Measures Of Anxiety Research Articles

Within- and between therapist variability in movement and physiological synchrony and its effects on symptom change.

The predictive power of movement and electrodermal activity (EDA) synchrony has been demonstrated in various studies. Although most studies have examined each synchrony modality separately, a growing interest in the simultaneous investigation of multiple modalities has emerged. Previous research has demonstrated the importance of disentangling within and between-dyad effects, however within and between-therapist effects have yet to be investigated. The aim of the present study was to test whether movement and EDA synchrony (measured both within and between therapists) predict across-session symptom change in two types of interventions (emotion-focused vs. cognitive). The results are based on 990 session segments of 90 clients with test anxiety who were treated with a six-session treatment program by 22 therapists, treating 3-15 clients each. Movement synchrony (on the basis of motion energy analysis (MEA) values) and EDA synchrony were quantified using cross-correlations. Symptom severity was assessed before each session using the state test anxiety measure. Movement and EDA synchrony correlated negatively (-0.19, p < .001). Moreover, higher movement synchrony as well as an interaction between movement and EDA synchrony was significantly associated with symptom improvement within, but not between therapists. In addition, an interaction between EDA synchrony and cognitive (versus emotion-focused) interventions was significantly associated with symptom improvement. These results provide initial evidence that therapists' average levels of synchrony may matter less than how synchronous they are with a specific client.

Cultural context shapes the selection and adaptiveness of interpersonal emotion regulation strategies.

In everyday life, we commonly experience, express, and regulate our emotions in interpersonal contexts. However, much of the existing research on utilizing others for modulating one's emotions has focused on Western, individualistic cultures, leaving a significant gap in understanding how the selection and adaptiveness of interpersonal emotion regulation (IER) strategies vary across cultural contexts. This cross-national comparison study aims to bridge this gap by examining intrinsic IER in 1,187 participants from Turkey and Germany, which are characterized by different cultural norms, values, and socialization practices regarding emotional experience and expression. All participants completed measures of intrinsic IER strategies alongside measures of adaptive outcomes, including depression, anxiety, negative affect, and positive affect. The results revealed cross-national differences between Turkish and German individuals in terms of the intrinsic IER strategies most frequently selected and their associations with depression, anxiety, negative affect, and positive affect. These findings emphasize the significance of cultural context in intrinsic IER and offer insights into the conditions under which these strategies are linked to adaptive outcomes. By recognizing the cultural nuances in how people navigate their emotions via social interactions, clinicians and researchers can develop more culturally sensitive interventions tailored to the specific needs of individuals in diverse cultural contexts. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exploring the association between moral injury and posttraumatic stress symptoms among Canadian public safety personnel.

Public safety personnel (PSP), such as police officers, firefighters, correctional workers, and paramedics, routinely face work stressors that increase their risk of developing posttraumatic stress disorder (PTSD). PSP may additionally face moral transgressions in the workplace (e.g., witnessing human suffering, working within broken systems), heightening the risk of moral injury (MI) in this population. Research among military personnel and health care workers shows an association between MI and PTSD; however, less is known about the association between these constructs among PSP. Canadian PSP completed an online survey between June 2022 and June 2023, including a demographic questionnaire and measures of PTSD, MI, dissociation, depression, anxiety, stress, and childhood adversity. Latent variable structural equation modeling (SEM) was performed to ascertain the impact of a latent MI construct (i.e., shame, trust violation, functional impairment) on a latent PTSD construct (i.e., intrusions, avoidance, negative alterations in cognition and mood, hyperreactivity, depersonalization, derealization). Sex, age, depression, anxiety, stress, and childhood adversity were included as covariates. A total of 314 PSP were included in the data analysis. A latent variable SEM regressing PTSD onto MI and including covariates accounted for 83.7% of the variance in PTSD. MI was the strongest predictor compared to all covariates and was significantly associated with PTSD symptoms, β =.506, p <.001, above and beyond the impacts of sex, age, depression, anxiety, stress, and childhood adversity. These findings are consistent with research among military members and health care providers and highlight the importance of further exploring MI among PSP.

