State-Trait Anxiety Inventory (STAI) for detecting anxiety disorders in adults.

Cognitive behavioural therapy (CBT) is the most researched psychological therapy for anxiety disorders in adults, and known to be effective in this population. However, it remains unclear whether these results apply to older adults, as most studies include participants between 18 and 55 years of age. This systematic review aims to provide a comprehensive and up-to-date synthesis of the available evidence on CBT and third wave approaches for older adults with anxiety and related disorders. To assess the effects of Cognitive Behavioural Therapy (CT, BT, CBT and third-wave CBT interventions) on severity of anxiety symptoms compared with minimal management (not providing therapy) for anxiety and related disorders in older adults, aged 55 years or over. To assess the effects of CBT and related therapies on severity of anxiety symptoms compared with other psychological therapies for anxiety and related disorders in older adults, aged 55 years or over. We searched the Cochrane Common Mental Disorders Controlled studies Register (CCMDCTR), CENTRAL, Ovid MEDLINE, Ovid Embase and Ovid PsycINFO to 21 July 2022. These searches were updated on 2 February 2024. We also searched the international studies registries, including Clinicalstudies.gov and the WHO International Clinical Trials Registry Platform (ICTRP), to identify additional ongoing and unpublished studies. These sources were manually searched for studies up to 12 February 2024. We included randomised controlled trials (RCTs) in older adults (≥ 55 years) with an anxiety disorder, or a related disorder, including obsessive compulsive disorder (OCD), acute stress disorder and post-traumatic stress disorder (PTSD), that compared CBT to either minimal management or an active (non-CBT) psychological therapy. Eligible studies had to have an anxiety-related outcome. Several authors independently screened all titles identified by the searches. All full texts were screened for eligibility according to our prespecified selection criteria. Data were extracted and the risk of bias was assessed using the Cochrane tool for RCTs. The certainty of evidence was evaluated using GRADE. Meta-analyses were performed for outcomes with quantitative data from more than one study. We included 21 RCTs on 1234 older people allocated to either CBT or control conditions. Ten studies focused on generalised anxiety disorder; others mostly included a mix of clinical diagnoses. Nineteen studies focused on the comparison between CBT and minimal management. Key issues relating to risk of bias were lack of blinding of participants and personnel, and participants dropping out of studies, potentially due to treatment preference and allocation. CBT may result in a small-to-moderate reduction of anxiety post-treatment (SMD -0.51, 95% CI -0.66 to -0.36, low-certainty evidence). However, compared to this benefit with CBT immediately after treatment, at three to six months post-treatment, there was little to no difference between CBT and minimal management (SMD -0.29, 95% CI -0.59 to 0.01, low-certainty evidence). CBT may have little or no effect on clinical recovery/ improvement post-treatment compared to minimal management, but the evidence is very uncertain (RR 1.56, 95% CI 1.20 to 2.03, very low-certainty evidence). Results indicate that five people would need to receive treatment for one additional person to benefit (NNTB = 5). Compared to minimal management, CBT may result in a reduction of comorbid depression symptoms post-treatment (SMD -0.57, 95% CI -0.74 to -0.40, low-certainty evidence). There was no difference in dropout rates post-treatment, although the certainty of the evidence was low (RR 1.19, 95% CI 0.80 to 1.78). Two studies reported adverse events, both of which related to medication in the control groups (very low-certainty evidence, no quantitative estimate). Only two studies compared CBT to other psychological therapies, both of which only included participants with post-traumatic stress disorder. Low-certainty evidence showed no difference in anxiety severity post-treatment and at four to six months post-treatment, symptoms of depression post-treatment, and dropout rates post-treatment. Other outcomes and time points are reported in the results section of the manuscript. CBT may be more effective than minimal management in reducing anxiety and symptoms of worry and depression post-treatment in older adults with anxiety disorders. The evidence is less certain longer-term and for other outcomes including clinical recovery/improvement. There is not enough evidence to determine whether CBT is more effective than alternative psychological therapies for anxiety in older adults.

