Pub Date : 2025-06-07DOI: 10.1016/j.janxdis.2025.103046
L. FitzGibbon , J. Morriss , M. Clasen , S. Wake , R. Nesbit , M. Malmdorf Andersen , H.F. Dodd
In this field study, we examined for the first time how Intolerance of Uncertainty influences expectations about negative, positive, and anxiety-related affect alongside the accuracy of those expectations. The study was conducted at a horror attraction, which offers an immersive, uncertain and threat-related experience. Participants (n = 1029) completed a measure of forecasted negative, positive and anxiety-related affect prior to the experience. Immediately after the experience, they rated their actual subjective experience of each of these affective states. Additionally, confidence ratings were reported for each forecasted emotion so that metacognitive awareness of forecasting accuracy could be assessed. Results showed that participants high in IU anticipated and actually experienced less positive affect, more anxiety-related affect and more negative-affect compared to those low in IU. IU predicted bias (overestimations) in emotional forecasts for negative affect, but not for positive or anxiety-related affect. The findings demonstrate that IU may be related to affective forecasting, which has implications for transdiagnostic models and treatment of psychopathology.
{"title":"Affective forecasting during a horror attraction: Insights into Intolerance of Uncertainty","authors":"L. FitzGibbon , J. Morriss , M. Clasen , S. Wake , R. Nesbit , M. Malmdorf Andersen , H.F. Dodd","doi":"10.1016/j.janxdis.2025.103046","DOIUrl":"10.1016/j.janxdis.2025.103046","url":null,"abstract":"<div><div>In this field study, we examined for the first time how Intolerance of Uncertainty influences expectations about negative, positive, and anxiety-related affect alongside the accuracy of those expectations. The study was conducted at a horror attraction, which offers an immersive, uncertain and threat-related experience. Participants (n = 1029) completed a measure of forecasted negative, positive and anxiety-related affect prior to the experience. Immediately after the experience, they rated their actual subjective experience of each of these affective states. Additionally, confidence ratings were reported for each forecasted emotion so that metacognitive awareness of forecasting accuracy could be assessed. Results showed that participants high in IU anticipated and actually experienced less positive affect, more anxiety-related affect and more negative-affect compared to those low in IU. IU predicted bias (overestimations) in emotional forecasts for negative affect, but not for positive or anxiety-related affect. The findings demonstrate that IU may be related to affective forecasting, which has implications for transdiagnostic models and treatment of psychopathology.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"114 ","pages":"Article 103046"},"PeriodicalIF":4.8,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307296","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 : 2025-06-06DOI: 10.1016/j.janxdis.2025.103045
Gabriel Esteller-Collado , Virtudes Pérez-Jover , Carlos Van-der Hofstadt Román , Elisabeth Malonda-Vidal , Anna Llorca-Mestre , Maider Prieto-Vila , María Carpallo-González , César González-Blanch , Paloma Ruíz-Rodríguez , Juan Antonio Moriana , Antonio Cano-Vindel , Roger Muñoz-Navarro
Introduction
Anxiety and depressive disorders represent a public health challenge, with high prevalence rates and considerable impact on quality of life (QoL) and functioning. Despite evidence supporting the efficacy of transdiagnostic cognitive behavioural therapy (TD-CBT), its implementation in settings such as primary care (PC) remains limited. The aim of this paper is to analyse the results of the PsicAP-CV, a clinical trial evaluating the effectiveness and implementation of TD-CBT in the PC setting.
Methods
The study included 320 patients from the PsicAP-CV trial, a Stepped Wedge Cluster-Randomised Trial (SW-CRT). Symptoms of anxiety and depression were assessed, as well as QoL and functioning. Linear models were used to study treatment effects on outcomes and rates of recovery, reliable recovery and deterioration were calculated.
Results
findings indicate that TD-CBT is more effective than treatment-as-usual (TAU) in reducing symptoms of anxiety and depression, as well as improving QoL and functioning. In addition, although the overall reduction in symptomatology was similar between patients who received immediate treatment (EG1) and those who received delayed treatment (EG2), there was a trend in favour of the EG1 group in the recovery indicators.
Discussion
these findings confirm the efficacy of TD-CBT for treating common mental disorders in PC and point to SW-CRT designs as a feasible and ethically sound avenue for implementing and scaling these evidence-based interventions within public health systems. They also support the broader integration of psychologists into PC, thus offering a scalable model that can significantly improve access to and outcomes of mental health care.
