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Psychotherapy (Chicago, Ill.) Sep 2022According to dynamic systems theory, initial symptom instability is necessary for long-term stable change to occur from psychotherapy. Such instability may be assessed... (Randomized Controlled Trial)
Randomized Controlled Trial
According to dynamic systems theory, initial symptom instability is necessary for long-term stable change to occur from psychotherapy. Such instability may be assessed using within-day sudden gains (SGs), sudden losses (SLs), and reversals. The present study examined these symptom change patterns and their association with treatment outcome using intensive diary assessment across three psychotherapies for generalized anxiety disorder (GAD). In a secondary analysis of Borkovec and Costello (1993), 59 clients diagnosed with GAD were randomly assigned to applied relaxation (AR; = 21), cognitive behavioral therapy (CBT; = 20), or nondirective (ND) therapy ( = 18). Clients completed thrice daily anxiety ratings while receiving psychotherapy. The occurrence of SGs, SLs, and reversals assessed for each individual was calculated using changes between each assessment. We examined the association between occurrence of SGs, SLs, and reversals and symptom change from pretreatment to posttreatment, and 6-month, and 1-year follow-up. Clients in ND (61.1%) were more likely to experience SGs than clients in CBT (20.0%) or AR (38.0%). 92.9% of SGs were followed by a reversal. Experiencing SGs was associated with less symptom change from pretreatment to follow-up in ND and not associated with outcome in CBT or AR. SLs and reversals were not associated with outcome. When measured at a within-day level, SGs are very likely to be reversed and may be associated with poorer long-term outcome in ND. Within-day SGs may have a fundamentally different meaning than session-to-session SGs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Topics: Anxiety; Anxiety Disorders; Cognitive Behavioral Therapy; Humans; Psychotherapy; Treatment Outcome
PubMed: 35666889
DOI: 10.1037/pst0000445 -
Dialogues in Clinical Neuroscience Jun 2017Cultural factors have influenced the presentation, diagnoses, and treatment of anxiety disorders in India for several centuries. This review covers the antecedents,... (Review)
Review
Cultural factors have influenced the presentation, diagnoses, and treatment of anxiety disorders in India for several centuries. This review covers the antecedents, prevalence, phenomenology, and treatment modalities of anxiety disorders in the Indian cultural context. It covers the history of the depiction of anxiety in India and the concept of culture in the classification of anxiety disorders, and examines the cultural factors influencing anxiety disorders in India. We review the prevalence and phenomenology of various disorders, such as generalized anxiety disorder, panic disorder, social anxiety, and phobic disorder, as well as culture-specific syndromes such as dhat and koro in India. Finally, the review examines the wide range of therapeutic modalities practiced in India, such as faith healing, psychotherapy, ayurveda, psychopharmacology, Unani medicine, homeopathy, yoga, meditation, and mindfulness. We conclude by emphasizing the significance of cultural factors in making relevant diagnoses and offering effective and holistic treatments to individuals with anxiety disorders.
Topics: Anxiety; Anxiety Disorders; Cultural Characteristics; Humans; India; Male; Panic Disorder; Prevalence
PubMed: 28867936
DOI: 10.31887/DCNS.2017.19.2/rparikh -
Dialogues in Clinical Neuroscience Sep 2015Social anxiety disorder (SAD) is a highly prevalent and disabling disorder with key behavioral traits of social fearfulness, social avoidance, and submissiveness. Here... (Review)
Review
Social anxiety disorder (SAD) is a highly prevalent and disabling disorder with key behavioral traits of social fearfulness, social avoidance, and submissiveness. Here we argue that hormonal systems play a key role in mediating social anxiety, and so may be important in SAD. Hormonal alterations, often established early in development through the interaction between biological and psychological factors (eg, genetic predisposition x early trauma), predispose to socially fearful, avoidant, and submissive behavior. However, whereas gene variants and histories of trauma persist, hormonal systems can be remodeled over the course of life. Hormones play a key role during the periods of all sensitive developmental windows (ie, prenatal, neonatal, puberty, aging), and are capable of opening up new developmental windows in adulthood. Indeed, the developmental plasticity of our social brain, and thus of social behavior in adulthood, critically depends on steroid hormones such as testosterone and peptide hormones such as oxytocin. These steroid and peptide hormones in interaction with social experiences may have potential for reprogramming the socially anxious brain. Certainly, single administrations of oxytocin and testosterone in humans reduce socially fearful, avoidant, and submissive behavior. Such work may ultimately lead to new approaches to the treatment of SAD.