IntroductionAdults with intellectual and developmental disabilities (IDD) have higher rates of psychiatric disorders, such as depression, anxiety, and bipolar disorder, compared to the general population. Unique challenges, like cognitive impairments and communication barriers, require tailored treatments. This poster reviews strategies for managing these conditions in adults with IDD, focusing on adaptations in psychopharmacology and psychotherapy.ObjectivesTo outline treatment approaches for depression, anxiety, and bipolar disorder in adults with IDD, highlight limitations and necessary adaptations, and advocate for collaborative treatment models involving healthcare providers and caregivers.MethodsA literature review identified studies and guidelines on psychopharmacologic and psychotherapeutic interventions tailored to adults with IDD, examining the effectiveness of pharmacological agents, cognitive behavioral therapy (CBT), and other adaptations.ResultsCurrent treatments for depression, anxiety, and bipolar disorder in adults with intellectual and developmental disabilities (IDD) often deviate from standard protocols, requiring modifications in both pharmacological and therapeutic approaches. Depression management in IDD typically relies on selective serotonin reuptake inhibitors (SSRIs), adapted with gradual dose escalation and close monitoring due to limited data on their specific effects in this population. Psychotherapy, particularly group cognitive behavioral therapy (CBT), has shown notable efficacy, with studies reporting significant symptom reduction in treated groups. For anxiety disorders, low-dose SSRIs remain the primary pharmacological option, with cautious titration to minimize adverse effects, while benzodiazepines are generally avoided to prevent paradoxical responses and disinhibition. CBT-based interventions, including graduated exposure therapy customized for specific phobias or triggers, show promise, though further randomized trials are warranted. Managing bipolar disorder in IDD is particularly challenging due to the heightened risk of severe functional impairment and symptom overlap, with mood stabilizers like lithium and antipsychotics administered sparingly given potential metabolic and neurological side effects. Given limited research, clinical strategies often rely on individualized treatment plans informed by provider expertise and patient-specific needs.ConclusionsTreatment for psychiatric disorders in adults with IDD requires significant adaptation, with careful dosing and monitoring of medications to minimize adverse effects. Evidence supports CBT as an effective option, yet there is a critical need for more research, especially randomized trials, to develop more robust guidelines specific to this population. Close collaboration between healthcare providers and caregivers is essential for successful outcomes.Disclosure of InterestNone Declared

ImportanceAnxiety disorders are commonly occurring mental health conditions. They are often unrecognized in primary care settings and substantial delays in treatment initiation occur.ObjectiveThe US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for anxiety disorders in asymptomatic adults.PopulationAsymptomatic adults 19 years or older, including pregnant and postpartum persons. Older adults are defined as those 65 years or older.Evidence AssessmentThe USPSTF concludes with moderate certainty that screening for anxiety disorders in adults, including pregnant and postpartum persons, has a moderate net benefit. The USPSTF concludes that the evidence is insufficient on screening for anxiety disorders in older adults.RecommendationThe USPSTF recommends screening for anxiety disorders in adults, including pregnant and postpartum persons. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety disorders in older adults. (I statement)

To evaluate the effect of atomoxetine (ATX) on attention-deficit/hyperactivity disorder (ADHD) and comorbid social anxiety disorder in adults. Randomized, double-blind, placebo-controlled, conducted in adults with ADHD and social anxiety disorder. Patients received 40-100 mg ATX (n=224) or placebo (n=218) for 14 weeks following a 2-week placebo lead-in period. Efficacy measures included the Conners' Adult ADHD Rating Scale: Investigator-Rated: Screening Version (CAARS:Inv:SV), Liebowitz Social Anxiety Scale (LSAS), Clinical Global Impression-Overall-Severity (CGI-O-S), State-Trait Anxiety Inventory (STAI), Social Adjustment Scale-Self Report (SAS), and Adult ADHD Quality of Life Scale-29 (AAQoL). Safety and tolerability were also assessed. ATX mean change (-8.7+/-10.0) from baseline (29.6+/-10.4) on CAARS:Inv:SV Total ADHD Symptoms score was significantly greater than placebo mean change (-5.6+/-10.2) from baseline (31.2+/-9.4; P<.001). ATX mean change (-22.9+/-25.3) from baseline (85.3+/-23.6) on LSAS Total score was significant compared to placebo mean change (-14.4+/-20.3) from baseline (82.1+/-21.3; P<.001). The visit-wise analysis revealed greater improvement on the CAARS:Inv:SV Total ADHD Symptoms score and LSAS Total score for ATX at every time point throughout the study (P values </=.012). Mean changes in CGI-O-S, STAI-Trait Anxiety scores, and AAQoL Total score were significantly greater for ATX compared to placebo. Mean change for both groups on STAI-State Anxiety scores was comparable. Improvement on SAS for ATX compared to placebo was not significant. Rates of insomnia, nausea, dry mouth, and dizziness were higher with ATX than with placebo. Discontinuation rates due to treatment-emergent adverse events were similar between groups. ATX monotherapy effectively improved symptoms of ADHD and comorbid social anxiety disorder in adults and was well tolerated.

