Anxiety Subtypes Research Articles

Music performance anxiety: a critical review of etiological aspects, perceived causes, coping strategies and treatment

Abstract Background Music performance anxiety (MPA) is understood as a sub-type of social anxiety and is characterised by fears of a musical presentation. Objective To carry out a critical literature review on clinical and etiological aspects, perceived causes, coping strategies and treatment of MPA. Methods Electronic databases PubMed, PsycINFO and Lilacs as well as specific periodicals were used based on the key-words symptoms, diagnosis, aetiology, perceived causes, coping strategies and treatment. Results MPA is highly prevalent among musicians (> 16%), regardless of culture and formation. Cognitive, behavioural and physiological factors are associated with the aetiology of MPA, including biological and psychological predispositions. In addition, one should highlight factors related to the individual, aspects related to tasks and musical situation as perceived causes and/or predictor variables of MPA. As for the coping strategies, one can also highlight the use of breathing/relaxing techniques, increased musical practice, use of homeopathy and substances without medical prescription. Discussion MPA is impacting in the musician’s life. Despite the increasing interest in its study, it is necessary to better understand this complex phenomenon, mainly in the therapeutic context, in addition to the publicising and offering of services for prevention and treatment of MPA.

Achievement of Adequate Glycemic Control in Patients With Type 2 Diabetes and Comorbid Mental Health Conditions Treated in a Primary Care Setting.

Objective.This study investigated the association between the presence of a mental health condition (MHC) diagnosis and glycemic control in patients with type 2 diabetes in a primary care clinic network.Methods.This retrospective cross-sectional study compared adequate glycemic control (A1C <8.0%) in patients with type 2 diabetes with and without any MHC, as well as by MHC subtypes of depression or anxiety, bipolar or schizophrenia disorders, and substance use disorder.Results.Of 3,025 patients with type 2 diabetes, 721 (24%) had a diagnosis for one or more MHC. The majority (54.9%) were <65 years of age, female (54.9%), and Caucasian (74.5%). Mean A1C was statistically lower in the MHC cohort at 7.14 ± 1.66% compared to 7.38 ± 1.73% in the group without any MHC (P = 0.001). Furthermore, those with an MHC were more likely to attain adequate glycemic control than those without an MHC (odds ratio 1.27, 95% CI 1.01–1.59). Among patients with MHCs, similar rates of adequate glycemic control were seen between those with depression or anxiety and those with other MHCs. However, fewer patients with substance use disorder had adequate glycemic control compared to those without this condition (66.7 vs. 80.10%, P = 0.004).Conclusion.Patients with diabetes and MHCs had slightly better glycemic control than those without any MHC. However, the presence of substance use disorder may present more barriers to adequate glycemic control. Additional research is needed to identify barriers unique to each MHC to optimize diabetes management in this population.

The natural course of anxiety symptoms in early adolescence: factors related to persistence

ABSTRACTBackground and objectives: Anxiety disorders are the most common mental health problems during childhood and adolescence. This study examined the course of anxiety symptoms in early adolescents from the general population over three phases.Design: Prospective cohort study.Methods: Two hundred and forty-two participants (mean-age of 13.52) from a baseline sample of 1514 (mean-age of 10.23) were followed up three times. Of the 1514 children, those with emotional risk and controls without risk constituted the second-phase sample (n = 562; mean-age of 11.25). The Screen for Child Anxiety Related Emotional Disorders-SCARED was administered in all three phases.Results: Fifty-six percent and 32% of respondents showed total scores above the SCARED cutoff point at one and three years follow-up, respectively. Eight percent showed fluctuating symptoms. Fifty-five percent of respondents showed high scores for any subtype of anxiety over three years. Social phobia and generalized anxiety symptoms were the most prevalent and persistent. Participants with persistent separation anxiety showed the highest co-occurrence with symptoms of other psychopathological disorders. Participants with persistent anxiety showed lower academic performance. Being male was a protective factor against persistence.Conclusions: The data support anxiety maintenance during early adolescence. Early adolescence is a critical period which may involve other serious academic, social, and family problems.

586. Using Anxiety and Depressive Subtypes to Predict Electrocortical Processing of Distracting Pictures

586. Using Anxiety and Depressive Subtypes to Predict Electrocortical Processing of Distracting Pictures

Adjustment disorder: Prevalence, sociodemographic risk factors, and its subtypes in outpatient psychiatric clinic.

