The current study sought to examine whether lifetime PTSD symptom severity is associated with a bias toward sampling extreme negative events from memory when making decisions involving uncertainty. To this end, 40 trauma-exposed warzone veterans performed a decision task in which information about outcomes was learned through experience and making choices required sampling memories of past experiences. On each trial, participants made choices between certain and uncertain gains and between certain and uncertain losses. Uncertain outcomes were equally likely to yield a relatively positive or relatively negative outcome. After accounting for overall willingness to take risks, lifetime PTSD symptom severity was associated with less frequent choice of the uncertain option for gains and for losses, a pattern consistent with a memory sampling bias for all negative experiences rather than only extreme negative experiences. The overweighting of negative experiences as a function of lifetime PTSD symptom severity, however, was not observed in a subsequent explicit memory task in which participants estimated the frequency with which different outcomes had occurred during the decision task. These findings suggest that the memory mechanism responsible for the PTSD-associated memory bias in decision making is distinct from that mediating explicit memory performance.

Although intolerance of uncertainty (IU) is associated with negative outcomes, studies focusing on older adults are still emerging. Specifically, the relationship between IU and psychological health in this population remains unclear. Moreover, no review has focused on understanding the unique contributions of IU and aging to anxiety and mental health in older adults. This scoping review and meta-analysis addressed this gap and provided a comprehensive understanding of the relationship between IU, aging, and mental health. Among 45 studies reviewed, 37 were included in the meta-analysis using mixed effect analysis to examine the relationship between IU and age across adulthood. The remaining eight studies, along with seven selected from the meta-analysis, were included in the scoping review to evaluate the relationship between IU, anxiety, and mental health. Among these, 12 studies focused on late adulthood, two on overall adulthood, and one included both late and overall adulthood. Results of the meta-analysis revealed an overall significant age difference in IU throughout adulthood. Moreover, results of the scoping review indicated a direct correlation between IU and anxiety, and other psychological issues in elderly. These findings provide insights for future research and interventions aimed at reducing IU and improving mental health among older adults.

Mindfulness- and acceptance-based programmes (MABPs) in the treatment of obsessive-compulsive disorder (OCD) are increasingly gaining research interest, yet a comprehensive systematic review and meta-analysis is missing. To fill this gap, we analysed 46 trials involving 2221 patients. Two independent reviewers screened records, extracted data, assessed risk of bias, and rated overall quality of evidence. MABPs were associated with large reductions in OCD-severity in between-group analysis in randomised controlled trials (k = 33; g =-.87; CI=-1.13,-.60) and within-group pre-post analysis in all MABPs (k = 49; g =-1.72; CI=-2.00,-1.44). Depressive symptoms decreased between- and within-group with a small to moderate effect, with maintained reductions at follow-up for both OCD and depression. Moderate to large pre-post improvements were also observed in anxiety, obsessive beliefs, and quality of life. MABPs did not differ from cognitive behavioural therapy and exposure and response prevention (k = 9; g=.02; CI=-.23,.26) but were superior to medication (k = 5; g =-.77; CI=-1.44,-.11) and waitlist (k = 16; g =-1.66; CI=-2.1,-1.24). Symptom reductions were observed across world regions, but to varying degrees. When combined, increases in mindfulness and psychological flexibility predicted reductions in OCD symptoms. Outcomes were not moderated by treatment duration, samples', and therapists' characteristics. MABPs can reduce OCD-severity, but further high-quality trials with long-term follow-ups are needed to confirm results.

Emerging evidence suggests that certain individuals are unable to address others by name, presumably owing to anxiety experienced in social situations. This fear of using personal names has been termed alexinomia and occurs in all forms of relationships and communication. The symptoms of alexinomia show large overlap with the symptoms typically associated with social anxiety, raising the question of whether social anxiety could be the main driving factor of this type of name avoidance. Here, we investigated the relationship between alexinomia and social anxiety by testing name avoidance behavior in a sample of 190 participants with varying degrees of social anxiety. Results showed a strong positive relationship between these two variables. High levels of social anxiety, as measured by two independent standardized psychological instruments (i.e., the Social Interaction Anxiety Scale and the Liebowitz Social Anxiety Scale), were associated with higher degrees of fear-based name avoidance. This was shown by regression analysis as well as analyses of group differences. The findings indicate that alexinomia could be a common symptom in socially anxious individuals that so far has not been discussed in the psychological literature on social anxiety.