{"title":"Effectiveness of the implementation of transdiagnostic PsicAP-CV protocol for anxiety and depression in primary care: A Stepped Wedge Cluster Randomised Trial","authors":"Gabriel Esteller-Collado , Virtudes Pérez-Jover , Carlos Van-der Hofstadt Román , Elisabeth Malonda-Vidal , Anna Llorca-Mestre , Maider Prieto-Vila , María Carpallo-González , César González-Blanch , Paloma Ruíz-Rodríguez , Juan Antonio Moriana , Antonio Cano-Vindel , Roger Muñoz-Navarro","doi":"10.1016/j.janxdis.2025.103045","DOIUrl":"10.1016/j.janxdis.2025.103045","url":null,"abstract":"<div><h3>Introduction</h3><div>Anxiety and depressive disorders represent a public health challenge, with high prevalence rates and considerable impact on quality of life (QoL) and functioning. Despite evidence supporting the efficacy of transdiagnostic cognitive behavioural therapy (TD-CBT), its implementation in settings such as primary care (PC) remains limited. The aim of this paper is to analyse the results of the PsicAP-CV, a clinical trial evaluating the effectiveness and implementation of TD-CBT in the PC setting.</div></div><div><h3>Methods</h3><div>The study included 320 patients from the PsicAP-CV trial, a Stepped Wedge Cluster-Randomised Trial (SW-CRT). Symptoms of anxiety and depression were assessed, as well as QoL and functioning. Linear models were used to study treatment effects on outcomes and rates of recovery, reliable recovery and deterioration were calculated.</div></div><div><h3>Results</h3><div>findings indicate that TD-CBT is more effective than treatment-as-usual (TAU) in reducing symptoms of anxiety and depression, as well as improving QoL and functioning. In addition, although the overall reduction in symptomatology was similar between patients who received immediate treatment (EG<sub>1</sub>) and those who received delayed treatment (EG<sub>2</sub>), there was a trend in favour of the EG<sub>1</sub> group in the recovery indicators.</div></div><div><h3>Discussion</h3><div>these findings confirm the efficacy of TD-CBT for treating common mental disorders in PC and point to SW-CRT designs as a feasible and ethically sound avenue for implementing and scaling these evidence-based interventions within public health systems. They also support the broader integration of psychologists into PC, thus offering a scalable model that can significantly improve access to and outcomes of mental health care.</div></div><div><h3>Trial registration</h3><div>EURADICT 2013-001955-11/ISRCTN58437086.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"114 ","pages":"Article 103045"},"PeriodicalIF":4.8,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144291021","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 : 2025-06-02DOI: 10.1016/j.janxdis.2025.103038
Sarah M. Kowall , Natalie Mota , Essence Perera , Nisali Muthumuni , Shay-Lee Bolton
Background
Posttraumatic stress disorder (PTSD) can be impacted by the type of trauma exposure. This is important to consider when evaluating the likelihood of having PTSD among Canadian veterans, which previous literature has not examined. The aim of this study was to: 1) Examine the prevalence and conditional probability of PTSD over a 16 year period by trauma type, differentiating by sex, and 2) Explore this relationship by worst trauma type.
Methods
We examined the prevalence of PTSD by sex among those with any exposure to 26 traumatic events, and used logistic regressions to examine trauma type and PTSD. The conditional probability of having PTSD over the 16-year follow-up period (2002–2018) and in the past year was calculated using population attributable fractions (PAFs). Identical analyses were used to examine the conditional probability of PTSD related to a self-reported ‘worst event’.
Results
Over the 16-year follow-up, we found that males showed higher conditional likelihood of developing PTSD from exposure to sexual trauma while females showed a higher conditional likelihood of developing PTSD from exposure to an accidentrelated trauma. For the probability of PTSD conditional on the worst event, accidentrelated or sexual trauma in females, and sexual and deployment-related trauma in males showed the highest PAF and strongest relationship.
Conclusion
This research supports differences in PTSD prevalence depending on the type of traumatic exposure. Importantly, different patterns of conditional probability of PTSD emerged by sex. These findings can provide important information for mental health providers within the military treating multiple traumas.
