Anticipatory fear, worry and generalised anxiety.
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26 to 50 of 4,916A randomized controlled trial of a smartphone-based application for the treatment of anxiety.
AbstractIntroduction: Generalized anxiety disorder (GAD) is prevalent among college students. Smartphone-based interventions may be a low-cost treatment method. Method: College students with self-reported GAD were randomized to receive smartphone-based guided self-help (n = 50), or no treatment (n = 50). Post-treatment and six-month follow-up outcomes included the Depression Anxiety Stress Scales-Short Form Stress Subscale (DASS Stress), the Penn State Worry Questionnaire (PSWQ-11), and the State-Trait Anxiety Inventory-Trait (STAI-T), as well as diagnostic status assessed by the GAD-Questionnaire, 4th edition. Results: From pre- to post-treatment, participants who received guided self-help (vs. no treatment) experienced significantly greater reductions on the DASS Stress (d = -0.408) and a greater probability of remission from GAD (d = -0.445). There was no significant between-group dif…
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Carl JR, Miller CB, Henry AL, Davis ML, Stott R, Smits JAJ, Emsley R, Gu J, Shin O, Otto MW, Craske MG, Saunders KEA, Goodwin GM, Espie CA (2020)randomised controlled trialMEDLINE-indexed journal, not yet read by usDepression and anxiety53 citations Efficacy of digital cognitive behavioral therapy for moderate-to-severe symptoms of generalized anxiety disorder: A randomized controlled trial.
Background: Cognitive behavioral therapy (CBT) is an efficacious intervention for generalized anxiety disorder (GAD). Digital CBT may provide a scalable means of delivering CBT at a population level. We investigated the efficacy of a novel digital CBT program in those with GAD for outcomes of anxiety, worry, depressive symptoms, sleep difficulty, wellbeing, and participant-specific quality of life.
Methods: This online, two-arm parallel-group superiority randomized controlled trial compared digital CBT with waitlist control in 256 participants with moderate-to-severe symptoms of GAD. Digital CBT (Daylight), was delivered using participants' own smartphones. Online assessments took place at baseline (Week 0; immediately preceding randomization), mid-intervention (Week 3; from randomization), post-intervention (Week 6; primary endpoint), and follow-up (Week 10).
Results: Overall, 256 parti…
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Effects of modifying interpretation bias on transdiagnostic repetitive negative thinking.
Objective: Repetitive negative thinking (RNT; e.g., worry and rumination) is common across emotional disorders, as is the tendency to generate negative interpretations (interpretation bias). Ameliorating negative interpretations via cognitive bias modification of interpretations (CBM-I) reduces worry/rumination, and improves mood in people diagnosed with generalized anxiety disorder (GAD) or depression. We investigated whether these findings generalize to high worry or rumination populations, irrespective of diagnosis, and whether effects are increased by enhancing emotional engagement with training with active generation of positive resolutions of ambiguity and imagery.
Method: Community volunteers with excessive worry and/or rumination, who were above clinical cut-off on anxiety and/or depression measures, were allocated to an active control condition (n = 54), interpretation training …
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Working out the worries: A randomized controlled trial of high intensity interval training in generalized anxiety disorder.
Background: Aerobic exercise (AE) demonstrated an overall medium treatment effect in anxiety disorders (AD) but there is evidence for an "intensity-response" relationship. High intensity interval training (HIIT) was highly effective on a range of (mental) health parameters. However, so far no randomised-controlled trial (RCT) investigated the efficacy of HIIT in AD.
