Pub Date : 2025-08-14DOI: 10.1016/j.janxdis.2025.103060
James M. Zech, Tapan A. Patel, Jesse R. Cougle
Substance use disorders have been linked to Generalized Anxiety Disorder (GAD), though much of this research predates DSM-5 diagnostic criteria. Further, little prior work has examined the demographic correlates of specific substance use disorders among individuals with GAD. These demographic correlates, as well as the presence of comorbid substance use disorder, may also impact treatment seeking in individuals with GAD. In the present study, we explored the relationship between GAD and common substance use disorders (Alcohol Use Disorder, Cannabis Use Disorder, and Tobacco Use Disorder), as well as the demographic factors associated with these disorders among individuals with GAD in a large, nationally representative sample. We also tested whether each of these substance use disorders were associated with GAD-related treatment seeking. Controlling for demographics and comorbidities, lifetime GAD was positively associated with lifetime Alcohol and Cannabis Use Disorder, but not Tobacco Use Disorder, whereas past-year GAD was positively associated with past year Cannabis and Tobacco Use Disorder but not past year Alcohol Use Disorder. Lastly, lifetime Alcohol Used Disorder but not Cannabis or Tobacco Use Disorder was associated with higher rates of GAD-related treatment seeking. Collectively, these findings reflect an updated examination of GAD and disordered substance use using DSM-5 diagnostic criteria and indicate the importance substance use comorbidities in the context of GAD.
{"title":"Prevalence and correlates of alcohol, cannabis, and tobacco use disorder in DSM-5 generalized anxiety disorder: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions-III","authors":"James M. Zech, Tapan A. Patel, Jesse R. Cougle","doi":"10.1016/j.janxdis.2025.103060","DOIUrl":"10.1016/j.janxdis.2025.103060","url":null,"abstract":"<div><div>Substance use disorders have been linked to Generalized Anxiety Disorder (GAD), though much of this research predates DSM-5 diagnostic criteria. Further, little prior work has examined the demographic correlates of specific substance use disorders among individuals with GAD. These demographic correlates, as well as the presence of comorbid substance use disorder, may also impact treatment seeking in individuals with GAD. In the present study, we explored the relationship between GAD and common substance use disorders (Alcohol Use Disorder, Cannabis Use Disorder, and Tobacco Use Disorder), as well as the demographic factors associated with these disorders among individuals with GAD in a large, nationally representative sample. We also tested whether each of these substance use disorders were associated with GAD-related treatment seeking. Controlling for demographics and comorbidities, lifetime GAD was positively associated with lifetime Alcohol and Cannabis Use Disorder, but not Tobacco Use Disorder, whereas past-year GAD was positively associated with past year Cannabis and Tobacco Use Disorder but not past year Alcohol Use Disorder. Lastly, lifetime Alcohol Used Disorder but not Cannabis or Tobacco Use Disorder was associated with higher rates of GAD-related treatment seeking. Collectively, these findings reflect an updated examination of GAD and disordered substance use using DSM-5 diagnostic criteria and indicate the importance substance use comorbidities in the context of GAD.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"115 ","pages":"Article 103060"},"PeriodicalIF":4.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144894845","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 : 2025-08-10DOI: 10.1016/j.janxdis.2025.103059
Nadine C. van der Burg , Muriel A. Hagenaars , Ad de Jongh , Agnes van Minnen
Tonic immobility (TI) is a profound paralysis that may occur during extreme stress. Previous studies have found that TI during trauma was associated with poorer recovery from posttraumatic stress disorder (PTSD). Importantly, TI can re-occur during re-experiencing the trauma (TIre-exp). It is unclear whether TIre-exp also hinders recovery from PTSD or declines along with other PTSD symptoms after treatment. We examined whether pre-treatment self-reported TIre-exp would predict PTSD symptoms after trauma-focused treatment, including related constructs as depression and dissociation. and investigated pre- to post-treatment changes in TIre-exp. We also explored individual differences in TIre-exp course. A total of 257 patients with PTSD, referred to a clinic for intensive trauma-focused therapy, completed measures for PTSD symptoms and TIre-exp at pre- and posttreatment, and potential confounding variables (dissociative tendencies, somatoform dissociation, dissociative subtype, and depression) at pre-treatment. Higher pre-treatment TIre-exp predicted elevated post-treatment PTSD symptoms, but not after controlling for potentially confounding constructs. Overall, TIre-exp decreased from pre- to post-treatment, and a greater decrease in TIre-exp was associated with a greater decrease in PTSD symptoms. However, four distinct clusters could be identified, which differed in TIre-exp course: High-stable, High-decrease, Moderate and Low TIre-exp. End-state was worse for patients in the High-stable and Moderate clusters. Thus, in the general sample, pre-treatment TIre-exp was not associated with reduced recovery, and TIre-exp generally decreased after treatment, suggesting that TIre-exp may be related to the PTSD symptomatology, responding well to trauma-focused CBT treatment. However, TIre-exp may not decline in specific patient groups. Future research may address how TIre-exp can be targeted for these patients.