This study aims at assessing the prevalence and risk factors of Adjustment disorder (AD), the AD subtypes, and the common causing stressors. A cross sectional study was conducted at outpatient psychiatric clinic in Duhok City from July 2008 to July 2009. 637 patients equal and above 18 of both genders were selected randomly. SCID-I/P (Version 2.0) was adopted to diagnose patients with AD. SPSS (version 21), was used for data analysis. The study showed that the prevalence of AD was 11.5%. It was more common among youngest age group (15-25 years) with a rate 69.9% (p=0.001) while lowest educational level (illiterate and primary) 53.5% (p=0.040), single 54.8% (p<0.001), students 39.7 (p<0.001) and from urban areas 71.2% (p=0.012) with statistically significant association. Although AD was more common among females (61.6%), no significant association was found between AD and gender (p=0.380). The most common subtype of AD was AD with mixed anxiety and depressed mood (34.2%) and was the commonest among females (19.2%) followed by AD with Anxiety subtype 30.1% which was the commonest among males (13.7%). The commonest psychosocial stressor was the illnesses (28.8%) followed by love affairs (26%) and domestic problems (16.4%). The prevalence of AD was found to be high. The risk factors included young, low educational level, single, students, and those from urban areas. The most common subtype was AD with mixed anxiety and depressed mood and the commonest psychosocial stressor was the illnesses followed by love affairs and domestic problems.

Altered Positive Affect in Clinically Anxious Youth: the Role of Social Context and Anxiety Subtype.

Anxious youth may experience altered positive affect (PA) relative to healthy youth, perhaps because of greater sensitivity to social experiences. Altered PA may be especially evident during the transition to adolescence, a period in which positive social events increase in salience and value. The current study evaluated whether anxious youth show differences in baseline PA, rate of return to baseline, and variability around baseline PA and tested whether these differences would depend on social context and anxiety subtype. Participants were 176 9- to 14-year-old youth, including 130 clinically anxious (with Social Anxiety Disorder, Generalized Anxiety Disorder, and/or Separation Anxiety Disorder) and 46 healthy youth. Youth reported their current PA, peak PA in the past hour, and social context in natural settings using ecological momentary assessment. Hierarchical linear models showed that both socially anxious and other anxious youth showed greater variability of PA relative to healthy youth. Youth with other anxiety disorders showed higher peak PA to a positive event relative to healthy youth. Feeling close to a friend was associated with higher peak PA, especially for socially anxious youth. Socially anxious youth showed significantly lower peak PA relative to both healthy and other anxious youth when interacting with a less close peer, but similar levels to these youth when interacting with a close friend. These findings suggest that clinically anxious youth may more sensitive to positive events and social interactions than healthy youth. Findings provide potential treatment targets for anxious youth, including applying regulatory strategies to positive events.

Sport participation in high school and anxiety symptoms in young adulthood

The longitudinal associations between sport participation and symptoms of four anxiety sub-types (panic disorder, generalized anxiety disorder (GAD), social phobia, agoraphobia) were assessed. Participants (n = 781; 45% male; Mage = 20.34 ± 0.71 years) provided data on sport participation over five years of high school and measures of anxiety three years post high school. Sport participation was analyzed both as the total number of years playing sports over five years and the number of years playing team or individual sports. In logistic regression analyses, number of years playing sports was associated with fewer panic disorder and agoraphobia symptoms in young adulthood. Further, number of years playing team sports was associated with fewer symptoms of panic and agoraphobia, while number of years playing individual sports was associated with fewer social phobia symptoms. The results suggest that consistent involvement in sport during high school is beneficial for mental health. Furthermore, this study emphasizes the importance of studying each anxiety symptom subtype as a unique outcome.

Subtypes in borderline patients based on reactive and regulative temperament

Considerable heterogeneity is observed among patients with a Borderline Personality Disorder (BPD). In the present study, we investigated whether we could identify and validate different personality subtypes in 150 BPD inpatients based on reactive and regulative temperament. We identified four BPD subtypes by means of cluster analysis on the Behavioral Inhibition and Behavioral Activation Scales (BISBAS) and the Effortful Control Scale (ECS): an Emotional/Disinhibited subtype (45%) scoring lowest on Effortful Control, an Inhibited subtype (24%) characterized by low levels of Behavioral Activation, a Low Anxiety subtype (21%) defined by low levels of Behavioral Inhibition, and a High Self-control subtype (10%) characterized by the highest score on effortful control. The four subtypes were validated by comparing them on clinical symptomatology, comorbid personality disorders, and coping. The current findings offer insight into meaningful differences among BPD patients based on temperamental features, which can offer guidelines for the treatment of BPD patients.