It is well established that objective early life stressors increase risk for anxiety disorders and that environmental stressors interact with dispositional factors such as trait anxiety. There is less information on how subjective perception of stress during childhood relates to later clinical anxiety. This study tested whether childhood perceived stress and trait anxiety were independently and interactively associated with adult anxiety disorders. Forty-seven adults diagnosed with anxiety disorders (M age = 34 yr., SD = 11) and 29 healthy participants (M = 33 yr., SD = 13) completed the adult Perceived Stress Scale, the State-Trait Anxiety Inventory, and the Global Perceived Early Life Events Scale as a measure of perceived stress during childhood. In a logistic regression model, high childhood perceived stress (β = 0.64) and trait anxiety (β = 0.11) were associated with significantly greater odds of adult anxiety disorder. The association between childhood perceived stress and adult anxiety remained significant when controlling for adult perceived stress. These findings suggest that children's perception of stress in their daily lives may be an important target of intervention to prevent the progression of stress into clinically significant anxiety.

BackgroundCognitive behavioural therapy (CBT) is the most widely recognised and efficacious psychological therapy for the treatment of anxiety disorders in children and adults. However, suboptimal remission rates indicate room for improvement in treatments, particularly when both children and their parents have anxiety disorders. Bidirectional transmission and maintenance of anxiety within parent–child dyads could be better targeted by CBT, to improve treatment outcomes for children and parents with anxiety disorders. This study aimed to develop and evaluate the feasibility and acceptability of a concurrent parent–child enhanced CBT intervention that targets the individual’s anxiety disorder(s), as well as the bidirectional factors that influence and maintain anxiety in the dyad.MethodsFeasibility and acceptability of the proposed CBT protocol will be evaluated in an open-label pilot trial of the intervention utilising qualitative and quantitative data collection. Ten parent–child dyad participants (n = 20) with anxiety disorders will be recruited for the proposed intervention. The intervention is based on an empirically supported 10-week CBT programme for anxiety disorders in adults, adapted to be delivered to parent–child dyads concurrently, and to target anxious modelling and overprotective behaviours through joint observational exposures. Intervention feasibility will be explored by pre-post symptom change on a range of clinician- and self-report measures to determine preliminary indications of participants’ intervention response and effect size calculations to estimate sample size for a future definitive randomised controlled trial (RCT). Additional feasibility measures will include recruitment rates, completion rates, and adherence to programme requirements. To explore participant acceptability of the intervention, qualitative interviews will be conducted with five parent–child dyads who complete the intervention (n = 10), along with five parent–child dyads with anxiety symptoms who express interest in the intervention (n = 10). Acceptability measures will include prospective and retrospective quantitative self-report and qualitative interview data.DiscussionThis pilot trial will utilise a mixed-methods design to determine the feasibility and acceptability of delivering an enhanced CBT intervention for the concurrent treatment of parent–child dyads with anxiety disorders. The results of this trial will inform the development and implementation of a future definitive randomised clinical trial to evaluate intervention efficacy.Trial registrationAustralian and New Zealand Clinical Trials Registry, ANZCTR1261900033410. Prospectively registered: pre-results. Registered 04 March 2019.

