Criteria For Generalized Anxiety Disorder Research Articles

The temporal association between religious/spiritual struggles and anxiety symptoms: A longitudinal study of psychiatric outpatients

BackgroundAnxiety disorders like Generalized Anxiety Disorder (GAD) often cooccur with religious/spiritual (R/S) struggles, but the temporal association between anxiety symptoms and R/S struggles has not been studied in many clinical samples. The current longitudinal study examines this association in a sample at high risk for elevated anxiety and R/S struggles—adult psychiatric outpatients. MethodsAfter their initial psychiatrist evaluation at a U.S. group practice, 163 outpatients completed measures of R/S struggles, anxiety symptoms, depressive symptoms, and religiousness. The analytic sample (N = 120; 77.9% T1 retention) completed these measures 6-months and 12-months later (T2 and T3). ResultsPatients exhibited high baseline rates of anxiety symptoms (72.5% met likely criteria for GAD) and R/S struggles (59.2% reported high levels of at least one R/S struggle subtype), yet they demonstrated small-to-moderate decreases in anxiety, depression, and R/S struggles over time. Controlling for sociodemographics and baseline struggles, anxiety, and depression, there was a bidirectional association between T2/T3 overall R/S struggles and T3/T2 anxiety symptoms. T2 moral and ultimate-meaning struggles were related to higher T3 anxiety symptoms, and T2 anxiety symptoms were related to higher T3 demonic struggles. LimitationsResults may have been impacted by attrition, selection bias, maturation, and statistical regression. Findings need replication in larger, more diverse samples and in other countries, treatment settings, and clinical populations. ConclusionsAdult psychiatric outpatients are at high risk for R/S struggles, and these struggles are important to assess and address in their mental health treatment. Moral, ultimate-meaning, and demonic struggles may be most anxiety-relevant.

What is the Prevalence of General Anxiety Disorder and Depression Symptoms in Semi-elite Australian Football Players: A Cross-Sectional Study

BackgroundThe prevalence of anxiety and depression symptoms in semi-elite Australian footballers is unknown. The primary objective of this study was to determine the prevalence of generalised anxiety disorder (GAD) and depressive symptoms in semi-elite Australian Football players. Our secondary objective was to explore the association between demographic and football-specific factors with GAD and depressive symptoms. A cross-sectional epidemiological study including 369 semi-elite Western Australian Football League (WAFL) players from the Men and Women’s 2022 season (n = 337 men, 91%) was conducted. Symptoms of depression were measured using the Patient Health Questionnaire-9 scale (PHQ-9) and symptoms of GAD with the GAD-7 scale.ResultsOur response rate was 82.9%. Thirteen players had missing data. The prevalence of GAD symptoms was 8.5% in men and 28.6% in women (10% overall). The prevalence of depressive symptoms was 20% in men and 57% in women (23% overall). Being a woman (gender) was associated with a sevenfold increased risk of GAD and/or depression symptoms [odds ratio (OR): 7.33, 95% confidence interval (CI): 3.18–16.92; p < 0.001]. Players of ‘Aboriginal or Torres Strait Islander’ ethnicity were two times more likely to report GAD and/or depression symptoms in comparison to players of ‘Australian’ ethnicity (OR: 2.13; 95% CI: 1.01–4.49; p = 0.048). Concussion history was not a significant risk factor for GAD or depression symptoms.ConclusionThis study demonstrated that approximately 1 in 10 WAFL players met the diagnostic cut-off criteria for probable GAD, and 1 in 5 for probable depression. The prevalence for depression symptoms in this study were far higher than the national average in the comparative age bracket. WAFL women’s players also reported a substantially higher prevalence of GAD and depressive symptoms than men, and should be further investigated as a priority by the WAFL.