Methods: 33 patients with generalized anxiety disorder (GAD) were randomly assigned to 12-day HIIT or a training of lower intensity (LIT). Anxiety, comorbid depression, stress-related bodily symptoms and perceived control over anxiety related stimuli (PC) were assessed at baseline, post-training and 30 days after baseline by using the Penn State Worry Questionnaire (PSWQ), the Hamilton Inventories for Anxiety and Depression (Ham-A, Ham-D), the Screening for Somatoform Symptoms-7 (SOMS-7) and the Anxiety Control Questionnaire …
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Stein A, Craske MG, Lehtonen A, Harvey A, Savage-McGlynn E, Davies B, Goodwin J, Murray L, Cortina-Borja M, Counsell N (2012)randomised controlled trialMEDLINE-indexed journal, not yet read by usJournal of abnormal psychology133 citations Maternal cognitions and mother-infant interaction in postnatal depression and generalized anxiety disorder.
Postnatal depression and anxiety have been shown to increase the risk of disturbances in mother-child interaction and child development. Research into mechanisms has focused on genetics and maternal behavior; maternal cognitions have received little attention. Our aim was to experimentally determine if worry and rumination in mothers with generalized anxiety disorder (GAD) and major depressive disorder (MDD), diagnosed in the postnatal 6 months, interfered with maternal responsiveness to their 10-month old infants. Mothers (N = 253: GAD n = 90; MDD n = 57; control n = 106) and their infants were randomized to either a worry/rumination prime (WRP) or a neutral prime (NP); mother-infant interactions were assessed before and after priming. Type of priming was a significant predictor of maternal cognitions, with WRP resulting in more negative thoughts, higher thought recurrence and more self…
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Llera SJ, Newman MG (2010)randomised controlled trialMEDLINE-indexed journal, not yet read by usEmotion (Washington, D.C.)94 citations Effects of worry on physiological and subjective reactivity to emotional stimuli in generalized anxiety disorder and nonanxious control participants.
The present study examined the effect of worry versus relaxation and neutral thought activity on both physiological and subjective responding to positive and negative emotional stimuli. Thirty-eight participants with generalized anxiety disorder (GAD) and 35 nonanxious control participants were randomly assigned to engage in worry, relaxation, or neutral inductions prior to sequential exposure to each of four emotion-inducing film clips. The clips were designed to elicit fear, sadness, happiness, and calm emotions. Self reported negative and positive affect was assessed following each induction and exposure, and vagal activity was measured throughout. Results indicate that worry (vs. relaxation) led to reduced vagal tone for the GAD group, as well as higher negative affect levels for both groups. Additionally, prior worry resulted in less physiological and subjective responding to the fe…
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A systematic review of adult attachment and social anxiety.
Background: Attachment has been implicated in the development of social anxiety. Our aim was to synthesise the extant literature exploring the role of adult attachment in these disorders.
Method: Search terms relating to social anxiety and attachment were entered into MEDLINE, PsycINFO and Web of Science. Risk of bias of included studies was assessed using and adapted version of the Agency for Healthcare Research and Quality assessment tool. Eligible studies employed validated social anxiety and attachment assessments in adult clinical and analogue samples. The review included cross sectional, interventional and longitudinal research.
Results: Of the 30 identified studies, 28 showed a positive association between attachment insecurity and social anxiety. This association was particularly strong when considering attachment anxiety. Cognitive variables and evolutionary behaviours were iden…
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Shedding light on the association between repetitive negative thinking and deficits in cognitive control - A meta-analysis.
Individuals who experience recurrent negative thoughts are at elevated risk for mood and anxiety disorders. It is thus essential to understand why some individuals get stuck in recurrent negative thinking (RNT), whereas others are able to disengage eventually. Theoretical models propose that individuals high in recurrent negative thinking suffer from deficits in controlling the contents of working memory. Empirical findings, however, are inconclusive. In this meta-analysis, we synthesize findings from 94 studies to examine the proposed association between RNT and deficits in cognitive control. We included numerous effect sizes not reported in the primary publications. Moderator analyses tested the influence of variables, such as stimuli valence, cognitive control function (e.g., shifting, discarding), or type of RNT (i.e., rumination or worry). Results demonstrated an association between…
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Self-guided virtual reality therapy for anxiety: A systematic review.