{"title":"Conditional probability of posttraumatic stress disorder in the Canadian Armed Forces: A longitudinal study","authors":"Sarah M. Kowall , Natalie Mota , Essence Perera , Nisali Muthumuni , Shay-Lee Bolton","doi":"10.1016/j.janxdis.2025.103038","DOIUrl":"10.1016/j.janxdis.2025.103038","url":null,"abstract":"<div><h3>Background</h3><div>Posttraumatic stress disorder (PTSD) can be impacted by the type of trauma exposure. This is important to consider when evaluating the likelihood of having PTSD among Canadian veterans, which previous literature has not examined. The aim of this study was to: 1) Examine the prevalence and conditional probability of PTSD over a 16 year period by trauma type, differentiating by sex, and 2) Explore this relationship by worst trauma type.</div></div><div><h3>Methods</h3><div>We examined the prevalence of PTSD by sex among those with any exposure to 26 traumatic events, and used logistic regressions to examine trauma type and PTSD. The conditional probability of having PTSD over the 16-year follow-up period (2002–2018) and in the past year was calculated using population attributable fractions (PAFs). Identical analyses were used to examine the conditional probability of PTSD related to a self-reported ‘worst event’.</div></div><div><h3>Results</h3><div>Over the 16-year follow-up, we found that males showed higher conditional likelihood of developing PTSD from exposure to sexual trauma while females showed a higher conditional likelihood of developing PTSD from exposure to an accidentrelated trauma. For the probability of PTSD conditional on the worst event, accidentrelated or sexual trauma in females, and sexual and deployment-related trauma in males showed the highest PAF and strongest relationship.</div></div><div><h3>Conclusion</h3><div>This research supports differences in PTSD prevalence depending on the type of traumatic exposure. Importantly, different patterns of conditional probability of PTSD emerged by sex. These findings can provide important information for mental health providers within the military treating multiple traumas.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"114 ","pages":"Article 103038"},"PeriodicalIF":4.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298143","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 : 2025-05-28DOI: 10.1016/j.janxdis.2025.103037
Jon D. Elhai , Silvia Casale , Rachel A. Bond
The fear of missing out (FOMO) involves an apprehension of missing out on rewarding experiences, and a desire to continually stay connected with people. However, this two-dimension conceptualization of FOMO has not been properly empirically examined. We examined this two-factor model using confirmatory factor analysis in 326 American college students, and 433 Italian participants recruited through social media. We discovered that in both samples, the two-factor model fit well; e.g., the US sample’s comparative fit index (CFI) = .990, Tucker-Lewis Index (TLI) = .985; Italian sample’s CFI = .941, TLI = .917. The two-factor model fit significantly better than a one-factor model in both samples (ps<.001) (though magnitude of differences was small, with CFI differences ranging from .001–.007). In both samples, problematic social media use severity was more correlated (ps<.001) with FOMO’s constant connection desire factor (US sample r = .749; Italian sample r = .845) than apprehension of missing out factor (US sample r = .622; Italian sample r = .500). In the American sample, problematic smartphone use severity also correlated more (p < .001) with constant connection desire (r = .668) than apprehension of missing out (r = .587). However, in the American sample depression severity correlated equally (ps>.05) with FOMO’s constant connection desire (r = .466) and apprehension of missing out (r = .503) factors; generalized anxiety disorder symptoms also equally correlated (ps>.05) with FOMO’s constant connection desire (r = .470) and apprehension of missing out (r = .508). We discuss implications of our findings for measurement of FOMO, and FOMO’s relationship with problematic Internet use and negative affectivity.
{"title":"FOMO’s apprehension of missing out and constant connection desire dimensions differentially correlate with problematic smartphone and social media use, but not with depression or generalized anxiety","authors":"Jon D. Elhai , Silvia Casale , Rachel A. Bond","doi":"10.1016/j.janxdis.2025.103037","DOIUrl":"10.1016/j.janxdis.2025.103037","url":null,"abstract":"<div><div>The fear of missing out (FOMO) involves an apprehension of missing out on rewarding experiences, and a desire to continually stay connected with people. However, this two-dimension conceptualization of FOMO has not been properly empirically examined. We examined this two-factor model using confirmatory factor analysis in 326 American college students, and 433 Italian participants recruited through social media. We discovered that in both samples, the two-factor model fit well; e.g., the US sample’s comparative fit index (CFI) = .990, Tucker-Lewis Index (TLI) = .985; Italian sample’s CFI = .941, TLI = .917. The two-factor model fit significantly better than a one-factor model in both samples (ps<.001) (though magnitude of differences was small, with CFI differences ranging from .001–.007). In both samples, problematic social media use severity was more correlated (ps<.001) with FOMO’s constant connection desire factor (US sample r = .749; Italian sample r = .845) than apprehension of missing out factor (US sample r = .622; Italian sample r = .500). In the American sample, problematic smartphone use severity also correlated more (p < .001) with constant connection desire (r = .668) than apprehension of missing out (r = .587). However, in the American sample depression severity correlated equally (ps>.05) with FOMO’s constant connection desire (r = .466) and apprehension of missing out (r = .503) factors; generalized anxiety disorder symptoms also equally correlated (ps>.05) with FOMO’s constant connection desire (r = .470) and apprehension of missing out (r = .508). We discuss implications of our findings for measurement of FOMO, and FOMO’s relationship with problematic Internet use and negative affectivity.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"114 ","pages":"Article 103037"},"PeriodicalIF":4.8,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144196295","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 : 2025-05-23DOI: 10.1016/j.janxdis.2025.103036