Savoring, worry, and positive emotion duration in generalized anxiety disorder: Assessment and interventional experiment

BackgroundIntentional attempts to savor positive emotions may be infrequent in Generalized Anxiety Disorder (GAD) due to avoidance of emotional contrasts. Yet purposeful enjoyment may help reduce worry and increase wellbeing in GAD. We sought to explore 1) the frequency, intensity, and duration of positive emotions from savoring in GAD and 2) its effect on pre-existing worry. MethodThe same 139 participants participated in two studies. They first took baseline measures. After, they were explicitly taught about savoring practices. In study 1, all participants were instructed to savor a photograph and video, timing and rating their emotion. Then in study 2, participants underwent a worry induction followed by an interventional experiment. In a savoring condition, participants were instructed to savor a personally-chosen enjoyable video. In a control condition, participants watched an emotionally neutral video. ResultsParticipants who met DSM-5 criteria for GAD had significantly lower scores on naturalistic savoring via self-report than those without GAD. Yet when explicitly taught and directed to savor in study 1, there were no differences between those with and without GAD in positive emotion duration and intensity. In study 2, longitudinal linear mixed models demonstrated that savoring after a worry induction significantly decreased worry, decreased anxiety, and increased positive emotions to greater degrees than the control task. These changes did not differ between diagnostic groups. All analyses controlled for depression symptoms. ConclusionAlthough persons with GAD tend to savor less in daily life than those without GAD, intentional savoring may decrease worry and increase positive emotion for both groups.

GAD: Over-reactive and unstable mood

• Generalized Anxiety Disorder (GAD) consists of an over-reactive and/or unstable mood that could be mistaken with mood swings and affective instability of bipolar disorder and borderline personality disorder. • Recognition of the over-reactive and/or unstable mood in GAD has significant clinical implication not to be misdiagnosed as bipolar disorder or borderline personality disorder that occurred in our research sample. • Inclusion of over-reactive and/or unstable mood in the next DSM edition as cardinal diagnostic criteria symptoms is a step towards a more comprehensive understanding of this very common psychiatric condition. We sought to clarify if over-reactive mood in Generalized Anxiety Disorder (GAD) could be misdiagnosed as mood swings of Bipolar Disorder, or with affective instability in Borderline Personality Disorder. We re-assessed 32 subjects who were referred to our clinic in 2020 and had been previously diagnosed with Bipolar and Borderline Personality Disorders, as they seem to fit more the diagnostic criteria of Generalized Anxiety Disorder (GAD), based on the structured clinical interview for DSM5 (SCID-DSM5) and our previously published general definition of this disorder. All the subjects met the DSM5 criteria of GAD and presented with excessive anxiety and worry lasting more than 6 months in different situations or spontaneous with no triggers, leading to dysfunctions in social, occupational, or any other important areas of the individual's life. The subjects also met our general definition of GAD and met the DSM5 diagnostic criteria for Social Anxiety Disorder, Panic Disorder and Major Depressive Disorder. Moreover some of these subjects had an over-reactive mood that was subjectively labeled by themselves as “mood swings”, but without any discreet hypomanic or manic episodes. Some of the subjects also described their mood as "unstable" that had led their previous clinicians with mislableing them with "affective instability" leading to the misdiagnosis of Borderline Personality Disorder. The result of the study showed that the over-reactive mood in GAD could simply by the patients be interpreted as mood swings and when reported to the physicians, diagnosed as Bipolar Disorder. In the same token the unstable mood in GAD could be taken as affective instability by the patients and the physicians, leading to the misdiagnosis of Borderline Personality Disorder. Other than mood over-reactivity and unstable mood in this sample that led their previous misdiagnoses with Bipolar and Borderline Personality Disorders, they were all presented with the symptoms of GAD like others without over-reactive and unstable mood. The findings of our present adds a new symptom of over-reactive mood in GAD that could be easily misinterpreted as mood swings and affective instability and misdiagnosed as Bipolar and Borderline Personality Disorders.

A randomized controlled feasibility trial of internet-delivered guided self-help for generalized anxiety disorder (GAD) among university students in India.