{"title":"The role of tonic immobility during re-experiencing trauma in PTSD treatment","authors":"Nadine C. van der Burg , Muriel A. Hagenaars , Ad de Jongh , Agnes van Minnen","doi":"10.1016/j.janxdis.2025.103059","DOIUrl":"10.1016/j.janxdis.2025.103059","url":null,"abstract":"<div><div>Tonic immobility (TI) is a profound paralysis that may occur during extreme stress. Previous studies have found that TI during trauma was associated with poorer recovery from posttraumatic stress disorder (PTSD). Importantly, TI can re-occur during re-experiencing the trauma (TI<sub>re-exp</sub>). It is unclear whether TI<sub>re-exp</sub> also hinders recovery from PTSD or declines along with other PTSD symptoms after treatment. We examined whether pre-treatment self-reported TI<sub>re-exp</sub> would predict PTSD symptoms after trauma-focused treatment, including related constructs as depression and dissociation. and investigated pre- to post-treatment changes in TI<sub>re-exp</sub>. We also explored individual differences in TI<sub>re-exp</sub> course. A total of 257 patients with PTSD, referred to a clinic for intensive trauma-focused therapy, completed measures for PTSD symptoms and TI<sub>re-exp</sub> at pre- and posttreatment, and potential confounding variables (dissociative tendencies, somatoform dissociation, dissociative subtype, and depression) at pre-treatment. Higher pre-treatment TI<sub>re-exp</sub> predicted elevated post-treatment PTSD symptoms, but not after controlling for potentially confounding constructs. Overall, TI<sub>re-exp</sub> decreased from pre- to post-treatment, and a greater decrease in TI<sub>re-exp</sub> was associated with a greater decrease in PTSD symptoms. However, four distinct clusters could be identified, which differed in TI<sub>re-exp</sub> course: High-stable, High-decrease, Moderate and Low TI<sub>re-exp</sub>. End-state was worse for patients in the High-stable and Moderate clusters. Thus, in the general sample, pre-treatment TI<sub>re-exp</sub> was not associated with reduced recovery, and TI<sub>re-exp</sub> generally decreased after treatment, suggesting that TI<sub>re-exp</sub> may be related to the PTSD symptomatology, responding well to trauma-focused CBT treatment. However, TI<sub>re-exp</sub> may not decline in specific patient groups. Future research may address how TI<sub>re-exp</sub> can be targeted for these patients.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"115 ","pages":"Article 103059"},"PeriodicalIF":4.5,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908483","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 : 2025-08-05DOI: 10.1016/j.janxdis.2025.103057
Carly A. Parsons, Hannah Jooyoung Kim, Surat Singh, Tuguldur Lkhagva, Jiayin Wang, Lynn E. Alden
Interpersonal reassurance-seeking is a common anxiety-management strategy used by individuals with a range of disorders, but can be particularly repetitive and exacting among individuals with obsessive-compulsive disorder (OCD). Although this strategy yields short-term relief, it also comes at a cost, creating frustration and straining relationships. Non-interpersonal sources of reassurance—such as the internet—have been less thoroughly studied, but may offer unique advantages. In this mixed-methods study, we explored the differentiating benefits and drawbacks of interpersonal and online reassurance-seeking for individuals with and without OCD. Participants (n = 62 OCD, n = 58 control) completed an imaginal exposure task, after which they indicated their reassurance source preference (interpersonal vs. online) and their primary reasons for this preference. Participants also answered two general questions about their usual motivations for seeking reassurance from each source at the exclusion of the other. We used content analysis to identify patterns in participants’ responses, and quantitative methods to examine the most common motivations as well as any between-group differences. Common reasons for seeking reassurance interpersonally included desires for emotional support and personalization, and these findings did not differ between groups. Common reasons for online reassurance typically involved interpersonal concerns, and participants with OCD were more likely to specifically express concern about the personal consequences of revealing one’s worries to others. Motivations related to trust and seeking shared experiences were common for both reassurance types. These findings are discussed in the context of the broader literature on reassurance-seeking and obsessive-compulsive symptomatology.
