Worry and the anxiety disorders: A meta-analytic synthesis of specificity to GAD

Although worry is central to the diagnosis of generalized anxiety disorder (GAD), it is also commonly observed in other anxiety disorders. In this meta-analytic review, we empirically evaluated the extent to which worry is specific to GAD relative to patients with other anxiety disorders, those with other psychiatric disorders, and nonpsychiatric controls. A total of 47 published studies (N = 8,410) were included in the analysis. The results yielded a large effect size indicating greater severity/frequency of worry, meta-worry, and domains of worry among anxiety disorder patients v. nonpsychiatric controls (d = 1.64). In contrast to the many differences emerging from comparisons between anxiety disordered patients and nonpsychiatric controls, when anxiety disordered patients were compared to people with other psychiatric disorders they differed only on severity/frequency and not on meta-worry or domains of worry. A large effect size indicating greater severity/frequency of worry, meta-worry, and domains of worry among patients with GAD v. nonpsychiatric controls was also found (d = 2.05). However, differences between GAD and those with other psychiatric disorders also emerged for severity/frequency of worry. GAD was associated with greater worry difficulties than other anxiety disorders, which generally did not differ from those with other psychiatric disorders and each other. The implications of these findings for conceptualizing worry in GAD and other anxiety disorders, and the potentially moderating effects of age and gender are discussed.     

LGB-Affirmative Cognitive Behavioral Treatment for Social Anxiety: A Case Study Applying Evidence-Based Practice Principles

Guided by the American Psychological Association's principles of evidence-based practice, this article reviews a single-case treatment outcome study whereby a client characteristic, sexual identity, was integrated into the assessment and treatment of social anxiety symptoms. The case involved a young adult European-American male who presented to a training clinic with a primary diagnosis of social anxiety disorder as well as secondary symptoms of excessive worry and concerns of sexual identity confusion. Recent evidence suggests that gay men report more symptoms of social anxiety when compared to heterosexual men, and those who make more efforts to conceal their sexual identity experience increased anxiety and have greater difficulty committing to a personal identity. Further, it has been hypothesized that fear of rejection from heterosexual individuals underlies this anxiety. The client attended 50 sessions over the course of 18 months. Treatment progress was assessed via self-report questionnaires assessing social anxiety and worry. Consistent with principles of evidence-based practice, a cognitive behavioral treatment protocol was employed at the outset of therapy and resulted in a decline in the client's social anxiety scores. However, once the case conceptualization and treatment focus shifted to focus on sexual identity, his scores continued to decline at an even steeper rate. He ultimately came to identify himself as having a same-sex sexual orientation, began living his life in a manner consistent with that identification, and reported a number of positive outcomes at termination of therapy. Implications for treatment of social anxiety in sexual minorities are discussed.     

Tits use amodal completion in predator recognition: a field experiment

Amodal completion enables an animal to perceive partly concealed objects as an entirety, and to interact with them appropriately. Several studies, based upon either operant conditioning or filial imprinting techniques, have shown that various animals (both mammals and birds) can perform amodal completion. Before this study, the use of amodal completion by untrained animals in the recognition of objects had not been considered. Using two feeders, we observed in a field experiment the reaction of tits to the torso of a sparrowhawk (partly occluded or an ‘amputated’ dummy) in two different treatments (sparrowhawk torso vs. complete dummy pigeon; and torso vs. complete dummy sparrowhawk). It is clear that the birds considered the two torso variants as predators and kept away from both of them when the second feeder offered a ‘pigeon’ instead. On the other hand, when a ‘complete sparrowhawk’ was present on the second feeder, the number of visits to the occluded torso remained low; while the number of visits to the amputated one increased threefold. Birds risked perching near what was clearly an amputated torso; while the fear of a “hiding” (occluded) torso remained unchanged, when the second feeder did not provide a safe alternative. Such discrimination between torsos requires the ability for amodal completion. Our results demonstrate that in their recognition process, the birds not only use simple sign stimuli, but also complex cognitive functions.     

Examining autobiographical memory content in patients with depression and anxiety disorders

The purpose of this study was to move beyond the traditional specificity model of autobiographical memory (ABM) and to examine the content of memories with a focus on disorder and schema-relevant content. The sample (N = 82) included 25 patients with major depressive disorder (MDD), 24 with social phobia (SP), and 33 with panic disorder with agoraphobia (PDA) who were referred to a large outpatient clinic for group treatment of depression or anxiety. Participants completed the Autobiographical Memory Test (AMT) and Beck Depression Inventory-II as part of the clinical intake process. Responses to the AMT were coded for disorder-specific content based on diagnostic criteria for each disorder as well as for schema-relevant (sociotropy vs. autonomy) content. A repeated measures multiple analysis of variance demonstrated significant differences in disorder-specific content, with patients in the MDD group reporting more depressotypic ABMs than those in the PDA group but not the SP group. Similarly, in the analysis of schema-relevant content, significant differences were found between MDD and PDA regarding the presence of autonomy-based ABM ratings. Study results provide partial support for the cognitive specificity hypothesis with ABM content. The results are discussed in relation to the cognitive models of depression and anxiety.     