Online guided self-help may be an effective and scalable intervention for symptoms of generalized anxiety disorder (GAD) among university students in India. Based on an online screen for GAD administered at 4 Indian universities, 222 students classified as having clinical (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria) or subthreshold (Generalized Anxiety Disorder Questionnaire, Fourth Edition, score ≥ 5.7) GAD were randomly assigned to receive either 3 months of guided self-help cognitive-behavioral therapy (n = 117) or a waitlist control condition (n = 105). Guided self-help participants recorded high program usage on average across all participants enrolled (M = 9.99 hr on the platform; SD = 20.87). Intent-to-treat analyses indicated that participants in the guided self-help condition experienced significantly greater reductions than participants in the waitlist condition on GAD symptom severity (d = -.40), worry (d = -.43), and depressive symptoms (d = -.53). No usage variables predicted symptom change in the guided self-help condition. Participants on average reported that the program was moderately helpful, and a majority (82.1%) said they would recommend the program to a friend. Guided self-help appears to be a feasible and efficacious intervention for university students in India who meet clinical or subthreshold GAD criteria. The trial is registered with ClinicalTrials.gov (NCT02410265). (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Freely Generated Word Responses Analyzed With Artificial Intelligence Predict Self-Reported Symptoms of Depression, Anxiety, and Worry.

BackgroundQuestion-based computational language assessments (QCLA) of mental health, based on self-reported and freely generated word responses and analyzed with artificial intelligence, is a potential complement to rating scales for identifying mental health issues. This study aimed to examine to what extent this method captures items related to the primary and secondary symptoms associated with Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). We investigated whether the word responses that participants generated contained information of all, or some, of the criteria that define MDD and GAD using symptom-based rating scales that are commonly used in clinical research and practices.MethodParticipants (N = 411) described their mental health with freely generated words and rating scales relating to depression and worry/anxiety. Word responses were quantified and analyzed using natural language processing and machine learning.ResultsThe QCLA correlated significantly with the individual items connected to the DSM-5 diagnostic criteria of MDD (PHQ-9; Pearson’s r = 0.30–0.60, p < 0.001) and GAD (GAD-7; Pearson’s r = 0.41–0.52, p < 0.001; PSWQ-8; Spearman’s r = 0.52–0.63, p < 0.001) for respective rating scales. Items measuring primary criteria (cognitive and emotional aspects) yielded higher predictability than secondary criteria (behavioral aspects).ConclusionTogether these results suggest that QCLA may be able to complement rating scales in measuring mental health in clinical settings. The approach carries the potential to personalize assessments and contributes to the ongoing discussion regarding the diagnostic heterogeneity of depression.

ALEXITHYMIA AND SOMATOSENSORY AMPLIFICATION AMONG GENERALIZED ANXIETY DISORDER PATIENTS

Generalized anxiety disorder (GAD) is a chronic, relapsing anxiety disorder characterized by symptom clusters of worry, functional somatic symptoms, and autonomic hyperactivity. International Classication of Diseases 10 (ICD-10) diagnostic criteria still includes symptoms from all the abovementioned psychopathology clusters of GAD (1). However, in the diagnostic and statistical manual of mental disorders (DSM), focus shift away from somatic to psychic concern in the diagnosis of GAD (2,3). However, the presence of functional somatic symptoms is must for the diagnosis of GAD both in DSM 5 and ICD-10. The literature on functional somatic symptoms in major depressive disorder, somatoform disorders suggest a correlation of the symptoms with constructs such as somatosensory amplication and alexithymia (4, 5).As functional somatic symptoms are one of the essential criteria of GAD, it is very much relevant from the etiological and psychotherapeutic point of views to measure these constructs in subjects with GAD. In our literature search, we could come across very little research on this important area of investigation (6, 7). In addition, patients from the South Asian countries are shown to present more often with somatic symptoms than psychological symptoms (8). However, the research on functional somatic symptoms in general and GAD in particular in South Asian countries is very scant, and none of the studies have evaluated the above-mentioned correlates in patients with GAD (9, 10). The purpose of the current study was to study somatosensory amplication and alexithymia, in patients with GAD.

