Anxious Mood States Research Articles

Avoidance of mild threat observed in generalized anxiety disorder (GAD) using eye tracking

Attentional biases towards threat are assumed to be a causal factor in the development of anxiety disorders, including generalized anxiety disorder (GAD). However, findings have been inconsistent, and studies often examine single time-point bias during threat exposure, instead of across time. Attention to threat may shift throughout exposure (e.g., from initial engagement to avoidance), and research suggests that threat intensity and state anxiety influence attentional biases. No studies to our knowledge have examined biases across time and with varying threat intensity and state anxiety. Participants with GAD (n=38) and non-anxious controls (n=25) viewed emotional (high threat, mild threat, and positive) and neutral image pairs under calm and anxious mood states while their eye movements were tracked. Participants showed an initial orientation to emotional images, and, under the anxious mood induction, demonstrated a bias towards threatening images at first fixation and over time. Results suggest it may be normative to attend to threat cues over other stimuli while in an anxious state. Individuals with GAD uniquely showed a bias away from mild (but not high) threat images over time relative to controls. Implications for theories of attentional biases to threat and clinical implications for GAD and anxiety disorders broadly are discussed.

A Single-Session Online Cognitive Bias Modification of Interpretations Modified for Adults With Anxiety and Depressive Symptoms

Anxiety and depression are common, co-occurring, and costly mental health disorders. Cognitive bias modification aims to modify biases to reduce associated symptoms. Few studies have targeted multiple biases associated with both anxiety and depression, and those that have lacked a control condition. This study piloted a single-session online cognitive bias modification (known as CBM-IA) designed to target two biases associated with anxiety and depression—interpretation bias and attribution style—in adults with varying levels of anxiety and depressive symptoms. Participants (18–26 years) with at least mild levels of anxiety/stress and depressive symptoms on the DASS-21 were randomly allocated to an intervention (n = 23) or a control (n = 22) condition. The training consisted of a single-session online CBM-IA to encourage positive interpretations and a positive attribution style.Interpretation bias, attribution style, anxious and depressive mood states, and anxiety, stress and depressive symptoms improved at posttraining and at follow-up, irrespective of condition. Changes in interpretation bias from pre- to posttraining were significantly associated with changes in anxious mood state. CBM-IA, as implemented in this single-session pilot study, did not significantly reduce targeted biases and symptoms compared to a control condition. This adds to the mixed evidence on the efficacy of single-session CBM-I for altering biases and symptoms.

An Integrated Medical-Psychological Approach in the Routine Care of Patients with Type 2 Diabetes: A Pilot Study to Explore the Clinical and Economic Sustainability of the Healthcare Intervention

The economic burden of Type 2 Diabetes Mellitus (T2DM) is a challenge for sustainability. Psychological factors, healthy behaviors, and stressful conditions are predictive and prognostic factors for T2DM. Focusing on psychological factors can reduce costs and help ensure the sustainability of diabetes care. The study aimed to support an integrated medical-psychological approach in the care of patients with T2DM. A group of patients undergoing usual healthcare treatment was compared to patients who received a psychotherapeutic intervention in addition to standard treatment. The study’s outcomes were: physical health (blood glucose, glycated hemoglobin, blood lipids, blood pressure); lifestyle (cigarettes, alcoholic drinks, physical activity, body mass index); mental health (anxiety, depression, stress, coping styles, alexithymia, emotion regulation, locus of control); costs (number of referrals to a specialist, standard cost of each visit). We examined the change from baseline to 24-week follow-up. Compared to the Standard Group, the Integrated Group reported a reduction in blood lipids and triglycerides, chronic depressive and anxious mood states, patient emotional coping, and the number of specialist visits and diagnostic tests. Close collaboration between diabetologists and psychologists is feasible, and it is worth considering integrated care as an option to contain and make healthcare spending more sustainable.

