Pub Date : 2026-03-01Epub Date: 2026-01-06DOI: 10.1016/j.janxdis.2026.103109
Sandra J. Llera , Nur Hani Zainal , Michelle G. Newman
Goal
We developed and validated an 8-item version of the 25-item Contrast Avoidance Questionnaire-General Emotion (CAQ-GE) scale, named the CAQ-GE-8.
Method
Using unselected university undergraduates (N = 8432), we conducted item-response theory (IRT) analyses with a confirmatory graded response model. We then examined the ability of the CAQ-GE-8 to predict probable generalized anxiety disorder (GAD) and major depressive disorder (MDD). With two other student samples, we examined the scale’s convergent/discriminant validity (N = 410) as well as retest reliability (N = 124).
Results
The CAQ-GE-8 contained the same 2 factors as the CAQ-GE (F1: Create and Sustain Negative Emotions to Avoid Negative Contrasts [SNE], 5 items; and F2: Discomfort with Emotional Shifts [DES], 3 items). Both factors demonstrated strong internal consistency. The brief scale predicted probable GAD using a cut-point score of ≥ 15 (area under the receiver operating characteristic curve [AUC]:.794), and probable MDD using a cut-point score of ≥ 13 (AUC:.782). The CAQ-GE-8 and its two subscales also demonstrated good convergent and discriminant validity, and good to excellent retest reliability over 1 week (r = .737–.879).
Conclusion
These findings support the use of the CAQ-GE-8, both in research and in treatment, to assess the construct of contrast avoidance.
{"title":"Development and validation of the eight item contrast avoidance questionnaire-general emotion scale (CAQ-GE-8): An item-response theory analysis","authors":"Sandra J. Llera , Nur Hani Zainal , Michelle G. Newman","doi":"10.1016/j.janxdis.2026.103109","DOIUrl":"10.1016/j.janxdis.2026.103109","url":null,"abstract":"<div><h3>Goal</h3><div>We developed and validated an 8-item version of the 25-item Contrast Avoidance Questionnaire-General Emotion (CAQ-GE) scale, named the CAQ-GE-8.</div></div><div><h3>Method</h3><div>Using unselected university undergraduates (<em>N</em> = 8432), we conducted item-response theory (IRT) analyses with a confirmatory graded response model. We then examined the ability of the CAQ-GE-8 to predict probable generalized anxiety disorder (GAD) and major depressive disorder (MDD). With two other student samples, we examined the scale’s convergent/discriminant validity (<em>N</em> = 410) as well as retest reliability (<em>N</em> = 124).</div></div><div><h3>Results</h3><div>The CAQ-GE-8 contained the same 2 factors as the CAQ-GE (F1: Create and Sustain Negative Emotions to Avoid Negative Contrasts [SNE], 5 items; and F2: Discomfort with Emotional Shifts [DES], 3 items). Both factors demonstrated strong internal consistency. The brief scale predicted probable GAD using a cut-point score of ≥ 15 (area under the receiver operating characteristic curve [AUC]:.794), and probable MDD using a cut-point score of ≥ 13 (AUC:.782). The CAQ-GE-8 and its two subscales also demonstrated good convergent and discriminant validity, and good to excellent retest reliability over 1 week (<em>r</em> = .737–.879).</div></div><div><h3>Conclusion</h3><div>These findings support the use of the CAQ-GE-8, both in research and in treatment, to assess the construct of contrast avoidance.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"118 ","pages":"Article 103109"},"PeriodicalIF":4.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145915382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-05DOI: 10.1016/j.janxdis.2025.103108
Xiaojie Yang , Xiaodong Zhang , Jia Luo , Pengchong Wang , Fang He , Limin Meng , Qin Qin , Tong Wu , Xiangyun Yang
Background
Cognitive behavioral therapy (CBT) is a first-line intervention for panic disorder (PD), yet a subset of patients exhibits suboptimal response. This randomized controlled trial investigated whether low-frequency repetitive transcranial magnetic stimulation (rTMS) augments the efficacy of CBT in unmedicated PD patients.
