Randomized controlled trial of false safety behavior elimination therapy: a unified cognitive behavioral treatment for anxiety psychopathology

We tested the efficacy of a unified cognitive-behavioral therapy protocol for anxiety disorders. This group treatment protocol, termed false safety behavior elimination therapy (F-SET), is a cognitive-behavioral approach designed for use across various anxiety disorders such as panic disorder (PD), social anxiety disorder (SAD), and generalized anxiety disorder (GAD). F-SET simplifies, as well as broadens, key therapeutic elements of empirically validated treatments for anxiety disorders to allow for easier delivery to heterogeneous groups of patients with anxiety psychopathology. Patients with a primary anxiety disorder diagnosis (N=96) were randomly assigned to F-SET or a wait-list control. Data indicate that F-SET shows good efficacy and durability when delivered to mixed groups of patients with anxieties (i.e., PD, SAD, GAD) by relatively inexperienced clinicians. Findings are discussed in the context of balancing treatment efficacy and clinical utility.     

Generalized anxiety and panic disorders: Response to Cox, Cohen, Direnfeld, and Swinson (1996)

Contrary to the contention of Cox, Cohen, Direnfeld and Swinson (1996, Behaviour Research and Therapy, 34, 949–954) that the Beck Anxiety Inventory (BAI; Beck & Steer, 1993, Manual for the Beck Anxiety Inventory) measures primarily symptoms associated with panic attacks rather than anxiety in general, we propose that the higher level of anxiety found in patients with panic disorders not only is not an artifact of the BAI's symptom content, but patients with panic disorders truly have more anxiety than patients with other types of anxiety disorders. Furthermore, the BAI contains symptoms present in other anxiety disorders, besides panic disorder, and specifically includes 11 symptoms of generalized anxiety disorder (GAD). The BAI and revised Hamilton Anxiety Rating Scale (HARS-R; Riskind, Beck, Brown & Steer, 1987, Journal of Nervous and Mental Disease, 175, 474–479) scores of 274 (69%) outpatients with panic disorders and 123 (31%) outpatients with GAD were found to differentiate these two diagnostic groups equally and significantly. The panic disorder outpatients had higher scores on both the BAI and the HARS-R than did the GAD patients. Thus, Cox et al.'s (1996) speculation about the BAI's yielding spuriously high levels of anxiety in patients with panic disorders revives an important issue relevant to the relation of panic disorder to GAD.     

Emotional,behavioral, and cognitive factors that differentiate obsessive-compulsive disorder and other anxiety disorders in youth

Abstract

The current study examined specific emotional, behavioral, and cognitive variables that may distinguish obsessive-compulsive disorder (OCD) from generalized anxiety disorder (GAD), social phobia (SoP), and separation anxiety disorder (SAD) in youth. Youth with OCD (n=26) and other anxiety disorders (ADs; n=31), aged 7–12 years (56.1% males), and their parents participated. The study compared the two anxious groups on levels of emotional, behavioral, and cognitive functioning, as well as impairment associated with the disorder. Results indicated that in comparison to youth with GAD, SoP, or SAD, youth with OCD were found to have poorer emotion regulation skills, as well as greater oppositionality, cognitive problems/inattention, and parent impairment associated with the disorder. The findings suggest that there are unique characteristics of OCD that may differentiate this disorder from other ADs in youth. Potential clinical implications and directions for future research are discussed.     

Body image in social anxiety disorder,obsessive–compulsive disorder,and panic disorder

Body dysmorphic disorder falls under the category of obsessive–compulsive and related disorders, yet research has suggested it may also be highly associated with social anxiety disorder. The current study examined body image variables among 68 outpatients with primary obsessive–compulsive disorder (OCD; n = 22), social anxiety disorder (SAD; n = 25), and panic disorder (PD; n = 21). Participants filled out self-report measures of body image disturbance, attitudes toward one's appearance, and anxiety. Body image disturbance and attitudes toward appearance did not significantly differ between the groups. However, SAD symptoms predicted body image disturbance, Appearance Evaluation and Body Areas Satisfaction, and OCD symptoms predicted Appearance Orientation. These findings suggest that SAD and OCD may be associated with different facets of body image. Implications for the treatment of anxiety disorders and for future research are discussed.     

