Anxiety Psychopathology Research Articles

Medical information seeking: Impact on risk for anxiety psychopathology

Background and objectivesIncreased utilization of online medical information seeking demands investigation of potentially detrimental effects of these activities. The present study investigated whether viewing medical websites may adversely affect anxiety sensitivity (AS), a well-established risk factor for the development of psychopathology. MethodsParticipants (N = 52) were randomly assigned to view medical symptom related websites or general health and wellness control websites. AS was measured before and after the website viewing. ResultsIndividuals in the medical website group reported higher AS compared to the control group at post-manipulation after controlling for baseline health anxiety and baseline AS. Additionally, intolerance of uncertainty (IU), an individual difference variable assessing negative beliefs about uncertainty, significantly moderated this effect such that medical website viewing only affected AS in participants with high IU but not in participants with low IU. LimitationsThe limitations of the current study include the lack of individualization of the website viewing and the short duration of the website viewing. ConclusionsThe results of this study provide initial evidence that exposure to online medical information could increase risk for anxiety psychopathology in individuals with elevated IU. Additionally, these results provide support for a learning based model of the etiology of AS.

Comparing paths to quality of life: Contributions of ACT and cognitive therapy intervention targets in two highly anxious samples

Anxiety disorders are associated with numerous costs and poor quality of life (QOL), and yet are highly treatable. The present study evaluated the relations between putative change processes, anxiety symptom severity, and QOL by employing path analysis to compare two theoretically-derived models of anxious psychopathology in an examination of pre-intervention data from two self-help effectiveness studies. Consistent with expectation, symptom severity predicted QOL in a model derived from cognitive therapy principles, though the model did not provide a good fit to the data. A model derived from Acceptance and Commitment Therapy principles suggested that the impact of experiential avoidance (EA) on QOL was independent of symptom severity and provided a better fit to the data. In fact, the path from anxious symptomatology to QOL became non-significant when EA was allowed to relate to QOL directly. Cognitive fusion strongly predicted anxiety sensitivity which, in turn, significantly predicted symptoms. Theoretical and practical implications of the findings are discussed in the context of improving available treatments for anxiety-related disorders.

Anorexia nervosa and its relation to depression, anxiety, alexithymia and emotional processing deficits

Psychopathological changes and dysfunction in emotion processing have been described for anorexia nervosa (AN). Yet, findings are applicable to adult patients only. Furthermore, potential for discriminative power in clinical practice in relation to clinical parameters has to be discussed. The aim of this study was to investigate psychopathology and emotional face processing in adolescent female patients with AN. In a sample of 15 adolescent female patients with AN (16.2 years, SD ± 1.26) and 15 age and sex matched controls we assessed alexithymia, depression, anxiety and empathy in addition to emotion labelling and social information processing. AN patients had significantly higher alexithymia, higher levels of depression, and state and trait anxiety compared to controls. There was a trend for a lower ability to recognize disgust. Happiness as a positive emotion was recognized better. All facial expressions were recognized significantly faster by AN patients. Associations of pathological eating behaviour and trait anxiety were seen. In accordance with the stress reduction hypothesis, typical psychopathology of alexithymia, anxiety and depression is prevalent in female adolescent AN patients. It is present detached from physical stability. Pathogenesis of AN is multifactorial and already fully present in adolescence. An additional reinforcement process can be discussed. For clinical practice, those parameters might have a better potential for early prognostic factors related to AN than physical parameters and possible implication for intervention is given.

Depressive and Anxiety Symptoms in the Outcome of Eating Disorders: 8-Year Follow-Up

