Effects of guided imagery with relaxation training on anxiety and quality of life among patients with inflammatory bowel disease

Background: Inflammatory Bowel Disease (IBD) impacts quality of life (QoL). Psychological factors influence the course of the disease and should be targeted for intervention.

Methods: Our study was a prospective, randomised control trial. Fifty-six outpatients were randomly chosen and allocated to a treatment group or a waiting-list control group. Treatment group patients attended three relaxation-training sessions and received an audio disc for home practice. Evaluations performed pre and post-treatment: state anxiety was assessed with the State-Trait Anxiety Inventory, QoL with the IBD Questionnaire. The Visual Analogue Scale assessed pain, depression, stress and mood. Patients completed a symptom monitoring diary. The control group's symptoms were monitored without study-related treatment.

Results: Thirty-nine subjects completed the study and were included in the data analysis. Following the relaxation-training intervention, the treatment group's (n?=?18) measured results showed a statistically significant improvement as compared to the control group (n?=?21) (time by treatment interaction): anxiety levels decreased (p?<?0.01), QoL and mood improved (p?<?0.05), while levels of pain and stress decreased (p?<?0.01).

Conclusions: Findings indicate IBD patients may benefit from relaxation training in their holistic care. New studies as well as further investigation of the subject are warranted.     

Anxiety,anger and depression: Relationships at the trait level

Abstract

The relationship between anxiety and depression has been extensively researched at the state and clinical syndrome levels. However, relatively few studies have directed their attention to the interrelations between the constructs at the trait level. The present two studies investigated the interrelationships between anxiety, anger and depression at the trait level in nonclinical, subclinical and clinical samples. The results showed anxiety and depression to be highly correlated in students, adults, medical and psychiatric in-patients. As to the relationship of anger with both anxiety and depression, results, especially between anxiety and anger, were likewise significant although much weaker than commonly reported at the affective state level. Moreover, partial correlations suggested the results on the anger-depression relationship to be mainly due to the mediating (causal) influence of anxiety. The results are discussed with reference to the discrepancy of distinctions commonly made between the constructs at the theoretical level and lack of such distinction found at the empirical level. The possible mediating role of both trait-anxiety and trait-anger-in in the development of a depressive disposition is offered as an alternative explanation for the interrelatedness of the three constructs at the trait level.     

Predictors of distress following an acute stroke: Disability,control cognitions,and satisfaction with care

Abstract

Whilst clinical predictors of distress following acute stroke have been identified (e.g., lesion site), this study hypothesised that greater prediction would be achieved by addressing individual differences in patients' cognitions (e.g., perceived control, satisfaction with care, recovery confidence) and coping responses. We examined these relationships in a longitudinal study of 71 survivors of acute stroke. Measures were collected at three time points: 10-20 days after the stroke, and one month and six months after hospital discharge. Stepwise multiple regression analyses were performed using only significant bivariate correlates and where the dependent variables were residualised scores which controlled for baseline levels of anxiety and depression. Satisfaction with treatment and confidence in recovery at one month predicted anxiety outcome at six months, and satisfaction with advice and confidence in recovery at one month predicted depression outcome at six months. These results offer tentative suggestions for interventions targeting patient cognitions and improving patient satisfaction.     

Attentional biases for threat after fear-related autobiographical recall

Background : Previous studies suggested that affective state could enhance stimulus salience and modulate attention allocation for mood-congruent information, but contrasting data have been reported on the effects of mood induction on attentional biases for threat (ABTs) in non-clinical individuals.

Objective : We aimed to assess whether laboratory-induced negative mood can increase individuals’ tendency to allocate attention on threatening stimuli, thus determining a difficulty in attentional disengagement from threat. We also aimed at assessing whether level of trait anxiety could modulate the effect of mood induction on attentional biases.

Methods : We used an autobiographical episode recall procedure for mood induction (fear, happiness and neutral episode recall), and an exogenous cueing task with threatening and non-threatening images to assess attentional biases in 120 undergraduate students.