قلق التفاعل وعلاقته بالتفاؤل غير الواقعي لدى طلبة جامعة عمر المختار

The study aimed to identify the level of interaction anxiety and its relationship to realistic optimism among students of Omar Al-Mukhtar University, as the number of the study population reached (11809) students from ten colleges and the scale was applied to a sample of (200), and the number of males reached (71) the number of females (41) Where the sample was randomly selected from four colleges in the university (College of Arts - Education - Engineering - Sciences) and the interaction anxiety scale was applied numbers (teacher: 2014) and the realistic optimism scale from numbers (Rasheed: 2013), and the validity of the study tool was verified. Validity of consistency, as it became clear that the study tool has high validity coefficients. The validity coefficients for each paragraph of the scale and the total score of the interaction anxiety scale ranged between (0.240 - 0.804), and the correlation coefficients between the scale dimensions and the total score of the scale after giving an opinion (0.119) after stress When speaking (0.782) after shyness and confusion (0.901), the measure of reliability was calculated as a whole by the Cronbach alpha coefficient and reached (0.84), after expressing an opinion (0.90), after tension when speaking (0.93), after shyness and confusion (0.90), the validity of the optimism scale was also verified Realistic where th enjoys A scale with validity coefficients for each paragraph of the scale and the total score of the scale ranged between (0.266 - 0.722). The correlation coefficients between the total score of the scale and the scale dimensions reached the academic dimension (0.879) after the social dimension (0.793) and the personal dimension (0.877). The realistic optimism scale also has high stability coefficients. The reliability coefficients for the overall score of the scale were (0.92) the academic dimension (0.75) the social dimension (0.83) the personal dimension (0.74), and some statistical treatments were used using the SbSS statistical package, which are arithmetic averages, standard deviations, the T-Test, and analysis of variance. one way ANOVA, and the results of the study resulted in the following points: - That the sample members have a high level of interaction anxiety and realistic optimism. There is a statistically significant relationship between the measure of interaction anxiety and realistic optimism. - There are statistically significant differences between the sample members according to gender on the interaction anxiety scale. - There are no statistically significant differences between the sample members according to the gender on the realistic optimism scale. - There are statistically significant differences between the sample members according to the college on the dimension reaction anxiety scale. The second and third are between the College of Education and the College of Arts and Engineering, and the differences were of statistical significance for the degree of the scale in favor of the College of Science and Engineering and the College of Arts. - There are differences of statistical significance between the sample members according to the college on the realistic optimism scale on the second and third dimension in favor of the College of Education, Arts and Engineering.

Sensory Processing and Anxiety: Within and Beyond the Autism Spectrum.

In this article, we briefly overview how the expression, measurement, and treatment of anxiety in autism may be different from the general population. We review the literature on links between sensory processing differences and anxiety, which show transdiagnostic patterns but are an especially prominent feature of anxiety in autism. Specifically, we focus on how the sense of interoception, i.e., how we perceive sensory information from within our bodies, contributes to anxiety in autism. We present new findings integrating multimodal interoceptive measures and total anxiety symptoms in a sample of n=38 non-autistic and n=43 autistic individuals, ages 8-55years. Using principal components analysis, we found two components relating to interoceptive confusion (i.e., self-reported ability to localize and interpret interoceptive cues): one component that closely relates to anxiety symptoms and one component that is distinct from anxiety. Interoceptive perception (i.e., performance on a lab-based task) was uniformly related to interoceptive confusion when distinguished from anxiety but showed complex relations with total anxiety symptoms. Combined, these findings suggest meaningful subtypes of interoceptive difficulties and their interrelationship with anxiety. We present conclusions and future directions for consideration of individual differences, toward creating a personalized understanding of anxiety-interoception links.

A proof-of-concept analysis of data from the first NHS clinic for young adults with comorbid cannabis use and psychotic disorders.

Cannabis use severely affects the outcome of people with psychotic disorders, yet there is a lack of treatments. To address this, in 2019 the National Health Service (NHS) Cannabis Clinic for Psychosis (CCP) was developed to support adults suffering from psychosis to reduce and/or stop their cannabis use. Examine outcome data from the first 46 individuals to complete the CCP's intervention. The sample (N = 46) consisted of adults (aged ≥ 18) with psychosis under the care of the South London and Maudsley NHS Foundation Trust, referred to the CCP between January 2020 and February 2023, who completed their intervention by September 2023. Clinical and functional measures were collected before (T0) and after (T1) the CCP intervention (one-to-one sessions and peer group attendance). Primary outcomes were changes in the Cannabis Use Disorders Identification Test-Revised (CUDIT-R) score and pattern of cannabis use. Secondary outcomes included T0-T1 changes in measures of delusions, paranoia, depression, anxiety and functioning. A reduction in the mean CUDIT-R score was observed between T0 (mean difference = 17.10, 95% CI = 15.54-18.67) and T1, with 73.91% of participants achieving abstinence and 26.09% reducing the frequency and potency of their use. Significant improvements in all clinical and functional outcomes were observed, with 90.70% being in work or education at T1 compared with 8.70% at T0. The variance in CUDIT-R scores explained between 34 and 64% of the variance in our secondary measures. The CCP intervention is a feasible strategy to support cannabis use cessation/reduction and improve clinical and functional outcomes of people with psychotic disorders.

