Journal of Anxiety Disorders最新文献

The metacognitive model of psychological disorders highlights that emotional distress is maintained by metacognitive strategies, which are related to underlying metacognitive beliefs. Considerable empirical evidence has supported the role of metacognitions in psychopathology, but few studies have examined the suggested links between metacognitive beliefs, metacognitive strategies, and symptoms within individuals. Within-person effects provide better empirical tests of theory-based hypotheses derived from clinical models as they relate to change at the individual level. Thus, the current study sought to test central predictions from the metacognitive model at the within-person level using Dynamic Structural Equation Modelling (DSEM). A sample of 222 participants gathered at convenience participated in a 26-day long assessment period where they reported daily measures of metacognitive beliefs, metacognitive strategies, and negative affect. Temporal precedence and bidirectional relations between the variables, and the possible day-to-day and within days mediation role of metacognitive strategies between metacognitive beliefs and negative affect, were tested. When controlling for previous days effects, metacognitions and negative affect (but not metacognitive strategies) predicted each other the next day, showing a reciprocal relationship. However, metacognitive strategies were significant mediators between metacognitions and negative affect within days and day-to-day. Implications and future directions based on these findings are discussed.

Social anxiety disorder (SAD) is highly prevalent with significant lifetime impacts, especially when left untreated. Cognitive behavioral therapy is the current gold standard treatment with successful patient outcomes. Cognitive behavioral group therapy (CBGT) is one form that provides unique benefits to participants including normalization of symptoms and social support, as well as providing increased access to treatment at a lower per-session cost. Research on this mode of treatment has been ongoing for over 20 years, but we still have much to learn about its overall efficacy. The goals of this critical review were to summarize and evaluate the most current research, including an analysis of the overall methodological design quality, and provide recommendations for the enhancement of future studies based on best practices. Recent studies included some best practice design elements used in measuring efficacy such as the use of comparison groups, masking procedures, fidelity assessments, and consideration of clinical significance in outcomes. However, many gaps exist such as a lack of consensus around measures and therapy manuals, as well as baseline competencies of facilitators. Future studies should consider incorporating additional best practice elements aligning with study goals to strengthen designs and provide the field with even more confidence in this mode of treatment.

Romantic relationships are vital for health, well-being and quality of life, and an increasing percentage of romantic relations begin via use of dating apps and subsequently progress to dates. In the present study we examined dating application use and dates among individuals with SAD (n = 54) and without SAD (n = 54). Our sample included young adults (age range 18 to 33) who were not in a romantic relationship at the time of the study. For both individuals with SAD and without SAD, half of the participants were men, and half were women. We used a daily diary measurement in which participants reported on their dating application use and dates, as well as on concomitant emotions and perceptions for 21 consecutive days. We found that individuals with and without SAD did not differ in the frequency/duration of application use nor in the number of dates attended. However, individuals with SAD experienced dates as more negative compared to individuals without SAD (Cohen’s d = 0.65). Interestingly, individuals with SAD did not significantly differ in their experience of dates as positive compared to individuals without SAD. Moreover, use of dating applications/going on dates were associated with increases in shame (Cohen’s d = 0.59) and embarrassment (Cohen’s d = 0.45) and this was found to a greater extent among individuals with SAD compared to individuals without SAD (Cohen’s d = 0.50, 0.39 for shame and embarrassment respectively). Findings are discussed in the context of cognitive behavioral models of SAD and implications for treatment are considered.

