Can the components of a cognitive model predict the severity of generalized anxiety disorder?

Over the past decade, a number of well-controlled studies have supported the validity of a cognitive model of generalized anxiety disorder (GAD) that has four main components: intolerance of uncertainty, positive beliefs about worry, negative problem orientation, and cognitive avoidance. Although these studies have shown that the model components are associated with high levels of worry in nonclinical samples and with a diagnosis of GAD in clinical samples, they have not addressed the question of whether the model components can predict the severity of GAD. Accordingly, the present study sought to determine if the model components are related to diagnostic severity, worry severity, and somatic symptom severity in a sample of 84 patients with a primary diagnosis of GAD. All model components were related to GAD severity, although positive beliefs about worry and cognitive avoidance were only modestly associated with the severity of the disorder. Intolerance of uncertainty and negative problem orientation had more robust relationships with the severity of GAD (and with worry severity, in particular). When participants were divided into Mild, Moderate, and Severe GAD groups, intolerance of uncertainty and negative problem orientation distinguished the Moderate and Severe GAD groups from the Mild GAD group, even when age, gender, and depressive symptoms were statistically controlled. Overall, the results lend further support to the validity of the model and suggest that intolerance of uncertainty and negative problem orientation are related to the severity of GAD, independently of sociodemographic and associated clinical factors. The theoretical and clinical implications of the findings are discussed.     

Does emotional reasoning change during cognitive behavioural therapy for anxiety?

Emotional reasoning refers to the use of subjective emotions, rather than objective evidence, to form conclusions about oneself and the world. It is a key interpretative bias in cognitive models of anxiety disorders and appears to be especially evident in individuals with anxiety disorders. However, the amenability of emotional reasoning to change during treatment has not yet been investigated. We sought to determine whether emotional reasoning tendencies change during a course of routine cognitive-behavioural therapy (CBT). Emotional reasoning tendencies were assessed in 36 individuals with a primary anxiety disorder who were seeking treatment at an outpatient clinic. Changes in anxiety and depressive symptoms as well as emotional reasoning tendencies after 12 sessions of CBT were examined in 25 individuals for whom there was complete data. Emotional reasoning tendencies were evident at pretreatment assessment. Although anxiety and depressive symptoms decreased during CBT, only one of six emotional reasoning interpretative styles (pertaining to conclusions that one is incompetent) changed significantly during the course of therapy. Attrition rates were high and there was not enough information regarding the extent to which therapy specifically focused on addressing emotional reasoning tendencies. Individuals seeking treatment for anxiety disorders appear to engage in emotional reasoning, however routine individual CBT does not appear to result in changes in emotional reasoning tendencies.     

Acute phase cognitive therapy for recurrent major depressive disorder: Who drops out and how much do patient skills influence response?

ObjectiveThe aims were to predict cognitive therapy (CT) noncompletion and to determine, relative to other putative predictors, the extent to which the patient skills in CT for recurrent major depressive disorder predicted response in a large, two-site trial.MethodAmong 523 outpatients aged 18–70, exposed to 12–14 weeks of CT, 21.6% dropped out. Of the 410 completers, 26.1% did not respond. To predict these outcomes, we conducted logistic regression analyses of demographics, pre-treatment illness characteristics and psychosocial measures, and mid-treatment therapeutic alliance.ResultsThe 17-item Hamilton Rating Scale for Depression (HRSD₁₇) scores at entry predicted dropout and nonresponse. Patients working for pay, of non-Hispanic white race, who were older, or had more education were significantly more likely to complete. Controlling for HRSD₁₇, significant predictors of nonresponse included: lower scores on the Skills of Cognitive Therapy-Observer Version (SoCT-O), not working for pay, history of only two depressive episodes, greater pre-treatment social impairment. Mid-phase symptom reduction was a strong predictor of final outcome.ConclusionsThese prognostic indicators forecast which patients tend to be optimal candidates for standard CT, as well as which patients may benefit from changes in therapy, its focus, or from alternate modalities of treatment. Pending replication, the findings underscore the importance of promoting patients' understanding and use of CT skills, as well as reducing depressive symptoms early. Future research may determine the extent to which these findings generalize to other therapies, providers who vary in competency, and patients with other depressive subtypes or disorders.     

Group cognitive-behavioral therapy for anxiety in a clinic setting: does child involvement predict outcome?

The current study examined the relationship between child involvement and treatment outcome in a group cognitive–behavioral treatment (GCBT) program for children with anxiety, using an adapted version of the Child Involvement Rating Scale (CIRS). Thirty-four children with a primary diagnosis of an anxiety disorder, referred for outpatient treatment at a hospital, and their parents participated in a manualized 12-session GCBT program. The Multidimensional Anxiety Scale for Children (MASC), administered at pretreatment, posttreatment, and at 4-month follow-up, served as the outcome measure. The psychometric properties of the adapted CIRS were good. Early involvement (EI) was calculated as the average score from Sessions 1 to 6 and late involvement (LI), the average score from Sessions 7 to 12. EI predicted lower MASC scores at posttreatment, after controlling for pretreatment MASC scores and for LI, B = – 1.05, t(3) = – 2.34, p < .05. EI did not predict outcomes at follow-up. Results were replicated using the original CIRS measure. Exploratory analyses suggested that the relationship between LI and treatment outcomes was moderated by medication. Involvement in therapy prior to exposures might be an important predictor of posttreatment outcomes in GCBT in a community setting.     

