indicated that participants in the CBT-txt-A group significantly reduced their GAD symptoms over time compared to the control condition, producing a large effect size (Cohen d = 0.83). One quarter of the treatment group moved into the high-end state functioning level, representing no or minimal GAD symptoms, compared to 5.5 % of the controls. Mediation analyses indicated that CBT-txt-A increased behavioral activation, and reduced perseverative thinking and cognitive distortion, at 2 months, which in turn, was then associated with reductions in GAD symptoms at 3 months. Results provide evidence for the efficacy of CBT-txt-A in reducing GAD symptoms through three hypothesized clinical mechanisms.
在过去的一年里，大约五分之一（19.5 %）的年轻人经历过广泛性焦虑症（GAD）。与其他年龄组相比，他们接受心理健康治疗的可能性最小，尽管他们报告对这些服务的需求更大。为了解决这些问题，我们对102名年轻人进行了一项随机临床试验，使用为期8周的自动短信传递认知行为疗法（CBT-txt-A）来治疗广泛性焦虑症。我们检查了治疗参与，测试了治疗效果，并测试了3种临床改变机制。参与者来自33个州，从Instagram和Facebook上招募，至少有中度广泛性焦虑症症状。评估在随机分组前的基线以及入组后的1、2和3个月进行。主要结局是GAD症状的严重程度，使用GAD-7量表进行评估。行为激活、持续性思维和认知扭曲是假设的临床机制。参与者被随机分配到CBT-txt-A或等待列表控制条件。结果表明，与对照组相比，CBT-txt-A组的参与者随着时间的推移显著减轻了他们的广泛性焦虑症症状，产生了很大的效应量（Cohen d = 0.83）。四分之一的治疗组进入高端状态功能水平，没有或只有轻微的广泛性焦虑症症状，而对照组为5.5% %。中介分析表明，CBT-txt-A在2个月时增加了行为激活，减少了持续性思维和认知扭曲，这反过来又与3个月时广泛性焦虑症症状的减轻有关。结果通过三种假设的临床机制为CBT-txt-A减轻GAD症状的有效性提供了证据。
{"title":"Treating young adult generalized anxiety disorder with text-message delivered cognitive behavioral therapy: A randomized clinical trial testing efficacy and clinical mechanisms","authors":"Michael J. Mason , J. Douglas Coatsworth , Aaron Brown , Nikola Zaharakis , Michael Russell , Jeremy Mennis","doi":"10.1016/j.janxdis.2025.103089","DOIUrl":"10.1016/j.janxdis.2025.103089","url":null,"abstract":"<div><div>Approximately one in five (19.5 %) young adults have experienced generalized anxiety disorder (GAD) in the past year. Compared with other age groups, they are least likely to receive mental health treatment despite reporting greater need for these services. To address these issues, we conducted a randomized clinical trial with 102 young adults using an 8-week, automated text-message delivered cognitive behavioral therapy (CBT-txt-A) to treat GAD. We examined treatment engagement, tested treatment efficacy, and tested 3 clinical mechanisms of change. Participants were from 33 states, recruited from Instagram and Facebook who presented with at least moderate GAD symptomatology. Assessments occurred at baseline prior to randomization and at 1, 2, and 3 months after enrollment. The primary outcome, severity of GAD symptoms, was assessed using the GAD-7 measure. Behavioral activation, perseverative thinking, and cognitive distortions were hypothesized clinical mechanisms. Participants were randomized to CBT-txt-A or a waitlist control condition. Results indicated that participants in the CBT-txt-A group significantly reduced their GAD symptoms over time compared to the control condition, producing a large effect size (Cohen <em>d</em> = 0.83). One quarter of the treatment group moved into the high-end state functioning level, representing no or minimal GAD symptoms, compared to 5.5 % of the controls. Mediation analyses indicated that CBT-txt-A increased behavioral activation, and reduced perseverative thinking and cognitive distortion, at 2 months, which in turn, was then associated with reductions in GAD symptoms at 3 months. Results provide evidence for the efficacy of CBT-txt-A in reducing GAD symptoms through three hypothesized clinical mechanisms.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"116 ","pages":"Article 103089"},"PeriodicalIF":4.5,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410506","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 : 2025-10-19DOI: 10.1016/j.janxdis.2025.103080
Craig S. Rosen , Alan L. Peterson , David S. Riggs , Christopher K. Haddock , Chunki Fong , Stacey Young-McCaughan , Jeffrey Cook , Katherine Anne Comtois , Elisa V. Borah , C. Adrian Davis , Katherine A. Dondanville , Erin P. Finley , Sara A. Jahnke , Melissa Mistretta , Andrea Neitzer , Shannon Wiltsey-Stirman , Erin R. Frick , Olivia Hayes , Spencer Clayton , Allison M. Conforte , Carmen P. McLean