Background: Virtual reality (VR) technology can be used to treat anxiety symptoms and disorders. However, most VR interventions for anxiety have been therapist guided rather than self-guided.
Objective: This systematic review aimed to examine the effectiveness and user experience (i.e., usability, acceptability, safety, and attrition rates) of self-guided VR therapy interventions in people with any anxiety condition as well as provide future research directions.
Method: Peer-reviewed journal articles reporting on self-guided VR interventions for anxiety were sought from the Cochrane Library, IEEE Explore Digital Library, PsycINFO, PubMED, Scopus, and Web of Science databases. Study data from the eligible articles were extracted, tabulated, and addressed with a narrative synthesis.
Results: A total of 21 articles met the inclusion criteria. The findings revealed that self-guided VR interv…
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The gut microbiota in anxiety and depression - A systematic review.
Growing evidence indicates the community of microorganisms throughout the gastrointestinal tract, (i.e., gut microbiota), is associated with anxiety and depressive disorders. We present the first systematic review of the gut microbiota in anxiety disorders, along with an update in depression. Consideration of shared underlying features is essential due to the high rates of comorbidity. Systematic searches, following PRISMA guidelines, identified 26 studies (two case-control comparisons of the gut microbiota in generalised anxiety disorder, 18 in depression, one incorporating both anxiety/depression, and five including symptom-only measures). Alpha and beta diversity findings were inconsistent; however, differences in bacterial taxa indicated disorders may be characterised by a higher abundance of proinflammatory species (e.g., Enterobacteriaceae and Desulfovibrio), and lower short-chain …
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Men's anxiety: A systematic review.
Aim: Anxiety disorders are amongst the most commonly diagnosed mental illnesses amongst men; however male-specific anxiety research is lacking. This review explores men's anxiety symptoms and disorders including help-seeking, coping and the role of masculinity.
Method: Four electronic database searches identified 8,333 citations, with 25 studies meeting inclusion criteria. Nineteen studies employed quantitative methods, five studies reported qualitative research, and one utilised mixed methods.
Results: Unique profiles of anxiety, including psychosomatic symptoms, were identified and persisted over extended periods of time. Men commonly reported self-reliance over formal help-seeking, and typically managed anxiety symptoms through problem-based coping. Masculinity was related to anxiety in complex ways; adherence to norms of toughness could be protective against anxiety onset, while adhe…
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The anxious heart in whose mind? A systematic review and meta-regression of factors associated with anxiety disorder diagnosis, treatment and morbidity risk in coronary heart disease.
Objective: To (1) report the prognostic association between anxiety disorder subtypes and major adverse cardiac events (MACE), (2) report anxiety disorder prevalence in coronary heart disease (CHD), and (3) report the efficacy of anxiety disorder treatments in CHD.
Methods: A comprehensive electronic database search was performed in November 2013 for studies reporting anxiety disorder prevalence according to structured interview in CHD samples or MACE, and randomized controlled trials (RCTs) comparing anxiety disorder treatment with placebo or usual care. From 4041 articles 42 samples were selected for extraction (8 for MACE prognosis, 39 for prevalence, no RCTs were eligible).
Results: Five generalized anxiety disorder (GAD) studies reported 883 MACE events (combined n=2851). There was a non-significant association between GAD and MACE (risk ratio=1.20, 95% CI .86-1.68, P=.28) however t…
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Anxiety during the menopausal transition: a systematic review.
Objective: There have been relatively few studies of the relationship between anxiety and menopause. Despite the paucity of clear evidence, some authors have suggested that the menopausal transition is a time of heightened risk for onset or exacerbation of anxiety symptoms. There is also controversy as to whether anxiety predates or is a consequence of hot flashes. The aim of this paper is to examine the evidence as to the relationship between menopause and anxiety, and between anxiety and hot flushes, one of the core symptoms of menopause.