Introduction: Eating Disorders (EDs) are severe and treatment-resistant conditions whose psychopharmacological treatments are still limited. Anxiety and depressive symptoms and specific personality traits play a key role in ED outcome. This 8-year follow-up study on a sample of ED patients treated with a multimodal model aims to produce a better insight in the intertwined aspects of anxiety, depression, and eating psychopathology. Methods: n=107 female individuals with EDs were assessed face-to-face 8 years after discharge from the outpatient facility of the Center for EDs using: Temperament and Character Inventory, Eating Disorder Inventory-2, Symptom Checklist 90, and Beck Depression Inventory-II. All outpatients underwent a multimodal treatment. Recovered and non-recovered subgroups were compared with ANCOVA. Multivariate regression analyses were performed between changes in personality, anxiety, and depression with those in eating symptoms and psychopathology. Results: Both ED samples were found to be improved in depression and anxiety along with ED symptoms and eating psychopathology at follow-up. Also the non-recovered individuals showed a significant improvement of anxiety and depression scores along with eating symptoms and psychopathology and personality. The relationship between changes in personality traits and eating psychopathology was stronger than the one we found between personality and anxiety and depression. Conclusion: The multimodal treatment may be effective to significantly improve mood and anxiety features of ED patients jointly with those in eating symptoms and psychopathology, and related personality traits. Even though the changes in personality may be relevant in order to stabilize eating symptoms, such changes do not significantly correlate with those of anxiety and depression in AN or BN subgroups. Moreover, the course of eating psychopathology is rather independent from that of anxiety and depression over the long-run. The relationship between psychopathology of anxiety and depression with eating symptoms and treatment resistance deserves further exploration to help clinicians in treatment planning.

Threat processing in generalized social phobia: An investigation of interpretation biases in ambiguous facial affect

Facial affect is one of the most important information sources during the course of social interactions, but it is susceptible to distortion due to the complex and dynamic nature. Socially anxious individuals have been shown to exhibit alterations in the processing of social information, such as an attentional and interpretative bias toward threatening information. This may be one of the key factors contributing to the development and maintenance of anxious psychopathology. The aim of the current study was to investigate whether a threat-related interpretation bias is evident for ambiguous facial stimuli in a population of individuals with a generalized Social Anxiety Disorder (gSAD) as compared to healthy controls. Participants judged ambiguous happy/fearful, angry/fearful and angry/happy blends varying in intensity and rated the predominant affective expression. The results obtained in this study do not indicate that gSAD is associated with a biased interpretation of ambiguous facial affect.

The neurosteroids allopregnanolone and dehydroepiandrosterone modulate resting-state amygdala connectivity

The neurosteroids allopregnanolone and dehydroepiandrosterone (DHEA) are integral components of the stress response and exert positive modulatory effects on emotion in both human and animal studies. Although these antidepressant and anxiolytic effects have been well established, to date, little research has examined their neural correlates, and no research has been conducted into the effects of neurosteroids on large-scale networks at rest. To investigate the neurosteroid impact on intrinsic connectivity networks, participants were administered 400 mg of pregnenolone (N = 16), 400 mg of DHEA (N = 14), or placebo (N = 15) and underwent 3T fMRI. Resting-state brain connectivity was measured using amygdala as a seed region. When compared with placebo, pregnenolone administration reduced connectivity between amygdala and dorsal medial prefrontal cortex, between amygdala and precuneus, and between amygdala and hippocampus. DHEA reduced connectivity between amygdala and periamygdala and between amygdala and insula. Reductions in amygdala to precuneus connectivity were associated with less self-reported negative affect. These results demonstrate that neurosteroids modulate amygdala functional connectivity during resting state and may be a target for pharmacological intervention. Additionally, allopregnanolone and DHEA may shift the balance between salience network and default network, a finding that could provide insight into the neurocircuitry of anxiety psychopathology.

Attentional bias and attentional control in Posttraumatic Stress Disorder

Extensive evidence exists for an association between attentional bias (AB; attentional vigilance or avoidance) and anxiety. Recent studies in healthy participants suggest that attentional control (AC) may facilitate inhibition of automatic attentional processes associated with anxiety.To investigate relationships among AC, trauma-related AB, symptom severity and trait anxiety in patients with Posttraumatic Stress Disorder (PTSD), participants (N=91) completed self-report measures of AC, posttraumatic stress symptoms (PTSS) and trait anxiety. AB was measured with a pictorial version of the Dot Probe Test.AC moderated the relationship between PTSS and AB (threat avoidance). Patients high in PTSS and low in AC showed attentional avoidance. No association between PTSS and AB in patients with medium or high levels of AC was found. A similar pattern of results was observed for the relationship between trait anxiety, AC and AB. These results suggest that a low ability to control attention is a risk factor for AB in PTSD. This first clinical study corroborates the accumulating evidence from analog studies that individual differences in top-down attentional control are of considerable importance in the expression of AB in anxious psychopathology.