PERSISTING GENERALIZED ANXIETY DISORDER AND PHYSICAL HEALTH SYMPTOMS 18 MONTHS AFTER THE DEEPWATER HORIZON OIL SPILL: A COMMUNITY SAMPLE

Generalized anxiety disorder (GAD) is a subtype of anxiety that often presents in primary care settings and is typically associated with a myriad of somatic complaints. Few studies have investigated the connection between this disorder and physical health symptoms after disasters such as oil spills. This study aims to analyze the relationship between GAD symptomology and physical health symptoms at different levels of exposure 18 months after the Deepwater Horizon oil spill. A community sample was surveyed about their contact with the oil spill, GAD symptoms, and physical health symptoms. Levels of GAD symptomology continued to be elevated above typical prevalence rates in the community at time of assessment. Individuals with direct contact to the oil reported significantly greater levels of GAD and more physical health symptoms than those without direct contact. These significant relationships have important implications in faster identification and treatment of disaster‐related mental and physical health problems.

Using Symbolic-Experiential Family Therapy to Treat Adjustment Disorder: A Case Study

ABSTRACTDespite studies claiming Adjustment Disorders (AD) affect up to 10% of the general population, research is severely lacking for effective treatment recommendations and screening tools. This article presents the treatment of a 30-year old Caucasian male diagnosed with AD - mixed anxiety and depression subtype. After 12 standard 60-minute sessions, treatment using a Symbolic-Experiential Family Therapy (SEFT) approach resulted in the alleviation of depression and anxiety symptoms. This case study provides preliminary evidence for the effectiveness of SEFT using a mixed methods case study. Implications for further study, and the usefulness of SEFT for the treatment of AD, is presented.

Food addiction relations to depression and anxiety in Egyptian adolescents

IntroductionFood addiction (FA) is a recent term used to describe craving for food in addition to functional impairment. FA has not been thoroughly studied in adolescents, so the aim of this study was to assess its presence in Egyptian adolescents and its relations to some psychiatric correlates; anxiety and depression. Subjects and methodsA cross sectional design was used. Four hundred adolescents were interviewed from the different geographic locations in Cairo to assess FA by the Yale Food Addiction Scale (YFAS), depression by the Child Depression Inventory (CDI) scale and anxiety by the Screen for Child Anxiety Related Disorders (SCARED) child version questionnaire. ResultsFA was present in 12% of the studied adolescents. Depression was present in 74 adolescents (18.5%). FA and depression coexisted in 5 subjects (10.4%). The diagnosis of anxiety was met in 38 adolescents (9.5%) and it coexisted with food addiction in only one adolescent (2%). FA scores showed moderately significant positive correlations with most of the anxiety subtypes as well as with the total score for anxiety and depression. Some FA symptomatology were significantly different between those with and without anxiety and depression. ConclusionFA exists in Egyptian adolescents and has strong associations with psychiatric comorbidities. Anxiety and depression should be evaluated in every individual with FA and vice versa as these psychiatric morbidities may be the inciting factor for the development of food addiction. Evaluation and treatment should address all the existent comorbidities. Careful attention should be paid to the presence of excess food consumption despite knowledge of adverse consequences, tolerance, withdrawal symptoms and important social or occupational activities given up or reduced because their presence coincided in this study with the presence of depression and/or anxiety which makes psychiatric evaluation more valuable.

The three-year developmental trajectory of anxiety symptoms in non-clinical early adolescents.

Adolescence is a period of vulnerability regarding the emergence of internalizing disorders such as anxiety. Anxiety symptoms can persist into adulthood and involve negative outcomes. The aim of the study was to examine the developmental trajectory of several anxiety subtypes by gender, in a non-clinical sample of early adolescents over three phases. Using a prospective design, 1514 children (mean-age = 10.23, SD = 1.23) underwent anxiety and depression screening in the first phase. Then, 562 children (mean-age = 11.25, SD = 1.04) participated in the second phase, and 242 (mean-age = 13.52; SD = .94) were followed up in the third phase. The Screen for Child Anxiety Related Emotional Disorders was administered in all phases. Developmental trajectories of anxiety scores were examined using latent growth modelling. Manifestations of social phobia and generalized anxiety disorders remained stable. Gender differences were found: boys showed a significant decrease in the developmental trajectories of somatic/panic symptoms, separation anxiety disorder and total anxiety in comparison to girls. The data indicate that anxiety symptomatology is a significant clinical phenomenon in school-age children but that it does not increase throughout early adolescence. It is important to identify developmental patterns for anxiety subtypes and in relation to gender.

