Maintenance Of Anxiety Disorders Research Articles

"The Role of Sleep Disorders in the Development and Maintenance of Anxiety Disorders: A Transdiagnostic Approach"

"The Role of Sleep Disorders in the Development and Maintenance of Anxiety Disorders: A Transdiagnostic Approach"

THE CONTRIBUTIONS OF COGNITIVE BEHAVIORAL THERAPY IN PROFESSIONAL PERFORMANCE ANXIETY: A narrative

Anxiety disorders have been widely discussed in the field of psychology and psychiatry. When anxiety is maladaptive, the damage is significant in the personal and professional spheres of the subjects' lives. In the professional sphere, it is understood that several phenomena become risk factors for the development or maintenance of anxiety disorders, also known as professional performance anxiety or performance anxiety. Feelings associated with uncertainty and fear are common, since there is great difficulty in entering, remaining, and returning to the job market, in addition, epidemiological crises, the type of work, perceptions associated with low autonomy, the Inauthentic leadership and the lack of strategic programs aimed at mental health contribute to worsening symptoms. With the aim of mapping the relationship between professional performance anxiety and treatment strategies, a literature review was carried out using databases Scielo, PubMed, CAPES journals, PEPSIC and PsycNet. Cognitive-Behavioral therapy has been shown to be efficient and effective in treating anxiety disorders and can help reduce performance anxiety. Various techniques can be used, which include recording thoughts, psychoeducation, mindfulness and even exposure via virtual reality.

A multi-method assessment of emotional processes predicting longitudinal anxiety symptom trajectories in an adolescent clinical sample

ObjectiveEmotion recognition, reactivity, and regulation are important in the development and maintenance of anxiety disorders. Whether and how these processes differentiate between different trajectories in anxiety remain unclear. The current study examined emotional processes as prospective predictors of anxiety symptom trajectories in psychiatrically hospitalized youth. MethodParticipants were 180 adolescents (Mage = 14.89; SD = 1.35) from a psychiatric inpatient unit. At index hospitalization, participants completed a behavioral task assessing facial emotion recognition, and self-report measures of emotion dysregulation and reactivity. They completed a self-report measure on anxiety symptoms at baseline and 3, 6, 12, and 18 months post-discharge. Latent growth curve analysis was conducted to identify subgroups of individuals based upon their trajectory of anxiety symptoms across 18-months. ANOVAs were used to examine subgroup differences in emotional processing variables. ResultsThree distinct trajectories were identified, a stable moderate-to-high anxiety group, a group with moderate-to-high anxiety at baseline with symptom improvement over time, and a group characterized by relatively stable low-to-moderate anxiety throughout the study. The two initially moderate-to-high anxiety groups scored higher for emotion dysregulation and emotion reactivity at baseline compared to the low-to-moderate anxiety group. Emotion regulation difficulties relating to emotional non-acceptance were higher for the stable moderate-to-high anxiety group than for the moderate-to-high anxiety group that experience symptom improvement over time. ConclusionsThese findings may have clinical implications for discharge planning. Future studies should explore emotion regulation with a focus on non-acceptance of one’s emotional experiences as a potential target of intervention in individuals with elevated anxiety.

Evaluating the effect of action-like video game play and of casual video game play on anxiety in adolescents with elevated anxiety: protocol for a multi-center, parallel group, assessor-blind, randomized controlled trial

