Penn State Worry Questionnaire Scores Research Articles

Acute Exercise Effects among Young Adults with Analogue Generalized Anxiety Disorder.

This study replicated initial findings of positive effects of acute vigorous-intensity aerobic exercise on worry, state anxiety, and feelings of energy and fatigue among young adult women with analogue GAD, examined responses among young adult men with analogue GAD, and explored sex-related differences and moderation by physical activity level, trait anxiety, depression, and poor sleep status. Thirty-five young adults (21.4 ± 2.3 yr; 19 males; 16 females) with Penn State Worry Questionnaire scores ≥45 (60 ± 8) completed two counterbalanced 30-min conditions: treadmill running at ~71.2% ± 0.04% HR reserve and seated quiet rest. Outcomes included worry, worry engagement, absence of worry, state anxiety, and feelings of energy and fatigue. No outcome or moderator differed at baseline between sexes. Exercise significantly improved state anxiety (P < 0.04; d = 0.27) and feelings of energy (P < 0.001; d = 1.09). Small nonsignificant improvements were found for worry (d = 0.22), worry engagement (d = 0.18), and feelings of fatigue (d = 0.21). The magnitude of improvements in worry, worry engagement, absence of worry, and feelings of energy were stronger among females. Significant large, potentially clinically meaningful increases in feelings of energy were found among women (d = 1.35) and men (d = 0.92). A nonsignificant, but potentially clinically meaningful, moderate reduction in worry (d = 0.53) was found among women. High-trait anxiety and poor sleep quality were supported as moderators. Findings replicated positive effects of acute aerobic exercise among young adult women with analogue GAD, and extended to support for positive effects among young adult men with analogue GAD.

Cognitive behavioural therapy for worry in young individuals with at-risk mental states: a preliminary investigation

Abstract Cognitive behavioural therapy (CBT) is a first-line strategy in reducing or delaying risk of transition to psychosis among young individuals with at-risk mental states (ARMS). However, there is little knowledge about its effects on other outcomes associated with ARMS. No study on CBT for ARMS has assessed worry, an important process associated with this condition. The present study investigated changes in worry at immediate post-treatment and 14-month follow-up after CBT for young individuals with ARMS seeking psychiatric care in mental health services. Thirty-seven young individuals (mean age = 26 years, SD = 6.07; 22.20% female) seeking psychiatric care in mental health services and classified as reporting ARMS through the Comprehensive Assessment of At-Risk Mental States were included. The Positive And Negative Syndrome Scales (PANSS) and Penn State Worry Questionnaire (PSWQ) were administered at baseline, post-treatment, and follow-up. CBT consisted of 30 weekly individual 1-hour sessions based on a validated CBT for ARMS manual enriched with components targeting worry [psychoeducation, problem-solving, (meta)cognitive restructuring, behavioural experiments]. Seven participants (18.91%) at follow-up had cumulatively made transition to psychosis. Repeated measures ANOVA with post-hoc pairwise comparisons showed significant changes in PSWQ scores from baseline to post-treatment and from baseline to follow-up; PSWQ scores remained stable from post-treatment to follow-up. This is the first study investigating changes in worry after CBT for ARMS, which appears to be a promising strategy also for this outcome. Future research with a larger sample size and control group may determine whether changes in worry are also associated with reduced transition risk. Key learning aims (1) To understand CBT evidence and procedures for young individuals with ARMS. (2) To reflect on the current limitations in the literature on CBT for ARMS. (3) To understand the importance and clinical implications of assessing worry in ARMS. (4) To focus on changes in worry as an outcome after CBT for ARMS. (5) To reflect on future research directions on the role of worry in CBT for ARMS.

Generalized Anxiety Disorder-7 (GAD-7) in people with infertility: A reliability and validity study