The Association Between Generalized Anxiety Disorder and Resting-State Prefrontal Cortex Oxygenation Is Modified by Self-Reported Physical Activity: Results From The Irish Longitudinal Study on Ageing.

Individuals with anxiety disorders exhibit lower intrinsic functional connectivity between prefrontal cortical areas and subcortical regions. The prefrontal cortex (PFC) is sensitive to the acute and chronic effects of physical activity (PA), while the anxiolytic effects of PA are well known. The current study examined the association of generalized anxiety disorder (GAD) and its interaction with PA, with resting-state, left PFC oxygenation. This cross-sectional study used data from participants (N = 2444) from The Irish Longitudinal Study on Ageing, a nationally representative prospective study of community-living adults aged 50 and older in Ireland. The Composite International Diagnostic Interview Short-Form determined fulfillment of criteria for GAD. The short-form International Physical Activity Questionnaire determined adherence to the World Health Organization PA guidelines. Resting-state, left PFC oxygenation was continuously measured via a Portalite. Tissue saturation index (TSI) was calculated as the ratio of oxygenated hemoglobin to total tissue hemoglobin (expressed as a percentage) for the final minute of a 5-minute supine-rest period. Multivariable linear regression quantified associations of GAD with TSI in the total population and population stratified by PA status. Participants with GAD had lower TSI (b = -1.416, p = .008) compared to those without GAD. However, this association was modified by PA. Among participants who met the PA guidelines, TSI did not differ according to GAD status (b = -0.800, p = .398). For participants who did not meet the guidelines, TSI was significantly lower among those with GAD (b = -1.758, p = .004). These findings suggest that PA may help to protect brain health among older adults with GAD.

Pandemic-Specific Factors Related to Generalized Anxiety Disorder during the Initial COVID-19 Protocols in the United States

Little is known about the psychological stress and secondary impacts emerging among the general U.S. population as a result of the ongoing COVID-19 pandemic. The purpose for the current study is to assess the prevalence rates of Generalized Anxiety Disorder (GAD) and to establish psychosocial correlates, pandemic-themed concerns, and other comorbidities for those with GAD at the initial onset of the COVID-19 pandemic. This online study included 2,101 U.S. adults between April 14–22, 2020, during the initial stay-at-home protocols and assessed GAD, psychosocial factors, and pandemic-related factors including concerns, changes in health behaviors, and adherence to protocols. The results demonstrated a high prevalence rate (17.9%) for GAD during the initial COVID-19 outbreak compared with the prior 1.8% 12-month estimate before the pandemic. Individuals with GAD reported significantly higher levels of stress, loneliness, fatigue, and empathic concern, along with reductions in levels of quality of life. Likewise, those with GAD reported significantly higher pandemic-related concerns, poorer changes in general health behaviors, and less confidence in the government’s response to the pandemic. For clinical purposes, these findings provide insight into the various types of pandemic-themed worries that individuals meeting clinical criteria for GAD will have the most difficulties controlling.

Response to the COVID-19 Outbreak in Urban Settings in China.