Method: A systematic review was undertaken based on literature published between 1960 and 2011, using the Medline, Web of Science and PsychINFO databases. The key terms 'anxiety', 'anxiety symptoms', 'anxiety disorder', 'menopause', 'menopausal transition', 'midlife', 'hot flushes or flashes' and 'vasomotor symptoms' were entered into the search. Stud…
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Threat reappraisal as a mediator of symptom change in cognitive-behavioral treatment of anxiety disorders: a systematic review.
Objective: Identifying mediators of therapeutic change is important to the development of interventions and augmentation strategies. Threat reappraisal is considered a key mediator underlying the effects of cognitive-behavioral therapy (CBT) for anxiety disorders. The present study systematically reviewed the evidence for the threat reappraisal mediation hypothesis.
Method: In our review, we included studies that (a) investigated the threat reappraisal mediation hypothesis; (b) included adults with an anxiety disorder diagnosis; (c) used a longitudinal design; and (d) did not report on previously published findings (to avoid the inclusion of multiple reports of the same data). After data extraction, we made review-specific quality judgments for each study using the following a priori criteria informed by mediation theory: (a) demonstrated statistical mediation; (b) demonstrated that CBT …
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Meades R, Ayers S (2011)systematic reviewMEDLINE-indexed journal, not yet read by usJournal of affective disorders230 citations Anxiety measures validated in perinatal populations: a systematic review.
Background: Research and screening of anxiety in the perinatal period is hampered by a lack of psychometric data on self-report anxiety measures used in perinatal populations. This paper aimed to review self-report measures that have been validated with perinatal women.
Methods: A systematic search was carried out of four electronic databases. Additional papers were obtained through searching identified articles. Thirty studies were identified that reported validation of an anxiety measure with perinatal women.
Results: Most commonly validated self-report measures were the General Health Questionnaire (GHQ), State-Trait Anxiety Inventory (STAI), and Hospital Anxiety and Depression Scales (HADS). Of the 30 studies included, 11 used a clinical interview to provide criterion validity. Remaining studies reported one or more other forms of validity (factorial, discriminant, concurrent and pre…
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Acupuncture for anxiety and anxiety disorders--a systematic literature review.
Introduction: The aim of this study was to evaluate the evidence for the efficacy of acupuncture in the treatment of anxiety and anxiety disorders by systematic review of the relevant research.
Methods: Searches of the major biomedical databases (MEDLINE, EMBASE, ClNAHL, PsycINFO, Cochrane Library) were conducted between February and July 2004. Specialist complementary medicine databases were also searched and efforts made to identify unpublished research. No language restrictions were imposed and translations were obtained where necessary. Study methodology was appraised and clinical commentaries obtained for studies reporting clinical outcomes.
Results: Twelve controlled trials were located, of which 10 were randomised controlled trials (RCTs). Four RCTs focused on acupuncture in generalised anxiety disorder or anxiety neurosis, while six focused on anxiety in the perioperative period.…
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Measurement of pregnancy-related anxiety worldwide: a systematic review.
Background: The perinatal period is often characterized by specific fear, worry, and anxiety concerning the pregnancy and its outcomes, referred to as pregnancy-related anxiety. Pregnancy-related anxiety is uniquely associated with negative maternal and child health outcomes during pregnancy, at birth, and early childhood; as such, it is increasingly studied. We examined how pregnancy-related anxiety is measured, where measures were developed and validated, and where pregnancy-related anxiety has been assessed. We will use these factors to identify potential issues in measurement of pregnancy-related anxiety and the geographic gaps in this area of research.
Methods: We searched the Africa-Wide, CINAHL, MEDLINE, PsycARTICLES, PsycINFO; PubMed, Scopus, Web of Science Core Collection, SciELO Citation Index, and ERIC databases for studies published at any point up to 01 August 2020 that asse…
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The relationship between executive functioning and repetitive negative thinking in youth: A systematic review of the literature.
