DSM-5 Anxiety Research Articles

Effectiveness of a blended group transdiagnostic treatment for emotional disorders: Study protocol for a randomized controlled trial

IntroductionEmotional disorders (ED) (mood and anxiety disorders) are very prevalent and disabling, and often appear in comorbid presentations. Although there are effective treatments for these disorders, there is still a large gap between the number of people who need them and those who actually receive them. The combination of three strategies may help in this regard, facilitating the dissemination and accessibility of treatment: the transdiagnostic perspective of ED, the group format, and the use of technologies in a blended format (i.e., the combination of online and face-to-face therapy elements). This study intends to compare the efficacy of a new ED intervention, a transdiagnostic group treatment protocol administered in a blended format, with that of a face-to-face treatment. This article describes the study protocol for the randomized controlled trial. Method and analysesA two-arm, parallel-group, randomized controlled clinical trial (RCT) will be conducted. Participants (N = 144) will be adult volunteers suffering from DSM-5 anxiety and/or depressive disorders and will be randomly assigned to one of two conditions: Face-to-face Group Transdiagnostic Protocol or Blended Group Transdiagnostic Protocol. The face-to-face condition will consist of a total of 16 weekly face-to-face group sessions, while the blended condition will consist of 8 biweekly face-to-face group sessions in combination with self-applied work through a web platform. Clinical and acceptability measures will be included in both groups. Assessments will be performed at baseline, during the treatment, at post-treatment, and at 3-, 6- and 12-month follow-ups. This study received the approval of the Ethics Committee of Universitat Jaume I in October 2021 (CD/91/2021). Intention-to-treat analyses will be performed. Statistical analyses will be carried out using SPSS version 28.0. The results will be reported in accordance with CONSORT recommendations. DiscussionThis is the first RCT to compare the effectiveness of an ED treatment protocol based on the transdiagnostic perspective and applied in group and blended format. It will offer relevant data to continue moving forward towards treatment alternatives that are cost-effective and more accessible, so that all patients with ED who require them can benefit. Trial registrationClinicalTrials.gov Identifier: NCT05569018. Registered 06 October 2022, https://clinicaltrials.gov/study/NCT05569018

Twelve-month prevalence, persistence, severity, and treatment of mood and anxiety disorders in Qatar's national mental health study.

To estimate 12-month prevalence, persistence, severity, and treatment of mental disorders and socio-demographic correlates in Qatar. We conducted the first national population-based telephone survey of Arab adults between 2019 and 2022 using the Composite International Diagnostic Interview and estimated 12-month DSM-5 mood and anxiety disorders and their persistence (the proportion of lifetime cases who continue to meet 12-month criteria). The 12-month prevalence of any disorder was 21.1% (10.4% mild, 38.7% moderate, and 50.9% severe) and was associated with: younger age, female, previously married, and with persistence of any disorder. Persistence was 74.7% (64.0% mood and 75.6% anxiety) and was significantly associated with secondary education or lower. Minimally adequate treatment received among those with any 12-month mental disorder was 10.6% (74.6% in healthcare and 64.6% non-healthcare sectors). Severity and the number of disorders significantly associated with each other and with treatment received (χ2=7.24, p=0.027) including adequate treatment within the mental health specialty sector (χ2=21.42, p<0.001). Multimorbidity and sociodemographics were associated with 12-month mental disorder. Treatment adequacy in Qatar are comparable to high-income countries. Low treatment contact indicate need for population-wide mental health literacy programes in addition to more accessible and effective mental health services.

The associations between mindfulness, metacognition and hba1c levels among diabetic pregnant patients: A case control study

Pregnancy, due to the diversity of lifestyle changes it leads to, may represent a period characterized by intensified stress. Women of childbearing age are at the highest risk for a number of health difficulties and complications, including glucose abnormalities. Such an occurrence often has a set of complex consequences for both the mother and the newborn. We aimed to examine how mindfulness and metacognition interact with HbA1c levels during pregnancy characterized by Gestational diabetes mellitus (GDM). One hundred pregnant women with GDM and ninety-eight healthy pregnant women were enrolled in the study. Average blood glucose levels were assessed by HbA1c monitoring. Participants completed the Hospital Anxiety and Depression Scale (HADS), DSM-5 Level 2- Anxiety- Adult measure (DSM-5 Anxiety), Five- Facet Mindfulness Questionnaire (FFMQ), and Metacognition Questionnaire-30 (MCQ-30). A negative correlation was found between HbA1c and FFMQ ?Describing? subtest, while a positive correlation was obtained between HbA1c and MCQ-30 ?Negative beliefs about uncontrollability and danger? subtest. Multiple linear regression showed an association between Mindfulness Describing subtest and HbA1c as an outcome variable. Findings imply the association between mindfulness on HbA1c during pregnancy period. Mindfulness cultivation seems to be relevant in emotional and cognitive processes in order to minimize negative stress related effects on well- being during pregnancy. Such approach may be beneficial in promoting treatment compliance among pregnant women with diabetes, but also among women experiencing low prenatal well-being.

