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Although numerous behavioral constructs have been proposed to account for anxiety disorders, how these disorders develop within an individual has been difficult to predict. In this perspective, I selectively review clinical and experimental evidence suggesting that avoidance (i.e., safety) behavior increases beliefs of threat or fear. The experimental evidence has been replicated numerous times, with different parameters, and shows that when human participants emit avoidance responses in the presence of a neutral stimulus, they later show heightened expectations of threat in the presence of the neutral stimulus. I interpret these findings as resulting from prediction errors as anticipated by the Rescorla-Wagner model, although other animal learning theories can also predict the phenomenon. I discuss some implications and offer a few novel predictions. The analysis presented here sheds light on a phenomenon of theoretical and clinical relevance which is accommodated by basic associative learning theory. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Ansiedad , Reacción de Prevención , Miedo , Humanos , Reacción de Prevención/fisiología , Miedo/fisiología , Miedo/psicología , Ansiedad/psicología , Animales , Trastornos de Ansiedad/psicología , Aprendizaje por Asociación/fisiología , Modelos PsicológicosRESUMEN
BACKGROUND: Although many studies have been conducted on the efficacy of behavioral activation in depression, few studies have evaluated the efficacy of this treatment in patients with mixed depression and anxiety through telecare. AIM: To determine the effects of a telenursing scheduled intervention of brief behavioral activation therapy on depression and anxiety symptoms of patients with mixed anxiety and depression disorder (MADD). DESIGN: A randomized controlled trial. METHODS: Thirty subjects with MADD were randomly assigned to an intervention group and a control group. The eight-session person-centered behavioral activation intervention was delivered twice weekly via tele-nursing. Depression and anxiety symptom severity were assessed using the Hamilton Anxiety Rating Scale and the Hamilton Depression Rating Scale at baseline, at the end, and one month after the intervention. Data were analyzed by independent t-tests, chi-square tests, and repeated-measures tests using SPSS version 24. RESULTS: The results showed that after the implementation of the intervention, the depression score in the intervention group decreased from 19.86 (±8.56) to 17.21 (±6.71). In contrast, depression scores increased from 18.67 (±9.72) to 19.47 (±7.33) in the control group. For anxiety symptoms, there was a clinically significant decrease after the intervention only in the intervention group. CONCLUSION: The results showed the effects of brief behavioral activation tele-nursing on a non-significant reduction in depression symptoms and a significant clinical reduction in anxiety symptoms after the intervention in MADD.
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Trastornos de Ansiedad , Humanos , Femenino , Masculino , Adulto , Trastornos de Ansiedad/terapia , Trastornos de Ansiedad/psicología , Teleenfermería , Escalas de Valoración Psiquiátrica , Depresión/terapia , Depresión/psicología , Terapia Conductista/métodos , Ansiedad/terapia , Ansiedad/psicología , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Depersonalization/derealization disorder (DPD) is a prevalent yet inadequately understood clinical condition characterized by a recurrent or persistent sense of unreality. This study aims to provide insight into DPD through descriptive and comparative analyses involving a large group of Chinese participants. The socio-demographic details (age, gender proportion, education, occupational status, marital status), depersonalized and dissociative symptom characteristics (symptomatic factors or subscales of the Cambridge Depersonalization Scale and the Dissociative Experiences Scale), development trajectory (age of onset, potential precipitating factors, course characteristics), treatment history (duration of delayed healthcare attendance, duration of delayed diagnosis, previous diagnoses), and adverse childhood experiences of the DPD patients are presented. Comparisons of anxiety and depressive symptoms, alongside psychosocial functioning, between DPD participants and those diagnosed with generalized anxiety disorder, bipolar disorders, and major depressive disorder were conducted. The analysis highlights a higher male preponderance and early onset of DPD, symptomatology marked by derealization, notable impairment in psychosocial functioning, and prolonged periods of delayed healthcare attendance and diagnosis associated with symptom severity. Furthermore, noteworthy relationships between adverse childhood experiences and symptom levels were identified. The findings substantiate the view that DPD is a serious but neglected mental disorder, urging initiatives to improve the current condition of DPD patients.