The COVID-19 outbreak in China was devastating and spread throughout the country before being contained. Stringent physical distancing recommendations and shelter-in-place were first introduced in the hardest-hit provinces, and by March, these recommendations were uniform throughout the country. In the presence of an evolving and deadly pandemic, we sought to investigate the impact of this pandemic on individual well-being and prevention practices among Chinese urban residents. From March 2–11, 2020, 4607 individuals were recruited from 11 provinces with varying numbers of COVID-19 cases using the social networking app WeChat to complete a brief, anonymous, online survey. The analytical sample was restricted to 2551 urban residents. Standardized scales measured generalized anxiety disorder (GAD), the primary outcome. Multiple logistic regression was conducted to identify correlates of GAD alongside assessment of community practices in response to the COVID-19 pandemic. We found that during the COVID-19 pandemic, the recommended public health practices significantly (p < 0.001) increased, including wearing facial mask, practicing physical distancing, handwashing, decreased public spitting, and going outside in urban communities. Overall, 40.3% of participants met screening criteria for GAD and 49.3%, 62.6%, and 55.4% reported that their work, social life, and family life were interrupted by anxious feelings, respectively. Independent correlates of having anxiety symptoms included being a healthcare provider (aOR = 1.58, p < 0.01), living in regions with a higher density of COVID-19 cases (aOR = 2.13, p < 0.01), having completed college (aOR = 1.38, p = 0.03), meeting screening criteria for depression (aOR = 6.03, p < 0.01), and poorer perceived health status (aOR = 1.54, p < 0.01). COVID-19 had a profound impact on the health of urban dwellers throughout China. Not only did they markedly increase their self- and community-protective behaviors, but they also experienced high levels of anxiety associated with a heightened vulnerability like depression, having poor perceived health, and the potential of increased exposure to COVID-19 such as living closer to the epicenter of the pandemic.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-020-00498-8.

1116 Interactions Among Interoceptive Sensitivity And Insomnia Symptoms In Individuals With Generalized Anxiety Disorder

Abstract Introduction Abnormal interoception is believed to contribute to anxiety disorders as well as possibly to Insomnia Disorder. We therefore hypothesized that interoceptive sensitivity in persons with Generalized Anxiety Disorder (GAD) would vary with sleep quality and would differ between GAD patients with and without insomnia. Methods 29 subjects (86% female) who reported GAD-7 scores ≥ 10 underwent psychiatric and sleep-disorders interviews and met DSM-5 criteria for GAD. Participants were assigned into an insomnia group if the Insomnia Severity Index (ISI) score exceeded 12 (N=18) or a non-insomnia group if ISI score &amp;lt; 11 (N=11). Participants completed approximately 2 weeks of actigraphy and sleep diaries (mean=14.09 days; SD=4.85) as well as online surveys of sleep quality including the Pittsburg Sleep Quality Index (PSQI) and interoceptive sensitivity including the Multidimensional Assessment of Interoceptive Awareness, the somatic anxiety scale of the State-Trait Inventory for Cognitive and Somatic Anxiety-Trait (STICSA-T) and the Anxiety Sensitivity Index. In addition, 28 participants underwent the Schandry heartbeat-counting task, an objective measure of interoceptive sensitivity. Results GAD-7 scores did not differ between insomnia and non-insomnia groups (t(18.36)=0.074, p = 0.941). However, insomniacs reported significantly higher scores on the somatic anxiety scale of the STICSA than non-insomniacs (t(17.71)=2.094, p=0.051). STICSA-T somatic anxiety scores positively correlated with greater PSQI scores (R=0.588; p=0.002) and trended negatively with actigraphy sleep-efficiency (R = -0.384; p=0.085). Non-insomniacs outperformed insomniacs in the Schandry task (t(25.9)=2.21, p=0.036). Higher Schandry scores were positively correlated with greater total sleep time (R=0.515; p=0.014) and lower ISI scores (R= -0.387; p=0.042). Conclusion Results suggest that GAD patients with insomnia have lesser objective interoceptive sensitivity and more subjective somatic anxiety than those without insomnia. Greater somatic anxiety predicted poorer subjective and objective sleep quality. Hence interoceptive sensitivity may vary with sleep disturbance in GAD. Support R21MH115279

Disengagement Training for the Treatment of Pathological Worry: A Preliminary Test