BackgroundAdolescence is a critical period for the onset and maintenance of anxiety disorders, which raises the importance of intervening early; one possibility of doing so is via digital interventions. Within that research field, at least two important research paths have been explored in the past years. On the one hand, the anxiolytic effect of casual video games has been tested as such gaming activity may distract away from anxious thoughts through the induction of flow and redirection of attention toward the game and thus away of anxious thoughts. On the other hand, the bidirectional link between weak attentional control and higher anxiety has led to the design of interventions aiming at improving attentional control such as working memory training studies. Taking stock that another genre of gaming, action video games, improves attentional control, game-based interventions that combines cognitive training and action-like game features would seem relevant. This three-arm randomized controlled trial aims to evaluate the feasibility and the efficacy of two video game interventions to document how each may potentially alleviate adolescent anxiety-related symptoms when deployed fully on-line.MethodsThe study aims to recruit 150 individuals, 12 to 14 years of age, with high levels of anxiety as reported by the parents’ online form of the Screen for Child Anxiety Related Disorders questionnaire. This trial contrasts a child-friendly, “action-like” video game designed to improve attentional control abilities in a progressive and stepwise manner (Eco-Rescue), a casual puzzle video game selected to act as a positive distraction tool (Bejeweled) and finally a control group with no assigned training intervention to control for possible test-retest effects (No-training). Participants will be assigned randomly to one of the three study arms. They will be assessed for main (anxiety) and secondary outcomes (attentional control, affective working memory) at three time points, before training (T1), one week after the 6-week training (T2) and four months after completing the training (T3).DiscussionThe results will provide evidence for the feasibility and the efficacy of two online video game interventions at improving mental health and emotional well-being in adolescents with high levels of anxiety. This project will contribute unique knowledge to the field, as few studies have examined the effects of video game play in the context of digital mental health interventions for adolescents.Trial registrationThe trial is registered on ClinicalTrials.gov (NCT05923944, June 20, 2023).

Gaze and avoidant patterns of visual attention to aversive stimuli during fear habituation trial: A pilot eye tracking study

Previous studies have revealed that attentional bias toward aversive stimuli may play a causal role in the development and maintenance of anxiety disorders. This pilot study designed an experiment, using eye tracking, to capture gaze patterns individuals may display during a fear habituation trial. Three trials were conducted with twenty-eight subjects who reported aversion to insects. Pictures of cockroaches were used as aversive stimuli. The time proportion of the total visit duration and average visit duration toward aversive stimuli were analyzed using a mixed ANOVA, with three habituation trials and four self-report on fear level scores as within-participants factors. Across trials, the time proportion of total visit duration was relatively low when fear levels were high, and increased when fear levels decreased. Across trials, the average visit duration was short when fear levels were relatively high, and the average visit duration became relatively long as fear levels decreased. The results indicated that higher fear levels during exposure are likely to lead to attentional avoidance which might be a strategic effortful coping process (Eysenck, et al. 2007). This study is an crucial first step toward understanding the gaze patterns that fearful individuals may display during exposure trials. Using eye tracking technology, we objectively identified these gaze patterns and opened avenues to enhance the efficacy of exposure-based interventions tailored to address phobias.

Individual patterns of visual exploration predict the extent of fear generalization in humans.

Generalization of fear is considered an important mechanism contributing to the etiology and maintenance of anxiety disorders. Although previous studies have identified the importance of stimulus discrimination for fear generalization, it is still unclear to what degree overt attention to relevant stimulus features might mediate its magnitude. To test the prediction that visual preferences for distinguishing stimulus aspects are associated with reduced fear generalization, we developed a set of facial stimuli that was meticulously manipulated such that pairs of faces could either be distinguished by looking into the eyes or into the region around mouth and nose, respectively. These pairs were then employed as CS + and CS- in a differential fear conditioning paradigm followed by a generalization test with morphs in steps of 20%. Shock expectancy ratings indicated a moderately curved fear generalization gradient that is typical for healthy samples, but its shape was altered depending on individual attentional deployment: Particpants who dwelled on the distinguishing facial features faster and for longer periods of time exhibited less fear generalization. Although both pupil and heart rate responses also showed a generalization gradient, with pupil diameter and heart rate deceleration increasing as a function of threat, these responses were not significantly related to visual exploration. In total, the current results indicate that the extent of explicit fear generalization depends on individual patterns of attentional deployment. Future studies evaluating the efficacy of perceptual trainings that aim to augment stimulus discriminability in order to reduce (over)generalization seem desirable. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Bochum Assessment of Avoidance-based Emotion Regulation for Children (BAER-C): Development and evaluation of a new instrument measuring anticipatory avoidance-based emotion regulation in anxiety eliciting situations.