Results: Participants showed a significant difficulty in disengaging attention from threat after recalling fear-related episodes, independently from their trait anxiety level.

Conclusions: These findings clarify that the ABTs are not exclusive to anxiety disorders or high trait anxiety individuals, and could also arise in non-clinical individuals in a fearful context.     

Does worry affect adjustment to bereavement? A longitudinal investigation

Background and objectives: Repetitive thought is a trans-diagnostic risk-factor for development of psychopathology. Research on repetitive thought in bereaved individuals has focused primarily on clarifying the role of rumination, repetitive thinking about past negative events and/or negative emotions. While detrimental effects of rumination have been demonstrated following bereavement, surprisingly few studies have aimed to clarify the role of worry, repetitive thinking about potential future negative events, in adjustment to loss. This study sought to fill this gap in knowledge. Methods/Design: One hundred eighty-three bereaved individuals (85.3% women) filled out questionnaires on sociodemographic and loss-related characteristics, worry, and symptom measures of depression, anxiety, and prolonged grief. After six months, 155 participants completed worry and symptom measures again. Using multiple regression analyses, concurrent and longitudinal associations between loss-related variables, worry, and symptoms of psychopathology were examined. Results: Main results were that worry was strongly positively associated with symptoms of anxiety, depression and prolonged grief concurrently and also predicted higher levels of anxiety, depression and prolonged grief longitudinally. Conclusions: Findings suggest that worry influences adjustment to bereavement negatively and may be a potential target in grief therapy, especially when aiming to reduce anxiety.     

The relationship between negative urgency and generalized anxiety disorder symptoms: the role of intolerance of negative emotions and intolerance of uncertainty

Background and Objectives: GAD symptoms are associated with greater negative urgency, a dimension of impulsivity defined as the tendency to act rashly when distressed. This study examined the degree to which intolerance of negative emotional states and intolerance of uncertainty account for the association between negative urgency and GAD symptoms. Design: An analysis of indirect effects evaluated whether intolerance of negative emotions and intolerance of uncertainty uniquely account for the association between negative urgency and GAD symptom severity. Methods: Undergraduate students (N?=?308) completed measures of GAD symptoms, trait anxiety, negative urgency, distress tolerance, and intolerance of uncertainty. Results: Greater symptoms of GAD, intolerance of negative emotional states, and intolerance of uncertainty were associated with greater negative urgency. There was an indirect relationship between negative urgency and GAD symptoms through intolerance of negative emotional states and intolerance of uncertainty even when controlling for trait anxiety. Intolerance of negative emotional states and intolerance of uncertainty each had an indirect relationship with GAD severity through negative urgency, suggesting possible bi-directional relations. Conclusions: Future studies should examine the role of intolerance of negative emotional states and intolerance of uncertainty in the impulsive behavior of individuals with GAD, and whether impulsive behavior reinforces these processes.     

Guest referees for 17(4)

Background and objectives: Although intimate partner violence (IPV) has demonstrated strong associations with anxiety and posttraumatic stress, these constructs have rarely been examined simultaneously in IPV research. Gaps in knowledge remain as to their differential associations to substance use problems among IPV-victimized women. Design: A sample of 143 community women self-reported on their current IPV victimization, mental health and substance use problems. Method: Hierarchical entry multiple regressions were used to test for the direct and indirect effects of psychological, physical, and sexual IPV to alcohol and drug problems through anxiety and posttraumatic stress. Results: Higher anxiety symptom severity and higher physical IPV severity were associated with greater alcohol and drug problems. Higher posttraumatic stress symptom severity was associated with greater alcohol and drug problems. Mediation analyses indicated (i) significant indirect pathways of IPV types to alcohol problems through posttraumatic stress symptom severity controlling for anxiety symptom severity and (ii) significant indirect pathways of IPV types to drug problems through anxiety symptom severity controlling for posttraumatic stress symptom severity. Conclusions: In examining the indirect pathways of psychological, physical, and sexual IPV to substance use problems this study highlights that anxiety and posttraumatic stress symptom severity have unique effects on alcohol and drug problems among IPV-victimized women.     

