Does Worrying Mean Caring Too Much? Interpersonal Prototypicality of Dimensional Worry Controlling for Social Anxiety and Depressive Symptoms

Worry, social anxiety, and depressive symptoms are dimensions that have each been linked to heterogeneous problems in interpersonal functioning. However, the relationships between these symptoms and interpersonal difficulties remain unclear given that most studies have examined diagnostic categories, not accounted for symptoms’ shared variability due to general distress, and investigated only interpersonal problems (neglecting interpersonal traits, interpersonal goals, social behavior in daily life, and reports of significant others). To address these issues, students (Study 1; N = 282) endorsed symptoms and interpersonal circumplex measures of traits and problems, as well as event-contingent social behaviors during one week of naturalistic daily interactions (N = 184; 7,036 records). Additionally, depressed and anxious patients (N = 47) reported symptoms and interpersonal goals in a dyadic relationship, and significant others rated patients’ interpersonal goals and impact (Study 2). We derived hypotheses about prototypical interpersonal features from theories about the functions of particular symptoms and social behaviors. As expected, worry was uniquely associated with prototypically affiliative tendencies across all self-report measures in both samples, but predicted impacting significant others in unaffiliative ways. As also hypothesized, social anxiety was uniquely and prototypically associated with low dominance across measures, and general distress was associated with cold-submissive tendencies. Findings for depressive symptoms provided less consistent evidence for unique prototypical interpersonal features. Overall, results suggest the importance of multimethod assessment and accounting for general distress in interpersonal models of worry, social anxiety, and depressive symptoms.     

Adolescents with and without a facial difference: The role of friendships and social acceptance in perceptions of appearance and emotional resilience

This study investigated the role of friendships and social acceptance in self-perceptions of appearance and depressive symptoms, comparing adolescents with and without a facial difference. Adolescents with a visible cleft (n = 196) were compared with adolescents with a non-visible cleft (n = 93), and with a comparison group (n = 1832). Boys with a visible difference reported significantly more positive perceptions of friendships and less depressive symptoms than the comparison group. These results were interpreted in the context of indicators of emotional resilience. The objective measure of facial difference did not explain levels of depressive symptoms, while subjective measures did. Subjective ratings of appearance mediated the association between social acceptance and depressive symptoms in all samples. Gender did not contribute in explaining the paths between friendships, appearance, and depressive symptoms. The associations between perceptions of social acceptance, appearance, and emotional distress, support the possible utility of strengthening social experiences in preventing and treating appearance-concerns.     

Transdiagnostic and Transcultural: Pilot Study of Unified Protocol for Depressive and Anxiety Disorders in Japan

Unified protocol (UP) is a transdiagnostic cognitive behavior therapy for emotional disorders. It remains unknown whether UP is applicable for use in non-Western countries and for depressive disorders. We therefore examined its feasibility for a Japanese clinical population using this clinical trial design, which is multicentered, open-labeled, and single-armed (Clinical registry: UMIN000008322). The primary outcome was severity of anxiety symptoms, as assessed using Structured Interview Guide for the Hamilton Anxiety Rating Scale. Secondary outcomes were depressive symptoms, clinical global impression, functioning, quality of life, affectivity, emotion regulation, and adverse events. Of the 28 prospective participants, 17 were eligible and enrolled (depressive disorders = 9, anxiety disorders = 8). Severity of anxiety symptoms, which decreased significantly after the intervention, remained low for 3 months (Hedges’ g = 1.29, 95% CI = 0.56–2.06). Similar tendencies were observed for secondary outcome measures. No severe adverse event occurred. Two participants dropped out of the intervention. High treatment adherence and interrater reliability were confirmed. Results suggest the feasibility of UP in the Japanese context sufficient to warrant a larger clinical trial.     

Risk factors of anxiety and depression in children and adolescents with headache: A cross-sectional study

IntroductionDespite numerous studies on the association between headache and psychological difficulties in children, the results remain inconclusive.ObjectiveThis cross-sectional study was conducted to clarify the links between anxiety-depression and headache in children. We evaluated the levels of anxious and depressive symptoms and the influence of risk factors: age, sex, headache diagnosis, frequency and history to identify and treat headache sufferers most at risk.MethodData were collected from a clinical sample of 368 children aged 8 to 17 years. First, a structured interview using the International Classification of Headache Disorders (ICHD-II) was used to diagnose 88 patients with migraine (M), 32 with tension-type headache (TTH), and 248 with a combination syndrome (M + TTH). Second, levels of anxiety and depressive symptoms were assessed with the Revised Children's Manifest Anxiety Scale (R-CMAS) and the Multiscore Depression Inventory for Children (MDI-C).ResultsAn ANOVA analysis showed that the mean scores for anxiety and depressive symptom levels were significantly higher among older patients and that only the M + TTH diagnosis was significantly associated with anxiety. Children with clinically significant levels of anxiety symptoms were more prevalent in our sample than in the general population (13% versus 5%). Anxiety and depression were not associated with child sex, headache frequency and history.ConclusionWe propose systematic screening for anxiety in children presenting with headache, particularly adolescents and patients with a combination diagnosis.     