Test anxiety,anxiety disorders,and school-related wellbeing: Manifestations of the same or different constructs?

Previous studies have shown that highly test anxious persons are more likely to meet criteria for an anxiety disorder and report more frequent symptoms of anxiety disorders than their low test anxious counterparts. However, it is unclear whether test anxiety should be treated as distinct to, or a manifestation of, anxiety disorders. Furthermore, the Dual Factor Model of Mental Health proposes that high subjective wellbeing cannot be solely inferred from the absence of psychopathology. To date, no studies have examined the Dual Factor Model in relation to test anxiety. In the present study, we examined how test anxiety, two common anxiety disorders (i.e., generalized anxiety disorder [GAD] and panic disorder [PD]), and subjective wellbeing in the school domain (i.e., school-related wellbeing) were related in a sample of 918 adolescents (M age = 15.77 years) using network analysis and latent profile analysis. Results from the network analysis indicated that test anxiety, GAD, PD, and school-related wellbeing were represented as distinct constructs. Bridge nodes were identified that linked test anxiety with GAD, PD, and school-related wellbeing. The latent profile analysis identified three of the four profiles predicted by the Dual Factor Model, including (a) troubled (i.e., low school-related wellbeing, high test anxiety, GAD, and PD), (b) complete mental health (i.e., high school-related wellbeing, low test anxiety, GAD, and PD), and (c) symptomatic but content (i.e., average school-related wellbeing, test anxiety, GAD, and PD). We concluded that test anxiety was distinct from, rather than a manifestation of, GAD and PD. We found support for the Dual Factor Model, albeit not unequivocal, using test anxiety as an additional indicator of psychopathology to that of GAD and PD.     

Specificity of peer difficulties to social anxiety in early adolescence: categorical and dimensional analyses with clinical and community samples

Background and Objectives: We investigated the specificity of social difficulties to social anxiety by testing associations of social anxiety and other anxiety presentations with peer acceptance and victimization in community and treatment-seeking samples of adolescents aged 12–14 years.

Design: Cross-sectional, quantitative survey.

Methods: Adolescents from the community (n?=?116) and a clinical setting (n?=?154) completed ratings of anxiety symptoms, perceived social acceptance, and peer victimization. Their parents also completed ratings of the adolescents’ anxiety and social acceptance.

Results: Social acceptance was lowest among adolescents with social anxiety disorder (SAD) and lower among adolescents with other anxiety disorders than in the community sample. Anxiety symptoms were negatively correlated with social acceptance, but these associations were not unique to social anxiety symptoms. Girls in the community sample reported more overt victimization than girls with SAD and with other anxiety diagnoses. Relational victimization was associated with social and nonsocial anxiety symptoms only in the community sample.

Conclusions: Our findings supplement recent laboratory-based observational studies on social functioning among adolescents with SAD and other anxiety disorders. Although social anxiety may be associated with unique social skill deficits and impairment, concerns about peer relations should also be considered among adolescents with other anxiety symptoms.     

Comorbidity and Internet-Delivered Transdiagnostic Cognitive Behavioural Therapy for Anxiety Disorders

Internet-delivered transdiagnostic anxiety interventions aim to reduce symptoms across several anxiety disorders using one treatment protocol. However, it is unclear whether comorbidity affects outcomes of such treatment. This study re-examined data from a recent randomised controlled trial (N = 129) that evaluated the efficacy of an Internet-delivered transdiagnostic cognitive behavioural therapy (iCBT) intervention for participants with principal diagnoses of generalised anxiety disorder (GAD), social phobia (SP) panic disorder and agoraphobia (PDA), of whom 72% met criteria for a comorbid anxiety disorder or depression. Participants were divided into two groups based on whether or not they had a comorbid disorder before treatment. Participants with comorbid conditions reported higher symptom levels at pre-treatment, post-treatment, and follow-up across a range of measures. Both groups showed significant reductions in symptoms over treatment; however, participants with comorbid disorders showed greater reductions in measures of GAD, PDA, SP, depression, and neuroticism. In addition, treatment significantly reduced the number of comorbid diagnoses at follow-up. These results indicate transdiagnostic iCBT protocols have the potential to reduce comorbidity.     

