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.     

Specificity of relations between adolescents’ cognitive emotion regulation strategies and symptoms of depression and anxiety

ABSTRACT

The aim of this study was to examine the extent to which cognitive emotion regulation strategies were “common or transdiagnostic correlates” of symptoms of depression and anxiety and/or “specific correlates” distinguishing one problem category from the other. The sample comprised 582 13- to 16-year-old secondary school students. Symptoms of depression and anxiety were measured by the SCL-90, and cognitive emotion regulation strategies were measured by the CERQ, in a cross-sectional design. Multivariate regression analyses were performed. Before controlling for comorbidity, the same cognitive emotion regulation strategies that were related to symptoms of depression were also related to symptoms of anxiety. However, after controlling for comorbid anxiety symptoms, rumination, self-blame (only girls), positive reappraisal, and positive refocusing (the latter two inversely) were uniquely (and significantly) associated with depression symptoms; and after controlling for comorbid depression symptoms, catastrophising and other-blame were uniquely related to anxiety symptoms. The results supported the cognitive content-specificity model, in which anxiety is supposed to be uniquely characterised by thoughts concerning the overestimation of threats and harm, and depression is supposed to be uniquely characterised by negative evaluations of self, and of past and future events.     

Neurobiological correlates of cognitions in fear and anxiety: A cognitive–neurobiological information-processing model

We review likely neurobiological substrates of cognitions related to fear and anxiety. Cognitive processes are linked to abnormal early activity reflecting hypervigilance in subcortical networks involving the amygdala, hippocampus, and insular cortex, and later recruitment of cortical regulatory resources, including activation of the anterior cingulate cortex and prefrontal cortex to implement avoidant response strategies. Based on this evidence, we present a cognitive–neurobiological information-processing model of fear and anxiety, linking distinct brain structures to specific stages of information processing of perceived threat.     

Psychopathic traits and adolescents’ delinquency: A short-term longitudinal study

Delinquency may partly develop as a consequence of psychopathic personality. But, what is the mechanism behind this connection? 150 Cypriot students were asked to complete four questionnaires (Inventory of Parents and Peers Attachment, Bullying and Victimization Questionnaire-Revised, Youth Psychopathic Traits Inventory and Delinquency Scale) in three time periods; (November 2015, February 2016, May 2016). We hypothesized that; (a) psychopathic traits will predict the increase in delinquent behaviour, (b) psychopathic traits at Time 1 will predict a poorer attachment with parents and peers, and an increase in bullying and victimization at Time 2, and this inter alias will predict an increase in delinquency at Time 3. A mediation effect is also hypothesized in this study. Results showed a direct relation between psychopathic traits and delinquency. Full mediation was found with bullying and victimization as mediators. Additionally, the quality of attachment and delinquency is not statistically significant related. The present findings suggest that bullying and victimization are part of the mechanism in the connection between psychopathy and delinquency. In conclusion, results provide important clues for understanding that psychopathic traits are not considered as a determining factor of delinquent behaviour since bullying could be controlled and modified with proper interventions.     

Confirmation and the generalized Nagel–Schaffner model of reduction: a Bayesian analysis

Synthese - In their 2010 (Erkenntnis 73:393–412) paper, Dizadji-Bahmani, Frigg, and Hartmann (henceforth ‘DFH’) argue that the generalized version of the Nagel–Schaffner...     

Why is personality tied to sleep quality? A biometric analysis of twins

Despite consistent links between personality traits and poor sleep, little is known about genetic and environmental influences that may produce them. This study examined how much genetic background and environmental experiences contributed to phenotypic linkages between personality and subjective sleep quality. Seven hundred and thirty-four twin pairs from the Minnesota Study of Twin Aging and Development rated their sleep quality and provided personality reports. Bi-variate analyses revealed that genetic factors accounted for the majority of observed associations between subjective sleep quality and traits, but also that non-shared environmental experience played a role that varied across traits. The findings strongly implicate genotype in tying subjective sleep quality to personality variation, alongside non-shared environmental influences, and suggest indicate influences unique to individual traits.     

Wakefield’s harmful dysfunction analysis of disorder and the problem of defining harm to nonsentient organisms

Theoretical Medicine and Bioethics - This paper criticizes Jerome Wakefield’s harmful dysfunction analysis (HDA) of disorder by arguing that the conceptual linkage it establishes between the...     