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Despersonalización , Humanos , Masculino , Femenino , Adulto , Despersonalización/psicología , Persona de Mediana Edad , China/epidemiología , Trastorno Depresivo Mayor/epidemiología , Trastorno Depresivo Mayor/psicología , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/psicología , Adulto Joven , Edad de Inicio , Adolescente , Trastorno Bipolar/psicología , Trastorno Bipolar/epidemiología , Factores Sexuales , Experiencias Adversas de la Infancia/estadística & datos numéricos , Experiencias Adversas de la Infancia/psicología , Pueblo Asiatico/psicología , Trastornos Disociativos/psicología , Trastornos Disociativos/epidemiología , Diagnóstico Tardío , Pueblos del Este de AsiaRESUMEN
OBJECTIVE: There is growing interest in how peers' genotypes may influence health (i.e., peer social genetic effects). The authors sought to clarify the nature of peer social genetic effects on risk for drug use disorder, alcohol use disorder (AUD), major depression, and anxiety disorder. METHOD: Cox models were used with data from a population-based Swedish cohort (N=655,327). Outcomes were drug use disorder, AUD, major depression, and anxiety disorder registrations between ages 17 and 30 from medical, criminal, and pharmacy registries. The authors indexed peer social genetic effects with peers' family genetic risk scores (FGRSs) for the same disorders, which are personalized measures of genetic risk inferred from diagnoses in first- to fifth-degree relatives. RESULTS: Across disorders, peer FGRSs predicted increased risks of proband registration (hazard ratio range, 1.01-1.59), with stronger effects for drug use disorder and AUD than for major depression and anxiety disorder. Peer social genetic effects were stronger for school classmates than for geographically proximal peers, and for peers from upper secondary school (ages 16-19) versus peers from lower secondary school (ages 7-16). Peer social genetic effects remained significant following statistical control for sociodemographic confounders, whether peers were affected, and peers' FGRS for educational attainment. Peer social genetic effects were more pronounced for probands at higher genetic risk. CONCLUSIONS: The genetic makeup of adolescents' peers has long-reaching consequences on risks for drug use disorder, AUD, major depression, and anxiety disorder. Individuals at high genetic risk are more sensitive to social genetic effects. Alternative hypotheses such as sociodemographic stratification, exposure to affected peers, and genetic predispositions for educational attainment did not explain the risk associated with peer social genetic effects for substance use and psychiatric disorders.
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Trastornos de Ansiedad , Trastorno Depresivo Mayor , Grupo Paritario , Trastornos Relacionados con Sustancias , Humanos , Suecia/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/genética , Trastornos Relacionados con Sustancias/psicología , Trastorno Depresivo Mayor/genética , Trastorno Depresivo Mayor/epidemiología , Trastorno Depresivo Mayor/psicología , Masculino , Femenino , Adolescente , Trastornos de Ansiedad/genética , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/psicología , Adulto , Adulto Joven , Modelos de Riesgos Proporcionales , Sistema de Registros , Predisposición Genética a la Enfermedad/genética , Factores de RiesgoRESUMEN
Family accommodation is a significant contributor to the maintenance and course of youth anxiety. There is also high co-occurrence of anxiety and irritability in youth. Research is lacking, however, on the influence of irritability in the association between anxiety and family accommodation, including among youth with clinically diagnosed anxiety disorders. We therefore examined this issue in a sample of clinic-referred anxious irritable and anxious nonirritable youth. Youth (Nâ¯=â¯645, Mageâ¯=â¯9.86 years, SDâ¯=â¯2.92) and their parents completed diagnostic interviews and questionnaires assessing youth anxiety, irritability, and family accommodation. Based on both youth and parent ratings, family accommodation was significantly and positively associated with youth anxiety and irritability. Anxious irritable youth rated family accommodation significantly higher than anxious nonirritable youth. In addition, youth self-rated irritability levels significantly moderated the association between their anxiety and family accommodation. No moderation effect was found for the parent ratings. Based on the youth ratings, our overall findings show that parents of anxious irritable youth are more accommodating of their children's anxiety, compared with parents of anxious nonirritable youth. Anxiety levels also predict family accommodation more strongly in youth with lower levels of irritability. Our findings provide novel insights about accommodation behaviors in families of anxious irritable youth and suggest its potential utility as a treatment target when working with anxious irritable youth.
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Ansiedad , Genio Irritable , Humanos , Masculino , Femenino , Niño , Ansiedad/psicología , Adolescente , Padres/psicología , Familia/psicología , Trastornos de Ansiedad/psicología , Encuestas y Cuestionarios , Relaciones Familiares/psicologíaRESUMEN
AIMS: Alcohol use disorder (AUD) is a common mental disorder characterized by sex-gender differences (SGDs). The present study was aimed at evaluating attitudes displayed by Italian AUD treatment services towards investigating the presence of SGDs in their patients and implementing gender-specific treatments for female AUD patients. METHODS: Potential SGDs were initially investigated in a sample of AUD outpatients, subsequently followed by a national survey on the adoption of specific interventions for female AUD outpatients. RESULTS: The presence of SGDs was confirmed in a sample of 525 (332 men; 193 women) AUD outpatients, including a higher prevalence of anxiety and mood disorders, and episodes of violence and trauma among female AUD outpatients compared to males. Despite the presence of these SGDs, only <20% of a total of 217 Italian AUD treatment services reported the implementation of specific strategies for female AUD outpatients. The majority of services (94%) reported investigating episodes of violence and/or trauma, largely resorting to specific procedures only when these issues were detected. CONCLUSIONS: Our findings confirm the presence of SGDs among AUD outpatients, including a higher prevalence of anxiety and mood disorders and episodes of violence and trauma among females compared with males. However, only a small number of services have adopted a gender medicine approach in AUD treatment. These results underline the urgency of investigating the specific needs of female, male, and non-binary AUD patients in order to personalize and enhance the effectiveness and appeal of AUD treatment.