Clinician training is often not sufficient to increase the adoption of evidence-based psychotherapies (EBPs). To address organizational barriers that may limit use of EBPs, a tailored implementation strategy—Targeted Assessment and Context-Tailored Implementation of Change Strategies (TACTICS)—was developed. TACTICS involved external facilitation (appointing a local implementation team and external coach, conducting need assessment interviews, creating site-specific implementation plans, and weekly coaching for the site champion) augmented with a planning rubric and resources for making operational changes. The effect of adding TACTICS after clinician training was evaluated in a cluster-randomized stepped-wedge trial across eight military treatment facilities. Psychotherapists (n = 212) received training in prolonged exposure (PE) therapy. TACTICS was subsequently introduced with timing randomized by site. PE utilization was measured via natural language processing of notes from 26,429 psychotherapy encounters across 3459 patients. After accounting for time effects, TACTICS increased PE use compared to training alone (OR = 1.05–2.21, p < .03). Nonetheless, overall use of PE declined over time (OR = 0.067–0.316, p < .001). In post-hoc analyses, declining use of PE over time was strongly associated with a decreasing supply of psychotherapy appointments per patient (r = .98). These findings suggest that local implementation support improves EBP adoption beyond training alone. However, lasting use may require broader system supports such as adequate staffing and policies that encourage use of EBPs.
临床医生的培训往往不足以增加循证心理疗法（ebp）的采用。为了解决可能限制ebp使用的组织障碍，开发了一种定制的实施策略-目标评估和情境定制的变革策略实施（TACTICS）。战术涉及外部促进（任命一个本地实施团队和外部教练，进行需求评估访谈，创建特定于站点的实施计划，以及每周对站点冠军进行指导），并增加了用于进行操作更改的计划大纲和资源。临床医生培训后加入TACTICS的效果在8个军事治疗设施的随机步进楔形试验中进行评估。心理治疗师（n = 212）接受了延长暴露（PE）治疗的培训。随后引入了战术，时间按地点随机化。通过对3459名患者的26429次心理治疗记录进行自然语言处理，测量了PE的使用情况。考虑到时间效应后，与单纯训练相比，战术训练增加了体育锻炼的使用(OR = 1.05-2.21, p
{"title":"Tailored strategies to increase the use of an evidence-based psychotherapy for posttraumatic stress disorder: A stepped-wedge randomized trial in military clinics","authors":"Craig S. Rosen , Alan L. Peterson , David S. Riggs , Christopher K. Haddock , Chunki Fong , Stacey Young-McCaughan , Jeffrey Cook , Katherine Anne Comtois , Elisa V. Borah , C. Adrian Davis , Katherine A. Dondanville , Erin P. Finley , Sara A. Jahnke , Melissa Mistretta , Andrea Neitzer , Shannon Wiltsey-Stirman , Erin R. Frick , Olivia Hayes , Spencer Clayton , Allison M. Conforte , Carmen P. McLean","doi":"10.1016/j.janxdis.2025.103080","DOIUrl":"10.1016/j.janxdis.2025.103080","url":null,"abstract":"<div><div>Clinician training is often not sufficient to increase the adoption of evidence-based psychotherapies (EBPs). To address organizational barriers that may limit use of EBPs, a tailored implementation strategy—Targeted Assessment and Context-Tailored Implementation of Change Strategies (TACTICS)—was developed. TACTICS involved external facilitation (appointing a local implementation team and external coach, conducting need assessment interviews, creating site-specific implementation plans, and weekly coaching for the site champion) augmented with a planning rubric and resources for making operational changes. The effect of adding TACTICS after clinician training was evaluated in a cluster-randomized stepped-wedge trial across eight military treatment facilities. Psychotherapists (n = 212) received training in prolonged exposure (PE) therapy. TACTICS was subsequently introduced with timing randomized by site. PE utilization was measured via natural language processing of notes from 26,429 psychotherapy encounters across 3459 patients. After accounting for time effects, TACTICS increased PE use compared to training alone (OR = 1.05–2.21, p < .03). Nonetheless, overall use of PE declined over time (OR = 0.067–0.316, p < .001). In post-hoc analyses, declining use of PE over time was strongly associated with a decreasing supply of psychotherapy appointments per patient (r = .98). These findings suggest that local implementation support improves EBP adoption beyond training alone. However, lasting use may require broader system supports such as adequate staffing and policies that encourage use of EBPs.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"116 ","pages":"Article 103080"},"PeriodicalIF":4.5,"publicationDate":"2025-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472159","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 : 2025-10-08DOI: 10.1016/j.janxdis.2025.103079