Methods
Fifty patients with PD were randomly assigned to receive either active or sham rTMS combined with standardized CBT. Outcomes were assessed using the Panic Disorder Severity Scale (PDSS), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD-17), Clinical Global Impression-Severity (CGI-S), Symptom Checklist-90 (SCL-90), and Personal and Social Performance scale (PSP). Bayesian linear mixed-effects model (LMM) was employed to analyze changes in clinical scores over time, accounting for repeated measures and baseline severity. Sensitivity analysis was also performed to evaluate the robustness of the findings.
Results
LMM analysis revealed a significant group × time interaction for both PDSS and HAMA scores. The active rTMS group showed significantly greater reduction in panic and anxiety symptoms compared to the sham group from week 2 onward. At the 12-week endpoint, both groups demonstrated significant improvements in overall psychopathological symptoms (SCL-90), depressive symptoms (HAMD-17), illness severity (CGI-S), and psychosocial functioning (PSP). However, the active rTMS group demonstrated significantly greater improvement in PSP scores compared to the sham control group, while no superior improvement was observed in SCL-90, CGI-S, or HAMD-17 scores. Both treatments were well tolerated.
Conclusions
Active rTMS significantly accelerated and enhanced early anxiety and panic symptom reduction when combined with CBT, demonstrating its potential as an effective adjunctive strategy in the initial phase of treatment. The combination was safe and feasible, supporting further investigation into optimized sequencing and long-term outcomes in PD management.
{"title":"Efficacy of combined low-frequency rTMS and cognitive behavioral therapy for unmedicated panic disorder: A randomized controlled trial","authors":"Xiaojie Yang , Xiaodong Zhang , Jia Luo , Pengchong Wang , Fang He , Limin Meng , Qin Qin , Tong Wu , Xiangyun Yang","doi":"10.1016/j.janxdis.2025.103108","DOIUrl":"10.1016/j.janxdis.2025.103108","url":null,"abstract":"<div><h3>Background</h3><div>Cognitive behavioral therapy (CBT) is a first-line intervention for panic disorder (PD), yet a subset of patients exhibits suboptimal response. This randomized controlled trial investigated whether low-frequency repetitive transcranial magnetic stimulation (rTMS) augments the efficacy of CBT in unmedicated PD patients.</div></div><div><h3>Methods</h3><div>Fifty patients with PD were randomly assigned to receive either active or sham rTMS combined with standardized CBT. Outcomes were assessed using the Panic Disorder Severity Scale (PDSS), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD-17), Clinical Global Impression-Severity (CGI-S), Symptom Checklist-90 (SCL-90), and Personal and Social Performance scale (PSP). Bayesian linear mixed-effects model (LMM) was employed to analyze changes in clinical scores over time, accounting for repeated measures and baseline severity. Sensitivity analysis was also performed to evaluate the robustness of the findings.</div></div><div><h3>Results</h3><div>LMM analysis revealed a significant group × time interaction for both PDSS and HAMA scores. The active rTMS group showed significantly greater reduction in panic and anxiety symptoms compared to the sham group from week 2 onward. At the 12-week endpoint, both groups demonstrated significant improvements in overall psychopathological symptoms (SCL-90), depressive symptoms (HAMD-17), illness severity (CGI-S), and psychosocial functioning (PSP). However, the active rTMS group demonstrated significantly greater improvement in PSP scores compared to the sham control group, while no superior improvement was observed in SCL-90, CGI-S, or HAMD-17 scores. Both treatments were well tolerated.</div></div><div><h3>Conclusions</h3><div>Active rTMS significantly accelerated and enhanced early anxiety and panic symptom reduction when combined with CBT, demonstrating its potential as an effective adjunctive strategy in the initial phase of treatment. The combination was safe and feasible, supporting further investigation into optimized sequencing and long-term outcomes in PD management.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"118 ","pages":"Article 103108"},"PeriodicalIF":4.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-29DOI: 10.1016/j.janxdis.2026.103126
Dan Eliray Hay , Shir Porat-Butman , Yogev Kivity , Einat Levy-Gigi , Eva Gilboa-Schechtman
Background
Social interactions and stable individual differences shape an individual's sense of belongingness —a core need of being accepted by others. Indeed, a sense of belonging is postulated—and found—to affect and be affected by socializing. A diminished sense of belonging and reduced socializing characterizes social anxiety (SA). However, the impact of SA on the temporal dynamics between socializing and belongingness remains unclear.