Topics: Animals; Anxiety Disorders; Fear; Humans; Neurosecretory Systems; Social Behavior
PubMed: 26487809
DOI: 10.31887/DCNS.2015.17.3/jhonk -
Comprehensive Psychiatry Feb 2021Prior studies have reported that separation anxiety disorder (SEPAD) can continue into or may begin in adulthood. Association of SEPAD with other psychiatric disorders...
Prior studies have reported that separation anxiety disorder (SEPAD) can continue into or may begin in adulthood. Association of SEPAD with other psychiatric disorders has been frequently examined, and high rates of comorbidities have been found. The aim of this study was to investigate the prevalence and clinical correlation of SEPAD in adult patients undergoing treatment for major depressive disorder (MDD). The study sample was comprised of 100 outpatients. Participants underwent a DSM-5-based comprehensive assessment. Purposefully-designed semi-structured sociodemographic information and illness history forms were filled out by the researchers, and diagnoses of SEPAD were made using the Structured Clinical Interview for Separation Anxiety Symptoms, Separation Anxiety Symptom Inventory and Adult Separation Anxiety Survey. The frequency of SEPAD was 41% in patients with MDD, three-quarters of whom were adult onset. The use of new-generation antidepressants, adjunctive medications and comorbidity of other anxiety disorders were higher in patients with SEPAD (p < 0.05). SEPAD was highly prevalent, with a majority of cases starting in adulthood among patients with MDD, while SEPAD comorbidity was associated with high levels of anxiety and an increased likelihood of suboptimal response to usual depression treatment. Further studies are required to define the relevance and pathological basis for the comorbidity of SEPAD in people with MDD.
Topics: Adult; Anxiety Disorders; Anxiety, Separation; Comorbidity; Depressive Disorder, Major; Humans; Outpatients; Prevalence
PubMed: 33378709
DOI: 10.1016/j.comppsych.2020.152219 -
Journal of Clinical Psychology Dec 2022Generalized anxiety disorder (GAD) is a chronic mental health condition that results in significant individual, societal, and economic burden. While cognitive behavioral... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Generalized anxiety disorder (GAD) is a chronic mental health condition that results in significant individual, societal, and economic burden. While cognitive behavioral therapy (CBT) is well established as an efficacious treatment for GAD, individuals have identified several logistical barriers to accessing face-to-face CBT. Remotely delivered treatments address many of these treatment barriers.
METHODS
The aim of the current study was to synthesize the current literature on the efficacy of remote CBT for GAD using a meta-analytic approach. Relevant articles were identified through an electronic database search and 10 studies (with 11 remote conditions and 1071 participants) were included in the meta-analysis.
RESULTS
Within-group findings indicate that remote CBT for GAD results in large effect sizes from pretreatment to posttreatment (g = 1.30; 95% confidence interval [CI]: 1.03-1.58). Both low intensity and high intensity remote CBT interventions were found to result in large effect sizes (g = 1.36; 95% CI: 1.11-1.61 and g = 0.83; 95% CI: 0.20-1.47, respectively), with no significant differences between the treatment formats (Q = 2.28, p = 0.13). Between-group effect sizes were medium in size at posttreatment (g = 0.76; 95% CI: 0.47-1.06).
CONCLUSIONS
These findings have potential implications for the delivery of evidence-based treatment for GAD and the inclusion of remote methods in stepped care treatment approaches.
