Pub Date : 2025-10-01Epub Date: 2025-08-31DOI: 10.1016/j.janxdis.2025.103068
James M. Zech , Tapan A. Patel , Jesse R. Cougle
Safety behaviors (SBs) are hypothesized to play a key role in social anxiety and present as a viable target of psychosocial treatments. While SB reduction is a component of some cognitive-behavioral therapies for social anxiety, prior research suggests safety behavior fading also represents a viable, standalone digital treatment for social anxiety. The aim of the present study was to test a one-month self-monitoring SB treatment in individuals reporting elevated social anxiety symptoms against a credible control condition. Participants (N = 201) were randomized to either a SB fading condition (n = 99) or an unhealthy behavior fading control (n = 102). Compared to control, SB fading led to lower SB use at post but not one-month follow-up. Contrary to predictions, both conditions saw significant and comparable reductions in social anxiety and related outcomes (depression, loneliness) at posttreatment and follow-up. Treatment credibility and expectancy moderated the effect of condition, such that among participants with more positive beliefs about treatment (after being provided with the rationale), those in the SB condition reported significantly lower follow-up social anxiety than those in control. Further, in the SB condition, both higher social interaction frequency and lower loneliness at baseline were predictive of lower social anxiety at follow-up. Overall, our findings show limitations to SB fading as a standalone intervention and suggest this strategy is more effective among those who interact with others more frequently and who are more confident in this treatment approach. We discuss clinical implications and future research directions, including potential refinements to SB treatment protocols.
{"title":"Safety behavior fading for social anxiety: A randomized controlled trial of a self-monitoring intervention","authors":"James M. Zech , Tapan A. Patel , Jesse R. Cougle","doi":"10.1016/j.janxdis.2025.103068","DOIUrl":"10.1016/j.janxdis.2025.103068","url":null,"abstract":"<div><div>Safety behaviors (SBs) are hypothesized to play a key role in social anxiety and present as a viable target of psychosocial treatments. While SB reduction is a component of some cognitive-behavioral therapies for social anxiety, prior research suggests safety behavior fading also represents a viable, standalone digital treatment for social anxiety. The aim of the present study was to test a one-month self-monitoring SB treatment in individuals reporting elevated social anxiety symptoms against a credible control condition. Participants (<em>N</em> = 201) were randomized to either a SB fading condition (<em>n</em> = 99) or an unhealthy behavior fading control (<em>n</em> = 102). Compared to control, SB fading led to lower SB use at post but not one-month follow-up. Contrary to predictions, both conditions saw significant and comparable reductions in social anxiety and related outcomes (depression, loneliness) at posttreatment and follow-up. Treatment credibility and expectancy moderated the effect of condition, such that among participants with more positive beliefs about treatment (after being provided with the rationale), those in the SB condition reported significantly lower follow-up social anxiety than those in control. Further, in the SB condition, both higher social interaction frequency and lower loneliness at baseline were predictive of lower social anxiety at follow-up. Overall, our findings show limitations to SB fading as a standalone intervention and suggest this strategy is more effective among those who interact with others more frequently and who are more confident in this treatment approach. We discuss clinical implications and future research directions, including potential refinements to SB treatment protocols.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"115 ","pages":"Article 103068"},"PeriodicalIF":4.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01Epub Date: 2025-09-19DOI: 10.1016/j.janxdis.2025.103074
Inhye Cho , Byung-Hoon Kim , Hankil Lee , Yun-Kyoung Song , Min Jung Chang , Junhyung Kim , Euna Han
Background
Digital therapeutics (DTx) have emerged as scalable and accessible treatment modalities for panic disorder.
Objective
This study aimed to identify the extent to which clinician guidance impacts the digital intervention effectiveness for panic disorder across multiple clinical outcomes.
Methods
This study included 40 randomized controlled trials of digital intervention for panic disorder published up to March 2025. Eligible studies enrolled adults with a primary diagnosis of panic disorder (with or without agoraphobia) and compared a digital therapeutic intervention against active (therapist-led or treatment-as-usual) or passive (waitlist or no-treatment) controls. Outcomes were the Panic Disorder Severity Scale (PDSS), Agoraphobic Cognitions Questionnaire (ACQ), and Body Sensations Questionnaire (BSQ). Random-effects meta-analyses, subgroup analyses, sensitivity analyses, and mixed-effects meta regressions were conducted. The moderator variables included the comparator type, guidance format (clinician-guidance or self-guided), intervention modality, and region.