Method
Using ecological momentary assessment (EMA), we examined the impact of SA on socializing-belongingness dynamics. Participants (N = 116) provided real-time reports on social interactions (three times a day) and belongingness (five times a day) across a 15–17-day period.
Results
SA moderated the relationship between socializing and belongingness. Individuals with low SA exhibited a maximizing pattern, with belongingness increasing continuously as socializing increased. In contrast, individuals with high SA showed a satiation effect, in which belongingness plateaued after a certain amount of socializing. Finally, both SA and socializing prospectively predicted perceived belongingness.
Conclusions
Our findings reveal person-specific dynamics of belongingness, with high levels of SA associated with reduced benefits from social engagement. These findings suggest that enhancing social opportunities and assisting individuals in recognizing optimal levels of socializing may jointly contribute to more fulfilling intra- and interpersonal functioning in SA.
{"title":"Socialsatiation: Social anxiety alters belongingness dynamics?","authors":"Dan Eliray Hay , Shir Porat-Butman , Yogev Kivity , Einat Levy-Gigi , Eva Gilboa-Schechtman","doi":"10.1016/j.janxdis.2026.103126","DOIUrl":"10.1016/j.janxdis.2026.103126","url":null,"abstract":"<div><h3>Background</h3><div>Social interactions and stable individual differences shape an individual's sense of belongingness —a core need of being accepted by others. Indeed, a sense of belonging is postulated—and found—to affect and be affected by socializing. A diminished sense of belonging and reduced socializing characterizes social anxiety (SA). However, the impact of SA on the temporal dynamics between socializing and belongingness remains unclear.</div></div><div><h3>Method</h3><div>Using ecological momentary assessment (EMA), we examined the impact of SA on socializing-belongingness dynamics. Participants (N = 116) provided real-time reports on social interactions (three times a day) and belongingness (five times a day) across a 15–17-day period.</div></div><div><h3>Results</h3><div>SA moderated the relationship between socializing and belongingness. Individuals with low SA exhibited a maximizing pattern, with belongingness increasing continuously as socializing increased. In contrast, individuals with high SA showed a satiation effect, in which belongingness plateaued after a certain amount of socializing. Finally, both SA and socializing prospectively predicted perceived belongingness.</div></div><div><h3>Conclusions</h3><div>Our findings reveal person-specific dynamics of belongingness, with high levels of SA associated with reduced benefits from social engagement. These findings suggest that enhancing social opportunities and assisting individuals in recognizing optimal levels of socializing may jointly contribute to more fulfilling intra- and interpersonal functioning in SA.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"118 ","pages":"Article 103126"},"PeriodicalIF":4.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-12-02DOI: 10.1016/j.janxdis.2025.103105
Joseph B. Friedman , Tate F. Halverson , Emily K. Juel , Nicholas S. Myers , Mujgan Inozu , Jonathan S. Abramowitz
The current study examined predictors of posttraumatic stress (PTS) and general distress symptoms following two campus-wide “armed and dangerous person” lockdowns at the University of North Carolina at Chapel Hill. Participants (N = 287) completed baseline surveys four weeks post-lockdowns, with 115 participating in follow-ups over seven months. Utilizing the cognitive model of PTSD, we investigated posttraumatic cognitions, anxiety sensitivity (AS), and prior trauma as predictors of PTS and general distress. Results revealed that higher initial posttraumatic cognitions and AS were associated with greater PTS and distress symptom severity. Interestingly, elevated posttraumatic cognitions predicted a faster reduction in PTS symptoms over time, while AS effects remained stable. Prior trauma did not significantly predict outcomes. These findings highlight the roles of specific cognitive factors in shaping responses to trauma and emphasize the potential for targeted interventions to mitigate symptoms following collective stressful events.