Creation and validation of the Questionnaire of Emotional Dependence on Friends (CDEA)

Although emotional dependence has been considered to be directed towards friends, only assessment instruments for measuring emotional dependence towards a partner have been found. The study aims to create and validate the “Questionnaire of Emotional Dependence on Friends (CDEA)”. Three studies were conducted to develop and validate the questionnaire. The preliminary version was administered to a sample of 278 adolescents, together with measures of emotional dependence on partners. The final version was administered to a sample of 675 adolescents, together with measures of attachment, stress, anxiety and depression. The CDEA scale was finally composed of 12 items grouped into two correlated dimensions: Exclusivity and Excessive Focus. It has shown adequate convergence with other emotional dependence instruments and related constructs. The CDEA is a brief self-report, valid and easy-to-complete assessment instrument that allows us to evaluate emotional dependence on friends in an adolescent population.

Psychedelics as an intervention for psychological, existential distress in terminally ill patients: A systematic review and network meta-analysis.

The interest in psychedelics as a therapeutic intervention for existential distress of people with terminal illness grounds on their mechanism of action and effect on the spiritual/existential aspects accompanying end-of-life experiences. This systematic review and network meta-analysis aimed at examining the efficacy and safety of psychedelic compounds for existential distress in terminally ill people. PubMed, CINAHL, PsycINFO, EMBASE, and clinicaltrials.gov were searched for randomized controlled trials (RCTs) administering psychedelics for existential distress in people with terminal illnesses. Meta-analysis estimated the standardized mean difference (SMD) and odds ratio (OR), with corresponding 95% confidence intervals (95% CI), between treated and control groups in pairwise and network comparisons, using random-effects models. Post-treatment measures of depression and anxiety, as proxies of existential distress, and tolerability were the primary outcomes. Nine studies, involving 606 participants (362 treated with psychedelics: psilocybin, ketamine, 3,4-methylenedioxymethamphetamine, and lysergic acid diethylamide (LSD)) were included. The meta-analysis supported the efficacy of psychedelics on depression (SMD: -0.80 (95% CI: -0.98, -0.63)) and anxiety (SMD: -0.84 (95% CI: -1.20, -0.48)). Network meta-analysis identified psilocybin as the most effective compound for depression, and LSD for anxiety. However, head-to-head comparison between psychedelics did not reach statistical significance. The rates of treatment discontinuation and adverse events between psychedelics and controls were comparable. Psychedelics, especially psilocybins and LSD, showed promising effects on depression and anxiety in people with terminal illnesses. Limitations include the small number of RCTs, methodological issues related to blinding, and the lack of direct comparisons between psychedelic compounds. Larger studies and comparative research are needed to consolidate these findings.

Brief Video-Delivered Intervention to Reduce Anxiety and Improve Functioning in Older Veterans: Pilot Randomized Controlled Trial.