Bidirectional associations between hope,optimism and social support,and trauma-related symptoms among survivors of terrorism and their spouses

The study examined bidirectional relationships between three key resources of resilience: hope, optimism, and social support, and a range of trauma-related symptoms (posttraumatic stress disorder, depression, and anxiety) among injured survivors of terror attacks and their spouses (N = 210). A series of actor-partner interdependence models were used to test the bidirectional dyadic associations. The results demonstrate negative associations between resilience resources of the survivors and their spouses and their trauma-related symptoms. Further, the levels of hope and social support reported by the survivors were negatively associated with the trauma-related symptoms experienced by their spouses, whereas the level of optimism reported by the spouses was negatively associated with the trauma-related symptoms experienced by the survivors. Theoretical and clinical implications 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.     

The mediating role of self-esteem in the relationship between big five personality traits and depressive symptoms among Chinese undergraduate medical students

The objectives of this study were to examine the correlations between big five personality traits and depressive symptoms among Chinese undergraduate medical students, and to explore the mediating role of self-esteem on the correlations. Self-reported questionnaires, including Big Five Inventory, the Center for Epidemiologic Studies Depression Scale, Rosenberg’s Self-Esteem scale, and socio-demographic section were distributed to 2000 undergraduate medical students at four medical colleges and universities in Liaoning province, China, in June 2014. 1738 students became the final subjects. After adjustment for age and gender, agreeableness (β = −0.329) and openness (β = −0.096) were negatively related to depressive symptoms, while neuroticism (β = 0.245) was positively related to the symptoms. Self-esteem functioned as a mediator in the relationship between agreeableness (a * b = −0.154, 95% CI: −0.182, −0.127)/openness (a * b = −0.097, 95% CI: −0.124, −0.069)/neuroticism (a * b = 0.031, 95% CI: 0.007, 0.058) and depressive symptoms. Therefore, identifying at-risk students and undertaking appropriate intervention strategies that focus on both personality traits and self-esteem may be effective in preventing and reducing depressive symptoms among Chinese medical students.     

Intelligence and emotional disorders: Is the worrying and ruminating mind a more intelligent mind?

Previous research has shown that anxiety and depression symptoms are negatively associated with measures of intelligence. However, this research has often not taken state distress and test anxiety into account, and recent findings indicate possible positive relationships between generalized anxiety disorder (GAD), worry, and intelligence. The present study examined the relationships between GAD, depression, and social anxiety symptoms, as well as their underlying cognitive processes of worry, rumination, and post-event processing, with verbal and non-verbal intelligence in an undergraduate sample (N = 126). While the results indicate that verbal intelligence has positive relationships with GAD and depression symptoms when test anxiety and state negative affect were taken into account, these relationships became non-significant when overlapping variance was controlled for. However, verbal intelligence was a unique positive predictor of worry and rumination severity. Non-verbal intelligence was a unique negative predictor of post-event processing. The possible connections between intelligence and the cognitive processes that underlie emotional disorders are discussed.     

Effects of a self-regulation intervention on exercise are moderated by depressive symptoms: A quasi-experimental study

This study investigated whether a computer-based self-regulation intervention increases physical exercise in individuals with or without depressive symptoms. A total of 361 individuals in orthopedic rehabilitation, 36 of them with depressive symptoms, were recruited in Germany. In a quasi-experimental study, individuals were allocated to either a computer-based self-regulation intervention or an online questionnaire. Exercise was measured at the beginning of rehabilitation and six weeks after rehabilitation. Depressive symptoms were assessed at the end of rehabilitation. An analysis of covariance was conducted, controlling for exercise baseline, sex, and phase of assessment. A main effect for depressive symptoms (p = .005) and intervention group (p = .011), as well as a marginal interaction of intervention x depressive symptoms were found (p = .076). Results indicate that the self-regulation exercise intervention in an orthopedic rehabilitation setting seem to be only effective in non-depressed individuals. Future research should examine how health behavior change programs can be designed more effectively for individuals with depressive symptoms.     