Repetitive negative thinking (RNT) and executive functioning (EF) deficits are each characteristic of many forms of youth psychopathology. Extensive work has examined the relationship between rumination, a form of RNT, and EF in adults. However, less is known about the relationship between RNT more broadly and EF in youth, for whom these constructs are developing and emerging. Here, we systematically and qualitatively reviewed 27 studies on the associations between EF (e.g., shifting, inhibition, working memory) and RNT (e.g., rumination, worry, obsessions) in youth. All forms of RNT were more commonly positively associated with questionnaire-reported EF problems in daily life, most frequently in the domain of shifting. Task-based assessments of EF were less consistently associated with RNT in youth, with no strong pattern of presence vs. absence of associations. Further, limited longitu…
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Hirshfeld-Becker DR, Masek B, Henin A, Blakely LR, Pollock-Wurman RA, McQuade J, DePetrillo L, Briesch J, Ollendick TH, Rosenbaum JF, Biederman J (2010)randomised controlled trialMEDLINE-indexed journal, not yet read by usJournal of consulting and clinical psychology114 citations Cognitive behavioral therapy for 4- to 7-year-old children with anxiety disorders: a randomized clinical trial.
Objective: To examine the efficacy of a developmentally appropriate parent-child cognitive behavioral therapy (CBT) protocol for anxiety disorders in children ages 4-7 years.
Method:
Design: Randomized wait-list controlled trial. Conduct: Sixty-four children (53% female, mean age 5.4 years, 80% European American) with anxiety disorders were randomized to a parent-child CBT intervention (n = 34) or a 6-month wait-list condition (n = 30). Children were assessed by interviewers blind to treatment assignment, using structured diagnostic interviews with parents, laboratory assessments of behavioral inhibition, and parent questionnaires.
Analysis: Chi-square analyses of outcome rates and linear and ordinal regression of repeated measures, examining time by intervention interactions.
Results: The response rate (much or very much improved on the Clinical Global Impression Scale for Anxiety) amon…
matched on Anxiety Disorders (mesh), Anxiety, Separation (mesh), Phobic Disorders (mesh), generalized anxiety (text)
Roy AK, Vasa RA, Bruck M, Mogg K, Bradley BP, Sweeney M, Bergman RL, McClure-Tone EB, Pine DS, CAMS Team (2008)randomised controlled trialMEDLINE-indexed journal, not yet read by usJournal of the American Academy of Child and Adolescent Psychiatry160 citations Attention bias toward threat in pediatric anxiety disorders.
Objective: To examine attention bias toward threat faces in a large sample of anxiety-disordered youths using a well-established visual probe task.
Method: Study participants included 101 children and adolescents (ages 7-18 years) with generalized anxiety disorder, social phobia, and/or separation anxiety disorder enrolled in a multisite anxiety treatment study. Nonanxious youths (n = 51; ages 9-18 years) were recruited separately. Participants were administered a computerized visual probe task that presents pairs of faces portraying threat (angry), positive (happy), and neutral expressions. They pressed a response key to indicate the spatial location of a probe that replaced one of the faces on each trial. Attention bias scores were calculated from response times to probes for each emotional face type.
Results: Compared to healthy youths, anxious participants demonstrated a greater atte…
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Forgiveness Therapy to Build Hope and Reduce Anxiety and Depression in Battered Women in Pakistan.
This study examined the impact of forgiveness therapy on battered women in Pakistan. The aim was to evaluate the effectiveness of a forgiveness-focused intervention in reducing depression, anxiety and anger while increasing forgiveness and hope among the battered women within shelter homes. Thirty participants, aged 25-40, were randomly assigned to either the experimental or control group. Participants were recruited from various cities across Punjab, including Hafizabad, Lahore, Gujrat, Khushab, Sargodha and Gujranwala. The Enright Forgiveness Inventory short form (to assess individual levels of forgiveness), the Center for Epidemiological Studies-Depression Scale (CES-D), Generalized Anxiety Disorder Scale, Herth Hope Index, and the Clinical Anger Scale were used as instruments to measure the outcomes of the intervention. The Domestic Violence Scale for Intimate Partners was employed f…
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Costs and cost-effectiveness of Shamiri, a brief, layperson-delivered intervention for Kenyan adolescents: a randomized controlled trial.