Older veterans with anxiety disorders encounter multiple barriers to receiving mental health services, including transportation difficulties, physical limitations, and limited access to providers trained to work with older persons. To address both accessibility and the shortage of available providers, evidence-based treatments that can be delivered via guided self-management modalities are a potential solution. This study aims to determine the feasibility and acceptability of a randomized controlled trial of 2 guided self-management interventions. This study compared the treatment effects of these 2 interventions (relaxation and health psychoeducation) on anxiety symptom severity and functioning in older veterans with anxiety disorders. Our exploratory aims examined factors related to home practices and treatment engagement and perceptions of the practices. Participants were randomized to one of two video-delivered interventions: (1) Breathing, Relaxation, and Education for Anxiety Treatment in the Home Environment (BREATHE)-breathing and progressive relaxation or (2) Healthy Living for Reduced Anxiety-psychoeducation about lifestyle changes. Telephone coaching calls were conducted weekly. Measures of anxiety, depression, and functioning were obtained at baseline, week 4 (end of treatment), week 8, and week 12. Participants completed a semistructured interview at week 12. Analyses included descriptive statistics to summarize measures of intervention engagement; mixed-effects models to characterize symptom change, and qualitative analyses. Overall, 56 participants (n=48, 86% men; n=23, 41% from ethnic or racial minority groups; mean age 71.36, SD 6.19 y) were randomized. No difference in retention between study arms was found. The Healthy Living group (29/56, 52%) completed significantly more lessons (mean 3.68, SD 0.86) than the BREATHE group (27/56, 48%; mean 2.85, SD 1.43; t53=2.60; P=.01) but did not differ in completion of coaching calls. In the BREATHE group, greater baseline anxiety scores (r=-0.41; P=.03) and greater severity of medical comorbidity (r=-0.50; P=.009) were associated with fewer completed practices. There was no effect of intervention on change in total anxiety scores or functioning. For specific anxiety subtypes, Healthy Living produced a greater decline in somatic anxiety compared with BREATHE. Qualitative analyses found barriers to practicing, including difficulty setting time aside to practice, forgetting, or having other activities that interfered with BREATHE practices. Some participants described adapting their practice routine to fit their daily lives; some also used relaxation skills in everyday situations. These findings suggest that a larger randomized controlled trial of guided self-management approaches to treating late-life anxiety is feasible; however, BREATHE was not effective in reducing anxiety compared with Healthy Living. Possible contributing factors may have been the reliance on a single technique. Progressive relaxation was reported to be enjoyable for most participants, but maintaining home practices was challenging. Those with milder anxiety severity and fewer health problems were better able to adhere to practices. ClinicalTrials.gov NCT02400723; https://clinicaltrials.gov/study/NCT02400723.

Association of home and neighbourhood conditions with anxiety and depression symptoms during the COVID-19 lockdown: Findings from the ALSPAC cohort

Background The first COVID-19 lockdown in the UK entailed widespread social restrictions, including instructions to stay at home at all times. This created a natural quasi-experiment, during which time home and neighbourhood conditions may have been especially important to mental health. However, evidence on this topic is scarce. Methods Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK population-based cohort, we examined associations of home and neighbourhood conditions with anxiety and depression symptoms during the first UK lockdown in 2020, when participants were approximately 28 years of age. Questionnaires were completed at two timepoints (T1: April; T2: May/June) and included validated measures of anxiety (GAD-7) and depression (SMFQ); as well as questions about current home conditions and behaviours. Neighbourhood conditions were obtained via linkage, and included population density, neighbourhood deprivation, social fragmentation, and greenspace. Main associations were examined using linear regression. Potential confounders were identified using a directed acyclic graph and included ethnicity, family psychiatric history, maternal social class, financial difficulties and unemployment before lockdown, and anxiety and depression at ages 18 and 24. Results At T1 after considering confounders, reduced access to nature (B=0.48, 95% CI=0.26-0.70, p&lt;0.001) and neighbourhood deprivation (B=0.25, 95% CI=0.04-0.47, p=0.024) were associated with anxiety. Furthermore, reduced access to nature (B=0.43, 95% CI=0.20-0.66, p=0.001), no garden access (B=0.22, 95% CI=0.01-0.43, p=0.043), living alone (B=0.33, 95% CI=0.13-0.53, p=0.002), and neighbourhood deprivation (B=0.22, 95% CI=0.00-0.44, p=0.048) were associated with depression. There were fewer associations at T2. Conclusion Disadvantaged home and neighbourhood conditions were associated with more anxiety and depression symptoms during the first UK lockdown. The findings underscore the importance of home and neighbourhood conditions for mental health and highlight potential interventions such as improved urban design to increase access to nature and reduce isolation. However, the causality of the findings is uncertain.

A challenge to identity: Identity processing style and moral injury.

Moral injury is a potentially deleterious mental health outcome that can result from exposure to morally challenging events. Treatment of moral injury is currently hindered by incomplete understanding of its underlying mechanisms. Theories of adaptation posit that maintaining a coherent sense of self while realigning one's sense of self with reality aids in adaptation following a disruptive life event. Differences in identity processing style are thought to impact the extent to which an individual engages with the challenges of maintaining a coherent sense of self following identity-related challenges. However, little is known about how identity processing style relates to moral injury event-related distress. This study sought to investigate a hypothesized relationship between identity processing style and event-related distress as well as alternative outcomes including traumatic stress, depression and anxiety. Adults (N = 167) who had been exposed to a potentially morally injurious event were recruited online and completed validated measures of event-related distress, traumatic stress, depression, anxiety and identity processing style. There were significant positive associations between diffuse-avoidant processing and all mental health outcomes, no significant associations between informational processing and any mental health outcomes, and significant negative associations between normative processing and event-related distress and depression.