Time Course of Attention in Socially Anxious Individuals: Investigating the Effects of Adult Attachment Style

Theoretical models of social anxiety propose that attention biases maintain symptoms of social anxiety. Research findings regarding the time course of attention and social anxiety disorder have been mixed. Adult attachment style may influence attention bias and social anxiety, thus contributing to the mixed findings. This study investigated the time course of attention toward both negative and positive stimuli for individuals diagnosed with social anxiety disorder (SAD) and assessed whether attachment style moderates this relationship.One hundred and thirty participants (age: M = 29.03) were assessed using a semistructured clinical interview. Those meeting eligibility criteria for the clinical sample met DSM-IV criteria for SAD (n = 90, age: M = 32.18), while those in the control sample did not meet criteria for any mental disorder (n = 23, age: M = 26.04, 11 females). All participants completed self-report measures examining depression, social anxiety, adult attachment style, and completed an eye-tracking task used to measure the time course of attention. Eye-tracking data were analysed using growth curve analysis.The results indicate that participants in the control group overall displayed greater vigilance towards emotional stimuli, were faster at initially fixating on the emotional stimulus, and had a greater percentage of fixations towards the emotional stimulus as the stimulus presentation time progressed compared to those in the clinical group. Thus, the clinical participants were more likely to avoid fixating on emotional stimuli in general (both negative and positive) compared to those in the control group.These results support the Clark and Wells (1995) proposal that socially anxious individuals avoid attending to emotional information. Attachment style did not moderate this association, however anxious attachment was related to greater vigilance toward emotional compared to neutral stimuli.     

Electrocortical Evidence of Enhanced Performance Monitoring in Social Anxiety

Self-focused attention is thought to be a key feature of social anxiety disorder. Yet few studies have used event-related potentials (ERPs) to examine whether socially anxious individuals display greater monitoring of their performance and attention to their errors. Similarly, only a few studies have used ERPs to examine how social anxiety is related to processing of performance feedback. Individuals with high (n = 26) and low (n = 28) levels of social anxiety completed a trial-and-error learning task. Self-focus was manipulated using false heart-rate feedback during a random subset of trials. Performance feedback was given using emotional and neutral faces in a positive context (correct = happy face; incorrect = neutral face) and negative context (correct = neutral face; incorrect = disgust face) in order to investigate biased interpretation and attention to feedback. Socially anxious subjects displayed enhanced amplitude of the ERN and CRN, suggesting greater response monitoring, and enhanced Pe amplitude, suggesting greater processing of errors relative to the low social anxiety group. No group differences were observed with respect to feedback processing. Before learning stimulus–response mappings in the negative context, the FRN was larger for self-focus compared to standard trials and marginally larger for socially anxious subjects compared to controls. These findings support cognitive models and suggest avenues for future research.     

Perinatal depression influences on infant negative affectivity: Timing,severity, and co-morbid anxiety

Accumulating evidence suggests that antenatal depression predicts infants’ negative affectivity, albeit with variable effect sizes. With a prospective longitudinal design, we sought to explain that variability by addressing questions about timing of the depression across pregnancy and the early postpartum, the role of high symptom levels relative to diagnosed depression, comorbidity with anxiety, and the potential mediating role of neuroendocrine functioning. Primiparous women (n = 77) with histories of depression prior to pregnancy were assessed for cortisol levels monthly beginning by mid-pregnancy. Depression symptom levels and diagnostic status were similarly assessed monthly in pregnancy and also until infants reached three months of age, when mothers completed the Infant Behavior Questionnaire-Revised to measure infant negative affectivity. Antenatal depression symptoms and infant negative affectivity were positively associated (r = .39). Controlling for depression symptom levels in other trimesters, only second trimester depression symptoms predicted higher infant negative affectivity (β = .44). With postpartum depression symptom levels in the model, only antenatal depression symptoms predicted infant negative affectivity (β = .45). In the context of depression, neither antenatal anxiety symptoms nor anxiety disorder diagnosis were associated with infant NA scores. The hypothesized role of elevated maternal cortisol as a mechanism for the association between antenatal depression and infant NA was not supported. Our findings contribute to efforts to more precisely identify infants of perinatally depressed mothers who are at greater risk for elevated negative affectivity, suggesting a window of vulnerability in mid pregnancy and the need for further study of potential mechanisms.     