Background: Low- and middle-income countries (LMICs) have the highest socio-economic burden of mental health disorders, yet the fewest resources for treatment. Recently, many intervention strategies, including the use of brief, scalable interventions, have emerged as ways of reducing the mental health treatment gap in LMICs. But how do decision makers prioritize and optimize the allocation of limited resources? One approach is through the evaluation of delivery costs alongside intervention effectiveness of various types of interventions. Here, we evaluate the cost-effectiveness of Shamiri, a group- and school-based intervention for adolescent depression and anxiety that is delivered by lay providers and that teaches growth mindset, gratitude, and value affirmation.
Methods: We estimated the cost-effectiveness of Shamiri using the Consolidated Health Economic Evaluation Reporting Standard…
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Effects of replay and rehearsal expressive writing on mental health: a randomized controlled trial.
Background: Expressive writing about previous interactions has been found to improve mental health, but the effect of expressive writing about future imagined interactions has not been explored.
Methods: To examine the effects of rehearsal expressive writing on mental health, we recruited 132 people, and 100 (76%) completed writing tasks (31 control, 34 replay, and 35 rehearsal). Each group was measured at baseline, after the 4th consecutive day of 15-minute-per-day writing, and at 1-month follow-up. Measures included psychological adjustment (Mental Health Inventory-18, MHI), self-perceived stress, PROMIS depression and anxiety, work and social adjustment, loneliness, coping (Brief COPE), and daily writing expressiveness. Repeated measures ANOVA examined time and time-by-group effects.
Results: Significant time effects were found for MHI, self-perceived stress, depression and anxiety sy…
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Venturo-Conerly KE, Osborn TL, Alemu R, Roe E, Rodriguez M, Gan J, Arango S, Wasil A, Wasanga C, Weisz JR (2022)randomised controlled trialMEDLINE-indexed journal, not yet read by usBehaviour research and therapy17 citations Single-session interventions for adolescent anxiety and depression symptoms in Kenya: A cluster-randomized controlled trial.
Objective: Expanding mental healthcare for adolescents in low-income regions is a global health priority. Group interventions delivered by lay-providers may expand treatment options. Brief, positively-focused interventions conveying core concepts of adaptive functioning may help reduce adolescent symptoms of mental illness. In this trial, we tested three such interventions (growth mindset, gratitude, and value affirmation) as separate single-session interventions.
Method: Consenting adolescents (N = 895; Mage = 16.00) from two secondary schools in Kenya were randomized by classroom (24 classrooms; Mclass = 37.29 students) into single-session interventions: growth (N = 240), gratitude (N = 221), values (N = 244), or an active study-skills control (N = 190). Mixed-effects models controlling for age and gender were used to estimate individual-level intervention effects on anxiety and depres…
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Computerized treatment of perfectionism through mistake making: A preliminary study.
Background and objectives: Perfectionism has important implications for self-worth, personal standards, and psychopathology. The aim of this study was to test the efficacy of a novel two-week, computerized, exposure-based treatment for perfectionism (ETP).
Methods: Seventy-one university students with elevated perfectionism were randomized to either the ETP group (n = 36) or the waitlist (WL) control group (n = 35). The ETP group was asked to complete the intervention at home, every three days for two weeks for a total of five treatment sessions. The tasks in the ETP condition were engineered to have participants repeatedly make mistakes. All participants returned two weeks after the baseline visit for a post-treatment assessment.
Results: Compared to WL, ETP led to lower overall perfectionism, concern over mistakes, personal standards, depressive symptoms, social anxiety symptoms, and e…
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