Six Month Follow up of the one of the First Patients to Complete MDMA-Assisted Therapy for PTSD Outside of Clinical Trials in Australia: Implications for Translating Clinical Research to Clinical Practice

Purpose: The goal of this case report is to illustrate the implementation of 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy for posttraumatic stress disorder (PTSD) and learning points for health professionals in the translation of psychedelic assisted therapy research into clinical practice. We present our key learnings and 6-month follow up data from one of the first patients to complete MDMA-assisted therapy for PTSD outside of clinical trials, in an Australian outpatient clinic setting. Methodology: The patient described in this case report had chronic PTSD, depression and anxiety due to experiencing domestic violence, including sexual, physical, and psychological abuse in her adolescence. Treatment was informed by the Multidisciplinary Association of Psychedelic Studies (MAPS) MDMA-assisted therapy manual. After completing treatment, she enrolled in our weekly integration peer support group, including meditation workshops and family support sessions. Data was gathered using the Australian National University (ANU) Psychedelic-assisted therapy Australian national outcome database (https://medicine-psychology.anu.edu.au/research/research-projects/australian-interventional-pharmacotherapy-psychedelic-assisted-psychotherapy), which collates de-identified questionnaire data and outcomes from MDMA, psilocybin and ketamine assisted psychotherapy. Outcome data was gathered at baseline, the beginning of preparation, in the week after each dosing session, at the end of the program. Follow up data is collected at 3-, 6-, 9- and 12-months post-treatment. At the time of writing, she had completed 3 and 6 month follow up. Tables and figures are used to present the outcome data. Findings: Our patient no longer met DSM-V criteria for PTSD or major depressive disorder at the end of treatment, and at 6-month follow up. Her Impact of Events Scale – Revised (IES-R) score was 61 at intake, reduced to 0 after the second dosing session and remained 0 at 3 and 6-months follow up. There were no adverse events, with the only side effect reported being loss of appetite in the first 24 hours after each dosing session. All scores on depression and anxiety measures reduced to the normal ranges after the second dosing session and remained in the normal ranges at her six month follow up. After the second dosing session reported having greater self-compassion and being less troubled by the trauma memories. After the third dosing session, she began to feel comfortable leaving her children with their father or trusted family member to run errands for the first time, and an increased sense of connectedness with herself and with others. All these gains were maintained at three- and six-months post-treatment, illustrating a case of safe and effective implementation of MDMA-assisted therapy for PTSD in an outpatient mental health service. Unique Contribution to Theory, Practice and Policy: Our case study offers one model of clinical practice, contributing to Australian practitioner’s implementation of safe and effective MDMA-assisted therapy in mental health services. We reflect on learning points for practitioners such as whether MDMA or psilocybin would be the most effective treatment, for a patient with both PTSD and treatment resistant depression. Recommendations for practitioners include the importance of working in a dyad, accessing ongoing supervision in the early stages of implementation, and the benefits of the having had legal experience with psychedelic medicines as part of therapist training.

Disentangling developmental trajectories of childhood anxiety and depression symptoms in the prediction of adolescent substance use.

Adolescent substance use is comorbid with internalizing problems (e.g., anxious and depressive symptoms) and externalizing problems (EPs). Developmental researchers have linked early anxious and depressive symptoms to later substance use behaviours via an "internalizing pathway". Support for this pathway exists among young adults; however, evidence from prospective studies of adolescents has been inconsistent. Given the paucity of prospective studies in this area, the current study used a developmental framework to examine childhood anxiety and depression symptom trajectories as predictors of adolescent substance use and whether these relationships depend on sex and EPs. Children with and without EPs participated annually in an ongoing longitudinal study (N = 744; Time 1 age = 6.3-10.6). Youth completed self-report measures of anxiety and depression symptoms (Times 3-6) and substance use (Times 7-8). Parents and teachers completed measures of children's EPs (Time 0). Parallel process growth models showed that changes over time in childhood depression symptoms were significantly positively associated with adolescent alcohol/cannabis use, substance-related consequences, and total score of problematic substance use. Changes over time in childhood anxiety symptoms were significantly negatively associated with adolescent alcohol/cannabis use. These results were invariant by EPs and sex. Research implications of this study emphasize the importance of isolating the respective pathways of anxious and depressive symptoms to later substance use outcomes, while clinical implications focus on targets for early identification and prevention of problematic substance use in adolescence.