Avoidance-based emotion regulation plays a central role in the development and maintenance of anxiety disorders across the life span. However, measures for children that account for different avoidance strategies, are scarce. Derived from Gross' Process Model of Emotion Regulation, the Bochum Assessment of Avoidance-based Emotion Regulation for Children (BAER-C) was developed to assess avoidance strategies (cognitive avoidance, behavioural avoidance, verbal reassurance, and social reassurance) and reappraisal in anticipatory anxious situations. In the present study, the BAER-C was administered to 129 school children aged 8 to 14 and 199 children with anxiety disorders aged 8 to 16 and their parents, along with established measures on anxiety, psychopathology, and emotion regulation. Factor structure, internal consistency, convergent, divergent and construct validity were analysed. Results of the anxious sample showed a satisfactory internal consistency (McDonald's ω = .94) for all scales as well as positive correlations with anxiety symptoms (all rs > .17, all ps < .05). Factor analysis supported a five-factor model. This model was confirmed in the student sample. Children with an anxiety disorder scored higher on behavioural avoidance, verbal reassurance, and social reassurance than school children (F (5,304) = 12.63, p = .003, ηp2 = .17). Results for construct validity were ambiguous. Our analyses suggest that the BAER-C is a promising theory-based new instrument to reliably assess different avoidance strategies in children. More research is needed to further analyse construct validity with other emotion regulation questionnaires.

Extinction Learning Across Development: Neurodevelopmental Changes and Implications for Pediatric Anxiety Disorders.

Alterations in extinction learning relate to the development and maintenance of anxiety disorders across the lifespan. While exposure therapy, based on principles of extinction, can be highly effective for treating anxiety, many patients do not show sufficient improvement following treatment. In particular, evidence suggests that exposure therapy does not work sufficiently for up to 40% of children who receive this evidence-based treatment.Importantly, fear learning and extinction, as well as the neural circuitry supporting these processes, undergo dynamic changes across development. An improved understanding of developmental changes in extinction learning and the associated neural circuitry may help to identify targets to improve treatment response in clinically anxious children and adolescents. In this chapter, we provide a brief overview of methods used to study fear learning and extinction in developmental populations. We then review what is currently known about the developmental changes that occur in extinction learning and related neural circuitry. We end this chapter with a discussion of the implications of these neurodevelopmental changes for the characterization and treatment of pediatric anxiety disorders.

Childhood Anxiety - The Role of Parenting: A Review

This article intends to review the influences of parenting on the development of childhood anxiety disorders. The literature cites acceptance of anxious behaviours as a parental behaviour that mitigates childhood clinical anxiety. Alternatively, controlling parental behaviours, and modelling of controlling parental behaviours are associated with high clinical anxiety in children. Some parental climates that exaggerate a child’s psychological arousal may instill negative perceptions in the maintenance of an anxiety disorder. The article also looks into stress-mediated pathways that explain how an anxious familial climate may result in a child ‘inducing’ anxiety. Recent developmental psychopathology perspectives consider causal relationships in development, maintenance and persistence of anxiety disorders. Furthermore, the Craske model provides a real-life application of the developmental psychopathology perspective to explain the role of parenting in childhood anxiety. Current limitations and research gaps in the literature pertaining to the influences of parenting in childhood anxiety disorders are also discussed.

Fear learning and generalization during pandemic fear: How COVID-19-related anxiety affects classical fear conditioning with traumatic film clips

The COVID-19 pandemic greatly disrupted our daily lives. Worldwide, people were confronted with health, financial, and existential fears or trauma-like experiences. Recent studies have identified an increase in stress, anxiety, and fear symptoms in connection with the pandemic. Furthermore, fear learning processes are central mechanisms in the development and maintenance of anxiety disorders. Patients commonly show impairments not only in fear learning but also in its generalization. Thus, pandemic-related anxiety may constitute a risk factor for both enhanced fear acquisition and generalization. In a pre-registered online study with a final sample of 220 healthy university students, we investigated whether participants with higher COVID-19-related anxiety (COVID-Anxiety) show impaired fear learning and generalization. For this purpose, we used a differential fear conditioning paradigm with a traumatic film clip as the unconditioned stimulus (US) and collected US-expectancy as the main measure of interest. Participants with high COVID-Anxiety show a tendency toward poorer discrimination between the reinforced conditioned stimulus (CS+) and the unreinforced conditioned stimulus (CS−) during acquisition and significantly poorer discrimination patterns during generalization. Furthermore, participants with high COVID-Anxiety show greater general fear throughout the whole experiment. Our results show that the subjective effects of the COVID-19 pandemic on psychological well-being are associated with impairments in both fear learning and fear generalization. As expected, high COVID-Anxiety leads to poorer performance in stimulus discrimination and greater levels of fear, which might contribute to a higher risk of anxiety disorders. German clinical trial registerDRKS00022761.

