Trajectory of change in anxiety sensitivity in relation to anxiety,depression, and quality of life among persons living with HIV/AIDS following transdiagnostic cognitive-behavioral therapy

ABSTRACT

Persons living with HIV/AIDS (PLHIV) disproportionately suffer from anxiety and depressive symptoms and disorders. Although past work has examined the efficacy of cognitive-behavioral therapy (CBT) for depression, and to a lesser extent anxiety, among PLHIV, little is known regarding potential mechanisms underlying improvement in anxiety/depression among this group. Anxiety sensitivity is a well-established risk/maintenance factor for anxiety and depressive disorders and is hypothesized to play an important role in maintaining anxiety among PLHIV. Past work has identified anxiety sensitivity as a mechanism of action underlying changes in various anxiety domains yet it is unknown whether changes in anxiety sensitivity relate to changes in anxiety symptoms among PLHIV undergoing transdiagnostic CBT for anxiety. The current study sought to examine treatment-related changes in anxiety sensitivity and how the trajectory of change relates to anxiety and depressive symptoms as well as overall quality of life. Individuals (n = 35) with HIV/AIDS and elevated anxiety symptoms received CBT for anxiety. Results indicated that reductions in anxiety sensitivity were significantly related to changes in anxiety, depression, and quality of life. Together, these data suggest that changes in anxiety sensitivity are significantly related to changes in anxiety/depression and quality of life among PLHIV seeking treatment.     

冠心病患者的抑郁和焦虑

许多临床研究表明,冠心病患者常发生抑郁及焦虑。而在严重精神症状（如抑郁或/和焦虑）者中有较高的冠心病发生率。抑郁增加冠心病患者的不良心血管事件发生率,影响预后。其机制有如下几个方面：对医疗措施及生活方式改变的依从性差、血小板功能异常、血管内皮功能紊乱以及心率变异性降低。选择性5-羟色胺再摄取抑制剂由于其较好的耐受性且无明显的心血管副作用而应用于冠心病合并抑郁及焦虑的药物治疗并改善患者的生活质量。但仍需要更大规模的临床研究以确定抑郁及焦虑对冠心病预后的影响。临床上应更加关注焦虑对冠心病的影响,进一步探讨焦虑能否作为冠心病的危险因素。     

Gut interpretations: how difficulties in emotion regulation may help explain the relation of visceral sensitivity with depression and anxiety among young adults with gastrointestinal symptoms

It is widely recognized that abdominal pain and discomfort are common problems in the United States and are often associated with negative quality of life. The prevalence of anxiety/depression elevations and disorders among persons with gastrointestinal disturbances (GI) is estimated to be at least two to three times the rate in the general population. Visceral sensitivity reflects anxiety about GI sensations and its accompanying contexts and often leads to worsening of sensations (e.g. bloating, upset stomach, diarrhea). Among individuals with GI symptoms, visceral sensitivity may be associated with interpreting common sensations as catastrophic which may be related to greater difficulties with emotion dysregulation (e.g. severe anxiety and depression). The current study evaluated the indirect association of visceral sensitivity via emotion dysregulation in relation to depression, anxious arousal, and social anxiety symptoms among 344 young adults with a current history of GI symptoms and problems. Results indicated an indirect effect of visceral sensitivity via emotion dysregulation. These findings provide novel empirical support for the association of visceral sensitivity with emotional distress symptoms among young adults with GI symptoms. Based on the results, targeting emotion dysregulation may be a promising health promotion tactic among young adults with GI symptoms and disorders.     

The correlations of socioeconomic status,disease activity,quality of life,and depression/anxiety in Chinese patients with rheumatoid arthritis

This study aimed (i) to investigate the relationships among socioeconomic status, disease activity, quality of life, and the psychological status in Chinese rheumatoid arthritis (RA) patients; (ii) to explore the possible risk factors of anxiety and depression. A total of 160 RA patients underwent standardized laboratory examinations and completed several questionnaires. Independent samples t-tests, χ² analyses, and logistic regression modeling were used to analyze the data. We found 30.6% RA patients were anxiety, and 27.5% had depression, which were significantly higher than the control group (7.8 and 11.7%, respectively). And there were significant correlations among education, pain, disease activity, medication adherence, functional capacity, quality of life, and anxiety/depression. Meanwhile, logistic regression analysis revealed that poor quality of life and low education level were significantly associated with anxiety/depression in RA patients. In conclusion, there were significant relationships among education, quality of life, and anxiety/depression in Chinese RA patients.     