Pathological worry is characterized by an inability to distract or disengage from worry, and this uncontrollability is the defining feature of generalized anxiety disorder (GAD). The present study assessed a novel computerized strategy that targets these attention difficulties. Worry Disengagement Training (WDT), which involves alternating between writing about one’s worry and positive topics, was evaluated in a sample with elevated worry (N = 50), most of whom met for GAD diagnosis (66%). Compared to waitlist, WDT led to increased ability to disengage from in vivo worry on a breath focus task, resulting in fewer negative intrusions (β = -.29, p = .02; sr2 = .08). Relative to waitlist, WDT also led to lower self-reported general worry (β = -.36, p = .001, sr2 = .14) and depressive symptoms (β = -.25, p = .02, sr2 = .07). These effects remained in the subset of participants meeting criteria for GAD. WDT did not impact anxious arousal, suggesting some specificity of effects. These findings provide preliminary support for WDT as an effective strategy to increase disengagement ability and reduce worry and depression. Limitations and future directions are discussed.

Associations between family factors, childhood adversity, negative life events and child anxiety disorders: an exploratory study of diagnostic specificity.

Chronic childhood adversity, negative life events, and anxiogenic parenting behaviours have all been implicated in the development and maintenance of childhood anxiety disorders. However, few studies have addressed whether these factors are associated with particular types of childhood anxiety disorders. The aims of this study were to investigate whether specific associations were obtained between specific types of childhood anxiety disorder - namely, social anxiety disorder (SOC), separation anxiety disorder (SEP) and generalized anxiety disorder (GAD) - and the nature of particular forms of psycho-social risk - namely, chronic childhood adversity, negative life events, and particular forms of parenting behaviours. Two-hundred and ten children (aged 7-12 years) who met diagnostic criteria for SOC, SEP or GAD and their primary caregivers completed questionnaire measures on chronic childhood adversity and negative life events. In addition, dyads participated in two laboratory-based assessments of parent-child interactions. We found little evidence for disorder specificity for chronic childhood adversity and negative life events, except in the case of separation anxiety disorder. Anxious children with separation anxiety were more likely than children with other forms of anxiety disorders to live with a single parent, experience more frequent parent arguments, and more negative life events. No group differences in observed parenting behaviours were found. Childhood SEP may be particularly associated with family challenges which may need specific consideration to optimize prevention and/or treatment. Beyond this, there is limited evidence of specific associations between family and environmental factors and specific types of childhood anxiety disorders.

CHURCH RELATIONSHIPS, DISCRIMINATION, AND GENERALIZED ANXIETY DISORDER AMONG OLDER AFRICAN AMERICANS

The African American church has played a major role in African American communities, and church relationships represent an important stress-coping resource for older African Americans. This study examined 1) the association between everyday discrimination and generalized anxiety disorder (GAD) and 2) whether church-based relationships buffer the negative effects of everyday discrimination on GAD among older African Americans. Logistic regression analyses were conducted using data from 670 African American respondents age 55 and older from the National Survey of American Life: Coping with Stress in the 21st Century. More frequent experiences of everyday discrimination was associated with higher odds of meeting criteria for GAD. Significant interactions indicated that frequent contact with church members and high levels of subjective closeness to church members buffered against the negative effects of discrimination on GAD. Interventions that focus on the use of church members for support capitalize on a major strength among older African Americans.

Development and validation of a DSM-5-based generalized anxiety disorder self-report Scale: Investigating frequency and intensity rating differences

There are limitations in the currently available measures for the assessment of generalized anxiety disorder (GAD). While changes have been made in the diagnostic criteria for GAD from DSM-IV to DSM-5, there are no scales which items correspond directly to DSM-5-based GAD symptomatology. Moreover, although recent studies support measuring both symptom frequency and intensity of mental disorders, most GAD measures assess only either symptom frequency or intensity, and there is no DSM-5-based self-report measure of GAD that assesses both. In order to address these limitations, two studies were conducted to develop and validate a new GAD self-report scale, the Generalized Anxiety Symptom Severity Inventory (GASSI), which measures symptom severity by assessing both the frequency and intensity of DSM-5-based GAD symptoms in samples of undergraduates and natural disaster survivors. Study 1 provides evidence for a one-factor summed frequency and intensity GAD score using exploratory factor analysis. GASSI was found to have good reliability and evidence of construct validity. Study 2 suggests that both frequency and intensity of symptoms are needed in assessing GAD severity based on the results of invariance testing. These findings have implications for the measurement of GAD symptoms, as well as in the development of interventions for GAD.