{"title":"Covert or connected: Motivations for online and interpersonal reassurance-seeking in OCD","authors":"Carly A. Parsons, Hannah Jooyoung Kim, Surat Singh, Tuguldur Lkhagva, Jiayin Wang, Lynn E. Alden","doi":"10.1016/j.janxdis.2025.103057","DOIUrl":"10.1016/j.janxdis.2025.103057","url":null,"abstract":"<div><div>Interpersonal reassurance-seeking is a common anxiety-management strategy used by individuals with a range of disorders, but can be particularly repetitive and exacting among individuals with obsessive-compulsive disorder (OCD). Although this strategy yields short-term relief, it also comes at a cost, creating frustration and straining relationships. Non-interpersonal sources of reassurance—such as the internet—have been less thoroughly studied, but may offer unique advantages. In this mixed-methods study, we explored the differentiating benefits and drawbacks of interpersonal and online reassurance-seeking for individuals with and without OCD. Participants (<em>n</em> = 62 OCD, <em>n</em> = 58 control) completed an imaginal exposure task, after which they indicated their reassurance source preference (interpersonal vs. online) and their primary reasons for this preference. Participants also answered two general questions about their usual motivations for seeking reassurance from each source at the exclusion of the other. We used content analysis to identify patterns in participants’ responses, and quantitative methods to examine the most common motivations as well as any between-group differences. Common reasons for seeking reassurance interpersonally included desires for emotional support and personalization, and these findings did not differ between groups. Common reasons for online reassurance typically involved interpersonal concerns, and participants with OCD were more likely to specifically express concern about the personal consequences of revealing one’s worries to others. Motivations related to trust and seeking shared experiences were common for both reassurance types. These findings are discussed in the context of the broader literature on reassurance-seeking and obsessive-compulsive symptomatology.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"115 ","pages":"Article 103057"},"PeriodicalIF":4.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144810651","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 : 2025-08-01Epub Date: 2025-06-30DOI: 10.1016/j.janxdis.2025.103050
Franciska Rehberg, Lydia Rihm, Ariane Göbel, Freya Thiel, Verena C S Büechl, Manon Even, Susan Garthus-Niegel
Background: Despite a growing body of literature, understanding of the relationship between maternal symptoms of perinatal posttraumatic stress disorder (PTSD) and the emerging mother-infant bond (MIB) remains limited. This systematic review and meta-analysis elucidates this association considering both general PTSD (gPTSD) symptoms (i.e., not originating from childbirth) as well as childbirth-related PTSD (CB-PTSD) symptoms.
Methods: A comprehensive literature search screening for articles published until 10/03/2024 was conducted. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled effect sizes were estimated with random effects models.
Results: The systematic review includes 22 studies (9472 participants) and indicates a positive association between perinatal PTSD symptoms and impaired MIB. However, the relationship might be explained by confounding factors (e.g., depressive symptoms, general psychological distress). Meta-analyses suggest a small to moderate positive association (r = .32) between postnatal gPTSD symptoms and impaired MIB (n = 8) and a moderate positive association (r = .38) between CB-PTSD symptoms and impaired MIB (n = 15). Additional exploratory meta-analyses indicate that within the CB-PTSD construct, general rather than childbirth-related PTSD symptoms are more strongly related to MIB (n = 5).
Limitations: Heterogeneity across studies, methodological complexities in distinguishing perinatal PTSD subtypes, and a small number of studies should be noted.
Conclusions: The results indicate differential associations between gPTSD versus CB-PTSD and MIB. However, further research is required to fully elucidate the relationship between maternal perinatal PTSD and MIB and the role of individual symptom domains to inform the targeted development of interventions.