Lieke C.J. Nijborg , Gerben J. Westerhof , Justina Pociūnaitė-Ott , Maarten J.J. Kunst , Jos de Keijser , Lonneke I.M. Lenferink
Violent losses increase the risk for prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD). Little is known about the course of grief-related psychopathology in the long term. Hence, we examined their latent trajectories, overlap, and predictors to enhance our understanding of differential long-term responses to violent loss. MH17-bereaved people (N = 299) completed annual self-report measures from one to nine years post-loss. Prolonged grief (PG), posttraumatic stress (PTS), and major depression (MD) symptom trajectories were identified using latent class growth modeling. Overlap in trajectory membership was examined using frequencies. Predictors of trajectory membership were examined using multinomial regression analyses. Four PG symptom trajectories emerged: low (41.0 %), moderate decreasing (34.2 %), high (13.5 %), and recovered (11.3 %). Four PTS symptom trajectories emerged: low (56.2 %), recovered (19.6 %), moderate increasing (17.6 %), and high (6.6 %). Four MD symptom trajectories emerged: low (55.7 %), moderate (19.6 %), moderate decreasing (15.1 %), and high (9.5 %). The findings indicate that if people report psychopathology, this often entails PGD by itself, and sometimes in combination with PTSD and MDD, yet rarely PTSD or MDD by itself. Around one in 20 people was assigned to all three high symptom trajectories. Different predictors were found across disorders. To conclude, most MH17-bereaved people reported low grief-related psychopathology, yet one in six reported high grief-related psychopathology levels (i.e., at least probable PGD, PTSD, or MDD) nearly a decade later. There is no indication of a delayed onset of grief-related psychopathology.
{"title":"Trajectories of grief-related psychopathology: A decade after the MH17 plane disaster","authors":"Lieke C.J. Nijborg , Gerben J. Westerhof , Justina Pociūnaitė-Ott , Maarten J.J. Kunst , Jos de Keijser , Lonneke I.M. Lenferink","doi":"10.1016/j.janxdis.2025.103036","DOIUrl":"10.1016/j.janxdis.2025.103036","url":null,"abstract":"<div><div>Violent losses increase the risk for prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD). Little is known about the course of grief-related psychopathology in the long term. Hence, we examined their latent trajectories, overlap, and predictors to enhance our understanding of differential long-term responses to violent loss. MH17-bereaved people (<em>N</em> = 299) completed annual self-report measures from one to nine years post-loss. Prolonged grief (PG), posttraumatic stress (PTS), and major depression (MD) symptom trajectories were identified using latent class growth modeling. Overlap in trajectory membership was examined using frequencies. Predictors of trajectory membership were examined using multinomial regression analyses. Four PG symptom trajectories emerged: low (41.0 %), moderate decreasing (34.2 %), high (13.5 %), and recovered (11.3 %). Four PTS symptom trajectories emerged: low (56.2 %), recovered (19.6 %), moderate increasing (17.6 %), and high (6.6 %). Four MD symptom trajectories emerged: low (55.7 %), moderate (19.6 %), moderate decreasing (15.1 %), and high (9.5 %). The findings indicate that if people report psychopathology, this often entails PGD by itself, and sometimes in combination with PTSD and MDD, yet rarely PTSD or MDD by itself. Around one in 20 people was assigned to all three high symptom trajectories. Different predictors were found across disorders. To conclude, most MH17-bereaved people reported low grief-related psychopathology, yet one in six reported high grief-related psychopathology levels (i.e., at least probable PGD, PTSD, or MDD) nearly a decade later. There is no indication of a delayed onset of grief-related psychopathology.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"114 ","pages":"Article 103036"},"PeriodicalIF":4.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144471064","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 : 2025-05-20DOI: 10.1016/j.janxdis.2025.103026
Bingyi Wang , Qiqiao Zhang , Ke Liu , Leiwen Fu , Cailing Ao , Peng Zhang , Chaohua Lan , Qiongfang Wu , Fang Yang , Yong Lu , Xiaobing Fu , Yan Li
Background
Despite anxiety disorders being a significant public health concern, studies assessing their global burden among older adults are limited. We aimed to analyse trends in the global burden of anxiety disorders in older adults aged ≥ 55 years.
Methods
Data on the incidence and disability-adjusted life-years (DALYs) for anxiety disorders were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. Temporal trends were quantified using estimated annual percentage changes.
Results
In 2021, global DALYs for anxiety disorders were estimated at 8.21 million (95 % UI 5.62–11.48 million), nearly 2.5 times higher than in 1990, with an age-standardised rate of 552.7 DALYs (95 % UI 378.1–772.5) per 100,000 population. Between 1990 and 2021, the age-standardised DALY rate (ASDR) remained stable (−0.05 % [95 % CI −0.16–0.05]), with minimal differences between men (0.04 % [−0.05–0.12]) and women (−0.08 % [−0.21–0.05]). The 55–59 age group showed the highest ASDR (538.5 [361.3–767.7] per 100,000 population). The highest increases in ASDR were observed in the low-middle (0.15 % [0.03–0.28]) and low sociodemographic index regions (0.09 % [0.02–0.15]). The regions with the highest ASDRs were Latin America, Western Europe, and High-income North America.