Depression mediates the relationship between social performance impairment and hostility

The goal of this study was to test depressive symptoms as a mediator between social difficulties and hostility in young adults. Hostility is often a reaction to both intrinsic and extrinsic factors; therefore a greater understanding of contributing factors is needed, especially among emerging adults. College students (n = 608; 408 females, 200 males) self-reported on social difficulties, depression, and hostility. Via exploratory factor analyses, two latent constructs related to social difficulty were identified: social performance and social motivation. Using structural equation modeling, the direct effects found that poor social performance was significantly positively associated with BPAQ Total (β = .44, p < .01). Social motivation was not associated with BPAQ Total (β = −.07, p = .21). Further, depression scores were found to partially mediate the relationship between social performance deficits (β = .34, p < .01; 95% CI = .05–.16), but not social motivation (β = −.06, p > .05; 95% CI = −.04 to .04), and overall aggression. Results are discussed in terms of the influence of negative affect and impaired emotion regulatory processes on hostility as a consequence of social performance deficits.     

Maternal postpartum depressive symptoms and infant externalizing and internalizing behaviors

Maternal postpartum depression has been shown to be one of the main predictors of externalizing and internalizing behaviors in toddlers and adolescents. Research suggests that presence of such behaviors can be observed as early as infancy. The current study uses longitudinal data from 247 mothers to examine the relationship between postpartum depressive symptoms at 8 weeks and the infant's externalizing and internalizing behaviors at 12 months. In unadjusted linear regression models, there were associations between postpartum depressive symptoms and infant externalizing behaviors (β = 0.082, SE = 0.032, p = 0.012) and internalizing behaviors (β = 0.111, SE = 0.037, p = 0.003). After controlling for potential confounding factors, including maternal age, race, education, home ownership, smoking status in the postpartum period, marital status, parenting stress, and happiness from becoming a parent, the associations between postpartum depressive symptoms and infant externalizing (β = 0.051, SE = 0.034, p = 0.138) and internalizing behaviors (β = 0.077, SE = 0.040, p = 0.057) were reduced and became non-significant. Furthermore, in these models the total amount of variance explained was 17.2% (p < 0.0001) for externalizing behaviors and 10.5% (p < 0.01) for internalizing behaviors; the only significant predictor of externalizing behaviors was maternal age (β = −0.074, SE = 0.030, p = 0.014), and of internalizing behaviors was white non-Hispanic ethnicity (β = −1.33, SE = 0.378, p = 0.0005). A combined effect of the confounding factors seems to explain the finding of no significant independent association between postpartum depressive symptoms and infant externalizing and internalizing behaviors.     

Randomized Controlled Trial of a Family Intervention for Children Bullied by Peers

This study examined the effects of a family intervention on victimization and emotional distress of children bullied by peers. The intervention, Resilience Triple P, combined facilitative parenting and teaching children social and emotional skills relevant to developing strong peer relationships and addressing problems with peers. Facilitative parenting is parenting that supports the development of children’s peer relationship skills. A randomized controlled trial was conducted with 111 families who reported chronic bullying of children aged 6 to 12 years. Families were randomly allocated to either an immediate start to Resilience Triple P (RTP) or an assessment control (AC) condition. Assessments involving children, parents, teachers, and observational measures were conducted at 0 (pre), 3 (post) and 9 months follow-up. RTP families had significantly greater improvements than AC families on measures of victimization, child distress, child peer and family relationships, including teacher reports of overt victimization (d = 0.56), child internalizing feelings (d = 0.59), depressive symptoms (d = 0.56), child overt aggression towards peers (d = 0.51), acceptance by same sex and opposite sex peers (d = 0.46/ 0.60), and child liking school (d = 0.65). Families in both conditions showed significant improvements on most variables over time including child reports of bullying in the last week reducing to a near zero and indistinguishable from the normative sample. The intervention combining facilitative parenting and social and emotional skills training for children produced better results than the comparison assessment control condition. This study demonstrated that family interventions can reduce victimization and distress and strengthen school efforts to address bullying.     

Personality styles in a non-clinical sample: The role of emotion dysregulation and impulsivity

Theories of personality and personality disorders are increasingly considering the centrality of emotion regulation and its dimensions. Impulsivity as well is recognized as a personality trait underlying diverse symptom presentations. Although research in this field has mainly regarded borderline personality disorder, recent studies supported the association of both emotion dysregulation and impulsivity with personality styles across all clusters. In the present study, we sought to extend extant research by investigating the joint contribution of selected difficulties in emotion regulation and impulsivity to traits of four personality styles in a community sample (N = 399, mean age = 37.91, 56.6% males). In particular, we focused on depressive, masochistic, passive-aggressive and sadistic personality styles. Multiple regression analyses showed the unique association of several domains of emotion dysregulation with all personality styles examined. Nonacceptance of emotional response was significantly and positively related with scores of all personality styles. Lack of emotional awareness was also characteristic of different styles. Beyond these similarities, distinct patterns were able to distinguish between externalizing (sadistic and passive-aggressive), and internalizing (depressive and masochistic) traits. Beyond the role of emotion dysregulation, trait impulsivity was also related to masochistic, passive-aggressive, and sadistic traits, independently explaining a significant amount of additional variance.     