Topics: Humans; Anxiety Disorders; Cognitive Behavioral Therapy; Treatment Outcome; Anxiety
PubMed: 35403706
DOI: 10.1002/jclp.23360 -
Dialogues in Clinical Neuroscience Jun 2017On the basis of epidemiological survey findings, anxiety disorders are the most prevalent mental disorders around the world and are associated with significant... (Review)
Review
On the basis of epidemiological survey findings, anxiety disorders are the most prevalent mental disorders around the world and are associated with significant comorbidity and morbidity. Such surveys rely on advances in psychiatric nosology and may also contribute usefully to revisions of the nosology. There are a number of questions at the intersection of psychiatric epidemiology and nosology. This review addresses the following: What is the prevalence of anxiety disorders and how do we best explain cross-national differences in prevalence estimates? What are the optimal diagnostic criteria for anxiety disorders, and how can epidemiological data shed light on this question? What are the comorbidities of anxiety disorders, and how do we best understand the high comorbidities seen in these conditions? What is the current treatment gap for anxiety disorders, and what are the implications of current understandings of psychiatric epidemiology and nosology for policy-making relevant to anxiety disorders? Here, we emphasize that anxiety disorders are the most prevalent of the psychiatric conditions, and that rather than merely contrasting cross-national prevalence in anxiety disorders, it is more productive to delineate cross-national themes that emerge about the epidemiology of these conditions. We discuss that optimizing diagnostic criteria for anxiety disorders is an iterative process to which epidemiological data can make a crucial contribution. Additionally, high comorbidity in anxiety disorders is not merely artefactual; it provides key opportunities to explore pathways to mental disorders and to intervene accordingly. Finally, work on the epidemiology and nosology of anxiety disorders has provided a number of important targets for mental health policy and for future integrative work to move between bench and bedside, as well as between clinic and community.
Topics: Anxiety Disorders; Comorbidity; Humans; Internationality; Prevalence; Surveys and Questionnaires
PubMed: 28867937
DOI: 10.31887/DCNS.2017.19.2/dstein -
Journal of Affective Disorders Mar 2021Associations between physical activity (PA) and subclinical anxiety disorder symptoms and status, and potential mediating effect of social physique anxiety (SPA), remain...
BACKGROUND
Associations between physical activity (PA) and subclinical anxiety disorder symptoms and status, and potential mediating effect of social physique anxiety (SPA), remain understudied. We examined associations between PA and analogue Generalized Anxiety Disorder (AGAD), analogue Social Anxiety Disorder (ASAD), and analogue Panic Disorder (APD) symptoms and status, the mediating effect of SPA, and sex-related differences.
METHODS
Participants (n = 470, 23.2 ± 4.8 years, 298 female) completed the Psychiatric Diagnostic Screening Questionnaire, seven-day PA recall, and Social Physique Anxiety Scale. ANCOVA examined differences in SPA and anxiety disorder symptoms between PA levels. Logistic regression examined associations between PA and analogue anxiety disorder status. Mediation analyses estimated the effect of change in PA on analogue anxiety disorder odds when SPA was at its mean.
RESULTS
AGAD, ASAD, and APD prevalence was 38.1%, 60.0%, and 15.1%, respectively. AGAD and ASAD symptoms, but not APD symptoms, were significantly lower among higher PA levels. PA was associated with lower odds of AGAD, ASAD, and APD; findings were not significant after adjustment. The pure indirect effect of SPA significantly accounted for 58.2% and 47.9% of the total effect of PA on AGAD and ASAD, respectively; findings were not significant after adjusting for depression. Females showed greater odds of AGAD, ASAD, and APD; mediation findings did not differ based on gender.
LIMITATIONS
Cross-sectional design, self-reported exposure and outcomes, and sample size are potential limitations.
CONCLUSION
Symptoms and odds of AGAD and ASAD status were lower among young adults with greater PA; SPA partially mediated associations and warrants experimental investigation.
Topics: Anxiety; Anxiety Disorders; Cross-Sectional Studies; Exercise; Female; Humans; Panic Disorder; Young Adult
PubMed: 33433380
DOI: 10.1016/j.jad.2020.12.163 -
Journal of Behavioral Addictions Dec 2017Introduction This study evaluates the association between generalized anxiety disorder (GAD) and Internet gaming disorder (IGD) and the role of behavior inhibition in...
Introduction This study evaluates the association between generalized anxiety disorder (GAD) and Internet gaming disorder (IGD) and the role of behavior inhibition in young adults. Methods We recruited 87 people with IGD and a control group of 87 people without a history of IGD. All participants underwent a diagnostic interview based on the fifth edition of Diagnostic and Statistical Manual of Mental Disorders, IGD and GAD criteria, and completed a questionnaire on behavior inhibition, depression, and anxiety. Results Logistic regression revealed that adults with GAD were more likely (odds ratio = 8.11, 95% CI = 1.78-37.09) to have IGD than those without it. The OR decreased when controlling for behavior inhibition. IGD subjects with GAD had higher depressive and anxiety score than those without GAD. Conclusions GAD was associated with IGD. Comorbid GAD can contribute to higher emotional difficulty. GAD should be well-assessed and interventions planned when treating young adults with IGD. Behavioral inhibition confounds the association between GAD and IGD. Further study is necessary to evaluate how to intervene in behavioral inhibitions to attenuate the risk of GAD and IGD comorbidity.