Symptoms of Specific and Generalized Social Phobia: An Examination of Discriminant Validity and Structural Relations With Mood and Anxiety Symptoms

Current models divide social phobia into specific (SSP) and generalized (GSP) subtypes and suggest strong overlap between GSP and avoidant personality disorder (APD). Meanwhile, other research suggests reclassifying anxiety and mood disorders as fear and distress disorders. To unify these separate lines of research, this study was designed to test the hypothesis that SSP is more related to fear disorders (e.g., panic and phobias), whereas GSP and APD are more related to distress disorders (e.g., depression and generalized anxiety). Confirmatory factor analysis suggested the best-fitting model had symptoms of GSP, APD, and depression loading on one factor, and symptoms of SSP, panic, and specific phobias loading on a second factor. Key components of this model were (a) the inclusion of GAD symptoms reduced model fit and (b) GSP and APD symptoms significantly predicted SSP symptoms; this is consistent with conceptualizations of individuals with both GSP and SSP reporting performance anxiety.     

The Interactive Contributions of Perceived Control and Anxiety Sensitivity in Panic Disorder: A Triple Vulnerabilities Perspective

Within the triple vulnerabilities model of anxiety disorders, a genetic contribution to the development of anxiety and negative affect (i.e., generalized biological vulnerability), a diminished sense of perceived control over aversive events and emotional experiences (i.e., generalized psychological vulnerability), and elevated levels of anxiety sensitivity (i.e., specific psychological vulnerability) are posited to increase the risk of developing and maintaining panic disorder (Barlow American Psychologist 55(11):1247–1263, 2000). The purpose of the present study was to investigate the direct and interactive effects of perceived control and anxiety sensitivity on panic disorder symptom severity. Structural equation models (SEM) were conducted in data derived from a sample of 379 adults with panic disorder participating in a multi-site randomized controlled trial. Findings indicated that both perceived control and anxiety sensitivity uniquely predicted panic disorder symptoms. A moderation model examining the interactive effects of perceived control and anxiety sensitivity on panic symptoms indicated that the effect of anxiety sensitivity on panic symptoms increased with greater deficits in perceived control. The present findings suggest that deficits in perceived control and elevated levels of anxiety sensitivity exert unique and shared effects on panic disorder symptoms, thereby illustrating the relationship between putative vulnerability factors and panic disorder symptoms as predicted by the triple vulnerabilities model.     

Cognitive-Behavior Therapy (CBT) for Panic Disorder: Relationship of Anxiety and Depression Comorbidity with Treatment Outcome

Research evaluating the relationship of comorbidity to treatment outcome for panic disorder has produced mixed results. The current study examined the relationship of comorbid depression and anxiety to treatment outcome in a large-scale, multi-site clinical trial for cognitive-behavior therapy (CBT) for panic disorder. Comorbidity was associated with more severe panic disorder symptoms, although comorbid diagnoses were not associated with treatment response. Comorbid generalized anxiety disorder (GAD) and major depressive disorder (MDD) were not associated with differential improvement on a measure of panic disorder severity, although only rates of comorbid GAD were significantly lower at posttreatment. Treatment responders showed greater reductions on measures of anxiety and depressive symptoms. These data suggest that comorbid anxiety and depression are not an impediment to treatment response, and successful treatment of panic disorder is associated with reductions of comorbid anxiety and depressive symptoms. Implications for treatment specificity and conceptual understandings of comorbidity are discussed.     