Abstract Background and objective Generalized anxiety disorder (GAD) is common in people with infertility problems, but no studies have examined the reliability and validity of measures of GAD among these patients. Thus, this study aimed to evaluate the psychometric properties of the Persian Version of the GAD-7 in people with infertility. Methods In a cross-sectional study, the GAD-7, the HADS (Hospital Anxiety and Depression Scale) and the PSWQ (Penn State Worry Questionnaire) were administered to 539 Iranian men and women with infertility problems in 2017. Internal consistency of the GAD-7 was assessed with Cronbach’s alpha, construct validity was evaluated via confirmatory factor analysis (CFA), and convergent validity was examined by correlating the GAD-7 with HADS and PSWQ scores. Results The mean total GAD-7 score was 7.37 ± 5.40, and 178 patients (33.0%) had scores of 10 or higher, suggesting moderate or high GAD. The results of CFA confirmed the unidimensional factor structure of the GAD-7 (χ2/df = 3.48; CFI = 0.99; GFI = 0.97; RMSEA = 0.068 and SRMR = 0.031). The internal consistency of the scale was good, with a Cronbach’s alpha of 0.876. All corrected item-total correlations and inter-item correlations were in acceptable range. The GAD-7 showed a moderate to strong correlation with the anxiety (r = 0.782) and depression (r = 0.524) subscales of the HADS, and with the PSWQ (r = 0.605), confirming convergent validity. Conclusion The GAD-7 demonstrated satisfactory reliability and validity; these results support its use to measure GAD in people with infertility problems.

Acute exercise effects on worry, state anxiety, and feelings of energy and fatigue among young women with probable Generalized Anxiety Disorder: A pilot study

BackgroundLittle is known about the acute effects of exercise among individuals with clinical or subclinical Generalized Anxiety Disorder (GAD). PurposeThus, this study examined worry, state anxiety, and feelings of energy and fatigue responses to acute aerobic exercise and quiet rest, and explored potential moderators of response among young adult women with worry scores indicative of GAD. MethodsSeventeen young women with Penn State Worry Questionnaire scores ≥45 (60 ± 8) completed 30-min treadmill running at 65%–85% heart rate reserve (%HRR) and 30-min seated quiet rest in counterbalanced order. Outcomes included worry, state anxiety, and feelings of energy and fatigue. Two condition X two time repeated measures ANOVA examined differences across condition and time. Hedges’ d effect sizes (95%CI) were calculated to quantify and compare the magnitude of change. Independent-samples t-tests explored potential moderators of outcome response. ResultsTotal exercise time was 35.8 ± 3.4min with a mean 30.3 ± 0.16 in-zone minutes (65%-85%HRR); participants exercised at ∼72.9 ± 0.03 %HRR (range 66%–79%). Compared with quiet rest, acute exercise significantly improved worry engagement, state anxiety, and feelings of energy and fatigue (all p ≤ 0.031). Moderate-to-large (d = 0.44 to 1.69) reductions in state anxiety and feelings of fatigue and improvements in feelings of energy were found. Exercise-induced reductions in worry engagement were significantly larger among non-high trait anxious participants. Compared to normal sleepers, quiet rest significantly increased feelings of fatigue among poor sleepers. ConclusionFindings provide support for the positive effects of acute aerobic exercise on worry, state anxiety, and feelings of energy and fatigue among young women with worry indicative of GAD.

Acute Exercise Effects on Mood Among Young Adults with Worry Symptoms Indicative of Generalized Anxiety Disorder

Evidence supports the effects of exercise training on clinical severity, associated signs and symptoms, dimensions of sleep quality and quantity, and health-related quality of life among individuals with Generalized Anxiety Disorder (GAD). However, little is known about the acute effects of exercise among individuals with clinical or subclinical GAD. PURPOSE: This study quantified mood responses to either acute aerobic exercise or quiet rest, examined potential sex-related differences in response, and explored potential moderators of response among young adult men and women with worry symptoms indicative of GAD. METHODS: Twenty-five young adults (8 males; 17 females; 21.1±1.3y) with Penn State Worry Questionnaire scores ≥45 (58±8) completed two 30-min conditions in counterbalanced order: vigorous treadmill running or seated quiet rest. Outcomes included worry symptoms, state anxiety, feelings of tension, depression, anger, energy, fatigue, and confusion, and total mood disturbance. RM-ANOVA examined differences across condition and time and between males and females. Hedges’ d effect sizes (95%CI) were calculated to quantify and compare the magnitude of change in response to exercise compared to control. Regression explored potential moderators of mood response. RESULTS: Average heart rate was 163±5.4 bpm and participants reported an average session RPE of 13±2 (range: 9 to 17). Compared with control, acute exercise significantly improved state anxiety, feelings of depression, anger, energy, fatigue, and confusion, and total mood disturbance (all p≤0.04). Moderate-to-large improvements were found for anger (d=0.57, 95%CI: 0.01, 1.13), fatigue (d=0.67, 95%CI: 0.10, 1.24), confusion (d=0.87, 95%CI: 0.29, 1.45), and energy (d=0.87, 95%CI: 0.29, 1.45), and total mood disturbance (d=1.10, 95%CI: 0.50, 1.69). The magnitude of improvements were greater (i.e., larger effect sizes) among men for all outcomes except feelings of energy and fatigue and worry symptoms. High trait anxiety, depression, and poor sleep did not moderate exercise effects (all p>0.10). CONCLUSION: Findings provide initial support for both the positive effects of acute aerobic exercise on mood and potential sex-related differences in exercise effects among young adults with worry symptoms indicative of GAD.