Conclusion
While global trends in anxiety disorders among older adults remained stable, the total burden increased significantly, with marked regional disparities. Tailored mental health interventions, early detection, and treatment in primary care are essential to reduce the future burden of anxiety disorders in older adults, especially in low and middle-income countries.
{"title":"Burden of anxiety disorders among older adults aged ≥ 55 years in 204 countries and territories, 1990–2021: A population-based study","authors":"Bingyi Wang , Qiqiao Zhang , Ke Liu , Leiwen Fu , Cailing Ao , Peng Zhang , Chaohua Lan , Qiongfang Wu , Fang Yang , Yong Lu , Xiaobing Fu , Yan Li","doi":"10.1016/j.janxdis.2025.103026","DOIUrl":"10.1016/j.janxdis.2025.103026","url":null,"abstract":"<div><h3>Background</h3><div>Despite anxiety disorders being a significant public health concern, studies assessing their global burden among older adults are limited. We aimed to analyse trends in the global burden of anxiety disorders in older adults aged ≥ 55 years.</div></div><div><h3>Methods</h3><div>Data on the incidence and disability-adjusted life-years (DALYs) for anxiety disorders were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. Temporal trends were quantified using estimated annual percentage changes.</div></div><div><h3>Results</h3><div>In 2021, global DALYs for anxiety disorders were estimated at 8.21 million (95 % UI 5.62–11.48 million), nearly 2.5 times higher than in 1990, with an age-standardised rate of 552.7 DALYs (95 % UI 378.1–772.5) per 100,000 population. Between 1990 and 2021, the age-standardised DALY rate (ASDR) remained stable (−0.05 % [95 % CI −0.16–0.05]), with minimal differences between men (0.04 % [−0.05–0.12]) and women (−0.08 % [−0.21–0.05]). The 55–59 age group showed the highest ASDR (538.5 [361.3–767.7] per 100,000 population). The highest increases in ASDR were observed in the low-middle (0.15 % [0.03–0.28]) and low sociodemographic index regions (0.09 % [0.02–0.15]). The regions with the highest ASDRs were Latin America, Western Europe, and High-income North America.</div></div><div><h3>Conclusion</h3><div>While global trends in anxiety disorders among older adults remained stable, the total burden increased significantly, with marked regional disparities. Tailored mental health interventions, early detection, and treatment in primary care are essential to reduce the future burden of anxiety disorders in older adults, especially in low and middle-income countries.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"113 ","pages":"Article 103026"},"PeriodicalIF":4.8,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144189851","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 : 2025-05-20DOI: 10.1016/j.janxdis.2025.103028
Philippe Landreville , Patrick Gosselin , Sébastien Grenier , Pierre-Hugues Carmichael
Treatments for generalized anxiety disorder (GAD) that circumvent the barriers to accessing mental health care in older adults are needed. The main goal of this multisite randomized controlled trial was to evaluate the efficacy of CBT-based self-help guided by a lay provider (LP) for generalized anxiety (i.e., threshold or subthreshold GAD) in older adults. Participants (≥ 60 years) were block randomized based on diagnosis to an experimental (n = 75) or wait-list control group (n = 75). Experimental group participants used a manual presenting CBT-based readings and exercises and received brief weekly support calls by LPs. Groups were similar in terms of sociodemographic characteristics and initially did not differ significantly on outcomes. At post-treatment, the experimental group showed greater improvement across both primary outcomes (i.e., worry tendency, p < .0001, Standardized mean difference [SMD] = −1.5971, and GAD severity, p < .0001, SMD = −1.1639) and most additional outcomes (e.g., targeted psychological vulnerabilities, depressive symptoms, sleep difficulties, and GAD diagnosis) with small to large effect sizes (SMD = −0.4358 to −1.5402). The experimental group also showed maintenance of treatment effects or other improvements at 6- and 12-month follow-up. Participants in the control group who completed the treatment after their waiting period also improved on worry tendency (SMD = −1.2477) and GAD severity (SMD = −0.8443) and most of the other variables (SMD = −0.3728 to −1.0154). Results demonstrate that self-help guided by a LP is effective for treating GAD in older adults and that the improvements are sustained after treatment.