Heightened sensitivity to emotional expressions in generalised anxiety disorder,compared to social anxiety disorder,and controls

Few studies have examined potential differences between social anxiety disorder (SAD) and generalised anxiety disorder (GAD) in the sensitivity to detect emotional expressions. The present study aims to compare the detection of emotional expressions in SAD and GAD. Participants with a primary diagnosis of GAD (n?=?46), SAD (n?=?70), and controls (n?=?118) completed a morph movies task. The task presented faces expressing increasing degrees of emotional intensity, slowly changing from a neutral to a full-intensity happy, sad, or angry expressions. Participants used a slide bar to view the movie frames from left to right, and to stop at the first frame where they perceived an emotion. The frame selected thus indicated the intensity of emotion required to identify the facial expression. Participants with GAD detected the onset of facial emotions at lower intensity of emotion than participants with SAD (p?=?0.002) and controls (p?=?0.039). In a multiple regression analysis controlling for age, race, and depressive symptom severity, lower frame at which the emotion was detected was independently associated and GAD diagnosis (B?=?–5.73, SE?=?1.74, p?相似文献   

Emotional, behavioral, and cognitive factors that differentiate obsessive-compulsive disorder and other anxiety disorders in youth

Abstract The current study examined specific emotional, behavioral, and cognitive variables that may distinguish obsessive-compulsive disorder (OCD) from generalized anxiety disorder (GAD), social phobia (SoP), and separation anxiety disorder (SAD) in youth. Youth with OCD (n=26) and other anxiety disorders (ADs; n=31), aged 7-12 years (56.1% males), and their parents participated. The study compared the two anxious groups on levels of emotional, behavioral, and cognitive functioning, as well as impairment associated with the disorder. Results indicated that in comparison to youth with GAD, SoP, or SAD, youth with OCD were found to have poorer emotion regulation skills, as well as greater oppositionality, cognitive problems/inattention, and parent impairment associated with the disorder. The findings suggest that there are unique characteristics of OCD that may differentiate this disorder from other ADs in youth. Potential clinical implications and directions for future research are discussed.     

Explicit memory in anxiety disorders

Two experiments were conducted to study selective memory bias favoring anxiety-relevant materials in patients with anxiety disorders. In the 1st experiment, 32 patients with generalized anxiety disorder (GAD), 30 with social phobia (speaking anxiety), and 31 control participants incidentally learned GAD-relevant words, speech anxiety-relevant words, strongly pleasant words, and words with a neutral valence. Participants did not show any explicit memory bias for threatening materials. Thirty patients suffering from panic disorder (PD) with agoraphobia and 30 controls took part in the 2nd experiment. The design was similar to the 1st experiment. This time a highly specific selective memory bias for threatening words was found. Words describing symptoms of anxiety were better recalled by PD patients. Results are consistent with previous findings but are inexplicable by existing theories.     

Provocation of panic: three elements of the panic reaction in four anxiety disorders

Subjects with agoraphobia (N = 25), panic disorder (N = 25), social phobia (N = 19) or generalized anxiety disorder (N = 10) and controls with no psychiatric history (N = 16) underwent two provocation tests, voluntary hyperventilation and inhalation of 5% CO2 in air, and three experimental control conditions. They were measured on three elements of the panic reaction: somatic symptoms, psychic anxiety and fears of impending doom, and on a standard YES/NO measure of panic attack. The provocation conditions produced increased somatic symptoms and psychic anxiety across all groups relative to the control conditions. The agoraphobic and panic disorder groups showed a significantly greater increase in fears of impending doom from control to provocation conditions than the social phobic and GAD patients. This difference was not observed on measures of somatic symptoms or psychic anxiety. The present results provide some support for the theory that panic attacks result from the catastrophic misinterpretation of anxious symptoms, in this case produced by the two provocation tests.     

Correlates of separation anxiety symptoms among first-semester college students: an exploratory study

Separation anxiety disorder (SAD) is rarely considered in college students with anxious symptomatology, but a growing body of evidence suggests that its symptoms are experienced by a significant number of young adults. The authors examined separation anxiety symptoms in a group of first-semester college students living on campus and experiencing extended separation from significant others, generally for the first time. They examined prevalence of separation anxiety symptoms among college students and the relationship between separation anxiety symptoms and students' educational decisions and performance. Results showed that 21% of first-semester college students reported symptoms of separation anxiety. In addition, separation anxiety symptoms were related to childhood SAD, panic attacks, and educational decisions. Results suggest that SAD may be a valid diagnosis in college students and may impact their educational choices and experiences.     