{"title":"Perinatal PTSD and the mother-infant bond: A systematic review and meta-analysis.","authors":"Franciska Rehberg, Lydia Rihm, Ariane Göbel, Freya Thiel, Verena C S Büechl, Manon Even, Susan Garthus-Niegel","doi":"10.1016/j.janxdis.2025.103050","DOIUrl":"10.1016/j.janxdis.2025.103050","url":null,"abstract":"<p><strong>Background: </strong>Despite a growing body of literature, understanding of the relationship between maternal symptoms of perinatal posttraumatic stress disorder (PTSD) and the emerging mother-infant bond (MIB) remains limited. This systematic review and meta-analysis elucidates this association considering both general PTSD (gPTSD) symptoms (i.e., not originating from childbirth) as well as childbirth-related PTSD (CB-PTSD) symptoms.</p><p><strong>Methods: </strong>A comprehensive literature search screening for articles published until 10/03/2024 was conducted. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled effect sizes were estimated with random effects models.</p><p><strong>Results: </strong>The systematic review includes 22 studies (9472 participants) and indicates a positive association between perinatal PTSD symptoms and impaired MIB. However, the relationship might be explained by confounding factors (e.g., depressive symptoms, general psychological distress). Meta-analyses suggest a small to moderate positive association (r = .32) between postnatal gPTSD symptoms and impaired MIB (n = 8) and a moderate positive association (r = .38) between CB-PTSD symptoms and impaired MIB (n = 15). Additional exploratory meta-analyses indicate that within the CB-PTSD construct, general rather than childbirth-related PTSD symptoms are more strongly related to MIB (n = 5).</p><p><strong>Limitations: </strong>Heterogeneity across studies, methodological complexities in distinguishing perinatal PTSD subtypes, and a small number of studies should be noted.</p><p><strong>Conclusions: </strong>The results indicate differential associations between gPTSD versus CB-PTSD and MIB. However, further research is required to fully elucidate the relationship between maternal perinatal PTSD and MIB and the role of individual symptom domains to inform the targeted development of interventions.</p>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"114 ","pages":"103050"},"PeriodicalIF":4.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817972","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 : 2025-07-25DOI: 10.1016/j.janxdis.2025.103055
Philip Hyland , Marcus Broughill , Mark Shevlin , Chris R. Brewin
Background
This study empirically tested several predictions arising from the Memory and Identity (M&I) Theory of ICD-11 Complex PTSD (CPTSD). Specifically, it examined the psychometric properties of two measures—the Experiences of Traumatic Memories Questionnaire (ETMQ) and the Trauma Identity Questionnaire (TIQ)—and tested relationships between different types of trauma exposure, disturbances in memory and identity, and CPTSD symptoms.
Methods
Data were collected from a non-probability based representative sample of the general adult population of the United Kingdom (N = 975), and latent variable modelling was used to test all hypotheses.
Results
Confirmatory factor analytic results provided support for the psychometric properties of the ETMQ and TIQ as measures of traumatic memories and negative identities. Multiple traumatization and interpersonal forms of trauma were associated with more disturbances in trauma memories and negative identities. Seven of the nine model-predicted associations between trauma memories, negative identities, and CPTSD symptoms were observed, including a link between a fragmented sense of self and emotional numbing.
Conclusions
Results support core elements of the M&I Theory, highlighting trauma memory and identity disturbances as key mechanisms in CPTSD.
{"title":"Memory and identity processes in ICD-11 complex posttraumatic stress disorder: Tests of a new theory","authors":"Philip Hyland , Marcus Broughill , Mark Shevlin , Chris R. Brewin","doi":"10.1016/j.janxdis.2025.103055","DOIUrl":"10.1016/j.janxdis.2025.103055","url":null,"abstract":"<div><h3>Background</h3><div>This study empirically tested several predictions arising from the Memory and Identity (M&I) Theory of <em>ICD-11</em> Complex PTSD (CPTSD). Specifically, it examined the psychometric properties of two measures—the Experiences of Traumatic Memories Questionnaire (ETMQ) and the Trauma Identity Questionnaire (TIQ)—and tested relationships between different types of trauma exposure, disturbances in memory and identity, and CPTSD symptoms.</div></div><div><h3>Methods</h3><div>Data were collected from a non-probability based representative sample of the general adult population of the United Kingdom (<em>N</em> = 975), and latent variable modelling was used to test all hypotheses.</div></div><div><h3>Results</h3><div>Confirmatory factor analytic results provided support for the psychometric properties of the ETMQ and TIQ as measures of traumatic memories and negative identities. Multiple traumatization and interpersonal forms of trauma were associated with more disturbances in trauma memories and negative identities. Seven of the nine model-predicted associations between trauma memories, negative identities, and CPTSD symptoms were observed, including a link between a fragmented sense of self and emotional numbing.</div></div><div><h3>Conclusions</h3><div>Results support core elements of the M&I Theory, highlighting trauma memory and identity disturbances as key mechanisms in CPTSD.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"114 ","pages":"Article 103055"},"PeriodicalIF":4.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721784","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 : 2025-07-25DOI: 10.1016/j.janxdis.2025.103056
Alexandra A. Harrison, Lan Nguyen, Karen Murphy, David Neumann
Social anxiety disorder is a pervasive clinical disorder characterised by intense fear and/or avoidance of one or more social situations, and has been linked to deficits in executive functioning performance. However, methodological differences and mixed results have made it difficult to draw definitive conclusions from individual studies. The current systematic review and meta-analysis collated the results from 49 studies to examine the link between social anxiety disorder and executive functioning across the lifespan. Findings revealed that individuals with social anxiety performed significantly worse than healthy controls or low social anxiety groups on measures of executive functioning (r = -.15), specifically cognitive flexibility (r = -.20), inhibitory control (r = -.18), and global executive functioning (r = -.17). No significant association was evident between working memory and social anxiety (r = -.06). In addition, the type of measure (self-report vs cognitive task) moderated the relationship between social anxiety and executive functioning. Although age did not moderate the overall relationship, the association between the individual domains of executive functioning and social anxiety differed between youth and adults, which may reflect the different developmental timelines between the domains across the lifespan. The findings offer valuable insight into our understanding of the development of executive functions for individuals with social anxiety and could assist with forming new strategies or interventions to improve daily functioning in this clinical population.