Developmental Trajectories of Anxiety Symptoms in Early Adolescence: The Influence of Anxiety Sensitivity

Children and adolescents seem to suffer from anxiety disorders at rates similar to adults. Interestingly, anxiety symptoms appear to generally decline over time within children as evidenced by lower rates in early and middle adolescence. There is some evidence that there may be heterogeneous subpopulations of adolescent children with different trajectories of anxiety symptoms, including a class of adolescents with elevated levels of anxiety that do not dissipate over time. Anxiety sensitivity has been identified as an important risk factor in the development of anxiety psychopathology. This study prospectively examined the development of anxiety symptoms in a sample of 277 adolescents (M age = 11.52; 44% female, 56% male) over a 3year period including the influence of anxiety sensitivity on this development. Further, this study investigated whether there were distinct classes of adolescents based on their anxiety symptom trajectories and including anxiety sensitivity as a predictor. Consistent with other reports, findings indicated an overall decline in anxiety symptoms over time in the sample. However, three classes of adolescents were found with distinct anxiety symptom trajectories and anxiety sensitivity was an important predictor of class membership. Adolescents with elevated anxiety sensitivity scores were more likely to be classified as having high and increasing anxiety symptoms over time versus having moderate to low and decreasing anxiety symptoms over time. There are important implications for identification of adolescents and children who are at risk for the development of an anxiety disorder.

Anxiety sensitivity and impairment: Evidence for a direct association and partial mediation by subclinical anxiety symptoms

BackgroundMounting evidence suggests that specific psychological risk factors increase the likelihood for the development of anxiety psychopathology. Anxiety sensitivity (AS), the fear of the consequences of anxiety, is one such risk factor. However, very little is known about the consequences of having elevated AS prior to the development of diagnosable psychopathology. We hypothesized that elevated AS may create impairment among premorbid individuals. The aims of the present study were twofold. The first aim was to examine whether having elevated AS would be predictive of impairment in a nonclinical sample. The second aim was to examine whether subclinical anxiety symptoms would partially mediate the association between AS and impairment in daily life. MethodThese aims were examined in two studies utilizing samples of individuals with elevated levels of AS. Study 1 (N=387) and Study 2 (N=79) were comprised of participants with elevated AS. Participants completed a battery of questionnaires and a diagnostic interview to assess for risk status. Only participants without an anxiety disorder were eligible to participate in the study to ensure that they were in the premorbid stage. ResultsIn Study 1, there was a direct effect of AS on impairment. Additionally, there was evidence for anxiety symptoms acting as a partial mediator in the relation between AS and impairment. Study 2 revealed the same pattern of results, with AS having a significant direct effect on impairment that was partially mediated by anxiety symptoms. LimitationsThe samples utilized in the present sample were primarily Caucasian females, thereby potentially limiting the generalizability of these findings. ConclusionsThis study provides evidence that a premorbid risk factor is associated with impairment before the actual development of an anxiety disorder. Implications of the present investigation and future directions are discussed.

Evaluating the unique contribution of intolerance of uncertainty relative to other cognitive vulnerability factors in anxiety psychopathology

BackgroundIntolerance of uncertainty (IU) is a cognitive vulnerability factor associated with a wide range of anxiety psychopathology. Other cognitive vulnerabilities such as anxiety sensitivity (AS), distress tolerance (DT), and discomfort intolerance (DI) have also been investigated as constructs of interest across anxiety disorders. As researchers increasingly uncover viable transdiagnostic vulnerabilities to anxiety, it becomes important to determine the degree of overlap between these constructs. MethodsThe present studies examined the unique relationships between IU, other vulnerability factors (AS, DT, and DI) and social anxiety, obsessive-compulsive, and worry symptoms across two nonclinical samples (n=217, n=241). ResultsFindings were highly consistent across samples. IU was significantly associated with anxiety symptoms in all analyses, even when accounting for other transdiagnostic risk variables. Anxiety sensitivity, was uniquely related to social anxiety and obsessive-compulsive symptoms in all analyses, but was related to worry in only one study. Distress tolerance was only uniquely associated with worry. Discomfort intolerance was not uniquely related to the anxiety symptoms in any analyses. LimitationsFuture research should attempt to replicate the findings in a clinical population and utilize a longitudinal design. ConclusionsThe robust and incremental relationships between IU and anxiety symptoms suggests the potential benefit of targeting IU in the context of transdiagnostic anxiety treatments.