Results
Self-guided DTx demonstrated a moderate effect size on PDSS (Hedges’ g =0.31, 95 % confidence interval [CI]: 0.05–0.68), whereas clinician-guided interventions exhibited stronger effects (g =0.95, 95 % CI: 0.44–1.46). These findings indicate that well-structured self-guided interventions can address symptom domains, involving panic frequency and physiological distress. Conversely, cognitive-focused outcome assessment using ACQ and BSQ revealed that only clinician-guided interventions yielded statistically significant and clinically meaningful improvements (ACQ: g =0.46, 95 % CI: 0.15–0.76; BSQ: g =0.67, 95 % CI: 0.30–1.05), whereas self-guided formats exhibited negligible effects (ACQ: g =0.11; BSQ: g =0.27).
Conclusions
This meta-analysis revealed that self-guided digital interventions effectively reduce the overall symptom severity in panic disorder, whereas clinician involvement exerts a notably stronger influence on cognition-related outcomes. These findings support a domain-specific and context-sensitive understanding of guidance. Accordingly, the DTx design and policy should match the mechanistic pathways through which psychological change will occur.
背景:数字疗法(DTx)已成为可扩展和可获得的恐慌障碍治疗方式。目的:本研究旨在确定临床医生指导在多大程度上影响了惊恐障碍的多种临床结果的数字化干预效果。方法:本研究纳入截至2025年3月发表的40项数字干预惊恐障碍的随机对照试验。符合条件的研究招募了初步诊断为惊恐障碍(有或没有广场恐怖症)的成年人,并将数字治疗干预与主动(治疗师主导或照常治疗)或被动(等候名单或无治疗)对照进行比较。结果为惊恐障碍严重程度量表(PDSS)、广场恐惧症认知问卷(ACQ)和身体感觉问卷(BSQ)。进行随机效应meta分析、亚组分析、敏感性分析和混合效应meta回归。调节变量包括比较者类型、指导形式(临床指导或自我指导)、干预方式和地区。结果:自我引导的DTx对PDSS表现出中等效应(Hedges' g =0.31, 95 %置信区间[CI]: 0.05-0.68),而临床指导的干预表现出更强的效应(g =0.95, 95 % CI: 0.44-1.46)。这些发现表明,结构良好的自我指导干预可以解决症状领域,包括恐慌频率和生理困扰。相反,使用ACQ和BSQ进行的以认知为中心的结果评估显示,只有临床指导的干预才能产生具有统计学意义和临床意义的改善(ACQ: g =0.46, 95 % CI: 0.15-0.76; BSQ: g =0.67, 95 % CI: 0.30-1.05),而自我指导的干预效果可以忽略(ACQ: g =0.11; BSQ: g =0.27)。结论:本荟萃分析显示,自我指导的数字干预有效地降低了恐慌障碍的整体症状严重程度,而临床医生的参与对认知相关结果的影响明显更强。这些发现支持对指导的特定领域和上下文敏感的理解。因此,DTx的设计和政策应该与心理变化发生的机制途径相匹配。
{"title":"Clinician guidance in digital therapeutics for panic disorder: Meta-analytic dissection and implications for regulatory framing and scalable deployment","authors":"Inhye Cho , Byung-Hoon Kim , Hankil Lee , Yun-Kyoung Song , Min Jung Chang , Junhyung Kim , Euna Han","doi":"10.1016/j.janxdis.2025.103074","DOIUrl":"10.1016/j.janxdis.2025.103074","url":null,"abstract":"<div><h3>Background</h3><div>Digital therapeutics (DTx) have emerged as scalable and accessible treatment modalities for panic disorder.</div></div><div><h3>Objective</h3><div>This study aimed to identify the extent to which clinician guidance impacts the digital intervention effectiveness for panic disorder across multiple clinical outcomes.</div></div><div><h3>Methods</h3><div>This study included 40 randomized controlled trials of digital intervention for panic disorder published up to March 2025. Eligible studies enrolled adults with a primary diagnosis of panic disorder (with or without agoraphobia) and compared a digital therapeutic intervention against active (therapist-led or treatment-as-usual) or passive (waitlist or no-treatment) controls. Outcomes were the Panic Disorder Severity Scale (PDSS), Agoraphobic Cognitions Questionnaire (ACQ), and Body Sensations Questionnaire (BSQ). Random-effects meta-analyses, subgroup analyses, sensitivity analyses, and mixed-effects meta regressions were conducted. The moderator variables included the comparator type, guidance format (clinician-guidance or self-guided), intervention modality, and region.