Perfectionistic concerns predict increases in adolescents’ anxiety symptoms: a three-wave longitudinal study

Background and Objectives: Although perfectionism has been proposed to be a risk factor for the development of anxiety, research on perfectionism and anxiety symptoms in adolescents is scarce and inconclusive. The aim of the present study was to investigate whether the two higher-order dimensions of perfectionism – perfectionistic strivings and perfectionistic concerns – predict the development and maintenance of anxiety symptoms. An additional aim of the present study was to examine potential reciprocal effects of anxiety symptoms predicting increases in perfectionism.

Design: The study used a longitudinal design with three waves spaced 4–5 months apart.

Methods: A non-clinical sample of 489 adolescents aged 12–19 years completed a paper-and-pencil questionnaire.

Results: As expected, results showed a positive effect from perfectionistic concerns to anxiety symptoms, but the effect was restricted to middle-to-late adolescents (16–19 years old): Perfectionistic concerns predicted longitudinal increases in adolescents’ anxiety symptoms, whereas perfectionistic strivings did not. Furthermore, anxiety symptoms did not predict increases in perfectionism.

Conclusions: Implications for the understanding of the relationship between perfectionism and anxiety symptoms are discussed.     

The impact of exercise environments on adolescents’ cognitive and psychological outcomes: A randomised controlled trial

Exercise in natural environments can improve cognition, positive affect, and reduce psychological stress. However, it remains unclear whether these benefits are subject to a gradient effect, whereby more natural features confer greater cognitive and psychological benefits. This study examined the influence of the exercise environment (i.e., the degree of nature) on cognition, and psychological outcomes in a sample of adolescents (n = 90; mean age = 14.3 ±.05 years). Four groups were randomised to one of the following experimental conditions: a non-exercise indoor control, indoor exercise, park exercise, and exercise in a nature reserve. Participants’ self-reported their stress, affect, and vitality and completed two measures of cognition (‘Rapid Visual Information Processing’ and ‘Spatial Working Memory’) immediately before and ~6 min after exercise. All exercise conditions participated in a group-based circuit lasting ~20 min, which included a mixture of aerobic and body-weight resistance activities. Linear mixed models were used to examine changes within and between groups. The indoor group increased sustained attention accuracy compared to the park group. There were no between-group differences in working memory. The indoor and nature groups increased cognitive arousal compared to control. The park group improved in state-level vitality compared to control. The mixed-results of this research do not support our ‘nature gradient’ hypothesis, whereby cognitive and psychological outcomes would improve in accordance with the degree of nature present in the exercise environment.     

The impact of post-migration stressors on refugees’ emotional distress and health: A longitudinal analysis

Refugees often experience poor physical and mental health outcomes following resettlement. These outcomes have been linked to the conditions that are experienced by refugees in the post-migration context, but little is known about the mechanisms by which these conditions influence health. We therefore conducted secondary analyses of the Survey of New Refugees, a large longitudinal study commissioned by the UK Home Office with data collected at four time points spanning 21 months. Refugees’ experience of emotional distress such as feeling stressed, worried, and depressed fully mediated the relationship between post-migration stressors and longitudinal general health. There was no evidence that perceived social support influenced this relationship. These findings suggest that emotional distress contributes to poor health outcomes among refugees and thus that interventions might target emotional distress.     

Internationally adopted children’s cognitive and social-emotional development during the first post-adoption year: A longitudinal study

Research is consistent in showing that international adoption is an intervention leading to great recovery for adopted children, but there is a need of research on factors associated with recovery. The present study is aimed at: (a) assessing children’s cognitive skills and social-emotional dimensions on their arrival to their new family; (b) evaluating their development after one year; (c) identifying which factors influence development, taking into account children’s gender, age, health status on arrival, years of institutionalization, and the initial psychological delay. Participants were 53 internationally adopted children (30 boys and 23 girls), aged 5.68 years old on average at placement (range 2–14). Results showed that children’s development one year after adoption was extraordinary, both in cognitive skills and in social-emotional dimensions. The children more delayed on arrival showed the larger progress over time, and their recovery was greater in cognitive skills than in social-emotional dimensions.     