Goal Directed Worry Rules Are Associated with Distinct Patterns of Amygdala Functional Connectivity and Vagal Modulation during Perseverative Cognition.

Excessive and uncontrollable worry is a defining feature of Generalized Anxiety Disorder (GAD). An important endeavor in the treatment of pathological worry is to understand why some people are unable to stop worrying once they have started. Worry perseveration is associated with a tendency to deploy goal-directed worry rules (known as “as many as can” worry rules; AMA). These require attention to the goal of the worry task and continuation of worry until the aims of the “worry bout” are achieved. This study examined the association between the tendency to use AMA worry rules and neural and autonomic responses to a perseverative cognition induction. To differentiate processes underlying the AMA worry rule use from trait worry, we also examined the relationship between scores on the Penn State Worry Questionnaire (PSWQ) and neural and autonomic responses following the same induction. We used resting-state functional magnetic resonance brain imaging (fMRI) while measuring emotional bodily arousal from heart rate variability (where decreased HRV indicates stress-related parasympathetic withdrawal) in 19 patients with GAD and 21 control participants. Seed-based analyses were conducted to quantify brain changes in functional connectivity (FC) with the amygdala. The tendency to adopt an AMA worry rule was associated with validated measures of worry, anxiety, depression and rumination. AMA worry rule endorsement predicted a stronger decrease in HRV and was positively associated with increased connectivity between right amygdala and locus coeruleus (LC), a brainstem noradrenergic projection nucleus. Higher AMA scores were also associated with increased connectivity between amygdala and rostral superior frontal gyrus. Higher PSWQ scores amplified decreases in FC between right amygdala and subcallosal cortex, bilateral inferior frontal gyrus, middle frontal gyrus, and areas of parietal cortex. Our results identify neural mechanisms underlying the deployment of AMA worry rules. We propose that the relationship between AMA worry rules and increased connectivity between the amygdala and prefrontal cortex (PFC) represents attempts by high worriers to maintain arousal and distress levels in order to feel prepared for future threats. Furthermore, we suggest that neural mechanisms associated with the PSWQ represent effortful inhibitory control during worry. These findings provide unique information about the neurobiological processes that underpin worry perseveration.

Evaluation of anxiety levels and factors associated with positive test results in patients with drug hypersensitivity.

High anxiety has been reported in patients with drug hypersensitivity reaction (DHR); however, its relationship with the test results was not studied previously. We aimed to investigate the association of patient anxiety with the results of drug tests together with the other contributing factors. Sixty-seven patients were included in the study between November 2012 and April 2013, in whom drug tests were performed after clinical evaluation and application of the Penn State Worry Questionnaire (PSWQ). The mean ± standard deviation (SD) age was 43.5 ± 12.9 years, and 73.1% of the patients were females. The patient group had significantly higher mean ± SD PSWQ score than 35 control subjects without histories of DHRs and major psychiatric disorders (47.95 ± 14.64 versus 40.22 ± 11.86, p = 0.008). However, the mean ± SD. PSWQ score of the patients with positive drug test results was not significantly different from the patients with negative drug test results (46.06 ± 13.41 versus 50.47 ± 18.02, p = 0.32). Panic attack symptoms were more common in the reactions with positive test results than in the reactions with negative test results (74.0% versus 48.9%, p = 0.01). However, presence of panic attack symptoms [odds ratio (OR): 1.25, 95% confidence interval (CI): 0.44-3.54; p = 0.67] was not found independently associated with positive test results in the multiple logistic regression model. Patients with DHR have high levels of anxiety; however, this is not related to the results of drug tests. Because panic reaction symptoms may accompany the objective symptoms of DHR, a complete clinical work-up is required before deciding whether the reaction is related to panic or a "true DHR."