A randomized controlled trial of strong minds: A school-based mental health program combining acceptance and commitment therapy and positive psychology

To date, most early intervention programs have been based on emotion regulation strategies that address dysfunctional cognitive appraisals, problem-solving skills, and rumination. Another emotion regulation strategy, ‘acceptance’ training, has largely been overlooked. To examine the efficacy of this strategy, a school-based mental health program combining positive psychology with acceptance and commitment therapy (Strong Minds) was evaluated in a randomized controlled trial with a sample of 267 Year 10 and 11 high-school students in Sydney, Australia. Mixed models for repeated measures examined whether the program led to reductions in symptoms amongst students who commenced the program with high depression, anxiety, and stress scores, and increased wellbeing scores amongst all students. Results demonstrated that compared to controls, participants in the Strong Minds condition with elevated symptom scores (n = 63) reported significant reductions in depression (p = .047), stress (p = .01), and composite depression/anxiety symptoms (p = .02) with medium to strong effect sizes (Cohen's d = 0.53, 0.74, and 0.57, respectively). Increased wellbeing (p = .03) in the total sample and decreased anxiety scores (p = .048) for students with elevated symptoms were significant for Year 10 students with medium effect sizes (Cohen's d = 0.43 and 0.54, respectively). This study tentatively suggests that including the emotion regulation strategy of acceptance in early intervention programs may be effective in reducing symptoms and improving wellbeing in high school students. Further research to investigate the generalizability of these findings is warranted.     

Does goal relevant episodic future thinking amplify the effect on delay discounting?

Delay discounting (DD) is the preference for smaller immediate rewards over larger delayed rewards. Research shows episodic future thinking (EFT), or mentally simulating future experiences, reframes the choice between small immediate and larger delayed rewards, and can reduce DD. Only general EFT has been studied, whereby people reframe decisions in terms of non-goal related future events. Since future thinking is often goal-oriented and leads to greater activation of brain regions involved in prospection, goal-oriented EFT may be associated with greater reductions in DD than general goal-unrelated EFT. The present study (n = 104, M_age = 22.25, SD = 3.42; 50% Female) used a between-subjects 2 × 2 factorial design with type of episodic thinking (Goal, General) and temporal perspective (Episodic future versus recent thinking; EFT vs ERT) as between factors. Results showed a significant reduction in DD for EFT groups (p < 0.001, Cohen’s d effect size = 0.89), and goal-EFT was more effective than general-EFT on reducing DD (p = 0.03, d = 0.64).     

Interpersonal rejection sensitivity predicts burnout: A prospective study

We examined whether interpersonal rejection sensitivity (IRS) – the hallmark of atypical depression – prospectively predicted burnout, controlling for baseline symptoms, history of depressive disorders, antidepressant intake, gender, age, and length of employment (mean between-assessment duration: 21 months; n = 578; 74% female). IRS was related to a 119% increased risk of burnout at follow-up. Three of four burned out participants reported to be affected by IRS, or 2.5 times the rate observed in participants with no (or subthreshold) burnout symptoms. Our study highlights a dispositional factor in burnout’s etiology also known to be a key component of atypical depression’s etiology. The ontogenesis of individual vulnerabilities to burnout should be further examined in future research.     

Social desirability and relations between goal orientations and competitive trait anxiety in young athletes

ObjectivesTo examine the impact of a social desirability response set on relations between goal orientation and performance anxiety in youth sports.DesignCorrelational field design.MethodData assessing goal orientation, performance anxiety, and social desirability were obtained from male (n=106) and female (n=75) adolescent athletes (M age=12.1 years; SD=1.3 years).ResultsFemale athletes reported significantly higher levels of task orientation and lower levels of ego orientation and concentration disruption, than males. As predicted, ego orientation was positively correlated with all indices of performance anxiety in males and females. Task orientation was negatively associated with all indices of performance anxiety in males but only concentration disruption in females. Social desirability was negatively related to ego orientation in males and females, and positively related to task orientation in females, but not males. Performance anxiety was negatively related to social desirability in females, but not males. Controlling for social desirability attenuated the observed relations between goal orientations and performance anxiety in females, but not males.ConclusionsThese results suggest the importance of incorporating measures of social desirability when studying psychosocial variables with either positive or negative connotations. Our results suggest that social desirability may contribute to relations between goal orientation and anxiety in athletes, particularly females.