</div></div><div><h3>Results</h3><div>Self-guided DTx demonstrated a moderate effect size on PDSS (Hedges’ g =0.31, 95 % confidence interval [CI]: 0.05–0.68), whereas clinician-guided interventions exhibited stronger effects (g =0.95, 95 % CI: 0.44–1.46). These findings indicate that well-structured self-guided interventions can address symptom domains, involving panic frequency and physiological distress. Conversely, cognitive-focused outcome assessment using ACQ and BSQ revealed that only clinician-guided interventions yielded statistically significant and clinically meaningful improvements (ACQ: g =0.46, 95 % CI: 0.15–0.76; BSQ: g =0.67, 95 % CI: 0.30–1.05), whereas self-guided formats exhibited negligible effects (ACQ: g =0.11; BSQ: g =0.27).</div></div><div><h3>Conclusions</h3><div>This meta-analysis revealed that self-guided digital interventions effectively reduce the overall symptom severity in panic disorder, whereas clinician involvement exerts a notably stronger influence on cognition-related outcomes. These findings support a domain-specific and context-sensitive understanding of guidance. Accordingly, the DTx design and policy should match the mechanistic pathways through which psychological change will occur.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"115 ","pages":"Article 103074"},"PeriodicalIF":4.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01Epub Date: 2025-09-18DOI: 10.1016/j.janxdis.2025.103072
Xiang Li, Daniel T.L. Shek, Xintong Zhang
As anxiety disorders are common and clinically significant psychiatric disorders in children and adolescents linked to a broad spectrum of psychiatric problems, we need valid assessment instruments of anxiety. The Screen for Child Anxiety Related Emotional Disorders (SCARED) is widely used to assess anxiety symptoms. However, its factor structure remains debated, and its psychometric properties are underexplored in China. This study examined the factor structure of the SCARED and its measurement invariance across gender, age, and time among Chinese students. Specifically, this study used a two-wave longitudinal design, with a six-month interval (Time 1: December 2019–January 2020; Time 2: June 2020–July 2020). Data included 6176 children and adolescents aged 8–19 years (51.6 % boys; mean age = 11.52, SD = 1.62) from Sichuan, China. Confirmatory factor analyses supported a five-factor model as the best fit. Measurement invariances across gender, age, and time were established at the configural, metric, scalar, error variance, factor variance, and factor covariance levels, as supported by changes in the comparative fit index (CFI ≤ 0.004) and root mean square error of approximation (RMSEA ≤ 0.002). Furthermore, structured means modeling analyses showed that girls experienced more anxiety than did boys. Children experienced higher separation anxiety but lower general anxiety and school phobia than did adolescents. Moreover, participants experienced fewer anxiety symptoms at Time 2. Overall, the SCARED was valid and reliable for measuring anxiety symptoms in Chinese children and adolescents, confirming its utility as an objective outcome measure.