{"title":"CBT-based self-help guided by a lay provider for generalized anxiety in older adults: A randomized controlled trial","authors":"Philippe Landreville , Patrick Gosselin , Sébastien Grenier , Pierre-Hugues Carmichael","doi":"10.1016/j.janxdis.2025.103028","DOIUrl":"10.1016/j.janxdis.2025.103028","url":null,"abstract":"<div><div>Treatments for generalized anxiety disorder (GAD) that circumvent the barriers to accessing mental health care in older adults are needed. The main goal of this multisite randomized controlled trial was to evaluate the efficacy of CBT-based self-help guided by a lay provider (LP) for generalized anxiety (i.e., threshold or subthreshold GAD) in older adults. Participants (≥ 60 years) were block randomized based on diagnosis to an experimental (<em>n</em> = 75) or wait-list control group (<em>n</em> = 75). Experimental group participants used a manual presenting CBT-based readings and exercises and received brief weekly support calls by LPs. Groups were similar in terms of sociodemographic characteristics and initially did not differ significantly on outcomes. At post-treatment, the experimental group showed greater improvement across both primary outcomes (i.e., worry tendency, <em>p</em> < .0001, Standardized mean difference [SMD] = −1.5971, and GAD severity, p < .0001, SMD = −1.1639) and most additional outcomes (e.g., targeted psychological vulnerabilities, depressive symptoms, sleep difficulties, and GAD diagnosis) with small to large effect sizes (SMD = −0.4358 to −1.5402). The experimental group also showed maintenance of treatment effects or other improvements at 6- and 12-month follow-up. Participants in the control group who completed the treatment after their waiting period also improved on worry tendency (SMD = −1.2477) and GAD severity (SMD = −0.8443) and most of the other variables (SMD = −0.3728 to −1.0154). Results demonstrate that self-help guided by a LP is effective for treating GAD in older adults and that the improvements are sustained after treatment.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"113 ","pages":"Article 103028"},"PeriodicalIF":4.8,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144189852","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 : 2025-05-14DOI: 10.1016/j.janxdis.2025.103027
Elizabeth Alpert , Annie B. Fox , Tara E. Galovski
Standardized measures have typically been used to assess symptom change during treatment in psychological research and practice. However, standardized measures may not fully capture patients' experiences of therapeutic change. Patients' global reports of their improvement during treatment across domains of symptoms and functioning are also important and may provide distinct information from standardized measures. The current study compared both types of patient reports of improvement during cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD). We also examined process-level predictors of improvement assessed using both methods. Participants were 254 adult survivors of interpersonal violence receiving CPT. Patients' global reports of improvement in each domain (PTSD symptoms, relationships, health concerns, sexual functioning, school/work performance, and life satisfaction), each rated on a Likert scale via the Treatment Outcome Questionnaire, were significantly correlated with the corresponding standardized measure of improvement in the same domain, with most effect sizes in the small-to-medium range. Patients' perceptions of the therapy (helpfulness, likability) significantly predicted both global ratings and standardized measures of improvement, while patients' perceptions of the therapeutic relationship, patients' perceptions of barriers to therapy attendance, and objective indices of attendance did not predict improvement. Results highlight the importance of patients' experiences with treatment and suggest that assessing patients' global ratings of their improvement during treatment provides distinct information from standardized measures of improvement, and both are important to include when measuring therapeutic change.
{"title":"Who defines improvement? Patients' global reports of improvement compared to standardized measures of improvement in cognitive processing therapy for posttraumatic stress disorder","authors":"Elizabeth Alpert , Annie B. Fox , Tara E. Galovski","doi":"10.1016/j.janxdis.2025.103027","DOIUrl":"10.1016/j.janxdis.2025.103027","url":null,"abstract":"<div><div>Standardized measures have typically been used to assess symptom change during treatment in psychological research and practice. However, standardized measures may not fully capture patients' experiences of therapeutic change. Patients' global reports of their improvement during treatment across domains of symptoms and functioning are also important and may provide distinct information from standardized measures. The current study compared both types of patient reports of improvement during cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD). We also examined process-level predictors of improvement assessed using both methods. Participants were 254 adult