Brett A. Messman , Siyuan Wang , Prathiba Batley , Nicole H. Weiss , Jennifer A. Newberry , Ateka A. Contractor
The Posttraumatic Stress Disorder (PTSD) Checklist for the DSM-5 (PCL-5) has demonstrated excellent psychometric qualities across cross-sectional studies, yet the scale’s performance in intensive longitudinal studies is less known. Using data from the PCL-5 administered daily for 9 days, we (a) conducted item analysis of the PCL-5 using the graded response model to examine item characteristics (thresholds and discrimination parameters) and (b) examined differential item functioning (DIF) to evaluate whether the PCL-5 measured the PTSD latent trait identically across daily surveys (i.e., longitudinal measurement invariance). Methodologically, 256 trauma-exposed university students (Mage = 21.01 ± 4.24; 85.8 % women; 41.0 % probable PTSD) completed the 20-item PCL-5 for 9 consecutive days. Across days, results indicated lower but acceptable discrimination for PCL-5 items 8 (traumatic amnesia), 16 (reckless or self-destructive behaviors), and 17 (hypervigilance). Further, 14 % of participants exhibited person misfit at least once across the 9 days. DIF analysis indicated that Item 2 (nightmares) exhibited DIF across days indicating potential bias; however, the effect sizes for DIF were negligible. In conclusion, the results broadly provide psychometric support for using the 20-item PCL-5 in intensive longitudinal studies. Future replication of study results across diverse and clinical populations could help to further strengthen these findings.
{"title":"Psychometric evaluation of the Posttraumatic Stress Disorder Checklist for DSM-5 in daily surveys: An item response theory and longitudinal measurement invariance analysis","authors":"Brett A. Messman , Siyuan Wang , Prathiba Batley , Nicole H. Weiss , Jennifer A. Newberry , Ateka A. Contractor","doi":"10.1016/j.janxdis.2025.103079","DOIUrl":"10.1016/j.janxdis.2025.103079","url":null,"abstract":"<div><div>The Posttraumatic Stress Disorder (PTSD) Checklist for the DSM-5 (PCL-5) has demonstrated excellent psychometric qualities across cross-sectional studies, yet the scale’s performance in intensive longitudinal studies is less known. Using data from the PCL-5 administered daily for 9 days, we (a) conducted item analysis of the PCL-5 using the graded response model to examine item characteristics (thresholds and discrimination parameters) and (b) examined differential item functioning (DIF) to evaluate whether the PCL-5 measured the PTSD latent trait identically across daily surveys (i.e., longitudinal measurement invariance). Methodologically, 256 trauma-exposed university students (<em>M</em>age = 21.01 ± 4.24; 85.8 % women; 41.0 % probable PTSD) completed the 20-item PCL-5 for 9 consecutive days. Across days, results indicated lower but acceptable discrimination for PCL-5 items 8 (traumatic amnesia), 16 (reckless or self-destructive behaviors), and 17 (hypervigilance). Further, 14 % of participants exhibited person misfit at least once across the 9 days. DIF analysis indicated that Item 2 (nightmares) exhibited DIF across days indicating potential bias; however, the effect sizes for DIF were negligible. In conclusion, the results broadly provide psychometric support for using the 20-item PCL-5 in intensive longitudinal studies. Future replication of study results across diverse and clinical populations could help to further strengthen these findings.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"116 ","pages":"Article 103079"},"PeriodicalIF":4.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145271242","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 : 2025-10-06DOI: 10.1016/j.janxdis.2025.103077
Ahsan Aziz Sarkar , Md Faruq Alam , Helal Uddin Ahmed , Mohammad Tariqul Alam , Niaz Mohammad Khan