There is evidence that exposure and response prevention (ERP) is efficacious in the treatment of obsessive-compulsive disorder (OCD). As an alternative to ERP metacognitive therapy (MCT) was developed. Two previous randomized controlled trials (RCTs) did not find significant differences between MCT and ERP. However, from non-significant results, non-inferiority of a treatment cannot be concluded. For this purpose, non-inferiority studies are required. Exner and colleagues carried out such a non-inferiority study whose results were recently published in this journal. The authors concluded from their results that MCT is a viable alternative treatment with efficacy similar to the standard ERP. However, this study raises several concerns, among them problems of transparency and of non-inferiority testing. These issues are critically discussed here in more detail. Taking all of these issues into account, the conclusions that can be drawn from the available studies are less clear. Further research is needed to decide whether MCT can really be considered as non-inferior to ERP or even as efficacious at all. Future studies need to fulfill the criteria of non-inferiority trials, that is (a) a priori define and (b) empirically justify a non-inferiority margin, (c) a preregistered sample size calculation ensuring a sufficient statistical power to confirm non-inferiority of the test treatment and (d) include a non-active control condition against which the standard and the test treatment are tested. Recommending a treatment prematurely as non-inferior to a standard treatment may prevent patients from receiving the most efficacious treatment.

Past work relates intelligence quotient (IQ) to risk for Post-Traumatic Stress Disorder (PTSD) among soldiers. We gathered data over multiple deployments to assess how IQ relates to the rate of symptom development both directly and through increasing the risk for traumatic combat exposure. Male infantry soldiers from a maneuver brigade (N = 582) were followed over the 3-year period of their mandatory military service. Data were collected at 3-time-points: 1) shortly after enlistment and before deployment; 2) about 15 months into the service following one deployment, and another year later following additional deployments. IQ was measured before recruitment into the military; PTSD symptoms and combat exposure were measured at each time-point. Lower general IQ, and in particular lower abstract reasoning capabilities, related to steeper increases in PTSD symptoms, TIME×IQ= -.05, SE= .02, t(442.79) = -3.255, p < .01, controlling for the effect of pre-military traumatic experience. This relation was partly mediated by combat exposure, Effect= -.04, BootSE= .01, 95 % CI [-.06, -.02]. The results identify important risk factors for PTSD that can inform approaches to PTSD mitigation in the military and other organizations. Given that this study enrolled a male sample the generalizability of the results awaits further research.

This paper reports on the outcomes of a proof-of-principle study for the Exposure Therapy Consortium, a global network of researchers and clinicians who work to improve the effectiveness and uptake of exposure therapy. The study aimed to test the feasibility of the consortium's big-team science approach and test the hypothesis that adding post-exposure processing focused on enhancing threat reappraisal would enhance the efficacy of a one-session large-group interoceptive exposure therapy protocol for reducing anxiety sensitivity. The study involved a multi-site cluster-randomized controlled trial comparing exposure with post-processing (ENHANCED), exposure without post-processing (STANDARD), and a stress management intervention (CONTROL) in students with elevated anxiety sensitivity. Feasibility was assessed using site performance metrics (e.g., timeline, sample size, missing data). Efficacy was assessed up to 1-month follow-up using the Anxiety Sensitivity Index-3. Despite challenges posed by unforeseen global crises, a standardized protocol for screening, assessment, and treatment at 12 research sites across four continents was successfully implemented, resulting in a total sample size of 400 with minimal missing data. Challenges in recruitment and adherence to the projected timelines were encountered. Significant reductions in anxiety sensitivity were observed in all conditions. Contrary to hypotheses, group differences were only observed at post-treatment, when ENHANCED and CONTROL outperformed STANDARD but were not significantly different from each other. This study demonstrates the feasibility of the Exposure Therapy Consortium. Findings raise questions regarding the efficacy of large group exposure interventions and underscore the importance of careful research site selection and an iterative approach to treatment development.

Climate anxiety is a phenomenon that is gaining importance due to the general public's increased awareness of the worsening climate crisis. At present, climate anxiety is not operationalized consistently across the existing literature. It is important to gain more consensus on the definition and operationalization of climate anxiety to facilitate reliable and generalizable research and to further develop interventions. Content analysis can contribute to this by providing insight into the overlap in the content of climate anxiety measures. With a systematic search, this study identified and analyzed 12 distinct scales measuring climate anxiety. The 119 items covered a total of 57 disparate symptoms. Jaccard indices showed that the mean overlap between symptoms of different climate anxiety scales was generally very low, as was the overlap between pairwise comparisons of climate anxiety scales. These results highlight the lack of uniformity in assessing climate anxiety and the need to properly define and operationalize this concept. The potential reasons for low overlap and how this might impact the reliability and validity of existing measures are discussed. It is critical that future work aims at finding consensus on the definition of climate anxiety (e.g., through a Delphi study) and psychometrically comparing the different questionnaires.