Perceiving precedence: Order of operations errors are predicted by perception of equivalent expressions

Students often perform arithmetic using rigid problem-solving strategies that involve left-to-right-calculations. However, as students progress from arithmetic to algebra, entrenchment in rigid problem-solving strategies can negatively impact performance as students experience varied problem representations that sometimes conflict with the order of precedence (the order of operations). Research has shown that the syntactic structure of problems, and students’ perceptual processes, are involved in mathematics performance and developing fluency with precedence. We examined 837 U.S. middle schoolers’ propensity for precedence errors on six problems in an online mathematics game. We included an algebra knowledge assessment, math anxiety measure, and a perceptual math equivalence task measuring quick detection of equivalent expressions as predictors of students’ precedence errors. We found that students made more precedence errors when the leftmost operation was invalid (addition followed by multiplication). Individual difference analyses revealed that students varied in propensity for precedence errors, which was better predicted by students’ performance on the perceptual math equivalence task than by their algebra knowledge or math anxiety. Students’ performance on the perceptual task and interactive game provide rich insights into their real-time understanding of precedence and the role of perceptual processes in equation solving.

Assessing the efficacy and safety of STOP (successful treatment for paranoia)—an app-based cognitive bias modification therapy for paranoia: a randomised clinical trial protocol

BackgroundParanoia, the belief that you are at risk of significant physical or emotional harm from others, is a common difficulty, which causes significant distress and impairment to daily functioning, including in psychosis-spectrum disorders. According to cognitive models of psychosis, paranoia may be partly maintained by cognitive processes, including interpretation biases. Cognitive bias modification for paranoia (CBM-pa) is an intervention targeting the bias towards interpreting ambiguous social scenarios in a way that is personally threatening. This study aims to test the efficacy and safety of a mobile app version of CBM-pa, called STOP (successful treatment of paranoia).MethodsThe STOP study is a double-blind, superiority, three-arm randomised controlled trial (RCT). People are eligible for the trial if they experience persistent, distressing paranoia, as assessed by the Positive and Negative Syndrome Scales, and show evidence of an interpretation bias towards threat on standardised assessments. Participants are randomised to either STOP (two groups: 6- or 12-session dose) or text-reading control (12 sessions). Treatment as usual will continue for all participants. Sessions are completed weekly and last around 40 min. STOP is completely self-administered with no therapist assistance. STOP involves reading ambiguous social scenarios, all of which could be interpreted in a paranoid way. In each scenario, participants are prompted to consider more helpful alternatives by completing a word and answering a question. Participants are assessed at baseline, after each session, and at 6, 12, 18 and 24 weeks post-randomisation. The primary outcome is the self-reported severity of paranoid symptoms at 24 weeks, measured using the Paranoia Scale. The target sample size is 273 which is powered to detect a 15% symptom reduction on the primary outcome. The secondary outcomes are standardized measures of depression, anxiety and recovery and measures of interpretation bias. Safety is a primary outcome and measured by the Negative Effects Questionnaire and a checklist of adverse events completed fortnightly with researchers. The trial is conducted with the help of a Lived Experience Advisory Panel.DiscussionThis study will assess STOP’s efficacy and safety. STOP has the potential to be an accessible intervention to complement other treatments for any conditions that involve significant paranoia.Trial registrationISRCTN registry, ISRCTN17754650. Registered on 03/08/2021. https://doi.org/10.1186/ISRCTN17754650.