This study presents nationally representative findings on the epidemiology of generalized anxiety disorder (GAD) among Bangladeshi adults, based on data from a nationwide household survey. Participants were initially screened using the Self-Reporting Questionnaire (SRQ), and those screening positive underwent face-to-face clinical interviews by trained psychiatrists. Diagnoses were established using DSM-5 criteria. A total of 7270 adults completed all measures used in this survey. The weighted lifetime prevalence of GAD was 3.5 % (95 % CI: 2.9–4.2), with higher rates observed among women (4.2 %) and rural residents (3.7 %) compared to men (2.7 %) and urban residents (2.8 %). Significant correlates included female sex (OR = 1.62, p = 0.012), lower educational attainment (OR = 2.42–3.49, p < 0.05), and a family history of mental illness (OR = 2.56, p = 0.004). Despite the substantial burden, the treatment gap remained alarmingly high, with only 3.9 % of individuals with GAD seeking professional help. Individuals with a family history of mental illness were significantly more likely to seek treatment (OR = 8.32, p < 0.001) for GAD, while no significant associations were found with other sociodemographic factors. These findings highlight the need for community-based awareness programs, the integration of mental health services into primary care, a focus on high-risk groups, and the strengthening of the mental health workforce to address the substantial burden of GAD and reduce the pervasive treatment gap in Bangladesh.
本研究基于一项全国家庭调查的数据，提出了孟加拉国成年人中广泛性焦虑症（GAD）流行病学的全国代表性研究结果。参与者最初使用自我报告问卷（SRQ）进行筛选，筛选阳性的参与者由训练有素的精神科医生进行面对面的临床访谈。诊断采用DSM-5标准。共有7270名成年人完成了本次调查中使用的所有措施。加权终生GAD患病率为3.5 %(95 % CI: 2.9-4.2)，与男性（2.7 %）和城市居民（2.8 %）相比，女性（4.2 %）和农村居民（3.7 %）的患病率更高。显著相关因素包括女性（OR = 1.62, p = 0.012）、较低的受教育程度(OR = 2.42-3.49, p
{"title":"Prevalence, correlates, and treatment gap of generalized anxiety disorder among adults in Bangladesh: Results from a nationally representative survey","authors":"Ahsan Aziz Sarkar , Md Faruq Alam , Helal Uddin Ahmed , Mohammad Tariqul Alam , Niaz Mohammad Khan","doi":"10.1016/j.janxdis.2025.103077","DOIUrl":"10.1016/j.janxdis.2025.103077","url":null,"abstract":"<div><div>This study presents nationally representative findings on the epidemiology of generalized anxiety disorder (GAD) among Bangladeshi adults, based on data from a nationwide household survey. Participants were initially screened using the Self-Reporting Questionnaire (SRQ), and those screening positive underwent face-to-face clinical interviews by trained psychiatrists. Diagnoses were established using DSM-5 criteria. A total of 7270 adults completed all measures used in this survey. The weighted lifetime prevalence of GAD was 3.5 % (95 % CI: 2.9–4.2), with higher rates observed among women (4.2 %) and rural residents (3.7 %) compared to men (2.7 %) and urban residents (2.8 %). Significant correlates included female sex (OR = 1.62, p = 0.012), lower educational attainment (OR = 2.42–3.49, p < 0.05), and a family history of mental illness (OR = 2.56, p = 0.004). Despite the substantial burden, the treatment gap remained alarmingly high, with only 3.9 % of individuals with GAD seeking professional help. Individuals with a family history of mental illness were significantly more likely to seek treatment (OR = 8.32, p < 0.001) for GAD, while no significant associations were found with other sociodemographic factors. These findings highlight the need for community-based awareness programs, the integration of mental health services into primary care, a focus on high-risk groups, and the strengthening of the mental health workforce to address the substantial burden of GAD and reduce the pervasive treatment gap in Bangladesh.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"116 ","pages":"Article 103077"},"PeriodicalIF":4.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253004","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 : 2025-10-03DOI: 10.1016/j.janxdis.2025.103078
Fabian Breuer , Anne Sophie Hildebrand , Johannes B. Finke , Leandra Bucher , Udo Dannlowski , Tim Klucken , Kati Roesmann , Elisabeth Johanna Leehr
Introduction
This study explored inhibitory control in spider phobic (SP) and healthy control (HC) individuals using an emotional antisaccade task. Attentional control theory (ACT) suggests anxiety related deficits in inhibitory control, yet studies on antisaccade performance in anxiety disordered patients are sparse. This study addressed this research gap and additionally aimed to explore putative associations of antisaccade performance with multimodal measures of fear of spiders.