The challenges of assessing anxiety symptoms for adolescents and young adults in residential treatment: The BHS-Anxiety and the GAD-7 Scales

ABSTRACT Anxiety symptoms are common, comorbid with other disorders, and damaging to well-being. High-quality assessment is necessary for detecting and monitoring these symptoms, especially within the context of residential treatment for psychiatric disorders. However, little is known about the psychometric accuracy of screening for anxiety symptoms within this severe, often comorbid sample. The current study examines the psychometric characteristics of two measures used in residential treatment: the Generalized Anxiety Disorder-7 (GAD-7) and the Behavioral Health Screen-Anxiety (BHS-Anxiety) scales. The sample included 5,639 adolescents and young adults admitted to residential psychiatric treatment in the United States. The sample was nearly all non-Hispanic White. Most (72.1%) were diagnosed with at least one DSM-5 anxiety disorder. Psychometric analyses revealed that the two measures were strongly correlated, and both showed good item discrimination, test information, and reliability. However, overlap with depressive symptoms was high, and classification accuracy based on preliminary anxiety diagnoses was low. The BHS-Anxiety scale showed measurement invariance across gender, age, and depression diagnosis groups, but the GAD-7 showed poor structural validity. Screening for highly comorbid symptoms within severe populations is difficult and understudied. High-quality measurement instruments, and innovative approaches to assessment, are needed to improve research and practice within residential treatment settings.

Treating child anxiety using family-based internet delivered cognitive behavior therapy with brief therapist guidance: A randomized controlled trial

Online treatment delivery has the potential to increase access to evidence-based mental health care for children with anxiety disorders. Using a randomized controlled trial design, we evaluated the efficacy of Cool Kids Online, a family-based and therapist supported internet-delivered cognitive behavioral treatment (CBT) designed to target anxiety disorders in children. Ninety-five children aged 7–12 years with a DSM-5 anxiety disorder were randomly allocated to Cool Kids Online or a waitlist control. Children were assessed at baseline, week 11, and 6-months following treatment. Children in waitlist received treatment after week 11 and also completed assessments immediately and six months after treatment, allowing treatment maintenance to be evaluated for all children. Compared to waitlist, Cool Kids Online led to significantly greater remission of anxiety disorders (primary and all anxiety diagnoses) and greater reduction of caregiver-reported anxiety symptoms and interference at week 11. Child-reported anxiety symptoms and interference and child- and caregiver-reported depressive or externalizing symptoms did not differ significantly between conditions. Medium to large within-treatment effects were observed for all children from pre to post treatment with post treatment effects maintained until follow-up. Overall, the findings provide support for the efficacy of the program in treating anxiety. Cool Kids Online compared to waitlist for the remission of anxiety disorders in clinically anxious children; anzctr.org.au; ACTRN12615000947505.

Accuracy of the Depression, Anxiety and Stress Scale (DASS-21) for Screening on Comorbid Internalizing Disorders among Youth in Substance Use Disorder Treatment

Introduction: Major depression, anxiety disorders, and post-traumatic stress disorder (PTSD) are among the most prevalent comorbid mental disorders in youth addiction treatment. Hence, screening for these internalizing disorders should be part of the standard routine at intake in substance use disorder treatment. We investigated the usefulness of the Depression, Anxiety and Stress Scale (DASS-21) as a screener for this purpose. Methods: A nationally representative sample of 421 treatment-seeking youths aged 16–22 years with a primary cannabis, alcohol, cocaine, or amphetamine use disorder participated in the study. At intake, we administered the DASS-21 and the Mini International Neuropsychiatric Interview (MINI; Sheehan et al., 1998) based on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), as “gold standard,” as part of a broader baseline assessment of the Youth in transition study [Moska et al. BMC Psychiatry. 2021;21(1):1–11]. Results: At comparable sensitivity (0.80–0.84), based on the optimal cut-off value, specificity was higher for the DASS-21 total score detecting any DSM-5 internalizing disorder (0.62) than for the DASS subscales specifically detecting depression, anxiety, or PTSD (0.44, 0.49, and 0.51, respectively). Receiver operating characteristic curve analyses showed an area under the curve (AUC) value of 0.80 for the DASS total score to detect any internalizing disorder (“good discrimination”), compared with AUC values of 0.70–0.75 of the DASS depression and anxiety subscales to detect DSM-5 depression, anxiety, and PTSD (“fair discrimination”). The optimal DASS total score cut-off value of ≥44 for detecting any internalizing disorder resulted in 0.81 sensitivity, 0.62 specificity, 0.80 positive predictive value, and 0.64 negative predictive value. Conclusion: Given the high prevalence of comorbid internalizing disorders in youth addiction care, the need to address these comorbid disorders in treatment, and the favorable accuracy of the DASS to detect these disorders, we recommend to implement the DASS-21 as routine screener in youth addiction treatment in the Netherlands.