Motivational Enhancement Therapy Reduces Anxiety Sensitivity

Anxiety sensitivity (AS), the fear of the consequences of anxiety, is known to be a risk factor in the development and maintenance of anxiety psychopathology. In recent years, AS has been shown to be responsive to a variety of interventions aimed at reducing this malleable risk factor. Motivational interviewing (MI) and motivation enhancement treatment (MET) have been shown to be effective in enhancing the treatment of anxiety disorders. Thus, it was hypothesized that motivational interventions may also be effective in those with elevated AS. The aim of the present study was to examine whether the use of MI/MET would be effective in reducing AS. Participants (N = 80) with elevated AS were randomized into an MET or health-focused psychoeducation control group. Results revealed that the MET condition showed a significant reduction in AS in comparison to the control group. These findings are comparable to reductions in AS observed in other AS interventions. Further, changes in motivation mediated the association between experimental group and post-intervention AS. This study is the first to demonstrate the efficacy of MI/MET strategies in the reduction of AS. Implications of the findings and directions for future research are discussed.

Unintentional Role Models: Links Between Maternal Eating Psychopathology and the Modelling of Eating Behaviours

This study explored the relationships between maternal modelling of eating behaviours with reported symptoms of maternal eating psychopathology, anxiety and depression. Mothers (N = 264) with a child aged 1.5 to 8 years completed three self-report measures designed to assess modelling of eating behaviours, eating psychopathology and levels of anxiety and depression. The study found that higher levels of maternal eating psychopathology were positively associated with eating behaviours that were unintentionally modelled by mothers but that maternal eating psychopathology was not associated with more overt/intentional forms of parental modelling. In addition, higher levels of maternal depression were associated with lower levels of both unintentional and intentional forms of maternal modelling, whereas maternal anxiety was not found to correlate with modelling behaviours. This study highlights the possible detrimental influences of maternal mental health in relation to mothers providing their child with a positive parental role model around eating and feeding.

Allopregnanolone Elevations Following Pregnenolone Administration Are Associated with Enhanced Activation of Emotion Regulation Neurocircuits

The neurosteroid allopregnanolone is a potent allosteric modulator of the gamma-aminobutyric acid type A receptor with anxiolytic properties. Exogenous administration of allopregnanolone reduces anxiety, and allopregnanolone blockade impairs social and affective functioning. However, the neural mechanism whereby allopregnanolone improves mood and reduces anxiety is unknown. In particular, brain imaging has not been used to link neurosteroid effects to emotion regulation neurocircuitry. To investigate the brain basis of allopregnanolone's impact on emotion regulation, participants were administered 400 mg of pregnenolone (n=16) or placebo (n=15) and underwent 3T functional magnetic resonance imaging while performing the shifted-attention emotion appraisal task, which probes emotional processing and regulation. Compared with placebo, allopregnanolone was associated with reduced activity in the amygdala and insula across all conditions. During the appraisal condition, allopregnanolone increased activity in the dorsal medial prefrontal cortex and enhanced connectivity between the amygdala and dorsal medial prefrontal cortex, an effect that was associated with reduced self-reported anxiety. These results demonstrate that in response to emotional stimuli, allopregnanolone reduces activity in regions associated with generation of negative emotion. Furthermore, allopregnanolone may enhance activity in regions linked to regulatory processes. Aberrant activity in these regions has been linked to anxiety psychopathology. These results thus provide initial neuroimaging evidence that allopregnanolone may be a target for pharmacologic intervention in the treatment of anxiety disorders and suggest potential future directions for research into neurosteroid effects on emotion regulation neurocircuitry.