{"title":"Assessing executive functioning in individuals with social anxiety disorder (SAD) across the lifespan: A systematic literature review and meta-analysis","authors":"Alexandra A. Harrison, Lan Nguyen, Karen Murphy, David Neumann","doi":"10.1016/j.janxdis.2025.103056","DOIUrl":"10.1016/j.janxdis.2025.103056","url":null,"abstract":"<div><div>Social anxiety disorder is a pervasive clinical disorder characterised by intense fear and/or avoidance of one or more social situations, and has been linked to deficits in executive functioning performance. However, methodological differences and mixed results have made it difficult to draw definitive conclusions from individual studies. The current systematic review and meta-analysis collated the results from 49 studies to examine the link between social anxiety disorder and executive functioning across the lifespan. Findings revealed that individuals with social anxiety performed significantly worse than healthy controls or low social anxiety groups on measures of executive functioning (<em>r</em> = -.15), specifically cognitive flexibility (<em>r</em> = -.20), inhibitory control (<em>r</em> = -.18), and global executive functioning (<em>r</em> = -.17). No significant association was evident between working memory and social anxiety (<em>r</em> = -.06). In addition, the type of measure (self-report vs cognitive task) moderated the relationship between social anxiety and executive functioning. Although age did not moderate the overall relationship, the association between the individual domains of executive functioning and social anxiety differed between youth and adults, which may reflect the different developmental timelines between the domains across the lifespan. The findings offer valuable insight into our understanding of the development of executive functions for individuals with social anxiety and could assist with forming new strategies or interventions to improve daily functioning in this clinical population.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"115 ","pages":"Article 103056"},"PeriodicalIF":4.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144750438","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 : 2025-07-22DOI: 10.1016/j.janxdis.2025.103054
Tomoko Kishimoto , Ximing Hao , Jianwei Qian
Deficits in positive emotion regulation (PER) contribute to emotional disorders but are less studied than negative emotion regulation (NER). One maladaptive PER strategy, positive emotion contrast-seeking (PEC-seeking), involves sustaining negative affect to enhance later positive emotions, reinforcing anxiety and depression. This study developed and tested a savoring-based, transdiagnostic intervention to reduce PEC-seeking and alleviate emotional disorder symptoms. A single-blind RCT with 59 Chinese college students with elevated depression and anxiety (majority meeting depression criteria) compared a two-week group savoring meditation intervention to waitlist control. Changes in depression, anxiety, savoring beliefs, and PEC-seeking were assessed at Baseline (T0), MidTest (T1), PostTest (T2), and one-month Follow-up (T3). The experimental group also reported positive and negative affect before and after each group session and individual practice. Savoring meditation significantly reduced depression (T1, d = −1.11, p = .005; T2, d = −1.60, p < .001) with effects maintained at follow-up (T3, p < .001). Negative affect also declined significantly (Session 5, p < .001), though changes in positive affect were not statistically significant. The intervention increased savoring beliefs (T1, d = 1.42, T2, d = 1.41, ps =.003) and reduced PEC-seeking (T1, d = −0.92, p = .027), which in turn mediated reductions in depression. Although anxiety symptoms declined within the experimental group over time, between-group differences did not reach statistical significance. Nonetheless, the effect size was larger for the experimental group (T2, d = 0.34) than for the waitlist group (d = 0.01), suggesting a potential anxiolytic effect of the intervention. These findings suggest that targeting maladaptive PER strategies, especially PEC-seeking, via savoring meditation may effectively reduce emotional disorder symptoms. This study highlights PER’s role in transdiagnostic interventions and provides novel insights into PER-focused therapies.