Impact of the intensive psychological intervention care on post-traumatic stress disorder and negative emotions of teenage female patients seeking an induced abortion.

This study aimed to investigate the effects of intensive psychological intervention care on adverse emotions and post-traumatic stress disorder (PTSD) symptoms in female teenage patients after induced abortion. This prospective cohort study included 100 teenage female patients seeking induced abortion who were randomly divided into two groups: the intervention group (n = 50) and the control group (n = 50). The intervention group received intensive psychological intervention care, while the control group received standard routine nursing. The scores of the PTSD checklist for DSM-5 (PCL-5), self-rating depression (SDS), and self-rating anxiety scale (SAS) were compared between the two groups at 1 month and 3 months after the operation. The intervention group had lower risk of developing PTSD (24% vs. 44%), depression (10% vs. 32%), and anxiety (0% vs. 12%) symptoms at 1 month after the surgery. However, there were no significant differences observed between the two groups at 3 months after the surgery. Furthermore, the intervention group had significantly lower scores in PCL-5 (27.4 ± 5.4 vs. 31.8 ± 5.7; 20.5 ± 7.1 vs. 25.0 ± 7.5; p < 0.05), SDS (31.8 ± 5.4 vs. 37.8 ± 6.6; 26.8 ± 5.0 vs. 31.4 ± 7.2; p < 0.05), and SAS (32.7 ± 5.0 vs. 39.8 ± 6.9; 25.0 ± 2.7 vs. 27.5 ± 2.8; p < 0.05) at 1 month and 3 months after induced abortion. These findings suggest that intensive psychological intervention care can reduce the incidence and severity of depression, anxiety, and PTSD symptoms in teenage patients who undergo induced abortion. https://www.chictr.org.cn/showproj.html?proj=185200, identifier ChiCTR2300067531.

Effects of physical exercise, LEGO, and Minecraft activities on anxiety in underserved children with autism: Study design and methodological strategies

Anxiety is a common comorbidity for individuals with ASD, and there is some preliminary data about the efficacy of physical exercise to alleviate anxiety. However, we are not aware of any studies that have compared the effects of a physical exercise program on anxiety in underserved children with ASD using a randomized controlled research design. This paper describes a method to evaluate and compare the efficacy of an 8-week physical exercise intervention with a sedentary play intervention to alleviate anxiety in young children with autism spectrum disorders (ASD) from underserved backgrounds. We assessed anxiety and its physical symptoms using the parent-rated Child Behavior Checklist DSM-5 anxiety (CBCL DSM-5) subscale, the child-rated Screen for Childhood Anxiety Related Emotional Disorder (SCARED), the parent-rated Child's Sleep Habits Questionnaire (CSHQ), and salivary cortisol. We also utilized the Physical Activity Questionnaire for Older Children (PAQ-C) to assess physical activity level and identify compounds. Unique components of this study include:•Implementation of novel physical exercise and sedentary play interventions that have been designed for children with ASD.•Recruitment of predominantly underserved and non-English speaking families.

Anxiety in autistic preschool children: Phenomenology and a network analysis of correlates.

Anxiety disorders in autistic children are associated with significant functional impairment. Few studies have examined impairing anxiety presentations in autistic preschool children (i.e., 3-5 years old). This cross-sectional study examined the phenomenology of impairing anxiety and the strongest correlates of anxiety in 75 autistic preschool children. Parents completed a diagnostic interview that assesses two anxiety types, DSM-5 anxiety disorders and impairing distinct anxiety presentations, and measures of anxiety correlates. An exploratory network analysis examined connections between anxiety and its correlates. Forty percent of children had impairing anxiety. Specific phobia followed by 'other social fear,' a type of distinct anxiety, were the most common anxiety types. Child intolerance of uncertainty (IU) was the only correlate that was associated with anxiety in a network analysis framework. Child IU linked anxiety to two other correlates, sensory over-responsivity and somatic symptoms. Findings emphasize the need for early intervention for anxiety and further research on its correlates.