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Alcoholismo , Pacientes Ambulatorios , Humanos , Femenino , Italia/epidemiología , Masculino , Persona de Mediana Edad , Adulto , Alcoholismo/epidemiología , Alcoholismo/psicología , Factores Sexuales , Trastornos del Humor/epidemiología , Trastornos del Humor/psicología , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/psicología , Violencia/psicología , Violencia/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud , Anciano , PrevalenciaRESUMEN
INTRODUCTION: Working on the frontline during the COVID-19 pandemic has been associated with increased risk to mental health and wellbeing in multiple occupations and contexts. The current study aimed to provide an insight into the rate of probable mental health problems amongst United Kingdom (UK) Government employees who contributed to the COVID-19 response whilst working from home, and to ascertain what factors and constructs, if any, influence mental health and wellbeing in the sample population. METHOD: This paper reports on the findings from two studies completed by UK Government employees. Study 1: A cross-sectional online survey, containing standardised and validated measures of common mental health disorders of staff who actively contributed to the COVID-19 response from their own homes. Binary logistic regression was used to assess factors associated with mental health outcomes. Study 2: A secondary data analysis of cross-sectional survey data collected across three timepoints (May, June, and August) in 2020 focusing on the wellbeing of employees who worked from home during the COVID-19 pandemic. RESULTS: Study 1: 17.9% of participants met the threshold criteria for a probable moderate anxiety disorder, moderate depression, or post-traumatic stress disorder. Younger, less resilient, less productive individuals, with lower personal wellbeing and less enjoyment of working from home, were more likely to present with poorer mental health. Study 2: Found lower wellbeing was consistently associated with having less opportunities to look after one's physical and mental health, and having unsupportive line managers and colleagues. CONCLUSION: It is important to ensure UK Government employees' psychological needs are met whilst working from home and responding to enhanced incidents. It is recommended that workplaces should be seeking to continually build and improve employee resilience (e.g., through opportunities to increase social ties and support networks), essentially ensuring employees have necessary resources and skills to support themselves and others.
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COVID-19 , Humanos , COVID-19/psicología , COVID-19/epidemiología , Estudios Transversales , Masculino , Reino Unido/epidemiología , Adulto , Femenino , Persona de Mediana Edad , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Empleados de Gobierno/psicología , Empleados de Gobierno/estadística & datos numéricos , Encuestas y Cuestionarios , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/psicología , Salud Mental/estadística & datos numéricos , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/psicología , Teletrabajo , Depresión/epidemiología , Depresión/psicología , Adulto Joven , SARS-CoV-2 , Análisis de Datos SecundariosRESUMEN
Negative emotions and associated avoidance behaviors are core symptoms of anxiety. Current treatments aim to resolve dysfunctional coupling between them. However, precise interactions between emotions and avoidance in patients' everyday lives and changes from pre- to post-treatment remain unclear. We analyzed data from a randomized controlled trial where patients with anxiety disorders underwent 16 sessions of cognitive behavioral therapy (CBT). Fifty-six patients (68 % female, age: M = 33.31, SD = 12.45) completed ecological momentary assessments five times a day on 14 consecutive days before and after treatment, rating negative emotions and avoidance behaviors experienced within the past 30 min. We computed multilevel vector autoregressive models to investigate contemporaneous and time-lagged associations between anxiety, depression, anger, and avoidance behaviors within patients, separately at pre- and post-treatment. We examined pre-post changes in network density and avoidance centrality, and related these metrics to changes in symptom severity. Network density significantly decreased from pre- to post-treatment, indicating that after therapy, mutual interactions between negative emotions and avoidance were attenuated. Specifically, contemporaneous associations between anxiety and avoidance observed before CBT were no longer significant at post-treatment. Effects of negative emotions on avoidance assessed at a later time point (avoidance instrength) decreased, but not significantly. Reduction in avoidance instrength positively correlated with reduction in depressive symptom severity, meaning that as patients improved, they were less likely to avoid situations after experiencing negative emotions. Our results elucidate mechanisms of successful CBT observed in patients' daily lives and may help improve and personalize CBT to increase its effectiveness.