积极情绪调节缺陷是导致情绪障碍的原因之一，但研究较少。一种适应不良的PER策略，积极情绪对比寻求（PEC-seeking），包括维持消极情绪以增强后来的积极情绪，强化焦虑和抑郁。本研究开发并测试了一种基于味觉的跨诊断干预，以减少寻求pec和缓解情绪障碍症状。一项对59名抑郁和焦虑程度较高的中国大学生（大多数符合抑郁标准）进行的单盲随机对照试验将两周的冥想干预组与候补组进行了比较。在基线（T0）、测试中（T1）、测试后（T2）和一个月随访（T3）时评估抑郁、焦虑、品味信念和pec寻求的变化。实验组也报告了每次小组练习前后和个人练习的积极和消极影响。品味冥想显著减少抑郁(T1, d = - 1.11, p = .005；T2, d = - 1.60, p <； .001)，随访时效果维持（T3, p <； .001）。消极情绪也显著下降（第5期，p <； .001），尽管积极情绪的变化没有统计学意义。干预增加了品味信念（T1, d = 1.42, T2, d = 1.41, ps = 0.003），减少了寻找pecc (T1, d = - 0.92, p = .027)，这反过来又介导了抑郁的减少。随着时间的推移，实验组的焦虑症状有所下降，但组间差异无统计学意义。尽管如此，实验组的效应量（T2, d = 0.34）大于等候名单组（d = 0.01），表明干预可能具有抗焦虑作用。这些发现表明，通过品味冥想，针对适应不良的PER策略，特别是寻求pec，可能有效地减少情绪障碍症状。这项研究强调了PER在跨诊断干预中的作用，并为PER重点治疗提供了新的见解。
{"title":"Savoring meditation for emotional disorders: Targeting positive emotion regulation deficits","authors":"Tomoko Kishimoto , Ximing Hao , Jianwei Qian","doi":"10.1016/j.janxdis.2025.103054","DOIUrl":"10.1016/j.janxdis.2025.103054","url":null,"abstract":"<div><div>Deficits in positive emotion regulation (PER) contribute to emotional disorders but are less studied than negative emotion regulation (NER). One maladaptive PER strategy, positive emotion contrast-seeking (PEC-seeking), involves sustaining negative affect to enhance later positive emotions, reinforcing anxiety and depression. This study developed and tested a savoring-based, transdiagnostic intervention to reduce PEC-seeking and alleviate emotional disorder symptoms. A single-blind RCT with 59 Chinese college students with elevated depression and anxiety (majority meeting depression criteria) compared a two-week group savoring meditation intervention to waitlist control. Changes in depression, anxiety, savoring beliefs, and PEC-seeking were assessed at Baseline (T0), MidTest (T1), PostTest (T2), and one-month Follow-up (T3). The experimental group also reported positive and negative affect before and after each group session and individual practice. Savoring meditation significantly reduced depression (T1, <em>d</em> = −1.11, <em>p</em> = .005; T2, <em>d</em> = −1.60, <em>p</em> < .001) with effects maintained at follow-up (T3, <em>p</em> < .001). Negative affect also declined significantly (Session 5, <em>p</em> < .001), though changes in positive affect were not statistically significant. The intervention increased savoring beliefs (T1, <em>d</em> = 1.42, T2, <em>d</em> = 1.41, <em>ps</em> =.003) and reduced PEC-seeking (T1, <em>d</em> = −0.92, <em>p</em> = .027), which in turn mediated reductions in depression. Although anxiety symptoms declined within the experimental group over time, between-group differences did not reach statistical significance. Nonetheless, the effect size was larger for the experimental group (T2, <em>d</em> = 0.34) than for the waitlist group (<em>d</em> = 0.01), suggesting a potential anxiolytic effect of the intervention. These findings suggest that targeting maladaptive PER strategies, especially PEC-seeking, via savoring meditation may effectively reduce emotional disorder symptoms. This study highlights PER’s role in transdiagnostic interventions and provides novel insights into PER-focused therapies.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"114 ","pages":"Article 103054"},"PeriodicalIF":4.8,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702323","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 : 2025-07-19DOI: 10.1016/j.janxdis.2025.103053
Adrian Meule, Leonie Seufert, David R. Kolar
Emetophobia refers to a specific fear of vomiting. There are only few original research studies on this condition and no study that has meta-analytically synthesized findings to describe the characteristics of persons with emetophobia. To this end, we extracted data from 31 reports and—as we examined different dependent variables—each meta-analysis was based on five to 21 samples. The pooled mean age of persons with emetophobia was 29 years but was reduced to 21–27 years when adjusting for publication bias. The pooled mean age of disorder onset was 10 years. The pooled proportion of females was 91 %. The pooled proportions of reporting fear of vomiting oneself, fear of seeing others vomit, or both, were 47 %, 11 %, and 39 %. The most common comorbid mental disorders were social anxiety disorder, depression, and generalized anxiety disorder. The pooled point prevalence of emetophobia was 5 %. Higher emetophobic symptomatology moderately related to higher disgust propensity and higher anxiety, and weakly related to higher depressive symptomatology. This meta-analysis is the first to quantify that most adults with emetophobia are in early adulthood but the disorder started in childhood, almost all are women, the primary locus of fear is vomiting oneself, the most common comorbid mental disorders are other anxiety and affective disorders, and higher emetophobic symptomatology relates to a more general tendency to be easily disgusted and to be anxious. Studies based on representative samples to obtain reliable estimates on the prevalence of emetophobia are needed.