{"title":"The screen for child anxiety related emotional disorders scale: A longitudinal validation study based on Chinese children and adolescents","authors":"Xiang Li, Daniel T.L. Shek, Xintong Zhang","doi":"10.1016/j.janxdis.2025.103072","DOIUrl":"10.1016/j.janxdis.2025.103072","url":null,"abstract":"<div><div>As anxiety disorders are common and clinically significant psychiatric disorders in children and adolescents linked to a broad spectrum of psychiatric problems, we need valid assessment instruments of anxiety. The Screen for Child Anxiety Related Emotional Disorders (SCARED) is widely used to assess anxiety symptoms. However, its factor structure remains debated, and its psychometric properties are underexplored in China. This study examined the factor structure of the SCARED and its measurement invariance across gender, age, and time among Chinese students. Specifically, this study used a two-wave longitudinal design, with a six-month interval (Time 1: December 2019–January 2020; Time 2: June 2020–July 2020). Data included 6176 children and adolescents aged 8–19 years (51.6 % boys; mean age = 11.52, <em>SD</em> = 1.62) from Sichuan, China. Confirmatory factor analyses supported a five-factor model as the best fit. Measurement invariances across gender, age, and time were established at the configural, metric, scalar, error variance, factor variance, and factor covariance levels, as supported by changes in the comparative fit index (CFI ≤ 0.004) and root mean square error of approximation (RMSEA ≤ 0.002). Furthermore, structured means modeling analyses showed that girls experienced more anxiety than did boys. Children experienced higher separation anxiety but lower general anxiety and school phobia than did adolescents. Moreover, participants experienced fewer anxiety symptoms at Time 2. Overall, the SCARED was valid and reliable for measuring anxiety symptoms in Chinese children and adolescents, confirming its utility as an objective outcome measure.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"115 ","pages":"Article 103072"},"PeriodicalIF":4.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145117821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01Epub 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":"2025-10-01","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 : 2025-10-01Epub Date: 2025-08-14DOI: 10.1016/j.janxdis.2025.103058
Emily Hutchinson , Erica Huynh , Mary Woody , Dev Chopra , Amelia Lint , Enoch Du , Kristy Benoit Allen , Cecile Ladouceur , Jennifer Silk
Adolescence is a key period in which anxiety symptoms dramatically increase, particularly among adolescent girls. Identifying potentially-modifiable risk factors that contribute to anxiety symptoms may be critical to mitigate anxiety symptoms and disorders among youth. Attention biases are one set of cognitive risk factors implicated in the development and maintenance of anxiety disorders. Yet previous research remains mixed as to what pattern of attention bias characterizes adolescents at-risk for developing anxiety. Further, prior literature has largely relied on indirect measures of attention (e.g., reaction time) and tasks with low ecological validity. The present study investigated how attention to social evaluative feedback contributed to concurrent and prospective anxiety symptoms in adolescent girls (n = 90, baseline Mage = 12.31, SD =.83). The present study used a novel speech task and mobile eye-tracking technology to assess gaze-directed attention in an ecologically valid context that adolescents encounter daily. We hypothesized that adolescents who engage in vigilance, avoidance, and the combination of vigilance-avoidance of potentially critical social evaluative feedback would report greater concurrent and prospective anxiety symptoms. We also explored the association between gaze-directed attention to positive social feedback. Contrary to our hypotheses, adolescents who exhibited both initial and sustained avoidance of potentially critical social feedback reported the greatest anxiety three-years later, controlling for baseline anxiety symptoms. Findings highlight the importance of avoidance in real-world socially threatening scenarios in contributing to and maintaining anxiety. Findings also highlight the value of studying attention biases that contribute to anxiety symptoms among adolescents using reliable methods and in real-world contexts.