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Trastornos de Ansiedad , Reacción de Prevención , Terapia Cognitivo-Conductual , Evaluación Ecológica Momentánea , Emociones , Humanos , Femenino , Adulto , Terapia Cognitivo-Conductual/métodos , Masculino , Trastornos de Ansiedad/terapia , Trastornos de Ansiedad/psicología , Emociones/fisiología , Persona de Mediana Edad , Depresión/terapia , Depresión/psicología , Adulto Joven , Resultado del TratamientoRESUMEN
According to biopsychosocial models, experiencing parental child abuse increases susceptibility to adulthood psychopathology. However, there is a paucity of studies examining potential mechanisms of the parental child abuse and adulthood psychopathology relationship. The purpose of the current study was to determine if Time 2 (T2) trait self-esteem mediated levels of Time 1 (T1) retrospectively recalled parental child abuse predicting (T3) past-year major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder (PD), alcohol use disorder (AUD), and substance use disorder (SUD) symptoms. The 18-year Midlife Development in the United States (MIDUS) study included participants (N = 3294; T1 average age of 45.62 years) assessed at three different time points, each spaced about nine years apart. We performed structural equation mediation modeling analyses to determine how maternal and paternal child abuse at T1 would independently predict T3 MDD, GAD, PD, AUD, and SUD symptoms. We also examined whether T2 self-esteem mediated these relations while controlling for adulthood T1 psychopathology symptoms, demographics, socioeconomic status, somatic symptoms, and parental psychopathology. Consistent with our hypotheses, higher T1 maternal and paternal abuse predicted increased T3 GAD, PD, AUD, and SUD symptoms via diminished T2 self-esteem as the mediator (% proportion mediated = 33.0-100). However, childhood paternal, but not maternal, abuse predicted adulthood MDD symptoms via reduced self-esteem. Findings remained after adjusting for covariates. Our research highlights the importance of understanding retrospectively recalled parental child abuse-adulthood psychopathology relations, their potential mechanisms, and self-esteem as a malleable treatment target for adults with heightened child abuse.
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Trastornos de Ansiedad , Trastorno Depresivo Mayor , Autoimagen , Trastornos Relacionados con Sustancias , Humanos , Femenino , Masculino , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/epidemiología , Persona de Mediana Edad , Adulto , Trastornos de Ansiedad/psicología , Trastornos de Ansiedad/epidemiología , Trastorno Depresivo Mayor/psicología , Trastorno Depresivo Mayor/epidemiología , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Adultos Sobrevivientes del Maltrato a los Niños/estadística & datos numéricos , Trastorno de Pánico/psicología , Trastorno de Pánico/epidemiología , Maltrato a los Niños/psicología , Maltrato a los Niños/estadística & datos numéricos , Estados Unidos/epidemiología , Niño , Ansiedad/psicología , Ansiedad/epidemiología , Depresión/psicología , Depresión/epidemiología , Alcoholismo/psicología , Alcoholismo/epidemiologíaRESUMEN
OBJECTIVE: The number of forced migrants has been rising for years. Many forced migrants suffer from post-traumatic stress disorder (PTSD), depression, and/or anxiety and need treatment. Here, we evaluate the effectiveness of psychological interventions (CBT, EMDR, expressive/art, mindfulness, mixed elements, NET and psychoeducation) in reducing symptoms of PTSD, depression, and anxiety in forced migrants. DESIGN AND DATA SOURCES: Systematic searches in PubMed and Web of Science and searches of preprint servers and grey literature were performed (final search date: 1 September 2023). Random-effects frequentist and Bayesian meta-analyses were used for data synthesis. RESULTS: We included 84 studies on treatment effects in adults (pooled N = 6302) and 32 on children and adolescents (pooled N = 1097). Our data show a reduction in symptoms of PTSD, depression and anxiety symptoms in both adults and child/adolescent forced migrants. Pooled pre- to post-treatment effects (effect size Cohen's d) ranged from -1.03 to -0.26 for PTSD, from -0.91 to -0.11 for depression and from -0.91 to -0.60 for anxiety, without there being differences in outcome per study design (i.e., RCT comparison vs. non-RCT comparison vs. single arm treatment study). Treatment effects remained evident over follow-up, and not a single type of treatment stood out as being superior to other treatment types. Structural differences in populations (e.g., regarding country of origin) over studies, however, could have hampered the validity of the comparisons between study characteristics such as treatment type. CONCLUSION: Our findings support the effectiveness of psychological treatment in adult and child/adolescent forced migrants.