All anxiety is not created equal: Correlates of parent/youth agreement vary across subtypes of anxiety.

Research has examined patterns and correlates of parent/youth informant discrepancies in the reporting of youth anxiety. However, little work has examined whether it is better to conceptualize patterns and correlates of informant disagreement across anxiety broadly, or more useful to consider disagreement on specific symptom clusters. Using data from the Child Adolescent/Anxiety Multimodal Study (CAMS; N = 488; Walkup et al., 2008), the current study applied the most recent recommended analytic strategies to study informant discrepancies and examined differences in the magnitude and patterns of disagreement for: (a) broadband anxiety symptoms, versus (b) symptoms of specific anxiety diagnoses (or anxiety subtypes; e.g., separation, social anxiety). Correlates of informant discrepancies were also examined. Results indicated that there was variability in agreement across anxiety subtypes, with parent/youth agreement higher on separation anxiety and school refusal symptoms relative to other domains. Parental psychopathology was associated with disagreement on broadband anxiety symptoms, such that parental psychopathology was highest when parents reported higher symptoms than their children; however, this finding was largely driven by a relationship between parental psychopathology and disagreement on separation anxiety symptoms. Age was associated with disagreement on total and separation anxiety symptoms. Gender was not associated with disagreement. Clinical implications are discussed.

Casting wider diagnostic nets for anxiety and depression: Disability-driven cross-diagnostic subtypes in a large population study

IntroductionData-driven techniques are frequently applied to identify subtypes of depression and anxiety. Although they are highly comorbid and often grouped under a single internalizing banner, most subtyping studies have focused on either depression or anxiety. Furthermore, most previous subtyping studies have not taken into account experienced disability.ObjectivesTo incorporate disability into a data-driven cross-diagnostic subtyping model.AimsTo capture heterogeneity of depression and anxiety symptomatology and investigate the importance of domain-specific disability-levels to distinguish between homogeneous subtypes.MethodsSixteen symptoms were assessed without skips using the MINI-interview in a population sample (LifeLines; n = 73403). Disability was measured with the RAND-36. To identify the best-fitting subtyping model, different nested latent variable models (latent class analysis, factor analysis and mixed-measurement item response theory [MM-IRT]) with and without disability covariates were compared. External variables were compared between the best model's classes.ResultsA five-class MM-IRT model incorporating disability showed the best fit (Fig. 1). Accounting for disability improved the differentiation between classes reporting isolated non-specific symptoms (“Somatic” [13.0%], and “Worried” [14.0%]) and those reporting more psychopathological symptoms (“Subclinical” [8.8%], and “Clinical” [3.3%]). A “Subclinical” class reported symptomatology at subthreshold levels. No pure depression or anxiety, but only mixed classes were observed.ConclusionsAn overarching subtyping model incorporating both symptoms and disability identified distinct cross-diagnostic subtypes. Diagnostic nets should be cast wider than current phenomenology-based categorical systems.Figure not available.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Anxiety and the Risk of Stroke: The Rotterdam Study.

It is unclear whether anxiety is a risk factor for stroke. We assessed the association between anxiety and the risk of incident stroke. This population-based cohort study was based on 2 rounds of the Rotterdam Study. Each round was taken separately as baseline. In 1993 to 1995, anxiety symptoms were measured using the Hospital Anxiety and Depression Scale-Anxiety (HADS-A). In 2002 to 2004, anxiety disorders were assessed using the Munich version of the Composite International Diagnostic Interview. Participants were followed up for incident stroke until January 2012. In the sample undergoing HADS-A (N=2625; mean age at baseline, 68.4 years), 332 strokes occurred during 32 720 years of follow-up. HADS-A score was not associated with the risk of stroke during complete follow-up (adjusted hazard ratio, 1.02; 95% confidence interval, 0.74-1.43; for HADS-A≥8 compared with HADS-A <8), although we did find an increased risk after a shorter follow-up of 3 years (adjusted hazard ratio, 2.68; 95% confidence interval, 1.33-5.41). In the sample undergoing the Munich version of the Composite International Diagnostic Interview (N=8662; mean age at baseline, 66.1 years), 340 strokes occurred during 48 703 years of follow-up. Participants with any anxiety disorder had no higher risk of stroke than participants without anxiety disorder (adjusted hazard ratio, 0.95; 95% confidence interval, 0.64-1.43). We also did not observe an increased risk of stroke for the different subtypes of anxiety. Anxiety disorders were not associated with stroke in our general population study. Anxiety symptoms were only related to stroke in the short term, which needs further exploration.