Group acceptance and commitment therapy (ACT) for bipolar disorder and co-existing anxiety – an open pilot study

Previous studies have supported acceptance and commitment therapy (ACT) for reducing impairment related to various chronic conditions. ACT may possibly be beneficial for bipolar disorder (BD) with co-existing anxiety, which is associated with a poorer treatment outcome. Efforts are needed to identify suitable psychological interventions for BD and co-existing anxiety. In this open clinical trial, we included 26 patients with BD type 1 or 2 at an outpatient psychiatric unit specializing in affective disorders. The intervention consisted of a 12-session manualized group treatment that included psychoeducation, mindfulness, engaging in values-based behaviour, cognitive defusion, acceptance and relapse prevention modules. Participants completed four self-report questionnaires covering anxiety symptoms (Beck Anxiety Inventory - BAI), depressive symptoms (Beck Depression Inventory - BDI-II), quality of life (Quality of Life Inventory - QOLI) and psychological flexibility (Acceptance and Action Questionnaire - AAQ-2) before, during and after the treatment. At post-treatment, the participants reported significant improvements in all outcome measures, with large effects (Cohen’s d between 0.73 and 1.98). The mean reduction in anxiety symptoms was 45%. At post-treatment, 96% of the patients were classified as responders on at least one of the outcome measures. A limitation is that the trial is uncontrolled. The results suggest that ACT has the potential to be an effective treatment for BD patients with co-existing anxiety. Further randomized studies are warranted.     

Applicability of the cognitive model of generalized anxiety disorder to adolescents’ sleep quality: A cross-sectional and longitudinal analysis

BackgroundPoor sleep quality is a prevalent health issue among adolescents, and few studies have examined the variables affecting adolescents’ sleep quality from the perspective of the co-occurrence of sleep issues and anxiety disorders. Therefore, the current study investigated whether the cognitive model of generalized anxiety disorder applies to adolescents’ sleep quality.MethodIn Study 1, a total of 2042 adolescents were recruited and they completed questionnaires relating to worry, intolerance of uncertainty (IU), negative problem orientation (NPO), cognitive avoidance (CA), and sleep quality. In Study 2, a total of 379 adolescents participated in a six-month longitudinal survey to verify the model that was obtained in Study 1.ResultsStudy 1 showed the modified cognitive model of generalized anxiety disorder can be applied to adolescents’ sleep quality. Specifically, IU was a higher-order vulnerability factor that directly affected worry, and indirectly fostered worry via NPO and CA, where worry only mediated the relationships between IU, NPO, and sleep quality. However, CA exerted no independent effect on worry or sleep quality beyond the influences of IU and NPO, therefore, it dropped out of the final model. Study 2 partially confirmed the above model again from the longitudinal perspective.ConclusionThe present study constructs a new model to explain adolescents’ sleep quality, providing a foundation for future interventions.     

Cognitive behavioral therapy for panic disorder and comorbidity: more of the same or less of more?

This study compared the effects of a higher dose of cognitive behavioral therapy (CBT) for panic disorder versus CBT for panic disorder combined with "straying" to CBT for comorbid disorders in individuals with a principal diagnosis of panic disorder with or without agoraphobia. Sixty-five participants were randomly assigned to one of two treatment conditions, either CBT focused solely upon panic disorder and agoraphobia or CBT that simultaneously addressed panic disorder and agoraphobia and, to a lesser degree, the most severe comorbid condition. Results indicated a significant reduction in panic disorder severity and a decline in severity of comorbid diagnoses across both treatment conditions. However, individuals receiving CBT focused only on panic disorder were more likely to meet high end-state functioning at post-treatment, even in intent-to-treat analyses, and report zero panic attacks at the 1-year follow-up, although this effect was not retained in intent-to-treat analyses. At follow-up, CBT focused only on panic disorder yielded more substantial improvement in the most severe baseline comorbid condition, although not in intent-to-treat analyses, and a greater proportion of individuals in this treatment condition were rated as having no comorbid diagnoses, even in intent-to-treat analyses. These findings raise the possibility that remaining focused on CBT for panic disorder may be more beneficial for both principal and comorbid diagnoses than combining CBT for panic disorder with 'straying' to CBT for comorbid disorders.     

Memory for faces: Are caricatures better than photographs?