Participants\u2019 perceptions of interactions with community health workers who promote behavior change: a qualitative characterization from participants with normal, depressive and anxious mood states

BackgroundInterventions that promote healthier lifestyles among Latinos often involve community health workers (CHWs). CHWs can effectively advocate for healthier lifestyles and may be pivotal in addressing such mental health conditions as depression and anxiety. The goal of this study was to characterize the relationship dynamics between Latino participants and CHWs, from the participant’s perspective. We aimed to determine if CHW-delivered community interventions effected behavior change, especially among participants who reported anxiety and depression.MethodsSemi-structured interviews were conducted with a purposive sample of 28 Latino participants that was based on a mental health scoring strata. Participants completed a lifestyle intervention that included multiple home visits from CHWs to promote physical activity and healthful food choice. Interviews were conducted in the participant’s preferred language (English or Spanish). Transcribed interviews were analyzed using a grounded theory approach until concept saturation was achieved.ResultsThe sample was primarily female (82%), lower socioeconomic status (64%), and mean age of 50 years. Participants discussed the rapport building and professionalism of CHWs as a feature that facilitated strong, positive relationships and lifestyle behavior changes. Participants described how CHWs patterned their change approaches, which were similar to commonly used therapeutic techniques in the treatment of anxiety and depression. While anxiety and depression were described as having an impact on behavior change, most, but not all, participants who reported negative mood states said that the CHW relationship helped in changing that state to some extent.ConclusionsParticipants’ perceptions indicated that positive personal changes were influenced by CHWs. Only participants who reported consistently poor scores for depression, anxiety or both reported negative or neutral experiences with the CHWs. This study lends qualitative support to the use of CHWs as extenders of care, particularly in areas that have a shortage of primary and mental health care providers.

Distinguishing the roles of trait and state anxiety on the nature of anxiety-related attentional biases to threat using a free viewing eye movement paradigm

Although attentional biases to threatening information are thought to contribute to the development and persistence of anxiety disorders, it is not clear whether an attentional bias to threat (ABT) is driven by trait anxiety, state anxiety or an interaction between the two. ABT may also be influenced by “top down” processes of motivation to attend or avoid threat. In the current study, participants high, mid and low in trait anxiety viewed high threat-neutral, mild threat-neutral and positive-neutral image pairs for 5 seconds in both calm and anxious mood states while their eye movements were recorded. State anxiety alone, but not trait anxiety, predicted greater maintenance of attention to high threat images (relative to neutral) following the first fixation (i.e., delayed disengagement) and over the time course. Motivation was associated with the time course of attention as would be expected, such that those motivated to look towards negative images showed the greatest ABT over time, and those highly motivated to look away from negative images showed the greatest avoidance. Interestingly, those ambivalent about where to direct their attention when viewing negative images showed the greatest ABT in the first 500 ms of viewing. Implications for theory and treatment of anxiety disorders, as well as areas for further study, are discussed.

Anger, anxiety, and feelings of delusional threat as predictors of aggressive attitudes: An experimental mood induction study in a non-clinical sample

In the present study the influence of angry and anxious mood states and various types of psychotic-like experiences on state aggressive behavior was examined in a non-clinical student sample. Participants (N=120) were asked to fill out several questionnaires on psychotic-like experiences, emotions, and behaviors. Then, a combined mood induction procedure with guided imagery and mood congruent music was started to bring participants into an anxious, angry, or neutral mood. After the mood induction, an aggression word-stem completion task was presented. Results indicated that feelings of persecution were significantly linked to an aggressive attitude, whereas positive symptoms in general, hallucinatory behavior, and social reference ideas were not. Further, it was found that persons with an angry or anxious mood state also displayed a more aggressive attitude than persons who were in a neutral mood. These findings yield evidence for the role of persecutory thoughts, anger, and anxiety in triggering aggressive feelings in non-clinical populations.