The Moderator Role Of Gender In The Relationship Between Behavioral Inhibition And Parental Behaviour In Preschool Children

IntroductionPreschool Behavioural Inhibition (BI) was found to be a temperamental risk factor of anxiety disorders in later life; especially in women. Similarly, previous research revealed that parental behaviour plays a major role in the development and maintenance of anxiety disorders. Gender differences in parental responses to child’s temperament may contribute to the stronger association between BI and anxiety disorders in females.ObjectivesWe aimed to examine the moderating effect of child’s gender in the association between child’s BI and parenting behaviour in a non-clinical sample of parents of preschool children.MethodsA cross-sectional sample of parents (N=94) of preschool children (girls 47.4%) filled out the Behavioural Inhibition Questionnaire (BIQ) and the Multidimensional Assessment of Parenting Scale (MAPS).ResultsChild’s gender was found to moderate the relationships between BIQ scores and MAPS Supportive Parenting (F(3,90)=4.350, p=.007, R2=.127), as well as Hostile Parenting (F(3,89)=3.478, p=.019, R2=.105). In boys, higher BIQ scores were associated with higher levels of Supporting Parenting (b=.005, p=.027), while in girls this association was reversed (b=-.004, p=.037). Furthermore, in boys, no association was found between BIQ scores and Hostile Parenting (b=.005, p=.835); however, higher BIQ scores were related to higher levels of Hostile Parenting in girls (b=.067, p&lt;.001).ConclusionsOur results suggest that parental responses to their preschool child’s Behavioural Inhibition may vary as a function of child’s gender. This may lead to gender differences in developmental pathways to anxiety disorders.DisclosureNo significant relationships.

Smokers show increased fear responses towards safety signals during fear generalization, independent from acute smoking

Smoking is highly prevalent among patients with anxiety disorders. Previous studies suggest that smokers show altered fear learning as compared to non-smokers. To test the effect of acute smoking on fear learning and generalization, we conducted a fear learning experiment online. 202 healthy subjects learned to differentiate a danger and a safe cue on day 1 and were tested for generalization of threat responses 24 h later. To see if the timing of smoking impacts fear learning, we formed three smoker groups with manipulations of acute smoking and withdrawal at different time-points (each group: n = 46) and one non-smoker control group (n = 64). Smoking manipulations contained a 6 h withdrawal after fear learning, smoking directly before or after fear learning. We found no group differences between smoker manipulation groups for fear learning or generalization. However, we found differences in fear generalization between smokers and non-smokers. Smokers showed increased fear ratings towards the stimulus that has been learned as safe and higher US expectancy to stimuli similar to the safe stimulus, when compared to non-smokers. Smoking might constitute a risk factor for impaired discrimination between danger and safety and smoking restrictions could be an effective way to reduce the risks of development or maintenance of anxiety disorders.

Responding to Threat: Associations Between Neural Reactivity to and Avoidance of Threat in Pediatric Anxiety

Previous research implicates elevated threat responsivity, including neural reactivity to and avoidance of threat, in the maintenance of anxiety disorders. However, these two potential mechanisms have previously been considered separately. Using multiple levels of analysis to improve our understanding of threat responsivity could maximize the clinical utility of empirical findings. The present study uses a multimodal approach to investigate the association between neural reactivity to and avoidance of threat in pediatric anxiety.

The Association Between Test Anxiety, Self-Efficacy, and Mental Images Among University Students: Results From an Online Survey.