Adverse child environments are associated with the onset of mood and anxiety disorders in adulthood. The mechanisms underlying these life-course associations remain poorly understood. We investigate whether emotional reactivity to stress is a mechanism in the association between childhood environment characteristics and adult mood and anxiety disorders. Data are from the Study of Adult Development, a longitudinal study of men (N = 268) followed for nearly seven decades beginning in late adolescence. Childhood social environment characteristics were assessed during home visits and interviews with respondents' parents at entry into the study. Stress reactivity was assessed during respondents' sophomore year of college via physician exam. Onset of mood and anxiety disorders in adulthood was ascertained by research psychiatrists who completed chart reviews of interview, questionnaire, and physical exam data collected during repeated assessments from age 20 to 70. Respondents with better overall childhood environments and a greater number of environmental strengths were at lower odds of developing a mood or anxiety disorder in adulthood than respondents with more adverse childhood environments. Higher stress reactivity was observed among respondents from families with lower socio-economic status and with childhood environments characterized by greater conflict and adversity. Elevated stress reactivity, in turn, predicted the onset of adult mood and anxiety disorders. Heightened emotional reactivity in early adulthood is associated with both adverse childhood environments and elevated risk for developing mood and anxiety disorders in adulthood. Emotional reactivity may be one mechanism linking childhood adversity to mood and anxiety disorders in adulthood.

Caffeine-related genes influence anxiety disorders in children and adults with ADHD

The prevalence of anxiety in older adults: Methodological issues and a review of the literature

IntroductionThe older adults have been considered one of the groups at highest risk of SARS-CoV-2 infection and death due to COVID-19. Fear of SARS-CoV-2 infections has become widespread. It’s constantly being enhanced by the media reports and social distancing principle.ObjectivesThe aim of the study was to assessment the occurrence of symptoms of fear of COVID-19 among participants of the Polish University of the Third Age (UTA).MethodsThe study included 296 participants of the UTA in Poland, including 258 women and 38 men. The study conducted with the use of the following validated psychometric scales: General Anxiety Disorder-7 (GAD-7), Short Health Anxiety Inventory (SHAI) and State-Trait Anxiety Inventory (STAI).ResultsThe mean scores in STAI and SHAI demonstrated mild symptoms indicative of anxiety disorders in the older adults. Women and men did differ significantly in terms of the scores obtained in STAI(X-1) (p=0.002) and STAI(X-2) (p=0.020). There were no statistically significant differences between respondents with higher education and those with a different level of education. The single respondents differed significantly from divorced ones in terms of STAI(X-1) (p=0.046). Moreover, widows/widowers differed significantly from divorced ones in terms of STAI(X-2) (p=0.045) and GAD-7 (p=0.032).ConclusionsThe subjective experience of anxiety symptoms associated with fear of contracting COVID-19 was increased due to the ongoing pandemic, but was not significantly high in the analysed population of older people. COVID-19-related anxiety was significantly more common in lonely individuals. Women and men differed significantly in terms of perceived state anxiety and trait anxiety measured by STAI.DisclosureNo significant relationships.

A Virtually Delivered Adapted Cognitive-Behavioral Therapy Group for Adults With Williams Syndrome and Anxiety

Current treatments of the anxiety disorders in adults

Generalized anxiety disorder (GAD) is under-treated yet prevalent among young adults. Identifying early risk factors for GAD would contribute to its etiological model and identify potential targets for intervention. Insecure attachment patterns, specifically ambivalent and disorganized, have long been proposed as childhood risk factors for GAD. Similarly, childhood behavioral inhibition has been consistently associated with anxiety disorders in adulthood, including GAD. Intolerance of uncertainty (IU), the tendency to react negatively to uncertain situations, has also been shown to be a crucial component of GAD. Furthermore, maternal anxiety is an important feature of developmental models of anxiety including GAD. Yet, to date, no study has examined, within a comprehensive model, how attachment and behavioral inhibition in childhood, maternal anxiety in adolescence, and IU in emerging adulthood contribute to GAD in adulthood. The present study thus examines these links using a longitudinal design with 62 Canadian participants and their mothers. At age 6, participants' attachment and behavioral inhibition were assessed observationally. Maternal anxiety was measured when participants were 14 years of age. IU and GAD were assessed when participants were 21 and 23 years of age, respectively. Structural equation modeling showed that IU mediates the relationships between behavioral inhibition and GAD, while controlling for maternal anxiety. Ambivalent and disorganized-controlling attachment patterns are also indirectly associated with increased GAD symptoms via greater IU scores. Furthermore, a direct and positive effect of behaviorally disorganized attachment was found on GAD symptoms. This longitudinal study supports integrating attachment, behavioral inhibition, and IU in a model of GAD.