There is concern that trauma memory processing in psychological therapies leads to PTSD symptom exacerbation. We compared PTSD symptoms at mid-treatment in trauma-focused psychological therapy to control groups. We systematically searched multiple databases and searched grey literature. We included randomised controlled trials involving adults comparing trauma-focused psychological interventions with active non-trauma-focused interventions or waitlist conditions. Twenty-three studies met our inclusion criteria. We found no evidence of PTSD symptom exacerbation at mid-treatment in trauma-focused interventions compared to control groups (g=−.16, [95 % confidence interval, CI, −.34,.03]). Sensitivity analyses with high quality studies (risk of bias assessment ≥ 7; g=−.25; [95 % CI −.48, −.03], k = 12) and studies with passive controls (g=−.32; [95 % CI −.59, −.05], k = 8) yielded small effect sizes favouring trauma-focused interventions. At post-treatment, trauma-focused interventions yielded a medium effect on PTSD symptoms compared to all controls (g=−.57; [CI −.79, −.35], k = 23). Regarding depression, trauma-focused interventions yielded a small effect size compared to controls at mid-treatment (g=−.23; [95 % CI −.39, −.08], k = 12) and post-treatment (g=−.45; [CI −.66, −.25], k = 12). This meta-analysis found no evidence that trauma-focused psychotherapies elicit symptom exacerbation at mid-treatment in terms of PTSD or depression symptoms. Instead, this meta-analysis suggests that the benefits of trauma-focused interventions can be experienced through improved depression and possibly PTSD before the conclusion of therapy. However, it is possible that symptom exacerbation occurred before mid-treatment and/or that people who experience symptom exacerbation drop out of studies and so are not included in the analysis.

People may experience anxiety and related distress when they come in contact with climate change (i.e., climate change anxiety). Climate change anxiety can be conceptualized as either emotional-based response (the experience of anxiety-related emotions) or impairment-based response (the experience of impairment in daily functioning). To date, it remains uncertain how these distinct manifestations of climate change anxiety are related. Conceptually, the experience of climate change anxiety may transform from an adaptive and healthy emotional response to an impairment in daily functioning. We conducted two two-wave longitudinal studies to examine the possible bidirectional relationships between three manifestations of climate change anxiety. We recruited 942 adults (mean age = 43.1) and 683 parents (mean age = 46.2) in Studies 1 and 2, respectively. We found that Time 1 emotion-based response was positively linked to Time 2 cognitive-emotional impairment, while Time 1 cognitive-emotional impairment was positively related to Time 2 functional impairment. In Study 2, we also found a bidirectional positive relationship between generalized anxiety and emotion-based climate change anxiety over time. Overall, our findings provide initial support to the temporal relationships between different manifestations of climate change anxiety, corroborating that climate change anxiety may develop from emotional responses to impairment in functioning.

Psychotherapies for posttraumatic stress disorder (PTSD) assume that PTSD symptom improvement will lead to improvements in functioning. Yet, few studies have examined the dynamic interplay between these constructs. Using a random intercepts cross-lagged panel model, we examined the association between functioning and PTSD, both modeled as a total score and as the DSM-5 subclusters, across twelve sessions of treatments that chiefly target functioning. Participants were 161 Veterans with PTSD enrolled in a randomized controlled trial comparing present centered therapy and an enhanced version of adaptive disclosure. Overall, PTSD symptoms, measured as the total PTSD score, led to changes in functioning more frequently than functioning predicting PTSD symptoms, although these effects did not appear until session 7. In terms of subclusters, functioning predicted changes in the PTSD subclusters B (intrusions), C (avoidance), and E (alterations in arousal and reactivity) at more timepoints compared to timepoints at which these subclusters predicted functioning. The dynamic relationships between PTSD and functioning in the context of functioning-focused treatments are complex, with functioning playing an important role in reduction of some of the core symptoms of PTSD.

The present study examined contextual factors that affect safety behavior use as well as positive emotions when using safety behaviors among individuals with SAD. Eighty-eight participants took part in the study, half (n = 44) met diagnostic criteria for SAD and half (n = 44) did not meet criteria for SAD. Participants completed a 21-day experience sampling methodology (ESM) measurement in which they reported on daily social interactions, safety behavior use, and emotions. Using multilevel linear modeling we found that both individuals with and without SAD used more safety behaviors when interacting with distant others compared to close others, but this effect was greater for individuals with SAD compared to individuals without SAD. We also found that social anxiety significantly moderated the relationship between safety behaviors in social interactions and positive emotions. Specifically, our findings indicated that individuals with higher levels of social anxiety reported lower levels of positive emotions when using safety behaviors. Implications of our findings for models of psychopathology and for treatment of SAD are discussed.