A qualitative study exploring the experience of people with IBD and elevated symptoms of anxiety and low mood and the type of psychological help they would like

Background: People with inflammatory bowel disease (IBD) are at increased risk of developing anxiety and low mood. We sought to explore the experience of people with IBD and moderate–severe symptoms of anxiety/low mood to identify psychological processes which could be targeted in psychological interventions, as well as the kind of psychological support preferred.

Methods: Twenty-five participants with IBD and moderate–severe symptoms of anxiety/low mood were recruited for interview. Template analysis was utilised to analyse interview data. We explored the situations, cognitions and behaviour linked to symptoms of anxiety and low mood by people with IBD, as well as the kind of psychological help preferred.

Results: Two themes were identified within participants accounts of symptoms of anxiety; ‘under performance’ and ‘preventing an accident’. Two further themes were identified for symptoms of low mood; ‘lack of understanding’ and ‘stigma’. Expertise and understanding was the main theme identified for the type of psychological help desired.

Conclusion: The analysis highlights situations, cognitions and behaviour linked to anxiety and low mood by people with IBD and the type of psychological support desired. Our findings link to the knowledge and competencies set for psychological therapist working with long-term conditions.     

Emotion regulation and biological stress responding: associations with worry,rumination, and reappraisal

ABSTRACT

Individual differences in the habitual use of emotion regulation strategies may play a critical role in understanding psychological and biological stress reactivity and recovery in depression and anxiety. This study investigated the relation between the habitual use of different emotion regulation strategies and cortisol reactivity and recovery in healthy control individuals (CTL; n?=?33) and in individuals diagnosed with social anxiety disorder (SAD; n?=?41). The tendency to worry was associated with increased cortisol reactivity to a stressor across the full sample. Rumination was not associated with cortisol reactivity, despite its oft-reported similarities to worry. Worry and rumination, however, were associated with increased cortisol during recovery from the stressor. The only difference between CTL and SAD participants was observed for reappraisal. In the CTL but not in the SAD group, reappraisal predicted recovery, such that an increased tendency to reappraise was associated with greater cortisol recovery. These results suggest an important role of the habitual use of emotion regulation strategies in understanding biological stress reactivity and recovery.     

Adult children of workaholics: Self-concept,anxiety, depression,and locus of control

Abstract

Adult children of workaholics were compared with adult children of nonworkaholics on self-concept, anxiety, depression, and locus of control. Results indicated greater depression and external locus of control among the offspring of workaholics. Children of workaholic fathers not only had greater depression and external locus of control but also scored higher on anxiety. No significant differences were found between children of workaholic mothers and children of nonworkaholic mothers on any of the variables. Self-concept was not related to parental workaholism in any of the comparisons.     

Deconstructing trait anxiety: a network perspective

Background and objectives: For decades, the dominant paradigm in trait anxiety research has regarded the construct as signifying the underlying cause of the thoughts, feelings, and behaviors that supposedly reflect its presence. Recently, a network theory of personality has appeared. According to this perspective, trait anxiety is a formative construct emerging from interactions among its constitutive features (e.g., thought, feelings, behaviors); it is not a latent cause of these features.

Design: In this study, we characterized trait anxiety as a network system of interacting elements.

Methods: To do so, we estimated a graphical gaussian model via the computation of a regularized partial correlation network in an unselected sample (N?=?611). We also implemented modularity-based community detection analysis to test whether the features of trait anxiety cohere as a single network system.

Results: We find that trait anxiety can indeed be conceptualized as a single, coherent network system of interacting elements.

Conclusions: This radically new approach to visualizing trait anxiety may offer an especially informative view of the interplay between its constitutive features. As prior research has implicated trait anxiety as a risk factor for the development of anxiety-related psychopathology, our findings also set the scene for novel research directions.     