Background and Objectives: A substantial portion of students report test anxiety, and those reporting low levels of self-efficacy seem to be especially affected. Previous research has indicated the relevance of mental images in the maintenance of anxiety disorders, however, no data are available with respect to test anxiety. In order to close this gap, the present study investigates the association between test anxiety, self-efficacy and mental images.Method: One hundred sixty-three university students completed an online survey. Test anxiety (PAF), general self-efficacy (WIRKALL-r), study-related self-efficacy (WIRK_STUD), intrusiveness of mental images (IFES), spontaneous use of imagery (SUIS) and vividness of imagery (VVIQ) were examined.Results: Test-related mental images were frequently reported among the surveyed students. Test anxiety showed a positive correlation with IFES and a negative correlation with self-efficacy. Mediation analyses showed that about one fifth of the influence of self-efficacy on test anxiety is mediated by IFES.Discussion: The present study gives first indication about an association between test anxiety, self-efficacy and mental images, even though the results are limited with respect to generalizability. Further investigations with respect to the impact of test-related mental images on the self-efficacy/test-anxiety linkage are needed.

Location-dependent threat and associated neural abnormalities in clinical anxiety

Anxiety disorders are characterized by maladaptive defensive responses to distal or uncertain threats. Elucidating neural mechanisms of anxiety is essential to understand the development and maintenance of anxiety disorders. In fMRI, patients with pathological anxiety (ANX, n = 23) and healthy controls (HC, n = 28) completed a contextual threat learning paradigm in which they picked flowers in a virtual environment comprising a danger zone in which flowers were paired with shock and a safe zone (no shock). ANX compared with HC showed 1) decreased ventromedial prefrontal cortex and anterior hippocampus activation during the task, particularly in the safe zone, 2) increased insula and dorsomedial prefrontal cortex activation during the task, particularly in the danger zone, and 3) increased amygdala and midbrain/periaqueductal gray activation in the danger zone prior to potential shock delivery. Findings suggest that ANX engage brain areas differently to modulate context-appropriate emotional responses when learning to discriminate cues within an environment.

Development of a behavioural measure of Intolerance of Uncertainty in preadolescent children: Adaptation of the beads task

Background and objectivesIntolerance of Uncertainty (IU) may be important for the development and maintenance of anxiety disorders but research with preadolescent children has relied entirely on questionnaire measures to assess IU. Here we aimed to develop a behavioural measure of IU that was appropriate for preadolescent children by adapting the beads task (Jacoby, Abramowitz, Buck, & Fabricant, 2014). MethodsParticipants were 51 typically developing children (26 female; 7–11 years). We examined first whether preadolescent participants could understand and complete the task, then how participants responded to varying levels of uncertainty. We also conducted exploratory analyses regarding associations between task measures and questionnaire measures of IU, anxiety and worry. ResultsOverall, the adapted Beads Task appears suitable for preadolescent children and is able to capture reactions to uncertainty. At least some of these reactions are related to questionnaire measures of IU and anxiety. Implications and areas for future research are discussed to provide insights into how behavioural tasks examining responses to uncertainty can improve our understanding of IU. LimitationsThe sample size was relatively small. There was no control task or condition without uncertainty. ConclusionsOverall, the adapted Beads Task appears suitable for preadolescent children and is able to capture reactions to uncertainty. This type of behavioural task would be appropriate for use in future research that aims to improve our understanding of IU in children.

The association between anxiety disorders and hippocampal volume in older adults.

The hippocampus, through its mediation of fear responses is thought to play a central role in the onset and maintenance of anxiety disorders. Prevalence of anxiety disorders remains high in older populations; however, little is known about their association with hippocampal changes in this age group. Due to differing levels of cortisol as adults age, age-related decreases in hippocampal volume, and the suggestion that age-related loss of neurogenesis results in anxiety disorders, this area requires investigation. We examined the association between hippocampal volume and anxiety disorders (social anxiety disorder, generalized anxiety disorder, agoraphobia, panic disorder, obsessive compulsive disorder and posttraumatic stress disorder) in 534 older adults participating in the Enquête de Santé Psychologique-Risques, Incidence et Traitement (ESPRIT) study of late-life neuropsychiatric disorders. Anxiety disorders were diagnosed using the Mini International Neuropsychiatric Interview MINI, French version 5.00. Cross-sectional analyses adjusted for age, educational level, gender, Mini-Mental State Examination scores, National Adult Reading Test scores, whole brain volume and depression found that a diagnosis of generalized anxiety disorder was positively associated with larger hippocampal volume. No other anxiety disorder was significantly associated with hippocampal volume. The present study is the first to examine the association between several anxiety disorders and hippocampal volume in an older population and the results highlight the need for further research relating to the relationship between hippocampal volume and anxiety disorders in older adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A Preliminary Investigation of ERP Components of Attentional Bias in Anxious Adults using Temporospatial Principal Component Analysis.

