Journal of Anxiety Disorders最新文献_第3页

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

On the non-inferiority of metacognitive therapy for OCD: Clarifying the methodology and rationale 论强迫症元认知治疗的非劣效性：澄清方法论和基本原理

IF 4.5 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-11-13 DOI: 10.1016/j.janxdis.2025.103094

Cornelia Exner , Alexandra Kleiman , Anke Haberkamp , Jana Hansmeier , Christopher Milde , Julia Anna Glombiewski

引用次数: 0

Measurement invariance of the Straightforwardly-Worded Social Interaction Anxiety Scale and Associations with life satisfaction among emerging adults attending University in 10 countries 10个国家大学新生社会交往焦虑量表的测量不变性及其与生活满意度的关系。

IF 4.5 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-11-13 DOI: 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 (M_age = 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.

本研究的目的是评估10个国家的社会互动焦虑量表（S-SIAS）的测量不变性，并在一个大样本的初入大学的成年人中探索与生活满意度的联系。参与者为来自10个国家（阿根廷、澳大利亚、加拿大、中国、印度、意大利、韩国、挪威、土耳其和美国）的4284名大学生（年龄= 19.89岁，SD = 1.83； 65% %为女性），他们完成了社交焦虑和生活满意度的自我报告评估。多组因素分析对齐方法的结果表明，S-SIAS在10个国家站点的测量近似不变性。挪威大学生的社交焦虑平均水平在所有群体中最高，而阿根廷大学生的社交焦虑平均水平最低。多组回归分析的结果表明，在所有样本中，社交焦虑与生活满意度呈负相关（除了阿根廷和澳大利亚，这两个国家没有收集生活满意度测量），但与其他国家的样本相比，挪威的关联强度更强。研究结果讨论了跨文化社交焦虑的意义和含义。

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引用次数: 0

Relationships between symptom profiles and memory in posttraumatic stress disorder 创伤后应激障碍的症状特征与记忆的关系

IF 4.5 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-11-12 DOI: 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.

患有创伤后应激障碍（PTSD）的个体表现出影响他们对负面信息反应的症状。具体来说，过度警觉会增强对负面刺激的注意力，而分离会转移注意力（Chiba等人，2021），这可能会导致对记忆编码的不同影响。本研究探讨了暴露于2015年11月13日巴黎恐怖袭击事件的个体，高度警惕和分离症状对负面情绪和情境信息记忆的影响。参与者包括暴露于创伤性事件的个体（N = 99；26人符合PTSD的全部诊断标准，28人表现出阈下症状，45人没有症状）和未暴露的个体（N = 65）。他们被要求记住表现出积极、中性和悲伤情绪的面孔，每个面孔都搭配一个代表职业的单词，作为非情绪性的上下文提示。该任务在两个时间点进行：攻击后1.5年和3.5年。采用情绪-职业识别任务，用一个指标来衡量情绪表达或职业是否被更好地识别。在第一个时间点，在暴露的个体中，观察到在悲伤面部表情的背景下，高度警惕或分离症状的突出分别与对情绪表达或职业的增强识别之间存在关系。此外，在两个时间点之间，这些症状的显著性变化与更好识别的内容类型的变化有关。总的来说，这些发现表明，在经历过创伤性事件的个体中，尤其是那些具有创伤后应激障碍完全诊断标准的个体，存在着记忆偏差——要么倾向于情感内容，要么远离情感内容。

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引用次数: 0

Exploring contradicting associations between anxiety disorders, obsessive-compulsive disorder, and academic achievement: A meta-analysis 探索焦虑障碍、强迫症和学业成就之间的矛盾关系：一项荟萃分析

IF 4.5 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-11-08 DOI: 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。

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引用次数: 0

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 个人主义与集体主义社会中社交焦虑、身体畸形和重度抑郁障碍症状的跨文化网络结构：美国、德国和日本人群的比较

IF 4.5 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-11-01 DOI: 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.

社交焦虑障碍（SAD）、身体畸形障碍（BDD）和重度抑郁症（MDD）是高度共病的，这可能受到个人主义与集体主义（尤其强调羞耻）相关的文化变量的影响。本研究调查了三个国家的SAD、BDD、MDD和羞耻感症状的网络结构，这些症状通常与高度集体主义倾向（日本）、高度个人主义倾向（美国）或介于两者之间（德国）有关。参与者包括来自各自国家的319名日本人、440名美国人和308名德国人，他们完成了评估上述症状以及个人主义和集体主义倾向的问卷调查。使用高斯图形模型进行心理测量网络分析，分别检查(a)个人主义和集体主义倾向以及(b) SAD、BDD、MDD和羞耻症状的网络结构。使用网络比较测试（NCT）来评估这些网络在各国的总体一致性。NCT显示，在个人主义和集体主义倾向的网络结构上，以及在SAD、BDD、MDD和羞耻感的症状网络上，日本和德国以及日本和美国之间存在显著的跨文化差异。虽然某些核心症状在所有国家都有，但其他症状则有所不同。这些发现强调了在SAD、BDD和MDD症状的表现和组织中，文化同质性和异质性共存，强调了文化敏感、有针对性的干预措施的重要性。

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引用次数: 0

Treating young adult generalized anxiety disorder with text-message delivered cognitive behavioral therapy: A randomized clinical trial testing efficacy and clinical mechanisms 用短信传递的认知行为疗法治疗青少年广泛性焦虑症：一项随机临床试验测试疗效和临床机制。

IF 4.5 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-10-25 DOI: 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。

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引用次数: 0

Tailored strategies to increase the use of an evidence-based psychotherapy for posttraumatic stress disorder: A stepped-wedge randomized trial in military clinics 量身定制的策略以增加创伤后应激障碍循证心理治疗的使用：军队诊所的阶梯形随机试验。

IF 4.5 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-10-19 DOI: 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

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引用次数: 0

Psychometric evaluation of the Posttraumatic Stress Disorder Checklist for DSM-5 in daily surveys: An item response theory and longitudinal measurement invariance analysis DSM-5创伤后应激障碍日常问卷的心理测量评估：项目反应理论和纵向测量不变性分析

IF 4.5 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-10-08 DOI: 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.

DSM-5 （PCL-5）中的创伤后应激障碍（PTSD）检查表在横断面研究中显示了出色的心理测量质量，但在密集的纵向研究中，该量表的表现却鲜为人知。使用连续9天每天给药的PCL-5的数据，我们(a)使用分级反应模型对PCL-5进行项目分析，以检查项目特征（阈值和区分参数）；(b)检查差异项目功能（DIF），以评估PCL-5在每天的调查中是否测量了相同的PTSD潜在特征（即纵向测量不变性）。方法：256名创伤暴露大学生（Mage = 21.01 ± 4.24；女性85.8% %；41.0% %可能有PTSD）连续9天完成20项PCL-5。结果显示，PCL-5项目8（创伤性遗忘）、16（鲁莽或自毁行为）和17（过度警惕）的歧视程度较低，但可以接受。此外，14 %的参与者在9天内至少有一次表现出不适应。DIF分析表明，项目2（噩梦）在几天内表现出DIF，表明潜在的偏见；然而，DIF的效应量可以忽略不计。综上所述，本研究结果为在密集的纵向研究中使用20项PCL-5提供了广泛的心理测量学支持。未来在不同的临床人群中重复研究结果可能有助于进一步加强这些发现。

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