survivors of interpersonal violence receiving CPT. Patients' global reports of improvement in each domain (PTSD symptoms, relationships, health concerns, sexual functioning, school/work performance, and life satisfaction), each rated on a Likert scale via the Treatment Outcome Questionnaire, were significantly correlated with the corresponding standardized measure of improvement in the same domain, with most effect sizes in the small-to-medium range. Patients' perceptions of the therapy (helpfulness, likability) significantly predicted both global ratings and standardized measures of improvement, while patients' perceptions of the therapeutic relationship, patients' perceptions of barriers to therapy attendance, and objective indices of attendance did not predict improvement. Results highlight the importance of patients' experiences with treatment and suggest that assessing patients' global ratings of their improvement during treatment provides distinct information from standardized measures of improvement, and both are important to include when measuring therapeutic change.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"113 ","pages":"Article 103027"},"PeriodicalIF":4.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144071501","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 : 2025-05-08DOI: 10.1016/j.janxdis.2025.103025
Aleiia J.N. Asmundson , Michelle M. Paluszek , Jordana L. Sommer , Shay-Lee Bolton , Jitender Sareen , Tracie O. Afifi , Renée El-Gabalawy , Gordon J.G. Asmundson
Background
Posttraumatic stress disorder (PTSD) and chronic pain are highly prevalent, comorbid, and debilitating conditions in the military. The present study was designed to examine the prevalence of chronic pain conditions (i.e., migraines, back problems, arthritis) across PTSD courses (i.e., no PTSD, remitted, new onset, persistent/recurrent) and examine the association between PTSD course and the presence and onset of chronic pain conditions in a population-representative sample of Canadian military members. Methods: Cross-tabulations and logistic regressions were conducted on data (n = 2941) from the 2002 Canadian Community Health Survey Mental Health and Well-being Canadian Forces Supplement and the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-Up Survey. Results: The prevalence of chronic pain conditions across PTSD courses ranged from 8 % to 61 %, with no PTSD consistently having the lowest prevalence. After adjusting for covariates, respondents with new onset PTSD had elevated odds of back problems (AOR=1.43, 95 % CI [1.10–1.90], p < .05), arthritis (AOR=1.46, 95 % CI [1.06–2.00], p < .05), and a new onset chronic pain condition more broadly (AOR=1.66, 95 % CI [1.15–2.39], p < .01), compared to those with no PTSD. Those with remitted PTSD had greater odds of migraines (AOR=2.43, 95 % CI [1.29–4.58], p < .01), while those with persistent PTSD had lower odds of back problems (AOR=0.45, 95 % CI [0.23–0.88], p < .05), compared to those with no PTSD. Conclusion: Findings indicate that the prevalence and type of chronic pain that co-occurs with PSTD in Canadian military members varies as a function of the course of PTSD. This underscores the importance of evaluating pain in those with PTSD and suggests that the course of PTSD is a relevant consideration in case conceptualization and treatment planning.
背景：创伤后应激障碍（PTSD）和慢性疼痛是军队中非常普遍、合并症和衰弱性疾病。本研究旨在研究慢性疼痛状况（如偏头痛、背部问题、关节炎）在创伤后应激障碍病程（即无创伤后应激障碍、缓解、新发、持续/复发）中的患病率，并研究PTSD病程与慢性疼痛状况的存在和发作之间的关系。方法：对2002年加拿大社区卫生调查《加拿大军人心理健康与福祉补编》和2018年加拿大武装部队成员和退伍军人心理健康随访调查的数据（n = 2941）进行交叉表列和logistic回归分析。结果：创伤后应激障碍病程中慢性疼痛的患病率从8% %到61% %不等，无创伤后应激障碍的患病率始终最低。协变量调整后,受访者与新出现创伤后应激障碍的几率升高背部问题(优势比= 1.43,95 % CI [1.10 - -1.90], p & lt; . 05),关节炎(优势比= 1.46,95 % CI [1.06 - -2.00], p & lt; . 05),和一个新的出现慢性疼痛条件更广泛(优势比= 1.66,95 % CI [1.15 - -2.39], p & lt; . 01),而那些没有创伤后应激障碍。与无PTSD患者相比，PTSD缓解者偏头痛发生率更高（AOR=2.43, 95 % CI [1.29-4.58], p <； .01），而持续性PTSD患者背部问题发生率更低（AOR=0.45, 95 % CI [0.23-0.88], p <； .05）。结论：研究结果表明，加拿大军人PTSD并发慢性疼痛的患病率和类型随PTSD病程的变化而变化。这强调了评估创伤后应激障碍患者疼痛的重要性，并表明创伤后应激障碍的病程是病例概念化和治疗计划的相关考虑因素。
{"title":"Longitudinal course of posttraumatic stress disorder and chronic pain conditions: A population-based study of Canadian military personnel over 16 years","authors":"Aleiia J.N. Asmundson , Michelle M. Paluszek , Jordana L. Sommer , Shay-Lee Bolton , Jitender Sareen , Tracie O. Afifi , Renée El-Gabalawy , Gordon J.G. Asmundson","doi":"10.1016/j.janxdis.2025.103025","DOIUrl":"10.1016/j.janxdis.2025.103025","url":null,"abstract":"<div><h3>Background</h3><div>Posttraumatic stress disorder (PTSD) and chronic pain are highly prevalent, comorbid, and debilitating conditions in the military. The present study was designed to examine the prevalence of chronic pain conditions (i.e., migraines, back problems, arthritis) across PTSD courses (i.e., no PTSD, remitted, new onset, persistent/recurrent) and examine the association between PTSD course and the presence and onset of chronic pain conditions in a population-representative sample of Canadian military members. Methods: Cross-tabulations and logistic regressions were conducted on data (n = 2941) from the 