Psychische Störungen bei HIV-Infektion und Aids

The human immunodeficiency virus (HIV) is the pathogen responsible for acquired immune deficiency syndrome (AIDS). Worldwide there are currently about 40 million people infected with HIV and an estimated 44,000 in Germany. If left untreated after a few years the infection leads to the manifestation of AIDS and eventually to death through opportunistic infections and malignant tumors. Infection with HIV is not curable. Nevertheless, antiretroviral treatment can slow the progress of the disease and prolong life expectancy significantly. Once antiretroviral treatment has started the medication must be taken regularly and lifelong. Serious side effects of the medication pose a significant stress on physical and psychological well-being and impair adherence. Infection with HIV means a total change in life perspectives and requires extensive adaptations in lifestyle. Problems with adaptation and mental disorders (e.g. depression, anxiety disorders, adjustment disorder) are, therefore, frequent. With disease progression neurocognitive impairments are increasingly likely. Mental disorders and neurocognitive impairments adversely affect treatment adherence, increase health risk behavior and reduce immune function. Psychological interventions contribute significantly to the reduction in health risk behavior, improve treatment adherence and are successful in the treatment of depression and anxiety.     

Predictors of treatment attendance and adherence to treatment recommendations among individuals receiving Cognitive Behavioral Therapy for Insomnia

ABSTRACT

Insomnia disorders affect up to 10% of adults and are associated with other health problems and poor quality of life. Cognitive Behavioral Therapy for Insomnia (CBT-I) is an effective treatment; however, its effectiveness is hindered by poor attendance and adherence to treatment recommendations. The present study sought to identify predictors of attendance and adherence in CBT-I. Participants were 108 adults with insomnia disorder. Participants were primarily female (71.3%), middle aged (mean age = 50.5), and Caucasian (92.6%). Demographic variables, physical health problems, Beck Anxiety Inventory, Center for Epidemiologic Studies Depression-Revised scale, and Insomnia Severity Index were used to predict attending three or more sessions and adherence to consistent bedtime and waketime. Higher age was associated with better attendance and less deviation in bed and wake times. Anxiety and depression symptoms were associated with less attendance, and depression was also associated with more deviation in waketimes. To promote better attendance and adherence in treatment, depression or anxiety symptoms should be addressed before or during CBT-I. Identifying and tailoring CBT-I treatments toward the needs of different age groups may also improve attendance and adherence.     

Rates and Correlates of DSM-IV Diagnoses in Women Newly Diagnosed with Breast Cancer

Although the presence of psychological distress has been documented in women with breast cancer, previous studies have not established rates of DSM-IV diagnoses in this population, nor have prior investigations compared the utility of diagnostic interviewing vs. symptom checklists to assess distress. DSM-IV diagnoses of anxiety disorders and major depression, symptoms of anxiety and depression, and quality of life were examined in 207 women with newly diagnosed breast cancer. Eighteen percent of breast cancer patients met criteria for a current DSM-IV anxiety or depressive disorder and 54% met criteria for a disorder at some point in their lifetime. These rates are comparable to those found in recent community epidemiological studies (e.g., R. C. Kessler, K. A. McGonagle, S. Zhao, C. B. Nelson, M. Hughes, S. Esheman, et al., 1994). Sensitivity, specificity, and positive predictive value for anxiety and depression symptoms as predictors of DSM disorders were relatively poor. However, after accounting for demographic, treatment, and cancer variables, self-reported anxiety symptoms were significantly related to the presence of an anxiety disorder and self-reported depressive symptoms were significantly related to a diagnosis of a depressive disorder. Symptoms of anxiety and depression contributed significantly and uniquely to physical, medical, and sexual quality of life; DSM-IV diagnoses were not significantly related to quality of life after controlling for symptoms of depression and anxiety. The importance of measuring both symptoms of distress and psychiatric diagnoses in cancer patients and the clinical practice implications of the results are discussed.     