Stories of the young and the old: personal continuity and narrative identity

This study examined narrative identity in 2 groups of participants who were younger (ages ranging from late adolescence through young adulthood) and older (over the age of 65 years). Participants completed an extensive interview in which they reported three self-defining memories. Interviews were coded for several characteristics of autobiographical reasoning: self-event connections representing self-stability or self-change, event-event connections, reflective processing, and thematic coherence. Results showed that the older and younger groups were not different in terms of the frequencies of self-event connections or the levels of reflective processing. However, in comparison with the younger group, the older group had more thematic coherence and more stories representing stability, whereas the younger group had more stories representing change. Gender differences also emerged, suggesting that females may have an advantage in the development of narrative identity. Results are discussed in terms of the different ways to represent narrative identity at 2 ends of the life span.     

Understanding emotional responses to breast/ovarian cancer genetic risk assessment: an applied test of a cognitive theory of emotion

This study explored whether Smith and Lazarus' (1990, 1993) cognitive theory of emotion could predict emotional responses to an emotionally ambiguous real-life situation. Questionnaire data were collected from 145 women upon referral for cancer genetic risk assessment. These indicated a mixed emotional reaction of both positive and negative emotions to the assessment. Hierarchical regression analyses revealed that the hypothesised models explained between 20% and 33% of the variance of anxiety, hope and gratitude scores, but only 10% of the variance for challenge scores. For the previously unmodelled emotion of relief, 31% of the variance was explained by appraisals and core relational themes. The findings help explain why emotional responses to cancer genetic risk assessment vary and suggest that improving the accuracy of individuals' beliefs and expectations about the assessment process may help subsequent adaptation to risk information.     

Go or no‐go? Developmental improvements in the efficiency of response inhibition in mid‐childhood

This experiment used a modified go/no‐go paradigm to investigate the processes by which response inhibition becomes more efficient during mid‐childhood. The novel task, which measured trials on which a response was initiated but not completed, was sensitive to developmental changes in response inhibition. The effect of inducing time pressure by narrowing allowable response time was also examined. While increasing time pressure did not reduce the inhibitory demands of the task for either age group, older children (aged 9 to 11 years) were able to inhibit their responses at an earlier stage of movement than younger children (aged 5 to 7 years). This shows that as children get older they become more efficient at controlling their behaviour which drives developmental improvements in response inhibition.     

The role of computer‐aided psychotherapy within an NHS CBT specialist service

To date, the feasibility of computer‐aided psychotherapy as an intervention has only been recognised in primary care practice. The present study sought to evaluate the impact of ‘Beating the Blues’ (BtB), an established computerised cognitive behaviour therapy (CCBT) self‐help programme for the management of anxiety and depression, within an NHS CBT specialist healthcare centre. Of the 555 service users who used BtB as part of routine care, with follow‐up assessment at six to eight weeks, 71% completed all eight sessions. Statistically significant differences on the Beck Depression Inventory‐II (BDI‐II) and Beck Anxiety Inventory (BAI) were found in completer and intention‐to‐treat analyses; 50% of completers achieved reliable change on the BDI‐II and approximately 25% of completers achieved reliable and clinically significant change on both measures. Outcomes were benchmarked against outcomes in studies of routine face‐to‐face CBT. These findings provide evidence that BtB may be of value to service users in secondary mental healthcare centres, alleviating current burdens on public health and therapeutic resources. Future research directions should include examining which factors influence individuals’ decisions to try computer‐aided psychotherapy, which individuals are best suited to using these interventions, and why some users drop out prior to programme completion.     

Is Optimism Always Best?: Future Outlooks and Preparedness

ABSTRACT— Although people generally appear optimistic about the future, they shift from optimism under certain circumstances. Drawing from a recent review of the literature, we describe how both optimism and shifts from optimism serve the common goal of preparedness, which includes a readiness to deal with setbacks and a readiness to take advantage of opportunities. Shifts from optimism occur in response to available information and to the possibility that things may not turn out as hoped. People tend to shift from optimism when feedback is anticipated in the near future, when the outcome is important, when negative outcomes are easily imagined, and when the outcomes are uncontrollable. In addition, people with low self-esteem shift from optimism more readily than do people with high self-esteem. Finally, both optimism and shifts from optimism have unique benefits in terms of preparedness.     

Influences of grasp selection in typically developing children

When reaching towards an object, adults favour grasps which, following the intended action, end in a comfortable position even when this requires them to start in an uncomfortable position (the end-state-comfort effect). However, this strategy is not consistently used by children who instead seem to favour a minimal pre-contact rotation of the hand, even when this results in an uncomfortable end position. In terms of multiple movements, the strategies used for grip selection are unclear; adults may still grasp for end-state-comfort given their propensity to plan to the end of a movement; however, children who are less able to concatenate movement may tend to start-state-comfort movements. The current study considered grip selection in children ranging from 4 to 12 years and in a group of adults. Participants were asked to rotate a disc so that an arrow pointed towards a specific target(s), the number of sequences in a movement was increased from one to three. Planning for end-state-comfort was seen in all participants and a clear developmental trajectory was identified whereby the relative comfort of an end position could be directly predicted by age in months. Adults and 10–12-year-olds favoured an end-state-comfort strategy whereas the younger children gave equal weighting to end-state-comfort, start-state-comfort and no initial rotation strategies. All groups were able to end a movement comfortably when it was composed of three steps; however, the proportion of movements relying on an end-state-comfort strategy decreased as sequence length increase whereas the proportion of start-state-comfort and no initial rotation strategies increased. The current data support the concept that a mechanism for planning grasps may be based on motor experience.