Validation of the Arabic version of the youth anxiety measure of the DSM-5

BACKGROUND: Child anxiety is a highly prevalent and debilitating condition. Questionnaires can help detecting high levels of anxiety in children. No child anxiety questionnaires entailing the full range of the DSM-5 anxiety disorders are available for the Arab World. Therefore, we aimed to translate the child self-report questionnaire of the Youth Anxiety Measure for DSM-5 (YAM-5, 50 items) into Arabic and to examine its psychometric properties.METHODS: We employed a translation-back-translation procedure. We recruited 678 patients who were 8-/12-year-old (M=10.74, SD=1.04) school-going children in Algeria.RESULTS: The internal consistency of the total scale was excellent, and the internal consistencies of the two subparts of the YAM-5 were good. The factor analyses showed that it seems most valid to provide Arabic children the available alternative version of the YAM-5, that combines symptoms of agoraphobia and panic disorder into one subscale.CONCLUSIONS: Overall, the results of this study indicate the usefulness of the Arabic version of the child anxiety questionnaire YAM-5.

Beyond maintaining safety: Examining the benefit of emotion-centered problem solving therapy added to safety planning for reducing late life suicide risk

Few clinical trials have examined brief non-pharmacological treatments for reducing suicide risk in older Veterans, a high-risk group. Problem Solving Therapy (PST) is a promising psychosocial intervention for reducing late life suicide risk by increasing adaptive coping to problems through effective problem solving and related coping skills. The current randomized clinical trial will compare the efficacy of six telephone-delivered sessions of Safety Planning (enhanced usual care; EUC) only or an updated version of PST (emotion-centered PST [EC-PST]) + EUC to determine the added clinical benefit of EC-PST for reducing severity of suicidal ideation and for increasing reasons for living, a critical protective factor. Participants randomized to EC-PST + EUC or EUC only will be 150 Veterans (75 each) with active suicidal ideation who are aged 60 or older; have a current DSM-5 anxiety, depressive, and/or trauma-related disorder; and without significant cognitive impairment. Primary outcomes (Geriatric Suicide Ideation Scale and Reasons for Living-Older Adults scale) will be assessed at 11 timepoints: baseline, after each of 6 treatment sessions, posttreatment, and at follow-up at 1, 3, and 6 months posttreatment, and analyzed using mixed effects modeling. Additionally, moderators and mediators of primary outcomes will be examined—functional disability, executive dysfunction, and problem-solving ability. Qualitative feedback from participants will identify potential Veteran-centric changes to the EC-PST protocol and to EUC. Ultimately, the goal of this study is to inform the evidence-based clinical practice guidelines for treatments to reduce suicide risk in older Veterans and specifically to inform clinical decision-making regarding the merit of adding EC-PST to EUC.

The role of metacognitions in cyberbullying and cybervictimization among adolescents diagnosed with major depressive disorder and anxiety disorders: A case-control study.

Cyberbullying is becoming increasingly widespread as individuals use technology more widely and frequently. Recent studies have shown a growing vulnerability for cyberbullying and cybervictimization, particularly in the adolescent population. We argue that dysfunctional metacognitions, which have been found to be prominent in various psychiatric disorders, may also play a role in predicting cyberbullying and cybervictimization over and above a variety of established factors including daily Internet use, social media use, depression and anxiety. For this purpose, we recruited 121 adolescents diagnosed with major depressive disorder (MDD) and 122 adolescents diagnosed with anxiety disorders (AD) from the child and adolescent psychiatric department of 'Çankırı State Hospital' along with age and gender matched healthy controls (n = 120). Participants completed the DSM-5 Depression and Anxiety Severity Scales, the Social Media Disorder Scale (SMDS), the Metacognitions Questionnaire for Children (MCQ-C) and the Revised Cyberbullying Inventory-II (RCBI-II). Cybervictimization scores were found to be higher in the MDD and AD groups when compared with healthy controls. Cyberbullying scores in the MDD group were higher than healthy controls. Additionally, the Superstition, Punishment and Responsibility subdimension of the MCQ-C was a significant predictor of cybervictimization in the AD group while controlling for daily Internet use, social media use and anxiety. However, metacognitions were not associated with cyberbullying in the MDD and AD groups, as well as with cybervictimization in the MDD group. We concluded that dysfunctional metacognitions may be a preventive therapeutic target in reducing the impact of cyberbullying in adolescents with AD.