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Teorema de Bayes , Trastornos por Estrés Postraumático , Humanos , Trastornos por Estrés Postraumático/terapia , Trastornos por Estrés Postraumático/psicología , Adolescente , Niño , Adulto , Trastornos de Ansiedad/terapia , Trastornos de Ansiedad/psicología , Intervención Psicosocial/métodos , Migrantes/psicología , Migrantes/estadística & datos numéricos , Refugiados/psicología , Trastorno Depresivo/terapia , Trastorno Depresivo/psicologíaRESUMEN
The identification of psychopathological markers has been the focus of several scientific fields. The results were inconsistent due to lack of a clear nosology. Network analysis, focusing on the interactions between symptoms, provided important insights into the nosology of mental disorders. These interactions originate several topological properties that could constitute markers of psychopathology. One of these properties is network connectivity, which has been explored in recent years. However, the results have been inconsistent, and the topological properties of psychopathological networks remain largely unexplored and unknown. We compared several topological properties (i.e., connectivity, average path length, assortativity, average degree, modularity, global clustering) of psychopathological networks of healthy and disordered participants across depression (N = 2830), generalized anxiety (N = 13,463), social anxiety (N = 12,814), and obsessive-compulsive disorder (N = 16,426). Networks were estimated using Bayesian Gaussian Graphical Models. The Janson-Shannon measure of divergence was used to identify differences between the network properties. Network connectivity distinguished healthy and disordered participants' networks in all disorders. However, in depression and generalized anxiety, network connectivity was higher in healthy participants. The presence and number of motifs also distinguished the networks of healthy and disordered participants. Other topological properties (i.e., modularity, clustering, average path length and average degree) seem to be disorder-specific. The psychopathological significance of network connectivity must be clarified. Some topological properties of psychopathological networks are promising markers of psychopathology and may contribute to clarifying the nosology of mental disorders.
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Trastornos de Ansiedad , Teorema de Bayes , Trastorno Obsesivo Compulsivo , Humanos , Femenino , Masculino , Adulto , Trastornos de Ansiedad/psicología , Trastornos de Ansiedad/fisiopatología , Trastorno Obsesivo Compulsivo/fisiopatología , Trastorno Obsesivo Compulsivo/psicología , Trastornos Mentales/psicología , Trastornos Mentales/fisiopatología , Persona de Mediana Edad , Trastorno Depresivo/psicología , Trastorno Depresivo/fisiopatología , Fobia Social/fisiopatología , Fobia Social/psicología , PsicopatologíaRESUMEN
BACKGROUND: Previous studies showed that comorbidity and demographic factors added to burden on health-related quality of life (HRQoL). Only one study explored the relationship between HRQoL and comorbidity in college students with mental disorders, leaving generalizability of findings uncertain. Less is known about the association of demographics on HRQoL. This study investigated HRQoL based on demographics and comorbidity among college students with mental disorders. METHODS: Participants were students (N = 5535) across 26 U.S. colleges and universities who met criteria for depression, generalized anxiety, panic, social anxiety, post-traumatic stress, or eating disorders based on self-report measures. ANOVA and linear regressions were conducted. RESULTS: Overall, female, minoritized (gender, sexual orientation, race, or ethnicity), and lower socioeconomic status students reported lower HRQoL than male, heterosexual, White, non-Hispanic, and higher socioeconomic status peers. After accounting for comorbidity, differences in physical HRQoL based on sex assigned at birth and gender were no longer significant. For mental HRQoL, only gender and sexual orientation remained significant. A greater number of comorbidities was associated with lower HRQoL regardless of demographic group. LIMITATIONS: The non-experimental design limits causal inference. The study focused on univariable associations without examining potential interactions between demographic factors. Future research should explore structural factors like discrimination. CONCLUSION: Results suggested that increased comorbidities placed an additional burden on HRQoL and that certain demographic groups were more vulnerable to HRQoL impairment among students with mental disorders. Findings suggest the need for prevention of disorders and their comorbidity and implementing tailored interventions for specific student subgroups with increased vulnerability.