{"title":"Prospective predictors of posttraumatic stress symptoms following two “armed and dangerous person” campus lockdowns","authors":"Joseph B. Friedman , Tate F. Halverson , Emily K. Juel , Nicholas S. Myers , Mujgan Inozu , Jonathan S. Abramowitz","doi":"10.1016/j.janxdis.2025.103105","DOIUrl":"10.1016/j.janxdis.2025.103105","url":null,"abstract":"<div><div>The current study examined predictors of posttraumatic stress (PTS) and general distress symptoms following two campus-wide “armed and dangerous person” lockdowns at the University of North Carolina at Chapel Hill. Participants (<em>N</em> = 287) completed baseline surveys four weeks post-lockdowns, with 115 participating in follow-ups over seven months. Utilizing the cognitive model of PTSD, we investigated posttraumatic cognitions, anxiety sensitivity (AS), and prior trauma as predictors of PTS and general distress. Results revealed that higher initial posttraumatic cognitions and AS were associated with greater PTS and distress symptom severity. Interestingly, elevated posttraumatic cognitions predicted a faster reduction in PTS symptoms over time, while AS effects remained stable. Prior trauma did not significantly predict outcomes. These findings highlight the roles of specific cognitive factors in shaping responses to trauma and emphasize the potential for targeted interventions to mitigate symptoms following collective stressful events.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"117 ","pages":"Article 103105"},"PeriodicalIF":4.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-11-21DOI: 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。
{"title":"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","authors":"Dharani Keyan , Nadine Garland , Polly Rise , Hana McMahon , Richard Bryant","doi":"10.1016/j.janxdis.2025.103096","DOIUrl":"10.1016/j.janxdis.2025.103096","url":null,"abstract":"<div><div>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, <em>r</em> = .45 (<em>95 %CI</em> [.40,.49], <em>p</em> < .0001). Additionally, mid-treatment reductions in trauma-related cognitions were significantly associated with mid-treatment reductions in PTSD severity, <em>r</em> = .42 (<em>95 %CI</em> [.34,.50], <em>p</em> < .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, <em>r</em> = .49 (<em>95 %CI</em> [.40,.57], <em>p</em> < .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.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"117 ","pages":"Article 103096"},"PeriodicalIF":4.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-12-08DOI: 10.1016/j.janxdis.2025.103107
Dori Rubinstein , Nachshon Korem , David G. Bullard , Ilan Harpaz-Rotem
Exposure techniques are foundational in trauma treatment, yet their application varies significantly across psychotherapies. This theoretical paper introduces the Exposure Continuum Model (ECM), a novel comprehensive framework that classifies trauma-centered therapeutic approaches along two key dimensions: Closeness (implicit to explicit or indirect to direct exposure) and Standardized Cumulative Dose (repetition and duration) of exposure. These dimensions provide a map that spans across evidence-based trauma-focused therapies (e.g., Prolonged Exposure [PE], Cognitive Processing Therapy [CPT], Eye Movement Desensitization and Reprocessing [EMDR]) and other, trauma-informed modalities (e.g., Interpersonal Psychotherapy [IPT], Somatic Experiencing [SE]). The paper reviews the clinical, cognitive, and neurobiological mechanisms that underpin exposure therapy, highlighting the diversity of its application across different therapeutic modalities. It also offers a detailed description of how these therapies incorporate exposure components and locate them within the model. By offering a structured framework for understanding the exposure component matrix across therapies, this cornerstone paper lays the foundation for future research and practice. These future data-driven explorations will help clinicians refine treatment approaches based on variables such as trauma type, time from trauma, symptom severity, and individual differences among patients, therapists, and therapeutic settings.
{"title":"The exposure continuum model: A theoretical framework for understanding exposure across trauma-centered psychotherapies","authors":"Dori Rubinstein , Nachshon Korem , David G. Bullard , Ilan Harpaz-Rotem","doi":"10.1016/j.janxdis.2025.103107","DOIUrl":"10.1016/j.janxdis.2025.103107","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"117 ","pages":"Article 103107"},"PeriodicalIF":4.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-12-02DOI: 10.1016/j.janxdis.2025.103104
Jeffrey R. Vittengl , Eunyoe Ro , Robin B. Jarrett , Lee Anna Clark
Background
Section-III of DSM-5 introduced an alternative model of personality disorder (AMPD) including both personality dysfunction and maladaptive-range traits. This study clarified relations of social anxiety symptoms, social anxiety disorder (SAD), and Section-II avoidant personality disorder (APD) with AMPD personality pathology.