Threat-related attention bias is thought to contribute to the development and maintenance of anxiety disorders. Dot-probe studies using event-related potentials (ERPs) have indicated that several early ERP components are modulated by threatening and emotional stimuli in anxious populations, suggesting enhanced allocation of attention to threat and emotion at earlier stages of processing. However, ERP components selected for examination and analysis in these studies vary widely and remain inconsistent. The present study used temporospatial principal component analysis (PCA) to systematically identify ERP components elicited to face pair cues and probes in a dot-probe task in anxious adults. Cue-locked components sensitive to emotion included an early occipital C1 component enhanced for happy versus angry face pair cues and an early parieto-occipital P1 component enhanced for happy versus angry face pair cues. Probe-locked components sensitive to congruency included a parieto-occipital P2 component enhanced for incongruent probes (probes replacing neutral faces) versus congruent probes (probes replacing emotional faces). Split-half correlations indicated that the mean value around the PCA-derived peaks were reliably measured in the ERP waveforms. These results highlight promising neurophysiological markers for attentional bias research that can be extended to designs comparing anxious and healthy comparison groups. Results from a secondary exploratory PCA analysis investigating the effects of emotional face position and analyses on behavioral reaction time data are also presented.

Avoiding at all costs? An exploration of avoidance costs in a novel Virtual Reality procedure

Approach-avoidance behaviours play a major role in the development and maintenance of anxiety disorders as repeated avoidance behaviours are assumed to prevent fear extinction. Approach-avoidance decisions (Conditioned Stimulus (CS)-avoidance and Unconditioned Stimulus (US)-avoidance) and their effect on fear extinction and renewal were investigated using a novel Virtual Reality fear conditioning procedure that included avoidance costs that are relevant in real-life settings (i.e., temporal delay and physical effort). Participants had to choose between a safe (low approach incentive, no US) and risky stimulus (high approach incentive, US in 75 %). After differential fear acquisition and avoidance learning, participants were randomized to an Avoidance condition or No Avoidance condition during fear extinction. Fear extinction took place in either the original contingency learning context or in a new context and was followed by a renewal test. Furthermore, the influence of trait anxiety, distress tolerance, and intolerance of uncertainty on approach-avoidance decisions was investigated. Exploratively, a second experiment with varying avoidance costs was conducted. Results showed that high (Study 1), but not low (Study 2), avoidance costs resulted in less avoidance behaviour. Even though there were no between-group differences, exploratory comparisons of avoiders and non-avoiders in both studies demonstrated that avoidance behaviours protected from extinction learning, resulting in the maintenance of retrospective US expectancies and a sustained preference for the safe stimulus. Finally, no renewal effect and no robust associations with the individual difference measures were found. Collectively, these findings provide insight in how avoidance behaviours maintain fear and how treatment might be improved by focusing on avoidance costs.

The Missing Pieces of the Puzzle: A Review on the Interactive Nature of A-Priori Expectancies and Attention Bias toward Threat.

The role of attention bias in the etiology and maintenance of anxiety disorders has been studied extensively over decades. Attention bias reflects maladaptation in cognitive processing, as perceived threatening stimuli receive prioritized processing even when they are task-irrelevant or factually unthreatening. Recently, there has been some interest in the role of a-priori expectancies in attention bias toward threat. The current review article will present recent studies as examples that emphasize the need for more comprehensive research about the interactive effects of various factors that affect the relationship between expectancies and attention bias toward threatening stimuli in anxiety. The current review article suggests a holistic view, which advocates for more integrative research, as a dynamic network could underlie changes in attention bias. The study of the interaction between such factors, with a focus on expectancy, can lead to more ecological and clinically important results, and thus to more informed and fine-tuned treatments that are based on manipulation of expectancies. Such methods, in turn, can also help in shedding light on the research of attention bias, in a mutual relationship between research and therapy.