Methods
A sample of 76 participants (41 SP, 35 HC) completed an antisaccade task, employing schematic pictures of spiders and flowers. We measured antisaccade latencies and error rates, respectively. In a free-viewing task, we obtained psychophysiological and subjective fear responses to pictures of spiders. Self-rated fear of spiders was assessed via questionnaires and avoidance behavior was assessed in a behavioral avoidance test.
Results
Contrary to ACT predictions, SP exhibited shorter antisaccade latencies irrespective of stimulus category, indexing more efficient inhibitory control, while showing no differences in antisaccade error rates when compared to HC. Consistent with prior findings, SP participants showed elevated psychophysiological responding, fear ratings and avoidance behavior. No significant associations emerged between inhibitory control performance and these measures of fear.
Discussion
Our findings suggest enhanced inhibitory control efficiency in SP compared to HC, contrasting impairments predicted by ACT and observed in subclinical anxiety. These findings may indicate a compensatory adaptation in anxiety disorders, enabling rapid attentional avoidance of threat. Our results also imply that inhibitory control may be differentially affected across various anxiety disorders, depending on their predisposition towards fear or anxiety, while also being independent from diverse measures of fear and anxiety.
{"title":"Antisaccade performance in spider phobia and its association with multimodal correlates of fear","authors":"Fabian Breuer , Anne Sophie Hildebrand , Johannes B. Finke , Leandra Bucher , Udo Dannlowski , Tim Klucken , Kati Roesmann , Elisabeth Johanna Leehr","doi":"10.1016/j.janxdis.2025.103078","DOIUrl":"10.1016/j.janxdis.2025.103078","url":null,"abstract":"<div><h3>Introduction</h3><div>This study explored inhibitory control in spider phobic (SP) and healthy control (HC) individuals using an emotional antisaccade task. Attentional control theory (ACT) suggests anxiety related deficits in inhibitory control, yet studies on antisaccade performance in anxiety disordered patients are sparse. This study addressed this research gap and additionally aimed to explore putative associations of antisaccade performance with multimodal measures of fear of spiders.</div></div><div><h3>Methods</h3><div>A sample of 76 participants (41 SP, 35 HC) completed an antisaccade task, employing schematic pictures of spiders and flowers. We measured antisaccade latencies and error rates, respectively. In a free-viewing task, we obtained psychophysiological and subjective fear responses to pictures of spiders. Self-rated fear of spiders was assessed via questionnaires and avoidance behavior was assessed in a behavioral avoidance test.</div></div><div><h3>Results</h3><div>Contrary to ACT predictions, SP exhibited shorter antisaccade latencies irrespective of stimulus category, indexing more efficient inhibitory control, while showing no differences in antisaccade error rates when compared to HC. Consistent with prior findings, SP participants showed elevated psychophysiological responding, fear ratings and avoidance behavior. No significant associations emerged between inhibitory control performance and these measures of fear.</div></div><div><h3>Discussion</h3><div>Our findings suggest enhanced inhibitory control efficiency in SP compared to HC, contrasting impairments predicted by ACT and observed in subclinical anxiety. These findings may indicate a compensatory adaptation in anxiety disorders, enabling rapid attentional avoidance of threat. Our results also imply that inhibitory control may be differentially affected across various anxiety disorders, depending on their predisposition towards fear or anxiety, while also being independent from diverse measures of fear and anxiety.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"116 ","pages":"Article 103078"},"PeriodicalIF":4.5,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245266","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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