Method
Adults (N = 600; including mental-health outpatients and non-patients at risk for personality pathology) completed self-report and interviewer-rated measures of social anxiety and AMPD constructs, including self and interpersonal functioning and trait negative affectivity, detachment, disinhibition, antagonism, and psychoticism. Most participants (n = 497) completed reassessment, on average 8 months later. We examined convergence of social anxiety with personality pathology, as well as prediction of longitudinal changes in social anxiety from baseline personality and vice versa. We focused on results replicating across self-reported social anxiety symptoms, interviewer-rated SAD and APD criterion counts, and self- and interviewer-rated personality.
Results
Concurrently, social anxiety related to higher negative affectivity, detachment, self dysfunction, and interpersonal dysfunction. Of these, the latter three dimensions predicted increases in social anxiety longitudinally. Social anxiety did not predict longitudinal changes in personality pathology as consistently.
Limitations
Generalization of findings to other populations, settings, and methods, such as adolescents, primary care, or direct observation, is uncertain. Longitudinal analyses suggested causality but could not establish it.
Conclusions
The AMPD enriches description of current social anxiety and prediction of changes in social anxiety. Assessment of personality pathology, including both personality dysfunction and maladaptive-range traits, may identify targets for prevention or treatment of social anxiety, to be tested in future research.
{"title":"Social anxiety in the context of the alternative DSM-5 model of personality disorder","authors":"Jeffrey R. Vittengl , Eunyoe Ro , Robin B. Jarrett , Lee Anna Clark","doi":"10.1016/j.janxdis.2025.103104","DOIUrl":"10.1016/j.janxdis.2025.103104","url":null,"abstract":"<div><h3>Background</h3><div>Section-III of <em>DSM-5</em> introduced an alternative model of personality disorder (AMPD) including both personality dysfunction and maladaptive-range traits. This study clarified relations of social anxiety symptoms, social anxiety disorder (SAD), and Section-II avoidant personality disorder (APD) with AMPD personality pathology.</div></div><div><h3>Method</h3><div>Adults (<em>N</em> = 600; including mental-health outpatients and non-patients at risk for personality pathology) completed self-report and interviewer-rated measures of social anxiety and AMPD constructs, including self and interpersonal functioning and trait negative affectivity, detachment, disinhibition, antagonism, and psychoticism. Most participants (<em>n</em> = 497) completed reassessment, on average 8 months later. We examined convergence of social anxiety with personality pathology, as well as prediction of longitudinal changes in social anxiety from baseline personality and vice versa. We focused on results replicating across self-reported social anxiety symptoms, interviewer-rated SAD and APD criterion counts, and self- and interviewer-rated personality.</div></div><div><h3>Results</h3><div>Concurrently, social anxiety related to higher negative affectivity, detachment, self dysfunction, and interpersonal dysfunction. Of these, the latter three dimensions predicted increases in social anxiety longitudinally. Social anxiety did not predict longitudinal changes in personality pathology as consistently.</div></div><div><h3>Limitations</h3><div>Generalization of findings to other populations, settings, and methods, such as adolescents, primary care, or direct observation, is uncertain. Longitudinal analyses suggested causality but could not establish it.</div></div><div><h3>Conclusions</h3><div>The AMPD enriches description of current social anxiety and prediction of changes in social anxiety. Assessment of personality pathology, including both personality dysfunction and maladaptive-range traits, may identify targets for prevention or treatment of social anxiety, to be tested in future research.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"117 ","pages":"Article 103104"},"PeriodicalIF":4.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-11-19DOI: 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.
{"title":"Actigraphy and subjective sleep predictors of nine-year generalized anxiety disorder","authors":"Nur Hani Zainal , Natalia Van Doren","doi":"10.1016/j.janxdis.2025.103095","DOIUrl":"10.1016/j.janxdis.2025.103095","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>Community adults (<em>N</em> = 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.</div></div><div><h3>Results</h3><div>The final multivariable predictive algorithm performed well (<em>R</em><sup><em>2</em></sup> = 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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"117 ","pages":"Article 103095"},"PeriodicalIF":4.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub 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":"2026-01-01","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 : 2026-01-01Epub 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":"2026-01-01","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}
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