The impact of uncontrollability beliefs and thought-related distress on ecological momentary interventions for generalized anxiety disorder: A moderated mediation model

This study was a secondary analysis of LaFreniere and Newman (2016), a randomized controlled trial comparing two ecological momentary interventions (EMIs) for generalized anxiety disorder (GAD): The worry outcome journal (WOJ) and thought log (TL). We predicted that higher thought-related distress would be a mediator by which higher uncontrollability beliefs (UB) would hinder the efficacy of the WOJ, but not the TL. Fifty-one undergraduates who met GAD criteria underwent one of the EMIs for 10 days. WOJ users tracked worries, associated distress, interference, expected outcome probabilities, and whether their worries came true four times/day. TL users tracked general thoughts, associated distress, and interference four times/day. Bootstrapping path analysis was used to analyze moderated mediation models. Higher UB predicted higher thought-related distress for both EMIs. Higher UB also predicted reduced efficacy of the WOJ at post-trial and of both EMIs at 30-day follow-up. However, for WOJ users, when higher initial UB levels predicted higher thought-related distress early in treatment, participants reported greater levels of worry at post-trial and follow-up. In contrast, UB’s effect on the TL group at post-trial and follow-up was not mediated by early distress. Thought-related distress appears to be a mechanism by which UB impedes the WOJ intervention.

Cognitive functions in young adults with generalized anxiety disorder

BackgroundAnxiety and worry are central symptoms of Generalized Anxiety Disorder (GAD) that have been theorized to negatively impact cognitive functions. However, most of the research has focused on threat-related or emotionally-charged stimuli, and a surprisingly small number of investigations examined ‘cold’ cognitive functions using classic neuropsychological tests. Such investigations are particularly important given that some theoretical models suggest compensatory mechanisms associated with anxiety that in certain circumstances may result in intact performance. The aim of the present study is to assess the neuropsychological profile associated with GAD, using a comprehensive neuropsychological battery. MethodsA sample of 23 college students meeting criteria for DSM-5 GAD and 20 control participants completed a psychometrically valid comprehensive computerized neuropsychological battery and clinical questionnaires. ResultsThe GAD sample presented with significantly elevated symptomatic rates of anxiety, worry, depression and stress. However, no significant differences were found on any neuropsychological outcome measures or domain indexes. Effect sizes were small, some of which favored the GAD sample. ConclusionDespite substantial psychopathological burden, GAD exhibited intact cognitive functioning. These results support the Cognitive Control Theory of Anxiety, suggesting that elevated primary anxiety may not impact ‘cold’ cognitive functions in the absence of threat or substantial cognitive load. Given that this is one of the only studies employing a comprehensive neuropsychological battery in GAD, more research is needed in this population to replicate these results and to examine the impact of anxiety on cognitive functions at varying degrees of cognitive load in this population.

Minority Stress Factors Associated With Depression and Anxiety Among Transgender and Gender-Nonconforming Youth