Because photographs capture an individual at a moment in time, they contain fleeting features as well as more stable ones. Caricature line drawings, however, include stable features and emphasize distinctive ones. As such, caricatures are closer to schematic memory representations than are photographs. Three experiments using faces of public figures test the hypothesis that caricatures yield better performance than do photographs. Contrary to hypothesis, photographs lead to better performance than do line-drawing caricatures in three different tasks: name recall, face recognition, and name-face verification reaction time. Photographs are also rated as more characteristic or representative of their targets than are line-drawing caricatures.     

The impact of a laryngectomy on the spouse: Who is better off?

Background: Diabetes self-care is a key element in the overall management of diabetes. However, the importance of psychosocial factors for successful disease management is under investigated. This study aimed at exploring the role of coping styles and social support in the relationship between self-care activities and glycated haemoglobin in patients with type 2 diabetes.

Methods: One hundred adults (60% female, aged 40–70 years) with type 2 diabetes completed questionnaires assessing self-care activities, coping styles and social support. In addition, a blood test was performed to obtain glycated haemoglobin levels.

Results: Result showed significant relationships of glycated haemoglobin with self-care activities, coping styles and social support. Regression analysis indicated that social support had a moderating role on the relationship between self-care activities and glycated haemoglobin, such that, at very high levels of social support the association, between Self-Care and HbA1c disappears.

Conclusions: Findings indicate that health care providers, within the context of the Iranian social and cultural situation, should pay more attention to psychosocial factors when addressing self-care activities. Delineation of the role of coping styles and social support might be useful for identifying patients in need of particular counselling and support for improving self-care activities and HbA1c levels.     

Who gets a mentor? A longitudinal assessment of the rising star hypothesis

This study assessed the rising star hypothesis, which proposes that individuals who are on the fast track to career success are more likely to gain mentors than others. The study used a sample of employees who had never been mentored and examined the relationship between rising star attributes measured at Time 1 and the attainment of a mentor a year later. In support of the hypothesis, individuals who were on the fast-track for promotion, had higher advancement expectations, and engaged in more proactive career behaviors were more likely to gain a mentor than individuals lacking these attributes. Implications of these results for the theory, research and practice of mentoring are discussed.     

Attentional biases to threat in social anxiety disorder: time to focus our attention elsewhere?

Background: Cognitive models propose that attentional biases to threat contribute to the maintenance of social anxiety disorder (SAD). However, the specific characteristics of such biases are still object to debate.

Objectives: The current study aimed to disentangle effects of trait and state social anxiety on attention allocation towards social stimuli.

Methods: Participants with SAD (n?=?67) and healthy controls (n?=?62) completed three visual search tasks while their eye movements were recorded. Half of the participants in each group were randomly assigned to a state anxiety induction.

Results: Contrary to our predictions, neither trait nor state social anxiety was associated with a facilitated attention to or a delayed disengagement from threat. However, participants with SAD did show reduced fixation durations for threatening stimuli, indicating an avoidance of threat. Induction of state anxiety led to an increased distractibility by threat.

Conclusions: We suggest that attention allocation in SAD is characterized by an avoidant rather than a vigilant attentional bias. Accordingly, our results contradict previous results that associate SAD with facilitated attention to threat and existing approaches to modify attentional biases, that aim to decrease attention towards threatening stimuli.     

Social media and interpersonal relationships: for better or worse?

Social media challenge--or have already redefined--conventional boundaries of public and private, personal and professional, friendship, and social relations generally. Here, I consider how these developments may affect professionalism, the physician-patient relationship, and our cultural experiences in a wholly different and unexpected way.     

Who Speaks for the Community?1

A survey in an unincorporated urban area compared the major community problems of concern to two groups: (a) a randomly selected sample of listed telephone subscribers, and (b) community leaders identified through nominations and reputational methods. In addition to asking about the major problems of the community, the randomly selected telephone subscribers were also asked to indicate for each problem (a) the persons or organizations to whom they looked for information and advice, (b) whom they considered qualified to speak for them, and (c) whom they expected to act in their behalf in the solution of these problems. The results of these surveys showed a large divergence of concerns expressed by the random samples and the reputed community leaders, as well as a striking number of respondents who felt themselves to be without spokesmen.     

An evolutionary hypothesis for obsessive compulsive disorder: a~psychological immune system?

A new hypothesis is presented within the framework of evolutionary psychology that attempts to explain the origins of obsessive-compulsive disorder. It is suggested that obsessions and compulsions originate from the overactivity of a mental module that the majority of humans possess and has the function of generating risk scenarios without voluntary intervention. It is hypothesised that obsessional phenomena function as an off-line risk avoidance process, designed to lead to risk avoidance behaviour at a future time, thus distinguishing it from anxiety and related phenomena as on-line emotional states, designed to lead to the avoidance of immediate and direct risks. Finally, the hypothesis makes a number of specific predictions that are testable and refutable. It is contended that the present hypothesis if supported by empirical evidence could serve as a basis for future research on this important disorder.