Relationships between self-perceptions and negative affect in adult Flemish psychiatric in-patients suffering from mood disorders

Objectives. To compare measures of physical self-perceptions and self-esteem of adult psychiatric patients suffering from mood disorders with norms of non-patients and to investigate the comparative influence of physical self-perceptions and self-esteem on indices of negative affect in these patients.Method. Cross-sectional. Adult psychiatric patients (53 males, 124 females), all with DSM-IV diagnosis of mood disorder and with elevated depression scores, completed the Physical Self-Perception Profile subscales assessing perceived sports competence and condition, body attractiveness, physical strength, and a domain scale of physical self-worth. Also assessed were global self-esteem, using the Rosenberg Self-Esteem Inventory, depression, with the Beck Depression Inventory, and anxiety with the State-Trait Anxiety Inventory.Results. Depressed patients scored significantly lower on physical self-perceptions and global self-esteem than non-patients, consistent with the symptomatology of depression and anxiety. Partial correlation analysis and path analysis indicated that physical self-perceptions explained a significant proportion of variance in negative affects (R² from 0.37 to 0.49). With the exception of trait anxiety in male patients, direct pathways became non-significant when global self-esteem was added to the model. Model fit parameters using structural equation modelling indicated the superior fit of the indirect model with global self-esteem as a mediator.Conclusion. The relationship between physical self-perceptions and negative affect is mainly indirect and mediated by global self-esteem in mood disordered psychiatric patients. The Expanded Exercise and Self-Esteem Model, which includes physical self-perceptions and self-esteem estimates, might be considered as a valuable framework for furthering our understanding of the depression and anxiety reducing potential of exercise and physical activity in clinically depressed individuals.     

Postsurgical physical activity and fatigue-related daily interference in women with non-metastatic breast cancer

Purpose: Women undergoing surgery for breast cancer experience side effects, such as fatigue, reduced quality of life (QOL) and depression. Physical activity (PA) is associated with improved psychological adjustment during treatment and survivorship, yet little is known about how PA relates to fatigue, depression and QOL in the period following surgery for breast cancer. The purpose of the study was to examine the relationships between these constructs in women who recently underwent surgery for breast cancer.

Methods: At 2–10 weeks post-surgery, 240 women with non-metastatic breast cancer reported intensity and duration of moderate and vigorous PA (MVPA), fatigue (intensity and interference), depressed mood, clinician-rated depression and functional QOL.

Results: In the path analysis models tested, women that reported greater weekly MVPA reported less fatigue interference, greater functional QOL, less depressed mood, and lower clinician-rated depression. Tests of indirect effects suggested that fatigue interference may be an intermediate pathway by which MVPA relates to functional QOL, clinician-rated depression and depressed mood.

Conclusion: Women who are more physically active in the months after breast cancer surgery show greater psychological adaptation in the initial phases of their treatment.     

Repetitive Negative Thinking Predicts Depressed Mood at 3-Year Follow-up in Students

Repetitive negative thinking (RNT; e.g., rumination and worry) is a key-factor involved in the maintenance of emotional problems like depression and anxiety. Recently, the Perseverative Thinking Questionnaire (PTQ) was developed as a content-independent measure of RNT. The current study investigated the validity of this new measure in predicting depressive symptoms prospectively. Eighty-one students completed measures of depressive symptoms, depressive rumination and repetitive negative thinking. Depressive symptoms were re-assessed 3?years later (40?months follow-up). Results showed that repetitive negative thinking as measured by the PTQ predicts depressive symptoms at follow-up, even when taking into account baseline depressive symptoms and rumination. The results suggest that the PTQ has good (prospective) predictive validity for depressed mood and reconfirm RNT’s role in the course of emotional complaints.     