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Comorbilidad , Trastornos de Alimentación y de la Ingestión de Alimentos , Calidad de Vida , Estudiantes , Humanos , Femenino , Masculino , Calidad de Vida/psicología , Estudiantes/estadística & datos numéricos , Estudiantes/psicología , Adulto Joven , Universidades , Trastornos de Alimentación y de la Ingestión de Alimentos/epidemiología , Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , Adulto , Identidad de Género , Adolescente , Etnicidad/estadística & datos numéricos , Etnicidad/psicología , Estrés Financiero/psicología , Estrés Financiero/epidemiología , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/psicología , Conducta Sexual/estadística & datos numéricos , Conducta Sexual/psicología , Estados Unidos/epidemiología , Escolaridad , Grupos Raciales/estadística & datos numéricos , Grupos Raciales/psicología , Padres/psicología , Depresión/epidemiología , Depresión/psicología , Ansiedad/epidemiología , Ansiedad/psicología , Trastornos Mentales/epidemiología , Trastornos Mentales/psicologíaRESUMEN
INTRODUCTION: Fears and anxieties are a common cause of suffering for patients at the end of life. These are often either fears about dying - for example, fear of unbearable pain or fear of suffocation - or fear of death itself. If unrecognized and untreated, fears and anxieties can contribute to a considerable reduction in the quality of life in the last phase of life. Careful diagnosis of anxiety and fear is therefore crucial. Multimodal treatment, which includes psychotherapy and other non-pharmacological and - if necessary - pharmacological treatments, can provide significant relief.
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Ansiedad , Miedo , Cuidado Terminal , Humanos , Miedo/psicología , Cuidado Terminal/psicología , Ansiedad/psicología , Ansiedad/terapia , Ansiedad/diagnóstico , Actitud Frente a la Muerte , Cuidados Paliativos/psicología , Terapia Combinada , Psicoterapia , Calidad de Vida/psicología , Trastornos de Ansiedad/psicología , Trastornos de Ansiedad/terapia , Trastornos de Ansiedad/diagnósticoRESUMEN
Importance: Anxiety disorders are prevalent and undertreated among young adults. Digital mental health interventions for anxiety are promising but limited by a narrow range of therapeutic components and low user engagement. Objective: To investigate the efficacy of and engagement with Maya, a scalable, self-guided, comprehensive mobile cognitive behavioral therapy (CBT) intervention with embedded engagement features, comparing the effects of 3 incentive conditions. Design, Setting, and Participants: This randomized clinical trial recruited young adults aged 18 to 25 years with anxiety disorders through online advertisements and outpatient psychiatry clinics at Weill Cornell Medicine. Enrollment was between June 16, 2021, and November 11, 2022. Data analysis was performed from December 21, 2022, to June 14, 2024. Intervention: Participants received a 6-week program of the intervention and were randomized to 1 of 3 different text message-based incentive conditions (gain-framed, loss-framed, or gain-social support). Main Outcomes and Measures: The primary outcome was change in anxious symptoms from baseline to end of treatment, as measured by the Hamilton Anxiety Rating Scale (HAM-A). The Anxiety Sensitivity Index and the Leibowitz Social Anxiety Scale scores were secondary measures. Results: The sample consisted of 59 participants (mean [SD] age, 23.1 [1.9] years; 46 [78%] female; 22 [37%] Asian, 3 [5%] Black, 5 [8%] Hispanic or Latino, 1 [2%] American Indian or Alaska Native, 25 [42%] White, and 6 [10%] >1 race; 32 [54%] college-educated and 12 [20%] graduate or professional school-educated; mean [SD] baseline HAM-A score, 15.0 [6.5]). Anxiety, measured by HAM-A, decreased across conditions from baseline to end of the intervention (mean difference, -5.64; 95% CI, -7.23 to -4.05), and symptomatic improvement was maintained at the week 12 follow-up (baseline to follow-up mean difference, -5.67; 95% CI, -7.29 to -4.04). However, there was no evidence that change in anxiety differed by incentive condition (loss-framed vs gain-social support mean difference, -1.40; 95% CI, -4.72 to 1.93; gain-framed vs gain-social support mean difference, 1.38; 95% CI, -1.19 to 3.96). Secondary anxiety measures (Anxiety Sensitivity Index and Liebowitz Social Anxiety Scale scores) showed a similar pattern of improvement, with no evidence of differences between incentive conditions. Participants completed most of the 12 sessions (mean [SD], 10.8 [2.1]; 95% CI, 10.3-11.4), and User Mobile Application Rating Scale app quality ratings exceeded the published threshold for acceptability at all study visits. There was no evidence that either session completion or app quality ratings differed by incentive condition. Conclusions and Relevance: In this randomized clinical trial of an app-based intervention for anxiety, the primary hypothesis that improvement in anxiety would be greatest in the condition using gain of points plus social incentives was not supported; however, the results suggest that a CBT application incorporating a full suite of CBT skills and embedded user engagement features was efficacious in improving symptoms in young adults with anxiety disorders. Given these findings, digital interventions represent a promising step toward wider dissemination of high-quality, evidence-based interventions. Trial Registration: ClinicalTrials.gov Identifier: NCT05130281.