Interpretation of PROMIS Depression and Anxiety Measures Compared with DSM-5 Diagnostic Criteria in Musculoskeletal Patients.

In this cross-sectional analysis, existing medical records were reviewed for 50 patients who presented to an interdisciplinary program within a tertiary care orthopaedic department for the treatment of ≥1 musculoskeletal condition. All patients completed PROMIS Depression and Anxiety measures and were evaluated by a board-certified clinical psychologist. Receiver operating characteristic (ROC) curve analyses were performed to assess the diagnostic accuracy of PROMIS Depression and Anxiety scores as compared with the psychologist's diagnosis of a DSM-5 depressive or anxiety disorder. Twenty-eight patients (56%) were diagnosed by the psychologist with a DSM-5 depressive disorder, and 15 (30%) were diagnosed with a DSM-5 anxiety disorder. The ROC analysis for PROMIS Depression had an area under the curve (AUC) of 0.82. The optimal score cutoff to predict a diagnosis of a DSM-5 depressive disorder was ≥53 (sensitivity, 79% [95% CI, 63% to 94%]; specificity, 86% [72% to 100%]; positive predictive value [PPV], 88% [75% to 100%]; negative predictive value [NPV], 76% [59% to 93%]). The ROC analysis for PROMIS Anxiety had an AUC of 0.67. The optimal score cutoff to predict a diagnosis of a DSM-5 anxiety disorder was ≥59 (sensitivity, 60% [95% CI, 35% to 85%]; specificity, 74% [60% to 89%]; PPV, 50% [27% to 73%]; and NPV, 81% [68% to 95%]). Modestly elevated PROMIS Depression scores were suggestive of the presence of a DSM-5 depressive disorder, whereas elevations in PROMIS Anxiety scores seemed to have less association with DSM-5 anxiety disorders. Nevertheless, neither PROMIS measure demonstrated adequate discriminant ability to definitively identify patients who met DSM-5 criteria. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Divergent presentation of anxiety in high-risk groups within the intellectual disability population

BackgroundAnxiety symptomatology is common in individuals with intellectual disability (ID). Symptomatology includes both traditional Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) anxiety disorders and autism spectrum disorder (ASD)-related anxiety traits. Some genetic disorders such as Cornelia de Lange (CdLS) and fragile X syndromes (FXS) are at very high risk of anxiety and afford the opportunity to examine prevalence, profiles and associated person characteristics. However, prevalence and associated characteristics of anxiety in these high-risk groups remain poorly described and understood. The aim of the current study was to examine the prevalence and profile of DSM-5 and ASD-related anxiety symptomatology in individuals with CdLS and FXS and associated behavioural and cognitive characteristics.MethodsQuestionnaires and interviews assessing DSM-5 and ASD-related anxiety were conducted with caregivers of individuals with CdLS (n = 49) and FXS (n = 36).ResultsDSM-5 anxiety symptomatology was present in both groups with high co-morbidity across anxiety diagnoses. ASD-related anxiety was also prevalent with specific difficulties related to intolerance of uncertainty identified in both groups. Symptomatology was persistent over the lifespan for both groups. Anxiety type was partially associated with repetitive behaviour but not measures of overall ASD phenomenology in CdLS.ConclusionsDSM-5 and ASD-related anxiety are common in these high-risk syndromes associated with ID. Prospective syndrome specific presentations and associations, which may implicate specific underlying mechanisms, are discussed. Clinicians should be aware of the risk and difficulties involved in assessment of anxiety in individuals with ID, including atypical types, to ensure these individuals do not “miss” diagnoses and support in general clinical practice.

Effects Of An Exercise-primed Cognitive Behavioral Therapy Pilot Trial On Anxiety In Adults With Depression