{"title":"Emetophobia (fear of vomiting): A meta-analysis","authors":"Adrian Meule, Leonie Seufert, David R. Kolar","doi":"10.1016/j.janxdis.2025.103053","DOIUrl":"10.1016/j.janxdis.2025.103053","url":null,"abstract":"<div><div>Emetophobia refers to a specific fear of vomiting. There are only few original research studies on this condition and no study that has meta-analytically synthesized findings to describe the characteristics of persons with emetophobia. To this end, we extracted data from 31 reports and—as we examined different dependent variables—each meta-analysis was based on five to 21 samples. The pooled mean age of persons with emetophobia was 29 years but was reduced to 21–27 years when adjusting for publication bias. The pooled mean age of disorder onset was 10 years. The pooled proportion of females was 91 %. The pooled proportions of reporting fear of vomiting oneself, fear of seeing others vomit, or both, were 47 %, 11 %, and 39 %. The most common comorbid mental disorders were social anxiety disorder, depression, and generalized anxiety disorder. The pooled point prevalence of emetophobia was 5 %. Higher emetophobic symptomatology moderately related to higher disgust propensity and higher anxiety, and weakly related to higher depressive symptomatology. This meta-analysis is the first to quantify that most adults with emetophobia are in early adulthood but the disorder started in childhood, almost all are women, the primary locus of fear is vomiting oneself, the most common comorbid mental disorders are other anxiety and affective disorders, and higher emetophobic symptomatology relates to a more general tendency to be easily disgusted and to be anxious. Studies based on representative samples to obtain reliable estimates on the prevalence of emetophobia are needed.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"114 ","pages":"Article 103053"},"PeriodicalIF":4.8,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680162","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 : 2025-07-17DOI: 10.1016/j.janxdis.2025.103052
Nur Hani Zainal , Natalia Van Doren
Background
Panic disorder (PD) is a chronic and impairing anxiety disorder. Individuals with more sleep disturbances might be predisposed to nine-year PD chronicity. However, linearity assumptions, small predictor sets, and analytic and design limitations have hindered optimal identification of which sleep disturbance variables are distal risk factors for PD chronicity. We thus used machine learning (ML) to predict nine-year PD chronicity using high-dimensional data.
Method
Community-dwelling adults (N = 1054) completed clinical interviews, self-reports, and seven-day sleep actigraphy at Wave 1 (W1) and the same clinical interview at Wave 2 (W2) nine years later. The baseline data comprised 43 actigraphy, self-reported sleep disturbances, clinical, and demographic variables. Seven ML models were examined. Gradient boosting machine (GBM) was the best-performing algorithm. PD chronicity was defined as the presence of a PD diagnosis at both W1 and W2.
Results
The GBM accurately predicted PD chronicity (area under the receiver operating characteristic curve [AUC] =.764). Shapley additive explanation analysis showed that the top W1 predictors of PD chronicity were comorbid major depressive disorder, low healthcare utilization, sleep medication use, lengthier wake after sleep onset, and sleep-wake circadian disruptions based on actigraphy and self-reports. Lower household income and younger age were also top predictors. Additionally, the final multivariate model was well-calibrated.
Conclusions
As proposed in our sleep-panic nexus theory, actigraphy and subjective sleep disturbances have essential prognostic value in predicting long-term PD chronicity. Harnessing ML facilitates accurate prediction by identifying complex, nonlinear relations across high-dimensional datasets, possibly improving prevention and treatment tailoring.