Topics: Adult; Anxiety Disorders; Behavior, Addictive; Female; Humans; Internet; Logistic Models; Male; Odds Ratio; Taiwan; Video Games; Young Adult
PubMed: 29280398
DOI: 10.1556/2006.6.2017.088 -
Canadian Journal of Psychiatry. Revue... Jun 2022Despite increasing rates of legalization of medical cannabis worldwide, the current evidence available on its effect on mental health outcomes including anxiety is of... (Observational Study)
Observational Study
OBJECTIVES
Despite increasing rates of legalization of medical cannabis worldwide, the current evidence available on its effect on mental health outcomes including anxiety is of mixed results. This study assesses the effect of medical cannabis on generalized anxiety disorder 7-item (GAD-7) scores in adult patients between 2014 and 2019 in Ontario and Alberta, Canada.
METHODS
An observational cohort study of adults authorized to use medical cannabis. The GAD-7 was administered at the time of the first visit to the clinic and subsequently over the follow-up time period of up to 3.2 years. Overall changes in GAD-7 scores were computed (mean change) and categorized as: no change (<1 point); improvement; or worsening-over time.
RESULTS
A total of 37,303 patients had initial GAD-7 scores recorded and 5,075 (13.6%) patients had subsequent GAD-7 follow-up scores. The average age was 54.2 years (SD 15.7 years), 46.0% were male, and 45.6% noted anxiety symptoms at the baseline. Average GAD-7 scores were 9.11 (SD 6.6) at the baseline and after an average of 282 days of follow-up (SD 264) the average final GAD-7 score recorded was 9.04 (SD 6.6): mean change -0.23 (95% CI, -0.28 to -0.17, [5,074]: -8.19, -value <0.001). A total of 4,607 patients (90.8%) had no change in GAD-7 score from their initial to final follow-up, 188 (3.7%) had a clinically significant decrease, and 64 (1.3%) noted a clinically significant increase in their GAD-7 scores.
CONCLUSIONS
Overall, there was a statistically significant decrease in GAD-7 scores over time (in particular, in the 6-12-month period). However, this change did not meet the threshold to be considered clinically significant. Thus, we did not detect clinical improvements or detriment in GAD-7 scores in medically authorized cannabis patients. However, future well-controlled clinical trials are needed to fully examine risks or benefits associated with using medical cannabis to treat anxiety conditions.
Topics: Adult; Alberta; Anxiety Disorders; Cannabis; Female; Humans; Male; Medical Marijuana; Middle Aged; Ontario; Patient Health Questionnaire
PubMed: 34520280
DOI: 10.1177/07067437211043393 -
Psychotherapy and Psychosomatics 2021Depressive and anxiety disorders are frequently associated. Depression may be a complication of anxiety and anxiety can complicate depression. The nature of their... (Review)
Review
Depressive and anxiety disorders are frequently associated. Depression may be a complication of anxiety and anxiety can complicate depression. The nature of their relationship has been a source of controversy. Reviews generally base their conclusions on randomized controlled trials and meta-analyses that refer to the average patient and often clash with the variety of clinical presentations that may occur when anxiety and depression coexist. The aim of this review was to examine the literature according to profiling of subgroups of patients based on clinimetric criteria, in line with the recently developed concept of medicine-based evidence. We critically reviewed the literature pertaining to the specific presentations of anxiety and depression, outlining the advantages and disadvantages of each treatment approach. The following prototypic cases were presented: depression secondary to an active anxiety disorder, depression in patients with anxiety disorders under treatment, anxious depression, anxiety as a residual component of depression, and demoralization secondary to anxiety disorder. We argue that the selection of treatment when anxiety and depression coexist should take into account the modalities of presentation and be filtered by clinical judgment. Very different indications may ensue when the literature is examined according to this perspective.
Topics: Anxiety; Anxiety Disorders; Cognitive Behavioral Therapy; Depression; Diagnosis, Differential; Humans
PubMed: 34344013
DOI: 10.1159/000517518