Anxiety Disorders in Late Life: Considerations for Assessment and Cognitive-Behavioral Treatment

Anxiety disorders are among the most frequently diagnosed mental disorders in late life. As older adults comprise a growing segment of the population, evidence-based treatments for anxiety disorders in late life have come into sharper focus. Cognitive-behavioral therapy (CBT) for anxiety disorders in late life has received less empirical attention and widespread dissemination relative to other age groups. Increasing older adults’ access to timely assessment and effective treatment can help reduce the personal and societal costs of anxiety disorders. The purpose of this review paper is to discuss important considerations for the assessment of anxiety disorders in older adults and offer adaptations to CBT treatment for this population. As part of assessment considerations, we discuss how physical health conditions, cognitive impairment, and functional limitations can impact anxiety disorder diagnoses with older adults. We also outline validated self-report measures of anxiety disorder symptoms for older adults and highlight the importance of assessing older adults’ suitability for CBT. Several recommendations for adapting CBT protocols for older adults with anxiety disorders are described, such as extending psychoeducation, altered treatment pacing, use of content aids, and medical contraindications for interoceptive exposure. A case study is included that illustrates helpful assessment and treatment adaptions for an older woman with panic disorder. We highlight the pressing need to increase research and dissemination of CBT for anxiety disorders for older adults to meet the needs of an increasing segment of the population worldwide.     

Elevated Appraisals of the Negative Impact of Naturally Occurring Life Events: A Risk Factor for Depressive and Anxiety Disorders

The tendency to appraise naturally occurring life events (LEs) as having high negative impact may be a predisposing factor for the development of depression and anxiety disorders. In the current study, appraisals of the negative impact of recent LEs were examined in relationship to depressive and anxiety disorders in a sample of 653 adolescents who were administered diagnostic and life stress interviews at ages 15 and 20. Participants’ appraisals of the negative impact of LEs reported at age 15 were statistically adjusted using investigator-based ratings to control for objective differences across LEs. Higher appraisals of the negative impact of LEs were associated with both past and current depressive and anxiety disorders at age 15 and predicted subsequent first onsets of depressive and anxiety disorders occurring between ages 15 and 20. In addition, appraisals of the negative impact of LEs were particularly elevated among those experiencing both a depressive and anxiety disorder over the course of the study. The findings suggest that systematically elevated appraisals of the negative impact of LEs are a predisposing factor for depression and anxiety disorders and may represent a specific risk factor for co-morbid depression and anxiety in mid-adolescence and early adulthood.     

The effects of COVID-19 stressors and family life on anxiety and depression one-year into the COVID-19 pandemic

The purpose of this study was to examine the effects of Coronavirus (COVID-19)-related stressors and family health on adult anxiety and depressive symptoms 1 year into the pandemic. The sample consisted of 442 adults living in the United States who were recruited via Amazon Mechanical Turk. Data were analyzed using multiple logistic regression. Results indicated that compared to a sample 1 month into the pandemic, participants in the current sample reported worse family health and increases in both positive and negative perceptions of the pandemic on family life and routines. COVID-19 stressors and perceived negative effects of the pandemic on family life increased the odds for moderate-to-severe depression and anxiety while having more family health resources decreased the odds for depression and anxiety symptoms. Participants reported lower odds for worse depression and anxiety since the beginning of the pandemic when they reported more positive family meaning due to the pandemic. The results suggest a need to consider the impact of family life on mental health in pandemics and other disasters.     