Differential item functioning of patient‐reported outcomes measures of anxiety and depression by severity of cognitive impairment

AbstractIntroductionPatient‐reported outcomes are increasingly being utilized in clinical settings to identify psychological symptoms and track fluctuations over time. Some clinicians and researchers have expressed concerns about the validity of symptom questionnaires cognitively impaired populations. We sought to determine if differential item functioning (DIF) is present based on cognitive impairment using the patient reported outcomes measurement information system (PROMIS) inventories of anxiety and depression.MethodsData from a longitudinal aging cohort study in Chicago, IL. Mild impairment was defined as a z‐score between ‐1 and ‐1.49 and moderate/severe impairment was a z‐score of ≤‐1.5 on 2+ tests in one of 5 cognitive domains. PROMIS Anxiety and Depression measures were utsed. Due to sample size and response variation, the anxiety model examined DIF with participants categorized using three categories (none, mild, or moderate/severe cognitive impairment). The depression model used 2 categories (none/mild vs moderate/severe impairment). Analyses were conducted in R (lordif package with Monte Carlo simulations). Effect sizes for DIF were calculated by test item. Test characteristic curves (TCCs) examined measure performance by cognitive impairment.ResultsData was available for 396 participants, who were 71 years old, mostly female (n = 285) and about half were non‐Hispanic White (n = 214). Approximately 72% had no cognitive impairment, 14% had mild cognitive impairment and 13% had moderate/severe impairment. There was evidence of DIF in 4 of 7 anxiety items and 3 of 8 depression items. The direction of DIF varied, suggesting the response patterns of moderately/severely impaired participants resulted in psychometric overestimation of anxiety and underestimation of depression. Effect sizes of DIF were relatively small for anxiety (0.016‐0.034) and depression (0.014‐0.043) and TCC curves were similar by cognitive impairment category for both measures.ConclusionThere is psychometric measurement bias on PROMIS anxiety and depression measures by severity of cognitive impairment. Researchers and clinicians should be aware that cognitive impairment may impact responses when using assessments, however, this study showed this bias is small and results in negligible change when examining the measures overall. These findings support the conclusion that PROMIS Anxiety and Depression are reliable assessments when used among individuals with different levels of cognitive impairment.

The Italian version of the Surgical Fear Questionnaire: validation of its measurement properties.

Surgical fear is present in many patients awaiting surgery. However, a validated Italian version of the Surgical Fear Questionnaire (SFQ) was not available yet. Therefore, the aim of this study was to translate the SFQ into Italian and to test its reliability and validity. Design: prospective cohort study on Italian-speaking Swiss patients scheduled for a minimally invasive spinal procedure or spinal surgery. After forward and back translation and a pilot test, reliability and validity of the 8-item SFQ was assessed using the intraclass correlation coefficient, (ICC), Cronbach's alpha, confirmatory factor analysis (CFA), and Spearman's correlation coefficient. Results on 63 patients revealed median SFQ-total scores of 22 (minimum-maximum: 0-68) at inclusion and 22.5 (0-70) one week before surgery. Test-retest reliability between first and second SFQ-total score was high, ICC=0.947 (95% CI: 0.912-0.968). Internal consistency of the SFQ-total score at both assessment times were high, Cronbach's alphas 0.916 and 0.931 respectively. This was also the case for the subscale short-term fear, item 1-4 and long-term fear, item 5-8 (range 0.853-0.909). CFA-results for a one-factor and a two-factor model favored the two-factor model. Correlations with pain catastrophizing, other anxiety measures, and health status were weak and only state anxiety assessed by PROMIS reached statistical significance. We conclude that the Italian version of the SFQ is suitable for use in practice and has a high reliability. Validity and sensitivity need additional testing on a larger population.

How strongly are trait positive and negative affectivity associated with anxiety symptoms? A multilevel meta-analysis of cross-sectional studies in anxiety disorders.

There are well-established theoretical and empirical foundations for a negative association between trait positive affectivity and anxiety symptoms in anxiety disorders and a positive association between trait negative affectivity and anxiety symptoms, respectively. However, no previous meta-analysis systematically estimated to what extent trait positive and negative affectivity are associated with anxiety symptoms in anxiety disorders. The aim of this study was to conduct a systematic review and meta-analysis to obtain an evidence-based estimate of the associations between trait positive and negative affectivity with anxiety symptoms in anxiety disorders. We performed a systematic search including studies reporting estimates of the associations between trait positive and negative affectivity measures and anxiety measures in clinical populations that suffer from at least one anxiety disorder. We identified 13 and 14 eligible studies, documenting 19 and 21 mainly unpublished effect sizes from 1489 individuals that suffer from an anxiety disorder. We estimated an overall correlational effect size (r) using multilevel meta-analytic models accounting for within- and between-study variance components. The results of the omnibus models showed a small to moderate negative association between positive affectivity and anxiety symptoms (r = -0.19, 95 % CI [-0.30, -0.09]) and a strong positive association between negative affectivity and anxiety symptoms respectively (r = 0.53, 95 % CI [0.44, 0.61]). These associations are different from each other (r = .35, p < .001). The results are consistent with theoretical claims that anxiety disorders are highly associated with negative affectivity but to a lesser extent with positive affectivity. More research and systematic documentation are necessary to determine moderators of these overall associations.