Implicit memory bias,explicit memory bias,and anxiety

Abstract

Normals high, medium, and low in trait anxiety performed two encoding tasks (one predominantly data-driven and the other conceptually driven) on threat-related and neutral words, followed by tests of word completion, cued recall, and free recall. Memory performance indicated the existence of negative memory biases in the high trait-anxious group, but it was generally not possible to decide whether the biases were associated with trait anxiety rather than with depression. The biases were obtained mainly when there was a match between the processes at encoding and those at the time of test, whether the matching processes were predominantly data-driven or conceptually driven. Implications of these findings for implicit and explicit memory biases associated with high trait anxiety are discussed.     

The distressed (Type D) personality mediates the relationship between remembered parenting and psychological distress in cardiac patients

Objective: Both the distressed (Type D) personality (i.e. the combination of negative affectivity and social inhibition traits) and dysfunctional parenting styles are associated with anxiety and depression. As parenting styles have been related to personality development, dysfunctional parenting styles may also be associated with Type D personality. We examined whether remembered parenting was associated with anxiety and depression in cardiac patients and whether Type D personality mediated this relationship.

Methods: Our sample comprised 435 patients treated with percutaneous coronary intervention (PCI) and 123 patients with congestive heart failure (CHF). Patients completed the Hospital Anxiety and Depression Scale, Type D Scale (DS14), and Remembered Relationship with Parents (RRP¹⁰) scale.

Results: Remembered parenting was significantly associated with higher anxiety and depression levels and Type D personality. In multivariable linear regression analyses, Type D personality accounted for 25–29% of the variance in anxiety and 23–46% of the variance in depression, while remembered parenting was no longer significantly associated with these domains. Sobel tests and bootstrapping indicated that Type D personality mediated the relationship between remembered parenting and anxiety and depression.

Conclusion: Type D personality mediated the relationship between remembered parenting and anxiety and depression in both PCI and CHF patients.     

The effect of tape-recorded relaxation training on well-being,symptoms, and peak expiratory flow rate in adult asthmatics: A pilot study

Abstract

Evidence indicates that psychological stress plays a role in precipitating and exacerbating asthma symptoms and suggests that relaxation techniques aimed at reducing stress and autonomic arousal leads to symptom reduction. This study explored the effect of a tape-recorded relaxation intervention on well-being (mood and stresson). asthma symptoms, and a measure of pulmonary function (PEFR). Twenty adult asthmatics were studied for 21 days in their natural environment using a multiple baseline design. Self-administered relaxation training (including both breathing exercises and muscle relaxation) led to decreased negative mood and stressor report. Reporting of asthma symptoms decreased over time, and PEFR was increased by relaxation training. Asthma medication use was unchanged. Results suggest that tape–recorded relaxation training positively impacts well-being, asthma symptoms. and PEFR in a naturalistic setting. Further study of the potential use of inexpensive tape-recorded interventions in chronic illness is warranted.     

The Development of Adolescent Generalized Anxiety and Depressive Symptoms in the Context of Adolescent Mood Variability and Parent-Adolescent Negative Interactions

This study explored the influence of adolescent mood variability on the symptom development of generalized anxiety and depression in the context of parent-adolescent negative interactions. Participants were 456 adolescents (55.7 % male) from a community sample, who were followed from age 13 to 16 years. During 4 annual assessments, adolescents reported on their generalized anxiety and depressive symptoms, and both parents and adolescents on levels of negative interactions with each other. Within each study year, adolescents rated their daily mood states during 5 consecutive days for 3 times per year (total of 9 weeks). The absolute differences between mood states on consecutive days were summed to construct a mood variability score. Results showed that high levels of adolescent mood variability predicted increases in generalized anxiety and depressive symptoms across the studied period. No influence of negative interactions on anxiety and depression development was found, but positive predictive links from mood variability to negative interactions at age 14 and 15 appeared. The study underscores the role of adolescent mood variability in the development of symptoms of generalized anxiety and depression during adolescence, but found little evidence for an influence of parent-adolescent negative interactions on internalizing problem development.