Acute exercise improves mood, cognitive function, energy and engagement in people suffering from depression. Priming cognitive behavioral therapy (CBT) sessions with acute exercise may enhance its effectiveness. Anxiety is a common major comorbidity of depression and can make treatments less effective but is also treated with CBT. Priming CBT with exercise may also enhance the anxiolytic response. PURPOSE: To quantitatively and qualitatively analyze the effects of eight weekly virtual CBT sessions primed with either 30 minutes of moderate intensity exercise (ActiveCBT) or quiet-rest (CalmCBT) on anxiety in adults with depression. METHODS: Ten adults diagnosed with DSM-5 depression were randomized to either ‘active’ (n = 5) or ‘calm’ (n = 5) conditions. Participants completed the Generalized Anxiety Disorder-7 (GAD-7) to provide anxiety symptom severity at baseline, final, and 3-month (3 m) follow-up visits. Mean GAD-7 scores and percent change from baseline to final and 3 m were calculated. A qualitative interview was conducted at the final visit. To investigate the conditions’ effects, three coders created a deductive codebook for initial coding to assess feasibility, satisfaction, and feedback of the overall treatment. The coded data was then used to identify the interventions’ effects on anxiety symptoms from the DSM-5 anxiety disorder criteria. RESULTS: Mean GAD-7 scores and standard deviations for the active condition were 15.0 (4.3) at baseline, 4.2 (2.7) at final, and 9.8 (6.5) at 3 m, and for the calm condition were 6.4 (4.4) at baseline, 5.0 (5.2) at final, and 5.3 (1.3) at 3 m. The active/calm conditions resulted in a 72%/22% decrease in GAD-7 score from baseline to final and 35%/17% from baseline to 3 m. Common themes from the qualitative interview included alleviating excessive anxiety and worry, improved ability to control anxiety and worry, and improved sleep quality that were potentially related to pre-CBT condition. CONCLUSIONS: The present results provide preliminary efficacy evidence that priming CBT sessions with exercise may more effectively treat anxiety in a depressed population than standard CBT. The 30 minutes before CBT sessions could be a useful window to engage in anxiolytic preparatory activities prior to therapy. Further research priming CBT with exercise is warranted.

The effects of a physical exercise program, LEGOR and Minecraft activities on anxiety in underserved children with autism spectrum disorder

BackgroundAnxiety is a frequent comorbidity in children with autism spectrum disorder (ASD). Physical exercise is a low cost and easy-to-access intervention with therapeutic benefits for reducing anxiety in adults and adolescents. There are currently no randomized controlled trials on the feasibility and efficacy of a physical exercise intervention to reduce anxiety in younger children with ASD. Method148 children (6–12 years old) with ASD were randomized into a clinical trial to evaluate the efficacy of an 8-week exercise protocol designed to reduce anxiety specifically in younger children with ASD. Participants were randomized to an exercise intervention group (N = 76) or sedentary activity LEGO/Minecraft group (N = 72). Both programs were administered 1–3 times weekly for 8 weeks. Anxiety was assessed via parent ratings with the Child Behavior Checklist DSM-5 anxiety subscale (CBCL DSM-5) at weeks 1, 3, 6, and 8 as well as follow up at weeks 12 and 16. Secondary outcome measures included child self-reported anxiety (Screen for Child Anxiety Related Disorders; SCARED), sleep (Child’s Sleep Habits Questionnaire, CSHQ-ATN), physical activity level (Physical Activity Questionnaire, PAQ-C), and salivary cortisol measured at weeks 1, 3, 6, and 8. ResultsParent-rated (CBCL DSM-5) and self-reported (SCARED) anxiety scores showed improvements at weeks 3, 6 and 8 in both groups with no significant differences between the physical exercise and sedentary activity (LEGO/Minecraft) groups. In addition, the CBCL DSM-5 anxiety scores decreased only in the physical exercise group at weeks 12 and 16 compared to baseline with no significant difference from LEGO/Minecraft group. Sleep also showed improvements during weeks 6 and 8 in the physical exercise group but not in the LEGO/Minecraft group with no significant differences between the groups. Physical activity level was significantly increased in the physical exercise group compared to the LEGO/Minecraft group at week 8. Salivary cortisol did not show any significant changes from weeks 1–8 or differences between groups. ConclusionEight-week physical exercise and sedentary LEGO/Minecraft interventions reduced parent-rated and self-reported anxiety in 6–12-year-old underserved children with ASD with no significant difference between the intervention groups.

Right Frontal Theta: Is It a Response Biomarker for Ketamine's Therapeutic Action in Anxiety Disorders?

Anxiety disorders are the most prevalent mental disorders in the world, creating huge economic burdens on health systems and impairing the quality of life for those affected. Recently, ketamine has emerged as an effective anxiolytic even in cases resistant to conventional treatments (TR); but its therapeutic mechanism is unknown. Previous data suggest that ketamine anxiety therapy is mediated by reduced right frontal electroencephalogram (EEG) theta power measured during relaxation. Here we test for a similar theta reduction between population-sample, presumed treatment-sensitive, (TS) anxiety patients and healthy controls. Patients with TS DSM-5 anxiety disorder and healthy controls provided EEG during 10 min of relaxation and completed anxiety-related questionnaires. Frontal delta, theta, alpha1, alpha2, beta, and gamma power, Higuchi’s fractal dimension (HFD) and frontal alpha asymmetry (FAA) values were extracted to match ketamine testing; and we predicted that the controls would have less theta power at F4, relative to the TS anxious patients, and no differences in HFD or FAA. We provide graphical comparisons of our frontal band power patient-control differences with previously published post-pre ketamine TR differences. As predicted, theta power at F4 was significantly lower in controls than patients and FAA was not significantly different. However, HFD was unexpectedly reduced at lateral sites. Gamma power did not increase between controls and patients suggesting that the increased gamma produced by ketamine relates to dissociation rather than therapy. Although preliminary, and indirect, our results suggest that the anxiolytic action of ketamine is mediated through reduced right frontal theta power.