Anxiety sensitivity within the anxiety disorders: disorder-specific sensitivities and depression comorbidity

The tendency to perceive anxious states as aversive and harmful is hypothesized to confer vulnerability to the development of anxiety disorders. The most commonly used measure of anxiety sensitivity, the Anxiety Sensitivity Index [ASI; Reiss, S., Peterson, R.A., Gursky, D.M., & McNally R.J. (1986). Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behavior Research and Therapy, 24, 1-8], is composed of multiple lower-order factors, assessing fear of physical symptoms, fear of publicly observable anxious symptoms, and fear of cognitive dyscontrol. This study examined the convergent validity of the lower-order anxiety sensitivity dimensions in DSM-IV diagnosed anxiety disorders. Participants with primary diagnoses of panic disorder with agoraphobia, social phobia, and generalized anxiety disorder (GAD) completed the ASI and measures of anxiety and depression severity. Support was found for the convergent validity of all ASI dimensions in reference to thematically related anxiety disorders and in the identification of patients presenting with and without secondary major depressive disorder (MDD). The ASI-fear of cognitive dyscontrol dimension displayed strong and nonredundant associations with GAD, dimensional depression scores, and secondary diagnoses of MDD. The conceptual implications of the shared importance of fear of cognitive dyscontrol in GAD and MDD are discussed.     

A parent-report measure of children's anxiety: psychometric properties and comparison with child-report in a clinic and normal sample

This study examined the psychometric properties of the parent version of the Spence Children's Anxiety Scale (SCAS-P); 484 parents of anxiety disordered children and 261 parents in a normal control group participated in the study. Results of confirmatory factor analysis provided support for six intercorrelated factors, that corresponded with the child self-report as well as with the classification of anxiety disorders by DSM-IV (namely separation anxiety, generalized anxiety, social phobia, panic/agoraphobia, obsessive-compulsive disorder, and fear of physical injuries). A post-hoc model in which generalized anxiety functioned as the higher order factor for the other five factors described the data equally well. The reliability of the subscales was satisfactory to excellent. Evidence was found for both convergent and divergent validity: the measure correlated well with the parent report for internalizing symptoms, and lower with externalizing symptoms. Parent-child agreement ranged from 0.41 to 0.66 in the anxiety-disordered group, and from 0.23 to 0.60 in the control group. The measure differentiated significantly between anxiety-disordered children versus controls, and also between the different anxiety disorders except GAD. The SCAS-P is recommended as a screening instrument for normal children and as a diagnostic instrument in clinical settings.     

Genetic and Environmental Contributions to Common Psychopathologies of Childhood and Adolescence: A Study of Twins and Their Siblings

We report findings based on analyses of self-reports of six common adolescent psychopathologies (attention deficit/hyperactivity disorder, ADHD; conduct disorder, CD; oppositional defiant disorder, ODD; generalized anxiety disorder, GAD; separation anxiety disorder, SAD; and major depressive disorder, MDD) in a sample of 1,162 male and female adolescent (12–19 years) twin pairs and 426 siblings. Prevalence statistics for past year and lifetime reports confirm differences between genders for CD, GAD, SAD, and MDD, and a lack of differences between twins and their non-twin siblings. Biometrical modeling was conducted to ascertain the relative influences of genes, and shared and non-shared environments contributing to these disorders. A more robust estimate of these parameters was obtained by including non-twin siblings. Age-specific thresholds were integrated into the analyses to appropriately model the developmental patterns of behavior. We found evidence for both genetic and non-shared environmental influences for all disorders. Shared environmental influences also seem to be important for MDD and lifetime GAD.     

Relations Among Perceived Control Over Anxiety-Related Events,Worry, and Generalized Anxiety Disorder in a Sample of Adolescents

This study examined the associations among perceived control over anxiety-related events, worry, and both symptoms and diagnoses of generalized anxiety disorder (GAD). The sample was comprised of 140 adolescents (60 girls) between the ages of 10 and 17 years (M _age  = 14.6 years; SD = 2.25) recruited from the general community. Findings were consistent with hypotheses. Self-reported perceived control over anxiety-related events related negatively to worry as well as symptoms and diagnoses of GAD even after accounting for variance associated with age, gender, and negative affectivity. Results are discussed in terms of the theoretical implications that perceived control over anxiety-related events may have for understanding GAD symptomatology among youth.