Anxiety and Depression in Medically Ill Older Adults

Anxiety and depression are extremely common in the elderly with medical problems. They can manifest not only as symptoms of a primary psychiatric illness, but also as physiologic sequelae of medical illnesses and medical treatments. Recognition and treatment of depression and anxiety in the medically ill is especially difficult. If these states go untreated, they result in higher morbidity and mortality, higher health care costs and utilization, and poorer functional status and outcomes. Three of the most common medical illnesses that afflict geriatric patients, cardiovascular disease, pulmonary disease, and rheumatoid arthritis, will be presented to illustrate the difficulty in recognizing depression and anxiety and the impact of treating these symptoms in the medically ill elderly. Multidisciplinary approaches combining optimal medication regimens and psychosocial interventions can be effective for treatment of anxiety and depression in the medically ill elderly.     

Depression and HIV infection: impact on immune function and disease progression

Can psychological factors, such as depression, affect human immunodeficiency virus progression? HIV infection is viewed as a chronic illness in which those infected often confront a number of emotional challenges and physical health and disease-related issues. Over the past 20 years, there has been increasing evidence that depression and other mood-related disturbances are commonly observed among HIV-positive individuals. There is also mounting data showing that depressive symptoms might further impact upon specific elements of immune system functioning and influence quality of life and health status. This paper will highlight studies examining the prevalence of depression during HIV infection and review some of the evidence examining the impact of depressive symptoms on immune function and HIV disease progression.     

Emotion Appraisal and Anxiety Symptomatology in a University Sample

Current conceptualizations for anxiety disorders focus heavily on cognitive and behavioral aspects of anxiety and address other emotions to a far lesser extent. Studies have demonstrated that negative appraisals of anxiety and fear (e.g., anxiety sensitivity) are elevated in each of the anxiety disorders and depressive disorders. Much less is known about how the appraisal of other emotions is related to anxiety disorder symptom presentation. The current study examines the appraisal of specific aversive emotions in relation to anxiety symptomatology. Undergraduate university students (N = 530) completed measures of specific anxiety and depressive symptoms, as well as a measure of emotional appraisal. A maximum likelihood estimated multivariate regression model was used to examine the unique relationships between emotional appraisal and anxiety and depressive symptoms. Results indicated that anxiety symptoms varied in their relationships with emotional appraisal. Each symptom group was highly related to fear of appraisals of anxiety; however, some anxiety symptoms were also related to fear of other emotional states, including guilt, sadness, disgust, lust, and embarrassment. Understanding the full range of appraisals of emotional experiences in anxiety conditions may help inform conceptualizations, and potentially treatments, by guiding the focus to the feared emotional states of the individual. The present study helps to clarify some of the relationships between emotion appraisal and anxiety symptoms.     

Personality,life events and the course of anxiety and depression

Using data from the Netherlands Study of Depression and Anxiety, we examined among 1322 participants with a DSM‐IV diagnosis of depression or anxiety: (i) whether positive and negative life events influence 1‐year course of anxiety and depressive symptoms; (ii) whether personality traits (neuroticism and extraversion) predict symptom course and moderate the impact of life events on symptom course; and (iii) whether life events mediate relationships of neuroticism and extraversion with symptom course. Negative life events were predictive of both anxiety and depressive symptoms, while positive life events predicted the course of depressive symptoms only. Personality traits had significant predictive and moderating effects on symptom course, though these effects were rather small. Copyright © 2011 John Wiley & Sons, Ltd.     

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.     

手机成瘾与抑郁：社交焦虑和负性情绪信息注意偏向的多重中介作用

为考察手机成瘾与抑郁的关系, 研究同时整合情绪和认知两方面因素, 探讨了社交焦虑和负性情绪信息注意偏向在手机成瘾和抑郁之间的多重中介作用。研究1共有545名大学生完成了大学生手机成瘾倾向量表、贝克抑郁量表和社会交往焦虑量表。研究2选取51名大学生采用问卷法和2(配对面孔表情的情绪类型: 负性、中性) × 2(探测点位置: 与负性情绪面孔表情同侧、与负性情绪面孔表情异侧)的被试内实验设计。结果表明: (1)手机成瘾、社交焦虑和抑郁两两间存在显著正相关, 且社交焦虑在手机成瘾和抑郁之间起完全中介作用; (2)社交焦虑和负性情绪信息注意偏向在手机成瘾与抑郁的关系中起链式中介作用, 而负性情绪信息注意偏向在手机成瘾与抑郁间的单独中介效应不显著。具体而言, 手机成瘾通过两条路径影响抑郁: 一是社交焦虑的单独中介作用; 二是社交焦虑→负性情绪信息注意偏向的链式中介作用。     