Evidence for a cerebral cortical thickness network anti-correlated with amygdalar volume in healthy youths: Implications for the neural substrates of emotion regulation

Recent functional connectivity studies have demonstrated that, in resting humans, activity in a dorsally-situated neocortical network is inversely associated with activity in the amygdalae. Similarly, in human neuroimaging studies, aspects of emotion regulation have been associated with increased activity in dorsolateral, dorsomedial, orbital and ventromedial prefrontal regions, as well as concomitant decreases in amygdalar activity. These findings indicate the presence of two countervailing systems in the human brain that are reciprocally related: a dorsally-situated cognitive control network, and a ventrally-situated limbic network. We investigated the extent to which this functional reciprocity between limbic and dorsal neocortical regions is recapitulated from a purely structural standpoint. Specifically, we hypothesized that amygdalar volume would be related to cerebral cortical thickness in cortical regions implicated in aspects of emotion regulation. In 297 typically developing youths (162 females, 135 males; 572 MRIs), the relationship between cortical thickness and amygdalar volume was characterized. Amygdalar volume was found to be inversely associated with thickness in bilateral dorsolateral and dorsomedial prefrontal, inferior parietal, as well as bilateral orbital and ventromedial prefrontal cortices. Our findings are in line with previous work demonstrating that a predominantly dorsally-centered neocortical network is reciprocally related to core limbic structures such as the amygdalae. Future research may benefit from investigating the extent to which such cortical-limbic morphometric relations are qualified by the presence of mood and anxiety psychopathology.

Psychiatric Diagnosis and Hypersexual Behavior Inventory, Sexual Addiction Screening Test, and Beck Depression Inventory/Beck Anxiety Inventory of the Sexual Offenders

The current study evaluated DSM-IV psychiatric diagnoses and investigated the psychological characteristics of sexual offenders by using the Hypersexual Behavior Inventory(HBI), Sexual Addiction Screening Test (SAST), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Fifty male sexual offenders and 36 male healthy controls completed the psychiatric diagnosis and 30 of the 50 male sexual offenders completed the psychological tests listed above. Thirty-two of the 50 sexual offenders were patients with paraphilias, these sexual offenders had been admitted by the Ministry of Justice to the Institute for Forensic Psychiatry in Gongjui-si due to sexual violence. Participants displayed high lifetime rates of psychiatric disorders: 32 (64%) had paraphilias, 16 (32%) had depressive disorders, 10 (20%) had anxiety disorders, 9 (18%) had impulse control disorders, 6 (12%) had schizophrenia, 2 (4%) had bipolar disorders, and 16 (32%) had personality disorders or some other Axis II disorder. Scores for the sexual offenders were significantly higher both on the HBI and the SAST than the comparison group. Scores for the sexual offenders were also higher for the BDI and the BAI as compared to the control group, but this difference was not statistically significant. Results indicate that sexual offenders may have sexual addictions and be hypersexual. In addition to depressive and anxious psychopathologies, they also seem to have sexual psychopathologies. These results suggested that the psychopathology of sexual offenders may be different than that of a control group.

1668 – Prevalance of PTSD, depression and anxiety symptoms among adolescents 6 months after van-erciş earthquake 2011

Introduction Earthquakes, one of the major natural disasters, tend to be unpredictable, uncontrollable, and highly destructive. They lead to strong initial trauma and significant long-term effects such as posttraumatic stress disorder, depression, anxiety, or other symptoms. Objectives In this research, posttraumatic stress, anxiety and depressive symptoms were studied among adolescents 6 months after Van-Ercis Earthquake 2011. Method In the present study a total of 738 Turkish high school students, aged 13-17 years, participated in the study in Van city affected severely by the earthquake. Participants completed a set of questionnaires including the demographic measures, posttraumatic stress reactions, depression, anxiety and dissociation. Results The results of the present study showed the presence of probable diagnosis of PTSD in 295 (40.69%), of anxiety in 384 (53.04%) and of depression in 245 (33.70%) of the adolescent examined. Multiple logistic and linear regression analyses were conducted to explore the predictive values of independent variables on development of posttraumatic, anxiety, depressive, and dissociative psychopathology among adolescents experienced Van earthquake. Conclusions Our results show high rates of PTSD, anxiety and depression symptoms in adolescents who survived the October 2011 Van-Ercis earthquake. Further, our results highlight the relevance of gender differences, previous psychopathology, trait anxiety, anxiety sensitivity in the response to mass trauma that should be taken into account when facing such events. Our results confirm the pervasive effects of a disaster and risk factors, such as an earthquake, for mental health in adolescents.