PurposeTransgender and gender-nonconforming (TGNC) adolescents and young adults experience mental health problems, including anxiety and depression, at an elevated rate as compared to their cisgender counterparts. A growing literature suggests that vulnerability to psychiatric problems in TGNC individuals results from social discrimination and minority stress. MethodsThe sample consisted of adolescent TGNC patients (N = 109) who completed behavior health screening questionnaires as standard of care at their first clinical visit to an interdisciplinary gender program within a pediatric academic medical center in a metropolitan Midwestern city. Binary logistic regressions were used to assess whether the likelihood that participants met clinical diagnostic criteria for Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) was predicted by gender identity appearance congruence, proximal forms of minority stress (e.g., negative expectations of the future related to gender identity; internalized transphobia) and community connectedness (i.e., resilience) . ResultsOverall, 33% (n = 36) of the sample met diagnostic criteria for MDD and 48% (n = 53) met diagnostic criteria for GAD. Those with high levels of internalized transphobia were significantly more likely to meet diagnostic criteria for both MDD and GAD. Those with low levels of gender identity appearance congruence were significantly more likely to meet diagnostic criteria for MDD but not GAD. ConclusionThere are several unique factors that may predict mental illness among TGNC youth. Understanding these factors may offer opportunities for targeted clinical and structural interventions.

Efficacy of Add-on Pregabalin in the Treatment of Patients with Generalized Anxiety Disorder and Unipolar Major Depression With an Early Nonresponse to Escitalopram: A Double-Blind Placebo-Controlled Study.

This study tests the efficacy of pregabalin versus placebo as adjunctive treatment in patients with generalized anxiety disorder (GAD) comorbid with unipolar major depression (UMD) and with an early nonresponse to escitalopram. This is a double-blind, placebo-controlled 8-week add-on study of pregabalin, 75-600 mg/day (n=31) versus placebo (n=29) on open-label escitalopram in outpatients meeting the DSM-IV-TR criteria for GAD and UMD. The main outcome measures were change from baseline to endpoint in total STAI-S, Trail-Making Test B (TMT-B) and the Center of Epidemiological Studies Depression Scale (CES-D). Also changes in the parameters of the pupil's reaction to light stimuli. There was no significant difference in any of the primary or secondary outcomes or response and remission rates concerning any analysis (last observation carried-forward of at least visit 2 or completers) between the 2 treatment arms. One additional finding of the current study is that adding pregabalin does not have a significant effect on autonomic function. This study does not support the usefulness of adding pregabalin in patients with GAD and UMD and with an early nonresponse to escitalopram (EudraCT Number: 2012-004062-17, Sponsor's Protocol Code Number: WS1702721).

A Pilot Study of the Effects of Mindfulness-Based Cognitive Therapy on Positive Affect and Social Anxiety Symptoms.

Randomized controlled trials have demonstrated that mindfulness-based cognitive therapy (MBCT) is efficacious in reducing residual depressive symptoms and preventing future depressive episodes (Kuyken et al., 2016). One potential treatment effect of MBCT may be improvement of positive affect (PA), due to improved awareness of daily positive events (Geschwind et al., 2011). Considering social anxiety disorder (SAD) is characterized by diminished PA (Brown et al., 1998; Kashdan, 2007), we sought to determine whether MBCT would reduce social anxiety symptoms, and whether this reduction would be associated with improvement of PA deficits. Adults (N = 22) who met criteria for varied anxiety disorders participated in a small, open-label trial of an 8-week manualized MBCT intervention. Most participants presented with either a diagnosis (primary, secondary, or tertiary) of generalized anxiety disorder (GAD) (N = 15) and/or SAD (N = 14) prior to treatment, with eight individuals meeting diagnostic criteria for both GAD and SAD. We hypothesized participants would demonstrate improvements in social anxiety symptoms, which would be predicted by improvements in PA, not reductions in negative affect (NA). Results of several hierarchical linear regression analyses (completed in both full and disorder-specific samples) indicated that improvements in PA but not reductions in NA predicted social anxiety improvement. This effect was not observed for symptoms of worry, which were instead predicted by decreased NA for individuals diagnosed with GAD and both decreased NA and increased PA in the entire sample. Results suggest that MBCT may be efficacious in mitigating social anxiety symptoms, and this therapeutic effect may be linked to improvements in PA. However, further work is necessary considering the small, heterogeneous sample, uncontrolled study design, and exploratory nature of the study.