Effect of short-term antidepressant treatment on early maladaptive schemas in patients with major depressive and panic disorder

Objective. We aimed to investigate the effect of anti-depressant treatment on early maladaptive schemas (EMSs). Methods. Eighty patients were self-referred to a psychiatric outpatient clinic and were diagnosed with major depressive disorder (MDD) (n = 40) and panic disorder (PD) (n = 40) according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV-TR). These patients were administered the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI) and the Young Schema Questionnaire-Short Form (YSQ-SF) before and after a 2-month period of antidepressant treatment and were compared with 40 healthy control subjects. Results and Conclusion. Depressive mood states were more likely to activate early maladaptive schemas compared to the anxious mood states, and treating these mood states simply with anti-depressive medications led to significant improvements in the activation of these schemas. We concluded that half of the schemas might be accepted as antidepressant treatment-resistant EMSs, or, in other words, they can be viewed in part as those specific to depressive mood states.

Cervical Spondylotic Myelopathy, Depression, and Anxiety: A Cohort Analysis of 89 Patients

To determine the prevalence of depressed and anxious mood states in patients with cervical spondylotic myelopathy (CSM), a degenerative spine condition with symptoms of neck pain, numb clumsy hands, gait difficulties, sphincter dysfunction, and impotence. To examine the relation between mood and functional deficits produced by CSM. We surveyed a cohort of 89 patients with CSM recruited during 1 year from a neurosurgery clinic. Patients underwent a structured interview to collect information on demographics, personal habits, CSM symptoms, comorbid diseases, and symptoms of depression and anxiety. Patients self-completed the Hospital Anxiety and Depression scale and were scored on the Nurick, Cooper, Harsh, and modified Japanese Orthopaedic Association (mJOA) scales. According to the Hospital Anxiety and Depression scale threshold value of 11, 29% of the cohort had a depressed mood and 38% had an anxious mood. Higher depression scores were associated with worse myelopathy, as measured by the Nurick scale (P = 0.01), the Cooper leg subscale (P = 0.006), the Harsh scale (P = 0.02), the mJOA arm subscale (P = 0.006), and the mJOA leg subscale (P = 0.004). There was no relation between depression scores and the Cooper arm subscale, Harsh sphincter scale, mJOA sensory subscale, or mJOA bladder subscale. Similar patterns were seen in the relations between myelopathy and anxiety. More than one-third of patients with CSM have a depressed or anxious mood. In patients with CSM, depression and anxiety scores are strongly associated with decreased mobility, inconsistently associated with arm dysfunction, and not associated with sensory deficits or sphincter dysfunction, suggesting that ambulatory dysfunction may cause or exacerbate the symptoms of depression and anxiety in patients with CSM.

Propiedades psicométricas de la escala geriátrica de depresión (GDS): análisis procedente de cuatro investigaciones

ObjectivesThe aim of this study was to determine the psychometric characteristics and factorial structure of the GDS scale, which would help and complement interpretation of the overall GDS score. MethodsThe 516 elderly participants were from four investigations. The mean age was 75 years and participants were from 27 nursing homes (51.7%) and from the community (48.3%); 41.7% were men and 58.3% were women. None showed cognitive impairment. A correlational method within a cross-sectional design was used. The subjects were similar in age, social class, and cognitive impairment. ResultsThe GDS showed good internal consistency (0.8) and test-retest reliability (0.8, p < 0.01). The exploratory factorial analysis revealed a 6-component structure (44.3% of explained variance): a) depressive and anxious mood state; b) well-being and optimism; c) worries and pessimism; d) cognitive functioning; e) loss of interest and anhedonia, and f) social activity. ConclusionsThe GDS provides valid and reliable information on depressive symptomatology in the elderly. While the overall score is related to depressive cognitive components, two solid factors can be observed: one of them is a mood component and the other is linked more to subjective well-being. This allows more accurate delimitation of depressive symptomatology in the elderly using the GDS scale. Some outcomes suggest the advisability of reducing the length of the instrument.

The Cognitive and Emotional Phenomenology of Depression and Anxiety: Are Worry and Hopelessness the Cognitive Correlates of NA and PA?