Profiles of Social Anxiety and Impulsivity Among College Students: A Close Examination of Profile Differences in Externalizing Behavior

Prior work indicates the presence of a subtype of Social Anxiety (SA) characterized by disinhibition or high externalizing behaviors such as substance use and Attention Deficit Hyperactivity Disorder (ADHD) symptoms. A sample of 375 undergraduates completed an online study including measures of SA, substance use, ADHD symptoms and impulsivity. Latent class analyses revealed three classes of individuals who evidenced: (a) low SA and low impulsivity, (b) high SA and low impulsivity, and (c) high SA and high impulsivity. Individuals high in both SA and impulsivity evidenced greater likelihoods of exhibiting externalizing behavior, relative to the two other classes. Post-hoc analyses revealed the largest and most significant differences between classes were seen with regard to ADHD. This finding extends previous work by replicating distinct profiles of SA and impulsivity, and highlighting that how these profiles relate to externalizing behaviors may depend on the externalizing domain.

Episodic foresight and anxiety: Proximate and ultimate perspectives.

In this paper, we examine the relationship between episodic foresight and anxiety from an evolutionary perspective, proposing that together they confer an advantage for modifying present moment decision-making and behaviour in the light of potential future threats to fitness. We review the body of literature on the role of episodic foresight in anxiety, from both proximate and ultimate perspectives. We propose that anxious feelings associated with episodic simulation of possible threat-related future events serve to imbue these simulations with motivational currency. Episodic and semantic details of a future threat may be insufficient for motivating its avoidance, but anxiety associated with a simulation can provoke adaptive threat management. As such, we detail how anxiety triggered by a self-generated, threat-related future simulation prepares the individual to manage that threat (in terms of its likelihood and/or consequences) over greater temporal distances than observed in other animals. We then outline how anxiety subtypes may represent specific mechanisms for predicting and managing particular classes of fitness threats. This approach offers an inroad for understanding the nature of characteristic future thinking patterns in anxiety disorders and serves to illustrate the adaptive function of the mechanism from which clinical anxiety deviates.

IL-4 Knock Out Mice Display Anxiety-Like Behavior.

Inflammation is a recognized antecedent and coincident factor when examining the biology of anxiety. Little is known, however, about how reductions in endogenous anti-inflammatory mediators impact anxiety. Therefore, mood- cognition- and anxiety-associated/like behaviors were examined in IL-4 knock out (KO) mice and wild-type (WT) mice. In comparison to WT mice, IL-4 KO mice demonstrated decreased burrowing and increased social exploration. No differences were seen in forced swim or saccharine preference testing. IL-4 KO mice had similar performance to WT mice in the Morris water maze and during object location and novel object recognition. In the elevated zero-maze, IL-4 KO mice, in comparison to WT mice, demonstrated anxiety-like behavior. Anxiety-like behavior in IL-4 KO mice was not observed, however, during open-field testing. Taken together, these data indicate that IL-4 KO mice display state, but not trait, anxiety suggesting that reductions in endogenous anti-inflammatory bioactives can engender subtypes of anxiety.

Fluency in Formation of Relational Framing and Physiological Responses inSocial Anxiety Subtypes: A Perspective of Relational Frame Theory

Fluency in Formation of Relational Framing and Physiological Responses inSocial Anxiety Subtypes: A Perspective of Relational Frame Theory

When social anxiety co-occurs with substance use: Does an impulsive social anxiety subtype explain this unexpected relationship?

Although most conceptualizations of social anxiety emphasise that socially anxious individuals are overtly shy, and utilise avoidant behavioural strategies (e.g., risk-aversion, passivity, and submissiveness), there is tentative support for the existence of an approach-motivated subtype, characterised by risk taking and a greater propensity for substance misuse. It is likely that this subtype may help explain the reported co-occurrence of substance misuse and social anxiety. The current study sought to test via latent class analysis whether an approach-motivated social anxiety subtype could be identified within a community sample. A self-report questionnaire was completed by 351 participants (age: 18–74 years). Two distinct social anxiety subgroups were identified: one characterised by prototypical SAD symptomatology (i.e., behavioural inhibition and risk-avoidance), the second by elevated levels of rash impulsiveness, reward sensitivity, risk-taking and co-occurring substance use problems. The current findings provides support for the existence of a distinct approach-motivated social anxiety subtype and indicates that impulsivity may be critical to understanding the comorbid substance use symptomatology of these individuals.