{"title":"Predicting anxiety symptoms through gaze-directed attention: A mobile eye-tracking study of adolescents during a real-world speech task","authors":"Emily Hutchinson , Erica Huynh , Mary Woody , Dev Chopra , Amelia Lint , Enoch Du , Kristy Benoit Allen , Cecile Ladouceur , Jennifer Silk","doi":"10.1016/j.janxdis.2025.103058","DOIUrl":"10.1016/j.janxdis.2025.103058","url":null,"abstract":"<div><div>Adolescence is a key period in which anxiety symptoms dramatically increase, particularly among adolescent girls. Identifying potentially-modifiable risk factors that contribute to anxiety symptoms may be critical to mitigate anxiety symptoms and disorders among youth. Attention biases are one set of cognitive risk factors implicated in the development and maintenance of anxiety disorders. Yet previous research remains mixed as to what pattern of attention bias characterizes adolescents at-risk for developing anxiety. Further, prior literature has largely relied on indirect measures of attention (e.g., reaction time) and tasks with low ecological validity. The present study investigated how attention to social evaluative feedback contributed to concurrent and prospective anxiety symptoms in adolescent girls (n = 90, baseline <em>M</em><sub>age</sub> = 12.31, <em>SD</em> =.83). The present study used a novel speech task and mobile eye-tracking technology to assess gaze-directed attention in an ecologically valid context that adolescents encounter daily. We hypothesized that adolescents who engage in vigilance, avoidance, and the combination of vigilance-avoidance of potentially critical social evaluative feedback would report greater concurrent and prospective anxiety symptoms. We also explored the association between gaze-directed attention to positive social feedback. Contrary to our hypotheses, adolescents who exhibited both initial and sustained avoidance of potentially critical social feedback reported the greatest anxiety three-years later, controlling for baseline anxiety symptoms. Findings highlight the importance of avoidance in real-world socially threatening scenarios in contributing to and maintaining anxiety. Findings also highlight the value of studying attention biases that contribute to anxiety symptoms among adolescents using reliable methods and in real-world contexts.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"115 ","pages":"Article 103058"},"PeriodicalIF":4.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144903216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01Epub Date: 2025-09-11DOI: 10.1016/j.janxdis.2025.103070
Matti Cervin , Philip C. Kendall , John C. Piacentini , Elizabeth A. Gosch , Jeffrey J. Wood , Sophie C. Schneider , Alison Salloum , Boris Birmaher , Andrew G. Guzick , David Mataix-Cols , Eric A. Storch
Youth anxiety disorders are common and heterogeneous. The Pediatric Anxiety Rating Scale (PARS) is a clinician-administered tool designed to assess overall anxiety severity, independent of specific symptoms. The thresholds on PARS for the reliable change index (RCI), the minimal clinically important difference (MCID), treatment response, and full and partial remission remain unclear. Using the Clinical Global Impression (CGI) scales and diagnostic interviews as benchmark measures, several thresholds for the 6-item PARS were estimated using data from 904 youth with anxiety disorders, of which 36 % had an autism diagnosis. Data were drawn from 9 clinical trials conducted in the United States. Threshold accuracy was evaluated in a holdout sample and in an independent Swedish sample (n = 49). The reliable change index (RCI) was 3.39 points. A raw score reduction of ≥ 4 points or a ≥ 20 % reduction best defined the MCID. A raw score reduction of ≥ 8 points or a ≥ 43 % reduction best defined treatment response. Scores of 0–10 after treatment accurately defined full and partial remission, and scores of 0–5 defined full remission. Threshold accuracies ranged from 74–91 % in the holdout and 67–78 % in the Swedish sample. Treatment response accuracy was similar across samples, while MCID accuracy was lower in the Swedish sample. Similar cutoffs emerged in youth with and without autism and across age groups and genders. Threshold accuracies for the 5- and 7-item PARS versions were comparable to the 6-item version. This study establishes response and remission thresholds for PARS that are applicable across age groups, genders, and autism status. We advise against using the RCI as it does not exceed the MCID.
{"title":"Assessing reliable change, MCID, treatment response, and remission using the Pediatric Anxiety Rating Scale (PARS) in youth with anxiety disorders","authors":"Matti Cervin , Philip C. Kendall , John C. Piacentini , Elizabeth A. Gosch , Jeffrey J. Wood , Sophie C. Schneider , Alison Salloum , Boris Birmaher , Andrew G. Guzick , David Mataix-Cols , Eric A. Storch","doi":"10.1016/j.janxdis.2025.103070","DOIUrl":"10.1016/j.janxdis.2025.103070","url":null,"abstract":"<div><div>Youth anxiety disorders are common and heterogeneous. The Pediatric Anxiety Rating Scale (PARS) is a clinician-administered tool designed to assess overall anxiety severity, independent of specific symptoms. The thresholds on PARS for the reliable change index (RCI), the minimal clinically important difference (MCID), treatment response, and full and partial remission remain unclear. Using the Clinical Global Impression (CGI) scales and diagnostic interviews as benchmark measures, several thresholds for the 6-item PARS were estimated using data from 904 youth with anxiety disorders, of which 36 % had an autism diagnosis. Data were drawn from 9 clinical trials conducted in the United States. Threshold accuracy was evaluated in a holdout sample and in an independent Swedish sample (<em>n</em> = 49). The reliable change index (RCI) was 3.39 points. A raw score reduction of ≥ 4 points or a ≥ 20 % reduction best defined the MCID. A raw score reduction of ≥ 8 points or a ≥ 43 % reduction best defined treatment response. Scores of 0–10 after treatment accurately defined full and partial remission, and scores of 0–5 defined full remission. Threshold accuracies ranged from 74–91 % in the holdout and 67–78 % in the Swedish sample. Treatment response accuracy was similar across samples, while MCID accuracy was lower in the Swedish sample. Similar cutoffs emerged in youth with and without autism and across age groups and genders. Threshold accuracies for the 5- and 7-item PARS versions were comparable to the 6-item version. This study establishes response and remission thresholds for PARS that are applicable across age groups, genders, and autism status. We advise against using the RCI as it does not exceed the MCID.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"115 ","pages":"Article 103070"},"PeriodicalIF":4.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01Epub 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":"2025-10-01","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 : 2025-10-01Epub Date: 2025-09-18DOI: 10.1016/j.janxdis.2025.103073
Kayla R. Steele , Emily Upton , Monique Holden , Amy Regan , Matthew J. Coleshill , Sophie Li , Amy E. Joubert , Alison E.J. Mahoney , Michael Millard , Jill M. Newby
This is the first randomised controlled trial (RCT) to examine the efficacy of intensive internet-delivered CBT (iCBT) for social anxiety disorder (SAD). Adults (mean age: 44.77 years, 75.4 % female) diagnosed with SAD were randomly allocated to iCBT (n = 33) or a waitlist control group (WLC; n = 28). The iCBT group received a clinician-guided, six lesson program delivered online over seven days. Participants completed self-report measures of social anxiety and depression symptoms, and functional impairment at two- (post-treatment) and six-weeks post-baseline (one-month follow-up), and a diagnostic interview to assess SAD and major depressive disorder (MDD) at baseline and one-month follow-up. The iCBT group reported significantly lower social anxiety symptoms (Hedges’ g’s > .96), and functional impairment at post and one-month follow-up (g’s > .59), but there were no significant differences in depression symptoms (g’s = .42). Participants in the iCBT group were less likely to continue to meet criteria for SAD (47.6 %) at follow-up compared to WLC (96.4 %). Adherence (83.9 % completion) and program satisfaction (85.2 % reported being ‘mostly’ or ‘very satisfied’) were promising. Delivering iCBT over an intensive treatment period is feasible and acceptable to participants with SAD and showed promise for reducing social anxiety and functional impairment. Further research is needed to compare intensive iCBT with active control groups, using a larger and more diverse sample and longer-term outcomes.
{"title":"Intensive 7-day internet-delivered cognitive behavioural therapy for social anxiety disorder: A randomized controlled trial","authors":"Kayla R. Steele , Emily Upton , Monique Holden , Amy Regan , Matthew J. Coleshill , Sophie Li , Amy E. Joubert , Alison E.J. Mahoney , Michael Millard , Jill M. Newby","doi":"10.1016/j.janxdis.2025.103073","DOIUrl":"10.1016/j.janxdis.2025.103073","url":null,"abstract":"<div><div>This is the first randomised controlled trial (RCT) to examine the efficacy of intensive internet-delivered CBT (iCBT) for social anxiety disorder (SAD). Adults (mean age: 44.77 years, 75.4 % female) diagnosed with SAD were randomly allocated to iCBT (<em>n</em> = 33) or a waitlist control group (WLC; <em>n</em> = 28). The iCBT group received a clinician-guided, six lesson program delivered online over seven days. Participants completed self-report measures of social anxiety and depression symptoms, and functional impairment at two- (post-treatment) and six-weeks post-baseline (one-month follow-up), and a diagnostic interview to assess SAD and major depressive disorder (MDD) at baseline and one-month follow-up. The iCBT group reported significantly lower social anxiety symptoms (Hedges’ <em>g’</em>s > .96), and functional impairment at post and one-month follow-up (<em>g’s</em> > .59), but there were no significant differences in depression symptoms (<em>g</em>’s = .42). Participants in the iCBT group were less likely to continue to meet criteria for SAD (47.6 %) at follow-up compared to WLC (96.4 %). Adherence (83.9 % completion) and program satisfaction (85.2 % reported being ‘mostly’ or ‘very satisfied’) were promising. Delivering iCBT over an intensive treatment period is feasible and acceptable to participants with SAD and showed promise for reducing social anxiety and functional impairment. Further research is needed to compare intensive iCBT with active control groups, using a larger and more diverse sample and longer-term outcomes.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"115 ","pages":"Article 103073"},"PeriodicalIF":4.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01Epub 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":"2025-10-01","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}