The study attempted to integrate the cognitive content-specificity and tripartite literatures to create a more holistic model of the emotional, physiological, and cognitive phenomenology of depression and anxiety. In addition, the constructs of hopelessness and worry were used to clarify ambiguous findings in the cognitive content-specificity research and to identify possible cognitive correlates of high NA and low PA. The results from 124 clients at a university counseling center supported this attempt at integrating these literatures. Overall, there was good evidence that worry is a cognitive correlate of high NA. Consequently, we view worry and high NA as features of a constellation of correlated indices that are shared with both depressed and anxious mood states. Alternatively, the results also support the position that hopelessness is a cognitive correlate of low PA. These features—low PA and hopelessness—define correlated indices that help discriminate depressed from anxious states. We view this integration of the cognitive and emotional literatures as providing evidence for a comprehensive map of the emotional and cognitive phenomenology in depression and anxiety.

The effects of mood manipulation and trait anxiety on susceptibility to distraction

Eysenck (1992) argues that high trait-anxious subjects are more likely to show a general susceptibility to distraction in anxious mood states, especially if the distracting material resembles the task stimuli. Unfortunately there is little direct evidence that supports this view. The present experiment therefore attempted to test Eysenck's proposition by modifying a test of distractibility for letters on a letter-transformation task, as originally devised by Eysenck and Graydon (1989), to incorporate a mood manipulation. Although high trait-anxious subjects were found to be generally more impaired than controls by the mood manipulation, they did not display greater susceptibility to distraction from task-similar material. These results are discussed in relation to current theoretical models of anxiety and cognitive processing.

Bias in interpretation of ambiguous sentences related to threat in anxiety.

In the 1st of 2 experiments, currently clinically anxious, recovered clinically anxious, and normal control subjects were presented with a mixture of unambiguous and ambiguous sentences; both threatening and nonthreatening interpretations were possible for the latter. A subsequent recognition-memory test indicated that the currently anxious subjects were more likely than normal control and recovered anxious subjects to interpret the ambiguous sentences in a threatening fashion rather than in a nonthreatening fashion. This suggests that the biased interpretation of ambiguity found in currently anxious subjects reflected their anxious mood state. A 2nd experiment established that the difference in interpretative processes between currently anxious and control subjects was not due to response bias and that the interpretative bias was a reasonably general one.

Bias in interpretation of ambiguous sentences related to threat in anxiety.

In the 1st of 2 experiments, currently clinically anxious, recovered clinically anxious, and normal control subjects were presented with a mixture of unambiguous and ambiguous sentences; both threatening and nonthreatening interpretations were possible for the latter. A subsequent recognition-memory test indicated that the currently anxious subjects were more likely than normal control and recovered anxious subjects to interpret the ambiguous sentences in a threatening fashion rather than in a nonthreatening fashion. This suggests that the biased interpretation of ambiguity found in currently anxious subjects reflected their anxious mood state. A 2nd experiment established that the difference in interpretative processes between currently anxious and control subjects was not due to response bias and that the interpretative bias was a reasonably general one.

Anxiety and attention

Normal individuals high and low in anxiety differ from each other in their attentional functioning in various ways. More specifically, they differ with respect to the content, capacity, distractibility and selectivity of attention. Any complete theoretical account of anxiety and attention will have to account for all four differences, although it is likely that these various aspects of attentional functioning are dynamically interrelated. Anxious patients with generalized anxiety disorder appear to differ from normal controls in similar ways, and there is evidence that some aspects at least of non-normal attentional functioning in anxious patients may reflect a vulnerability factor rather than merely an anxious mood state.

Behavioral Social Work with Obsessive-Compulsive Disorder

The symptomatology of obsessive-compulsive disorder is described and its negative impact on daily functioning is noted. The outcome of the application of various forms of behavioral treatment, including systematic desensitization, imaginal exposure, aversion treatment and thought-stopping is discussed with reference to theoretical formulations of the function of obsessions and compulsions vis-o-vis anxiety. Behavioral treatment via a combination of exposure to feared situations and response prevention or blocking of ritualistic behavior has proven to be the treatment of choice for this disorder. It is described here in some detail and suggestions regarding clinical issues in conducting this treatment are given. Factors identified as possible predictors of outcome include depression, anxious mood state, patients' beliefs in the probability of feared consequences, social functioning, motivation level and therapist characteristics. It is concluded that exposure and response prevention has substantially impro...