A scoping review investigating the use of exposure for the treatment and targeted prevention of anxiety and related disorders in young people.

Cognitive Behavioural Therapy (CBT) is the gold standard intervention for anxiety and related mental health disorders among young people; however, the efficacy of individual elements of CBT (e.g., exposure to feared stimuli) have received little scrutiny. This scoping review, informed by three stakeholder groups and a scientific advisory group, aimed to identify the nature and extent of the available research literature on the efficacy of exposure to feared stimuli, moderators of effectiveness in young people aged 14-24years. Three international stakeholder groups composed of clinicians (N=8), parents/carers (N=5) and youth with lived experience of anxiety (N=7) provided input into study design and results. Using the PRISMA extension for scoping reviews, a search of MEDLINE/Ovid, PsycINFO, PubMed, CINAHL, SCOPUS, EMBASE, ERIC, and Health Collection (informit) was conducted using terms related to anxiety, ages 14-24, and exposure. From 3508 unique abstracts, 64 papers were included for the review. While there was evidence for the efficacy of exposure as a treatment for youth anxiety disorders, fundamental gaps in knowledge of exposure in this age group were identified. Most studies examined post-traumatic stress disorder, obsessive-compulsive disorder, and specific phobias with no randomised clinical trials uniquely evaluating exposure for the treatment of DSM-5 anxiety disorders. Exposure was typically delivered accompanied by other anxiety management techniques. A multitude of optimisation strategies have been tested, yet only one of these effects (timing relative to sleep) showed preliminary evidence of replication. A systematic and theoretically driven program of research investigating the efficacy of exposure in young people and factors that moderate its efficacy, along with methods to overcome barriers for delivery, is urgently needed.

Anxiety–Amygdala Associations: Novel Insights From the First Longitudinal Study of Autistic Youth With Distinct Anxiety