A multi-dimensional model of the origins of attitude certainty: teachers’ attitudes toward attention-deficit/hyperactivity disorder

This research tested and extended a laboratory-derived model of the origins of attitude certainty using a real attitude object: Teaching children with attention-deficit/hyperactivity disorder (ADHD). In Study 1, an experiment manipulated the amount of information, thought, and consistency of information delivered to pre-service teachers ( $n = 224$ ) with no prior experience with ADHD. Structural equation modelling (SEM) of Study 1 did not support the original model, in which relationships between attitude certainty and objective knowledge, thought, and consistency were mediated by perceived knowledge, thought, and ambivalence. Instead, objective amount of information, thought, and consistency interacted in their effect on attitude certainty. Study 2 ( $n = 368$ ) used a survey to test whether experiences with ADHD (personal, direct and indirect) among in-service and pre-service teachers were antecedents of attitude certainty, and to test perceived accessibility as a mediator. SEM supported both these hypotheses. Perceived accessibility and perceived knowledge mediated the relationship between attitude certainty and prior experiences with ADHD, and between attitude certainty and objective knowledge. Together, the results suggest that psychological processes underlying strong attitude certainty differ according to the familiarity and personal relevance of the attitude object, and the context and stage of attitude formation. The results have practical utility for teacher training at pre-service and in-service levels.     

Social cognitive and demographic factors related to adolescents’ intrinsic satisfaction with school

Based on social cognitive theory, the purpose of this study is to examine certain social cognitive and demographic factors involved in intrinsic satisfaction amongst secondary school students of different cultural backgrounds in a new migrant-receiving country. Given the role of schools in youth acculturation and adaptation, it is important to detect the variables related to successful academic adaptation of adolescents. The sample comprised of 938 South American, African and Spanish adolescents who settled in Spain. Correlation analyses showed that age, social self-efficacy, academic self-concept, attribution style and intrinsic satisfaction were related. ANOVAs revealed that girls displayed a greater tendency to attribute their outcomes to internal factors than boys. Furthermore, older and Spanish adolescents displayed lower levels of intrinsic satisfaction than younger and immigrant adolescents. Path analyses found that social self-efficacy and academic self-concept were the best predictors of intrinsic satisfaction. Therefore, the promotion of social self-efficacy and academic self-concept should increase intrinsic satisfaction in schools. In addition, research into the role of cultural origin in self-regulation in schools may be necessary.     

What’s in a name? Intolerance of uncertainty,other uncertainty-relevant constructs,and their differential relations to worry and generalized anxiety disorder*

A number of studies have examined the association of intolerance of uncertainty (IU) to trait worry and generalized anxiety disorder (GAD). However, few studies have examined the extent of overlap between IU and other psychological constructs that bear conceptual resemblance to IU, despite the fact that IU-type constructs have been discussed and examined extensively within psychology and other disciplines. The present study investigated (1) the associations of IU, trait worry, and GAD status to a negative risk orientation, trait curiosity, indecisiveness, perceived constraints, self-oriented and socially prescribed perfectionism, intolerance of ambiguity, the need for predictability, and the need for order and structure and (2) whether IU is a unique correlate of trait worry and of the presence versus absence of Probable GAD, when overlap with other uncertainty-relevant constructs is accounted for. N = 255 adults completed self-report measures of the aforementioned constructs. Each of the constructs was significantly associated with IU. Only IU, and a subset of the other uncertainty-relevant constructs were correlated with trait worry or distinguished the Probable GAD group from the Non-GAD group. IU was the strongest unique correlate of trait worry and of the presence versus absence of Probable GAD. Indecisiveness, self-oriented perfectionism and the need for predictability were also unique correlates of trait worry or GAD status. Implications of the findings are discussed, in particular as they pertain to the definition, conceptualization, and cognitive-behavioral treatment of IU in GAD.     

Testing the cognitive catalyst model of depression: does rumination amplify the impact of cognitive diatheses in response to stress?

Recent studies have found that rumination functions as a catalyst of cognitive vulnerability to depression. Specifically, these studies have reported synergistic effects between rumination and negative cognitive content (beliefs and attitudes), such that rumination amplifies the association between negative cognitive content and depression (Ciesla & Roberts, 2002, 2007; Robinson & Alloy, 2003). The current study extended this work by testing whether cognitive vulnerability involving the combination of negative cognitive content and rumination increases the impact of stress on the course of depressive symptoms. One hundred ninety-one college students with elevated depressive symptoms participated in a two-wave longitudinal study. Results indicate that the maintenance of depressive symptoms was predicted by the three-way interaction of negative cognitive content, rumination, and stressful life events. More specifically, students who endorsed both maladaptive cognitive content and a tendency to ruminate were particularly vulnerable to the deleterious impact of life stress.     

Psychotherapeutic practitioners’ views of the efficacy of mindfulness for the treatment of obsessive compulsive disorder: A qualitative key informant analysis

Objectives: A substantial proportion of individuals affected by obsessive compulsive disorder (OCD) are not experiencing adequate therapeutic outcomes from current standard psychotherapeutic treatments. Mindfulness has had a positive therapeutic impact on many symptoms associated with OCD. This study investigated the views of experienced psychotherapeutic practitioners concerning the potential efficacy of mindfulness as a therapeutic intervention for individuals with OCD.