{"title":"Sleep disturbances predict nine-year panic disorder chronicity: The sleep-panic nexus theory with machine learning insights","authors":"Nur Hani Zainal , Natalia Van Doren","doi":"10.1016/j.janxdis.2025.103052","DOIUrl":"10.1016/j.janxdis.2025.103052","url":null,"abstract":"<div><h3>Background</h3><div>Panic disorder (PD) is a chronic and impairing anxiety disorder. Individuals with more sleep disturbances might be predisposed to nine-year PD chronicity. However, linearity assumptions, small predictor sets, and analytic and design limitations have hindered optimal identification of which sleep disturbance variables are distal risk factors for PD chronicity. We thus used machine learning (ML) to predict nine-year PD chronicity using high-dimensional data.</div></div><div><h3>Method</h3><div>Community-dwelling adults (<em>N</em> = 1054) completed clinical interviews, self-reports, and seven-day sleep actigraphy at Wave 1 (W1) and the same clinical interview at Wave 2 (W2) nine years later. The baseline data comprised 43 actigraphy, self-reported sleep disturbances, clinical, and demographic variables. Seven ML models were examined. Gradient boosting machine (GBM) was the best-performing algorithm. PD chronicity was defined as the presence of a PD diagnosis at both W1 and W2.</div></div><div><h3>Results</h3><div>The GBM accurately predicted PD chronicity (area under the receiver operating characteristic curve [AUC] =.764). Shapley additive explanation analysis showed that the top W1 predictors of PD chronicity were comorbid major depressive disorder, low healthcare utilization, sleep medication use, lengthier wake after sleep onset, and sleep-wake circadian disruptions based on actigraphy and self-reports. Lower household income and younger age were also top predictors. Additionally, the final multivariate model was well-calibrated.</div></div><div><h3>Conclusions</h3><div>As proposed in our <em>sleep-panic nexus theory</em>, actigraphy and subjective sleep disturbances have essential prognostic value in predicting long-term PD chronicity. Harnessing ML facilitates accurate prediction by identifying complex, nonlinear relations across high-dimensional datasets, possibly improving prevention and treatment tailoring.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"114 ","pages":"Article 103052"},"PeriodicalIF":4.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144704649","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 : 2025-07-08DOI: 10.1016/j.janxdis.2025.103051
Alexandra N. Brockdorf , Lauren E. Simpson , David DiLillo
The co-occurrence between pain and posttraumatic stress disorder (PTSD) is commonly explained by the mutual maintenance model, which proposes that each condition exacerbates the other. We tested this model by examining within-day associations between pain and PTSD using a three-week ecological momentary assessment (EMA) design. Young adult cisgender women (N = 82) who experienced sexual assault and reported PTSD symptoms and probable alcohol misuse completed three self-report surveys per day assessing momentary pain intensity and PTSD symptoms. Results from a dynamic structural equation model supported hypotheses, such that pain predicted greater PTSD symptoms four hours later and PTSD symptoms predicted greater pain. However, exploratory follow up analyses revealed differential findings by cluster, such that intrusions, negative alterations in cognition and mood, and hyperarousal each predicted subsequent pain, whereas pain predicted only later hyperarousal. Findings add nuance to our understanding of the mutual maintenance model and point to hyperarousal symptoms as a key symptom cluster linking daily pain and PTSD among women who have experienced sexual assault. Findings underscore the potential value of targeting hyperarousal symptoms in integrative interventions.
{"title":"Bidirectional associations between PTSD symptoms and pain in daily life among women survivors of sexual assault","authors":"Alexandra N. Brockdorf , Lauren E. Simpson , David DiLillo","doi":"10.1016/j.janxdis.2025.103051","DOIUrl":"10.1016/j.janxdis.2025.103051","url":null,"abstract":"<div><div>The co-occurrence between pain and posttraumatic stress disorder (PTSD) is commonly explained by the mutual maintenance model, which proposes that each condition exacerbates the other. We tested this model by examining within-day associations between pain and PTSD using a three-week ecological momentary assessment (EMA) design. Young adult cisgender women (<em>N</em> = 82) who experienced sexual assault and reported PTSD symptoms and probable alcohol misuse completed three self-report surveys per day assessing momentary pain intensity and PTSD symptoms. Results from a dynamic structural equation model supported hypotheses, such that pain predicted greater PTSD symptoms four hours later and PTSD symptoms predicted greater pain. However, exploratory follow up analyses revealed differential findings by cluster, such that intrusions, negative alterations in cognition and mood, and hyperarousal each predicted subsequent pain, whereas pain predicted only later hyperarousal. Findings add nuance to our understanding of the mutual maintenance model and point to hyperarousal symptoms as a key symptom cluster linking daily pain and PTSD among women who have experienced sexual assault. Findings underscore the potential value of targeting hyperarousal symptoms in integrative interventions.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"114 ","pages":"Article 103051"},"PeriodicalIF":4.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144596435","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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