2002 Canadian Community Health Survey Mental Health and Well-being Canadian Forces Supplement and the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-Up Survey. Results: The prevalence of chronic pain conditions across PTSD courses ranged from 8 % to 61 %, with no PTSD consistently having the lowest prevalence. After adjusting for covariates, respondents with new onset PTSD had elevated odds of back problems (AOR=1.43, 95 % CI [1.10–1.90], <em>p</em> < .05), arthritis (AOR=1.46, 95 % CI [1.06–2.00], <em>p</em> < .05), and a new onset chronic pain condition more broadly (AOR=1.66, 95 % CI [1.15–2.39], <em>p</em> < .01), compared to those with no PTSD. Those with remitted PTSD had greater odds of migraines (AOR=2.43, 95 % CI [1.29–4.58], <em>p</em> < .01), while those with persistent PTSD had lower odds of back problems (AOR=0.45, 95 % CI [0.23–0.88], <em>p</em> < .05), compared to those with no PTSD. Conclusion: Findings indicate that the prevalence and type of chronic pain that co-occurs with PSTD in Canadian military members varies as a function of the course of PTSD. This underscores the importance of evaluating pain in those with PTSD and suggests that the course of PTSD is a relevant consideration in case conceptualization and treatment planning.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"113 ","pages":"Article 103025"},"PeriodicalIF":4.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088960","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 : 2025-05-08DOI: 10.1016/j.janxdis.2025.103024
Tomoko Kishimoto , Ximing Hao , Qiyu Bai
Anxiety disorders are often characterized by excessive sympathetic activation and dysfunction. While breathing relaxation reliably reduces anxiety by dampening sympathetic activity and enhancing parasympathetic tone, the autonomic signatures underlying positive emotion interventions, such as savoring meditation, remain less understood. In this pilot randomized controlled trial, we recruited 44 participants with probable generalized anxiety disorders (GAD) by questionnaires (GAD-7 score ≥ 10, which represents moderate or higher anxiety severity), who were assigned to a savoring meditation (n = 22) or a breathing relaxation (n = 22) intervention. We measured heart rate variability (HRV) indicators (respiratory sinus arrhythmia, RSA; low-frequency HRV, LF; the low-frequency/high-frequency ratio, LF/HF) and self-reported emotional states (happiness, anxiety, sadness, calmness) before and after the intervention. Linear mixed models with multiple imputation examined outcome change between and within conditions. The savoring group exhibited increased sympathetic and decreased parasympathetic activity (significantly lower RSA, higher LF and LF/HF), contrasting with the relaxation group’s pattern. Both interventions resulted in significant and similar reductions in anxiety after worrying. These preliminary results suggest that savoring meditation for anxiety reduction may have unique autonomic signatures, offering novel insights for positive emotion interventions in anxiety research.
{"title":"The unique autonomic signatures of savoring meditation for anxiety reduction: A pilot randomized controlled trial","authors":"Tomoko Kishimoto , Ximing Hao , Qiyu Bai","doi":"10.1016/j.janxdis.2025.103024","DOIUrl":"10.1016/j.janxdis.2025.103024","url":null,"abstract":"<div><div>Anxiety disorders are often characterized by excessive sympathetic activation and dysfunction. While breathing relaxation reliably reduces anxiety by dampening sympathetic activity and enhancing parasympathetic tone, the autonomic signatures underlying positive emotion interventions, such as savoring meditation, remain less understood. In this pilot randomized controlled trial, we recruited 44 participants with probable generalized anxiety disorders (GAD) by questionnaires (GAD-7 score ≥ 10, which represents moderate or higher anxiety severity), who were assigned to a savoring meditation (<em>n</em> = 22) or a breathing relaxation (<em>n</em> = 22) intervention. We measured heart rate variability (HRV) indicators (respiratory sinus arrhythmia, RSA; low-frequency HRV, LF; the low-frequency/high-frequency ratio, LF/HF) and self-reported emotional states (happiness, anxiety, sadness, calmness) before and after the intervention. Linear mixed models with multiple imputation examined outcome change between and within conditions. The savoring group exhibited increased sympathetic and decreased parasympathetic activity (significantly lower RSA, higher LF and LF/HF), contrasting with the relaxation group’s pattern. Both interventions resulted in significant and similar reductions in anxiety after worrying. These preliminary results suggest that savoring meditation for anxiety reduction may have unique autonomic signatures, offering novel insights for positive emotion interventions in anxiety research.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"113 ","pages":"Article 103024"},"PeriodicalIF":4.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936291","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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