The prevalence of anxiety disorders, and mental chronic diseases, has increased over the last decade among adolescents. Since aerobic exercise reduces the risk of chronic diseases and stress symptoms, we aimed to examine the association between aerobic exercise in adolescence and anxiety disorders in adulthood. Self-reported, publicly available data from 5,114 adolescents who participated in Waves I and IV of the National Longitudinal Study of Adolescent Health (Add Health) was analyzed from 1994-2009. We included US-based individuals aged 16 years on average and observed them for 15 years. Weighted Poisson regression models estimated the association between aerobic exercise in Wave I (1994, baseline) and anxiety disorders in Wave IV (2009, adulthood), adjusting for sociodemographic characteristics and substance use at baseline. Overall, 639/5,114 (weighted 12.96%) individuals experienced anxiety disorders at baseline. Age and sex differed significantly across all exercise groups (p's<0.001). Aerobic exercise did not significantly protect against anxiety disorders in adulthood: compared to adolescents who did not exercise at all, those who exercised 1-2 times/week had 0.85 times the prevalence of anxiety disorders during adulthood (95% CI = 0.65, 1.12; p = 0.25). Those who exercised 3-4 times/week had 0.81 times the prevalence (95% CI = 0.61, 1.08, p = 0.15) and those who exercised 5+ times/week had 0.84 times the prevalence (95% CI = 0.63, 1.13, p = 0.25) than those who did not exercise at all. Aerobic Exercise in adolescence did not protect against anxiety disorders in adulthood. More evidence is needed on this association, including using homogeneous measures of exercise and repeated measures methods.

AimsIn recent years there has been accelerated clinical interest in Mindfulness based interventions (MBI's) leading to an upswell in research due the impact of its wide clinical application. Mindfulness Based Cognitive Therapy (MBCT) and Acceptance and Commitment Therapy (ACT) have recently been investigated for the beneficial treatment of anxiety-based disorders in adults. The aim of the current review was to appraise and synthesise findings of studies published within the last decade, in determining the efficacy of MBCT and ACT in treating anxiety disorders in adults, given gaps identified in the existing literature.MethodsScoping searches were conducted using MEDLINE, PsycINFO, Emcare, and Cochrane databases. The Synthesis Without Meta-analysis protocol (SWiM) was adopted for this review, in evaluating the efficacy of MBCT and ACT for anxiety disorders in adults. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Standards.ResultsThe results of this review suggest that MBCT and ACT are effective therapeutic modalities in improving anxiety in adult populations. The results are, however, tentative. Whilst both MBI's show promise in the treatment of anxiety disorders, with the paucity of existing systematic reviews and methodological flaws within overall primary study design, the results should be interpreted with caution.ConclusionThe overall therapeutic effectiveness of MBI's has been assessed and the general data support its efficacy. However, a judicious approach is required as results continue to remain inconclusive grounded in the totality of the evidence.The current review revealed the ongoing methodological concerns encountered in determining the comparative effectiveness of MBCT and ACT for anxiety disorders in adults. Due to the current limited number of comparative studies of mindfulness based with mindfulness informed interventions, it could be suggested that a lack of systematic research is slowly influencing a collective understanding of MBI's being a homogenous group of treatments. The lack of delineation can have an impact on research, clinical practice and policy making. Further high quality research is required to continue to bridge the science practice gap. Without depth of understandings associated with the mechanisms of change and the impact that contextual aspects have on the outcome effectiveness, there are significant implications for practice and patient care. It is of importance that the adaptation and subsequent developments in clinical practice do not outpace the research base to fully understand the mechanisms that make each MBI effective, for which population and diagnoses.