Method: Six psychotherapeutic professionals experienced in using mindfulness with individuals affected by OCD were interviewed. Data were subjected to thematic analysis.

Results: Participants reported that engaging in mindfulness enabled people with OCD to experience an altered relationship with their symptoms and self. This new attitude, in conjunction with cognitive behavioural therapy, was perceived as helping individuals manage their OCD in an effective and healthy way. However, participants were unsure whether an exclusively mindfulness-based treatment would be effective.

Conclusion: This study indicates the potential for mindfulness practice to constitute a valuable therapeutic resource in helping people manage their OCD experience. Implications for future research and practice are considered.     

Fetal behavioral responses to the touch of the mother’s abdomen: A Frame-by-frame analysis

The aim of the present study was to examine whether fetuses respond to the touching of the mother’s abdomen, and if they do, whether they differentiate based on familiarity and the source of the touch, utilizing 3D real-time (4D) sonography.Behavioral responses of 28 fetuses (20th to 33rd week of gestation; N = 15 in the 2nd and N = 13 in the 3rd trimester) were frame-by-frame coded using a coding system comprising 20 codes and were analyzed in four conditions, during the touch of the (1) mother, (2) the father, (3) the stranger and in a (4) no-touch, control condition.Fetuses showed differential responses to the touch, in particular in the duration of their reaching out to touch the uterus wall in the four conditions, and self-touch, dependent on the gestational age of the fetus. Fetuses in the 3rd trimester touched the uterus wall significantly longer than fetuses in the 2nd trimester did, when the mother touched compared to the control condition. At the same time, fetuses in the 3rd trimester also touched themselves less during the mother’s touch, compared when the stranger touched and also compared to the control condition.This differential response of the older fetuses might be due to the maturation of the central nervous system, and may indicate the emergence of a proprioceptive self-awareness by the 3rd trimester.     

Preterm birth enhances the contribution of mothers’ mind-mindedness to infants’ expressive language development: A longitudinal investigation

Maternal mind-mindedness has been shown to be a powerful predictor of many developmental outcomes and to buffer the impact of psychosocial risk conditions, but no study has investigated whether this parental feature might support child development in the presence of biological risk, such as preterm birth. The present study addresses this gap, by investigating whether early maternal mind-mindedness contributes to the growth of a child’s linguistic abilities in the following two years of life, and if the contribution of this maternal feature might be stronger in the presence of preterm birth. Forty mother–child dyads (twenty with a preterm infant) were followed longitudinally, with maternal mind-mindedness assessed at 14 months of age and child’s expressive linguistic abilities at 24 and 36 months through observational measures. Multilevel models showed that linguistic abilities increased from 24 to 36 months of age, but that this increase was stronger in full-term infants. Maternal mind-mindedness also contributed to this growth, playing a stronger role in preterm infants than in full-term infants. Altogether, these findings contribute more deeply to the understanding of language development in preterm infants and of the joint contribution made by biological risk and environmental factors; from a practical standpoint, they suggest the importance of addressing mother’s mind-mindedness in order to support child’s language development.     

Internet-based cognitive behavioral therapy for anxiety in an outpatient specialized care setting: A qualitative study of the patients’ experience of the therapy

Knowledge about user experiences of internet-based cognitive behavioral therapy (iCBT) has mostly been drawn from non-clinical groups or with iCBT offered via self-referral. The present study therefore focused on patients who had undergone iCBT with minimal support while actively awaiting outpatient psychological treatment in the form of face-to-face CBT. To seek out barriers to adherence the study also included patients who had withdrawn from the iCBT treatment before completion. The study was performed in an outpatient clinic for anxiety disorders where twelve participants with a primary diagnosis of either social anxiety disorder or panic disorder were recruited from an ongoing randomized control trial for semi-structured interviews. Statements from the interviews showed that the iCBT treatment was unfavorably compared to the usual face-to-face treatment at the clinic. Despite this, a majority of the interview participants still expressed to have experienced various benefits from the treatment. Some participants did however, experience difficulties putting the materials to practical use. Furthermore, a large majority of the participants expressed a need for additional support, with a strong tendency for non-completers specifically expressing a need for face-to-face contact with a clinician. Implications for future research and implementation of iCBT in clinical practice are discussed.