In the current issue of Biological Psychiatry, Andrews et al. ( 1 Andrews D.S. Aksman L. Kerns C.M. Lee J.K. Winder-Patel B.M. Harvey D.J. et al. Association of amygdala development with different forms of anxiety in autism spectrum disorder. Biol Psychiatry. 2022; 91: 977-987 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar ) offer novel and important insights into how the amygdala is associated with anxiety in autism. Despite much theoretical rationale for a role of the amygdala in anxiety in individuals diagnosed with autism spectrum disorder (ASD) ( 1 Andrews D.S. Aksman L. Kerns C.M. Lee J.K. Winder-Patel B.M. Harvey D.J. et al. Association of amygdala development with different forms of anxiety in autism spectrum disorder. Biol Psychiatry. 2022; 91: 977-987 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar , 2 Yarger H.A. Nordahl C.W. Redcay E. Examining associations between amygdala volumes and anxiety symptoms in autism spectrum disorder [published online ahead of print Oct 21]. Biol Psychiatry Cogn Neurosci Neuroimaging. 2021; PubMed Google Scholar , 3 Herrington J.D. Maddox B.B. Kerns C.M. Rump K. Worley J.A. Bush J.C. et al. Amygdala volume differences in autism spectrum disorder are related to anxiety. J Autism Dev Disord. 2017; 47: 3682-3691 Crossref PubMed Scopus (41) Google Scholar , 4 Juranek J. Filipek P.A. Berenji G.R. Modahl C. Osann K. Spence M.A. Association between amygdala volume and anxiety level: Magnetic resonance imaging (MRI) study in autistic children. J Child Neurol. 2006; 21: 1051-1058 Crossref PubMed Scopus (94) Google Scholar , 5 Yarger H.A. Redcay E. A conceptual model of risk and protective factors associated with internalizing symptoms in autism spectrum disorder: A scoping review, synthesis, and call for more research. Dev Psychopathol. 2020; 32: 1254-1272 Crossref PubMed Scopus (5) Google Scholar ), previous empirical studies have yielded mixed results on the magnitude (or presence), direction, and laterality of the association between anxiety and amygdala volumes. Measurement of anxiety has varied across studies, with differing assessment tools, as well as the use of dimensional versus categorical approaches to evaluating the presence of anxiety. In addition, recent research ( 2 Yarger H.A. Nordahl C.W. Redcay E. Examining associations between amygdala volumes and anxiety symptoms in autism spectrum disorder [published online ahead of print Oct 21]. Biol Psychiatry Cogn Neurosci Neuroimaging. 2021; PubMed Google Scholar , 6 Kerns C.M. Winder-Patel B. Iosif A.M. Nordahl C.W. Heath B. Solomon M. et al. Clinically significant anxiety in children with autism spectrum disorder and varied intellectual functioning. J Clin Child Adolesc Psychol. 2021; 50: 780-795 Crossref PubMed Scopus (32) Google Scholar ) has argued that traditional, “DSM” anxiety disorders as operationalized in the DSM-5 ( 7 American Psychiatric A. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. American Psychiatric Association, Washington, D.C.2013 Crossref Google Scholar ) (e.g., generalized anxiety disorder, separation anxiety, specific phobia, and social phobia—referred to as “DSM anxiety” in the remainder of the commentary) do not capture all types of anxiety that individuals with ASD experience ( 6 Kerns C.M. Winder-Patel B. Iosif A.M. Nordahl C.W. Heath B. Solomon M. et al. Clinically significant anxiety in children with autism spectrum disorder and varied intellectual functioning. J Clin Child Adolesc Psychol. 2021; 50: 780-795 Crossref PubMed Scopus (32) Google Scholar ). Instead, researchers have posited that individuals with ASD experience “distinct anxiety,” which includes anxieties such as idiosyncratic fears (e.g., fears of toilets), social anxiety without the fear of evaluation by others (required criterion for diagnosis of DSM social anxiety), or fear of change. The diverse methods used to assess anxiety and the failure to evaluate the presence of anxiety experienced specifically by those with ASD (i.e., distinct anxiety) may be contributing to these mixed results. Andrews et al. ( 1 Andrews D.S. Aksman L. Kerns C.M. Lee J.K. Winder-Patel B.M. Harvey D.J. et al. Association of amygdala development with different forms of anxiety in autism spectrum disorder. Biol Psychiatry. 2022; 91: 977-987 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar ) address these limitations in the first published study to investigate and report associations between amygdala volumes and DSM anxiety and distinct anxiety in autistic youth and, notably, is the first to look at developmental trajectories in amygdala growth over time with relation to distinct and DSM anxiety in autistic youth. SEE CORRESPONDING ARTICLE ON PAGE 977 SEE CORRESPONDING ARTICLE ON PAGE 977 Association of Amygdala Development With Different Forms of Anxiety in Autism Spectrum DisorderBiological PsychiatryVol. 91Issue 11PreviewThe amygdala is widely implicated in both anxiety and autism spectrum disorder. However, no studies have investigated the relationship between co-occurring anxiety and longitudinal amygdala development in autism. Here, the authors characterize amygdala development across childhood in autistic children with and without traditional DSM forms of anxiety and anxieties distinctly related to autism. Full-Text PDF

Neurocircuitry of treatment in anxiety disorders.

Background:Understanding how treatments change neurobiology is critical to developing predictors of treatment response. This is especially true for anxiety disorders—the most common psychiatric disorders across the lifespan. With this in mind, we examined neurofunctional predictors of treatment response and neurofunctional changes associated with treatment across anxiety disorders.Methods:PubMed/Medline was searched for prospective treatment studies that included parallel examinations of functional activation or connectivity (both task-based and resting state) in adults and youth with panic disorder and generalized, separation, and/or social anxiety disorders published before April 30, 2021. All studies examining baseline predictors or changes related to pharmacologic and psychotherapeutic treatment of DSM-TV and DSM-5 anxiety disorders were included. Demographic, clinical, and treatment data as well as neurofunctional outcomes were extracted and summarized.Results:Twenty-nine studies examined changes in functional activation and/or connectivity (56 treatment arms) related to treatment and twenty-three examined neurofunctional predictors of treatment response. Predictors of treatment response and treatment-related neurofunctional changes were frequently observed within amygdala-prefrontal circuits. However, immense heterogeneity and few replication studies preclude a cohesive neurofunctional treatment response model across anxiety disorders.Conclusions:The extant literature describing neurofunctional aspects of treatment response in anxiety disorders is best viewed as a partially constructed scaffold on which to build a clinically translatable set of robust neuroimaging biomarkers that can be used to guide treatment and to select from available treatment. The construction of this understanding will require harmonization of analytic and task approaches, larger samples, and replication of component studies.