Understanding the associations among anxiety sensitivity, distress tolerance, and discomfort intolerance: A comparison of three models

Emerging work has identified several related constructs that appear to be relevant to anxiety psychopathology including anxiety sensitivity (AS), distress tolerance (DT) and discomfort intolerance (DI). AS refers to the fear of the consequences of anxiety-related sensations. DT measures tolerance of negative emotions, whereas DI measures tolerance of uncomfortable physical sensations. Questions, however, have been raised regarding the overlap among AS, DT, and DI. The present study conducted confirmatory factor analyses to test three models of emotional and physical tolerance to determine which model provided the best fit for the associations among AS, DT, and DI. Nonclinical individuals (N=411) and individuals with anxiety psychopathology (N=253) completed self-report questionnaires. Results supported a hierarchical factor structure with 2 higher order factors with AS as a lower order factor of DT. The implications of these findings for the conceptualization of the relationships among AS, DT, and DI are discussed.

Factor mixture model of anxiety sensitivity and anxiety psychopathology vulnerability

BackgroundThe purpose of the present study was to shed light on the latent structure and nature of individual differences in anxiety sensitivity (AS) and related risk for psychopathology. MethodsThe present study evaluated the latent structure of AS using factor mixture modeling (FMM; Lubke and Muthén, 2005) and tested the relations between the observed FMM-based model of AS and psychopathology in a large, diverse adult clinical research sample (N=481; 57.6% women; M(SD)age=36.6(15.0) years). ResultsFindings showed that a two-class three-factor partially invariant model of AS demonstrated significantly better fit than a one-class dimensional model and more complex multi-class models. As predicted, risk conferred by AS taxonicity was specific to anxiety psychopathology, and not to other forms of psychopathology. LimitationsThe sample was not epidemiologic, self-report and psychiatric interview data were used to index AS and psychopathology, and a cross-sectional design limited inference regarding the directionality of observed relations between AS and anxiety psychopathology. ConclusionsFindings are discussed with respect to the nature of AS and related anxiety psychopathology vulnerability specifically, as well as the implications of factor mixture modeling for advancing taxonomy of vulnerability and psychopathology more broadly.

High-Risk Feedback: A Brief Intervention to Increase Motivation to Change Anxiety

Elevated levels of anxiety sensitivity (AS), the fear of anxiety and its consequences, places individuals at an increased risk for the development of anxiety disorders, especially panic disorder. Research has shown that treating AS may reduce the future development of anxiety psychopathology. However, individuals high in AS may be unaware of the risks associated with this risk factor and, therefore, may tend to be unaware or unmotivated to change AS. The purpose of the current study was to investigate the effect of providing high-risk feedback in those at-risk for developing anxiety psychopathology. Participants consisted of 55 non-treatment seeking individuals with clinically significant levels of AS. Participants completed a battery of baseline questionnaires, received high-risk feedback about their level of anxiety sensitivity, and completed post-study questionnaires. Results revealed significant increases in motivation. Specifically, there were significant increases in the importance and confidence to change anxiety after receiving the high-risk feedback. Implications of the findings and future directions are discussed.

DIFFERENTIAL PREDICTION OF C02 CHALLENGE RESPONSE AS A FUNCTION OF THE TAXON AND COMPLEMENT CLASSES OF ANXIETY SENSITIVITY

Anxiety sensitivity (AS) is a trait-like characteristic capturing fears of the experience of anxiety and the potential psychological, somatic, or social consequences associated with anxiety. Recently, research has provided evidence for the latent structure of AS suggesting two discrete types, i.e. a taxonic class and a complement class. Investigations have identified combinations from the 16-items of the Anxiety Sensitivity Index (ASI) that are able to predict the taxon class of AS, referred to as the ASI taxon scales. The current study investigated the ability of a new ASI taxon scale, comprised of the seven overlapping items of the previously identified ASI taxon scales, to predict CO(2) challenge responses. This was examined in a sample of 387 nonclinical participants presenting for an AS treatment program. Participants completed a battery of questionnaires and a 20% CO(2) challenge as part of the program. Analyses indicated that the ASI taxon scale uniquely predicted CO(2) challenge response, whereas the complement scale did not have a significant association. The present study provides the first evidence of the AS taxon having the ability to predict an exaggerated fear response to a novel stressor known to be associated with anxiety psychopathology. Implications of these findings are discussed.