Influence of tau pathology and anxiety and depressive symptoms on metamemory in cognitively normal older adults

AbstractBackgroundThe ability to accurately discern memory function (i.e., metamemory) decreases with age and is further diminished in Alzheimer’s disease (AD). As such, changes in metamemory may be a sensitive behavioral indicator of pre‐symptomatic AD.MethodCognitively normal older adult participants (N=48) completed a neuropsychological battery consisting of episodic memory tasks (California Verbal Learning Task, Face‐Name Associative Memory Exam) and self‐reported measures of metamemory (Multifactorial Memory Questionnaire) and anxiety and depressive symptoms (Geriatric Depression Scale, Penn State Worry Questionnaire, Mood and Anxiety Symptom Questionnaire). Z‐scores from each measure were combined into three separate composite scores: memory ability, metamemory, and anxiety and depressive symptoms. All participants also had a tau PET scan ([18F]MK‐6240) completed within 12.7 (SD = 11.6) months of neuropsychological testing in which standardized uptake value ratios (SUVR) referenced to the inferior cerebellar gray matter were calculated using Freesurfer‐defined ROIs for Braak I, Braak II, metatemporal, and amygdala regions of interest (ROIs). Linear regression models were used to test for the contribution of anxiety and depression symptoms, tau pathology, and memory ability on metamemory; education, age, and sex were entered as covariates in all models.ResultBehavioral analyses suggest that anxiety and depression symptoms (t = ‐2.1, p=0.046), but not memory ability (t = 0.4, p=0.698), were related to metamemory. Interestingly, tau pathology helped to explain additional variance in the relationship between metamemory and anxiety and depressive symptoms. Specifically, amygdala tau interacted with anxiety and depression symptoms to predict metamemory (t = ‐2.61, p=0.013), when controlling for age, sex, education, and memory ability, such that participants with both high levels of anxiety and depressive symptoms and high levels of amygdala tau pathology had lower self‐reported metamemory (Figure 1). This relationship was not observed in Braak I, Braak II, or metatemporal ROIs (ps &gt; 0.07).ConclusionTogether, these results suggest that depressive and anxiety symptoms are an important metric to consider when examining the relationships between tau pathology and metamemory. Further, the results underscore that mechanisms supporting metamemory are likely distinct from those underlying memory ability and each merit unique consideration towards understanding their relationship to AD pathology.

The Sleep Course: An inclusive trial examining the feasibility, acceptability, and preliminary efficacy of a digital sleep intervention for adults with self-reported sleep difficulties

Cognitive Behavioural Therapy for Insomnia (CBTi) is a well-established first-line treatment for insomnia and sleep difficulties, yet numerous barriers hinder its widespread adoption. One potential criticism of the existing evidence base for CBTi is that many trials exclude participants that would commonly be seen in in primary care, such as those aged over 65, with comorbid health conditions, or prescribed sleep medication. The current pilot study therefore aimed to assess the acceptability and efficacy of a brief, digitally delivered sleep intervention, the Sleep Course using a broad range of participants. Participants (n = 74) completed the 6-week, 4-lesson intervention alongside measures of sleep disturbance, sleep-related impairment, depression, anxiety and sleep-wake patterns (via sleep diary). Generalized estimating equations analysis modelled change in participants' outcomes from pre- to post-treatment and 3-month follow-up, and subgroup analyses explored the role of possible moderators (e.g., age over 65, co-morbidities, and concurrent prescription medication use). The intervention was associated with good rates of satisfaction (79 %) and lesson completion (70 %). Results showed significant and large reductions in insomnia, sleep disturbance and associated symptoms (e.g., d = 1.06–1.37 change in insomnia symptoms). Evidence of high acceptability and clinical improvement was found irrespective of age, physical comorbidity, and sleep medication use. However, there was evidence of less improvement among those taking medications or having tried psychological treatment in the past. These results provide strong preliminary evidence for the intervention as an acceptable, efficacious and scalable treatment for a broad range of participants with sleep difficulties. Larger randomised controlled trials are needed.