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Trastornos de Ansiedad , Terapia Cognitivo-Conductual , Aplicaciones Móviles , Humanos , Femenino , Masculino , Adulto Joven , Trastornos de Ansiedad/terapia , Trastornos de Ansiedad/psicología , Terapia Cognitivo-Conductual/métodos , Adulto , Adolescente , Resultado del Tratamiento , TelemedicinaRESUMEN
Tolin et al. (2004) developed the Chain of Contagion Task (CCT) to experimentally test the law of contagion and looming vulnerability (LV). In the CCT, contaminated pencils are brought into contact with clean pencils. The degree of contamination transferred to further new pencils refers to the level of biased contagious beliefs. Although this could be an important transdiagnostic tool, the usability of the original paradigm has been very laborious. Therefore, an imagery- and video-based CCT is introduced and validated in Study 1 in a nonclinical sample with 85 participants. In Study 2, the imagery-based CCT was validated in a clinical study with 15 participants diagnosed with contamination-related obsessive-compulsive disorder (C-OCD), 15 participants suffering from an anxiety disorder, and 15 nonclinical controls. The number of participants is consistent with those in Tolin's original sample and the statistical evaluation of Study 2 was preregistered. Both CCT could be validated and the results could be replicated. In the imagery-based CCT, the C-OCD group displayed significantly higher contamination ratings, avoidance tendencies and LV than the two control groups. We argue that this open access diagnostic instrument can be applied in research as well as in therapeutic practice (Download CCT videos and imagery: https://doi.org/10.5281/zenodo.7730459).
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Asco , Imágenes en Psicoterapia , Trastorno Obsesivo Compulsivo , Humanos , Femenino , Masculino , Adulto , Trastorno Obsesivo Compulsivo/psicología , Trastorno Obsesivo Compulsivo/diagnóstico , Imágenes en Psicoterapia/métodos , Trastornos de Ansiedad/psicología , Trastornos de Ansiedad/diagnóstico , Adulto Joven , Grabación en Video , Persona de Mediana Edad , AdolescenteRESUMEN
BACKGROUND: Traumatic brain injury (TBI) is defined as acquired cerebral damage caused by an external mechanical impact, which has the potential to lead to transient or enduring debilitation. TBI is associated with many forms of long-lasting psychiatric conditions, including anxiety disorders. As anxiety is highly debilitating by causing impaired social functioning and decreased quality of life for the afflicted, especially in the form of anxiety disorders such as generalized anxiety disorder, certain efforts have been made to explore the factors associated with it, and one such factor is TBI. METHODS: We searched PubMed, Scopus, and Web of Science on January 26th, 2024 for observational case-control or cohort or cross-sectional studies assessing the incidence of anxiety symptoms or disorders in patients with TBI compared to healthy individuals or the same individuals if pre-TBI information regarding anxiety was available. We calculated the pooled incidence and relative risk (RR) and 95% confidence interval (95CI) using the inverse variance method. Publication bias was assessed using Eggers's regression test. Quality assessment was performed using the Newcastle-Ottawa scale. Sub-group analyses were conducted for the type of anxiety (anxiety disorder vs anxiety symptoms), TBI severity, and type of anxiety disorders. RESULTS: The incidence rate of anxiety after traumatic brain injury was 17.45% (95CI: 12.59%, 22.31%) in a total of 705,024 individuals. Moreover, TBI patients were found to be 1.9 times as likely to have anxiety compared to their non-TBI counterparts [Random effects model RR = 1.90 [1.62; 2.23], p-value < 0.0001] using a population of 569,875 TBI cases and 1,640,312 non-TBI controls. Sub-group analysis revealed TBI severity was not associated with anxiety and generalized anxiety disorder was the most common type of anxiety disorder reported post-TBI. CONCLUSION: Patients who have experienced a TBI exhibit a significantly greater incidence of anxiety symptoms and anxiety disorders in the aftermath when compared to healthy individuals.