Anxiety,depression, and health-related quality of life in aging people living with HIV compared to diabetes patients and patients with minor health conditions: a longitudinal study

HIV infection has evolved from a fatal to a treatable condition, leading to an increase in the rate of elderly People Living with HIV (PLWH). However, little is known about the psychosocial burden of elderly PLWH. Thus, the aim of this longitudinal multi-center cohort study was to investigate whether elderly PLWH experience more anxiety and depression and reduced health related quality of life (HRQOL) compared to elderly patients with other chronic conditions. PLWH were compared to diabetes patients (DM) and patients with minor health conditions (MHC), e.g. patients with hypertension or allergic conditions. All patients were over 50 years old. Anxiety and depression (HADS) as well as HRQOL (SF-36) were assessed at baseline and after 12 months. 218 PLWH, 249 DM and 254 MHC were included. At baseline, the study groups did not differ in anxiety, depression, and physical HRQOL. However, PLWH indicated lower mental HRQOL than DM and MHC patients (p = 0.001). We did not obtain any moderating effects showing a differential effect of patient characteristics on anxiety, depression, and HRQOL in the three patient groups. At follow-up, the level of anxiety, depression, and HRQOL did not change significantly. The prevalence of anxiety ranged between 27 and 35%, and that of depression between 17 and 28%. Thus, the results of our investigation tentatively suggest that the psychosocial adaptation to HIV among elderly PLWH resembles those of other chronic diseases. There may be some subtle impairments, though, as PLWH experienced lower mental HRQOL.     

A Social Problem-Solving Model of Adherence to HIV Medications.

HIV medication adherence remains a challenge and limits the degree to which treatment benefit can be maximized. This study tested an explanatory model of HIV medication adherence using a social problem-solving (SPS) framework. Associations of SPS with adherence are hypothesized to be direct and/or indirect via psychological health. HIV+ adults were interviewed using validated measures of SPS, psychological health, and antiretroviral therapy (ART) medication adherence. Structural equation modeling (SEM) techniques were used to test hypothesized relationships and to evaluate overall fit of the model to the data. SEM supported an indirect association (but not direct) of SPS on adherence via psychological health among the 545 HIV+ adults included in the analyses. Overall, the findings resulted in a model of adherence that offered very good fit to the data and correctly classified 97% of the cases as adherent versus nonadherent. Results support the use of SPS as a conceptual framework for understanding adherence to ART. Findings offer rationale and direction for SPS interventions to enhance adherence by improving psychological health. Such approaches, if effective, have the potential to positively impact psychological well being and adherence, thereby maximizing clinical benefit from treatment, which is linked to lower mortality from AIDS.     

ACT HEALTHY: A Combined Cognitive-Behavioral Depression and Medication Adherence Treatment for HIV-Infected Substance Users

The two most common comorbid conditions with HIV are substance use disorders and depression, and individuals with comorbid HIV, depression, and substance dependence face a more chronic and treatment-resistant course. As an example of how to adapt evidence-based approaches to a complex comorbid population, the current case study examined the integration of a combined depression and HIV medication adherence treatment. The resulting intervention, ACT HEALTHY, combines a brief behavioral activation approach specifically developed to treat depression in individuals receiving residential substance abuse treatment (LETS ACT; Daughters et al., 2008) with a brief cognitive-behavioral approach to improving HIV medication adherence (Life-Steps; Safren et al., 1999; Safren et al., 2009). The current case series demonstrates the use of ACT HEALTHY among 3 depressed HIV-positive, low-income African Americans entering residential substance abuse treatment.