Asunto(s)
Ansiedad , Lesiones Traumáticas del Encéfalo , Humanos , Lesiones Traumáticas del Encéfalo/epidemiología , Lesiones Traumáticas del Encéfalo/psicología , Lesiones Traumáticas del Encéfalo/complicaciones , Incidencia , Ansiedad/epidemiología , Ansiedad/etiología , Ansiedad/psicología , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/etiología , Trastornos de Ansiedad/psicologíaRESUMEN
BACKGROUND: Anxious depression is a prevalent subtype of depression associated with adverse outcomes such as higher depression severity and higher rates of suicidality. This study leveraged a state-wide research registry of depressed and/or suicidal youth to compare the prevalence, clinical correlates, and symptom patterns of those with versus without anxious depression. METHODS: We included baseline data from 797 participants (ages 8-20) with a diagnosis of a depressive disorder. A score on the Generalized Anxiety Disorder Scale (GAD-7) ≥ 10 was used to define individuals with and without anxious depression. A structured battery was used to capture psychiatric diagnostic status, depression/anxiety severity, suicide risk, history of trauma, functioning, and resilience. RESULTS: The prevalence of anxious depression among youth with depressive disorders was 59.5 % (n = 474). Youth with anxious depression had greater depression severity and anxiety symptoms, higher suicidality, and a higher prevalence of comorbid anxiety disorders than those without. Youth with anxious depression had greater impairment in functioning defined as worse pain interference, pain severity, fatigue, and social relationships compared to those without anxious depression. Youth with anxious depression also reported higher rates of depressive symptoms such as irritable mood, feelings of guilt, and psychomotor agitation compared to those without anxious depression. CONCLUSION: Anxious depression is associated with worse depression severity, higher suicidality, and lower functioning. Longitudinal work is needed to examine long-term courses of anxious depression to explore its stability as a diagnostic subcategory.
Asunto(s)
Trastornos de Ansiedad , Humanos , Adolescente , Femenino , Masculino , Niño , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/psicología , Texas/epidemiología , Adulto Joven , Prevalencia , Comorbilidad , Trastorno Depresivo/epidemiología , Trastorno Depresivo/psicología , Ansiedad/epidemiología , Ansiedad/psicología , Índice de Severidad de la Enfermedad , Suicidio/estadística & datos numéricos , Suicidio/psicología , Depresión/epidemiología , Depresión/psicología , Ideación Suicida , Escalas de Valoración PsiquiátricaRESUMEN
We aimed to assess the mental health of adults living in Ukraine one year after onset of the Russo-Ukrainian war, along with quality of life and coping strategies. Quota sampling was used to collect online survey data from 2364 adults aged 18-79 years living in Ukraine from April 5, 2023 to May 15, 2023. Among adults living in Ukraine, 14.4 % had probable post-traumatic stress disorder (PTSD), another 8.9 % had complex PTSD (CPTSD), 44.2 % had probable depressive disorder, 23.1 % had anxiety disorder and 38.6 % showed significant loneliness. In adjusted models, the number of trauma events experienced during the war showed a dose-response association with PTSD/CPTSD and was associated with depressive disorder and anxiety disorder. Quality of life domains, particularly physical quality of life, were negatively associated with PTSD/CPTSD, depressive disorder, anxiety disorder, and number of trauma events. Maladaptive coping was positively associated with depressive disorder, anxiety disorder, PTSD/CPTSD and loneliness. All quality of life domains were positively associated with using adaptive coping strategies. Mental health disorders are highly prevalent in adults living in Ukraine one year into the war. Policy and services can promote adaptive coping strategies to improve mental health and quality of life for increased resilience during war.
Asunto(s)
Adaptación Psicológica , Calidad de Vida , Trastornos por Estrés Postraumático , Humanos , Adulto , Persona de Mediana Edad , Calidad de Vida/psicología , Masculino , Ucrania/epidemiología , Femenino , Estudios Transversales , Anciano , Adulto Joven , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/psicología , Adaptación Psicológica/fisiología , Adolescente , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/psicología , Trastorno Depresivo/epidemiología , Trastorno Depresivo/psicología , Salud Mental , Federación de Rusia/epidemiología , Soledad/psicologíaRESUMEN
Prominent models of adult social anxiety disorder emphasize the role of hyperreactivity and emotion regulation (ER) difficulties. However, it is unclear whether these factors are relevant in childhood, a critical period for the development of this disorder. We used ecological momentary assessment with mobile phones to assess daily-life emotional reactivity and use and effectiveness of ER strategies in children aged 10-13 years. We compared three groups: Social anxiety disorder (n = 29), clinical controls with mixed anxiety disorders (n = 27) and healthy controls (n = 31). We also investigated long-term effects of ER on trait social anxiety 12 months later. Hierarchical linear modelling revealed higher emotional reactivity and more use of suppression in children with social anxiety disorder compared to clinical and healthy controls. Contrary to our expectations, children with social anxiety disorder reported more use of avoidance and reappraisal compared to clinical, but not healthy, controls. The groups did not differ in subjective effectiveness of ER strategies. Use of suppression, avoidance, and rumination each predicted an increase in social anxiety 12 months later. Taken together, our results extend previous findings from lab and questionnaire studies and illustrate the role of maladaptive ER for child social anxiety disorder.