76. The influence of running volume on CD4+ T cell subpopulations and the role of stress

The purpose of this study was to determine the influence of stress on exercise-induced immune changes. Twenty-nine recreational runners were recruited for this study. Each recorded the number of miles that they ran in the week leading up to the study visit, completed the State Trait Anxiety Inventory (STAI) and the Penn State Worry Questionnaire (PSWQ), and donated blood for assessment of CD4+ T cell subpopulations and cytokine production. Participants ran an average of 30 (13.4) miles per week and had average STAI and PSWQ scores of 32.6 (12.6) and 40 (16.6), respectively. Average values (SD) for immune biomarkers were as follows: Treg, 3.2% (1.2); Tr1, 27.1% (8.3); Th3, 7.4 (6.1); IFNγ, 32,027 pg/ml (26,404); IL4, 8.1 pg/ml (13.7); IFNγ/IL4, 10,610 (12,485); IL10, 512 pg/ml (288). Overall, there were significant correlations between Treg and running volume (beta = 0.051%, p = 0.002) and IL10 production and running volume (beta = −10.57 pg/ml, p = 0.007), and a borderline significant correlation between Tr1 and running volume (beta = −0.198%, p = 0.093). High levels of anxiety and worry were associated with a significant negative correlation between Tr1 and running volume and a significant positive correlation between IFNγ and running volume while low levels of anxiety and worry were not. These data indicate that high levels psychological stress can potentiate immunological changes resulting from endurance-based exercise.

An exploration of worry content and catastrophic thinking in middle-aged and older-aged adults with and without Parkinson's disease.

Worry is a common and distressing problem in Parkinson's disease (PD). However, little is known about the nature and content of worry in PD and how it might differ to non-PD populations. The study aimed to explore the content and nature of worry in middle-aged and older-aged adults with and without PD. Four groups of participants, 20 PD patients (10 high worry and 10 low worry) and 19 middle-aged and older-aged adults (10 high worry and nine low worry), completed the catastrophising interview (CI) for three worry topics. Worriers were classified (high/low) on the basis of Penn State Worry Questionnaire scores. Data were analysed using framework analysis. High worriers showed a greater diversity of worry topics than low worriers. Health worries differentiated high and low worriers in the non-PD sample but were common across all PD participants. The CI revealed that the root concern of worry was often different to that initially described. In particular, PD high worriers were more likely to express underlying concerns about negative self-perception and death/severe incapacity. The CI was able to identify the root cause of worry, demonstrating the value of this technique in the exploration and treatment of worry and psychological distress. Exploring worry content may help to distinguish patients with problematic worry, with worries about self-perception and death/severe incapacity characteristic of high worriers. Therapeutic interventions designed to alleviate problematic worry and distress in PD need to take account of the realities of living with PD and the potentially realistic nature of worries that may appear catastrophic in a healthy population.

Fear of falling during activities of daily living after total hip arthroplasty in Japanese women: a cross-sectional study

ObjectivesTo investigate the prevalence of fear of falling, and identify factors associated with fear of falling during activities of daily living after total hip arthroplasty (THA). DesignCross-sectional study. SettingCommunity. ParticipantsTwo hundred and fourteen women who had undergone THA. Main outcome measuresFear of falling after THA was assessed for 12 activities of daily living using a fear of falling score. The number of falls in the past year, total Oxford Hip Score (OHS), total Penn State Worry Questionnaire (PSWQ) score and walking capacity were recorded as descriptive statistics. Multiple linear regression analysis was performed, with total fear of falling score as the dependent variable and age, body mass index, time since THA, bilateral THA, total OHS, history of falling, walking capacity and total PSWQ score as the independent variables. ResultsA number of participants (mean age = 64.2) experienced fear of falling while ascending and descending stairs: 45% (97/214), taking a bath: 26% (56/214), bending to pick something up off the floor: 26% (55/214), and getting up from lying on the floor: 25% (54/214). Fear of falling during activities of daily living after THA was significantly correlated with total OHS, history of falling, walking capacity, total PSWQ score and age (P<0.05). ConclusionsFear of falling develops in certain activities of daily living after THA. It is associated with poorer functional outcome, history of falling, lower walking capacity, higher anxiety level and older age.

White matter integrity alterations in first episode, treatment-naive generalized anxiety disorder

BackgroundSeveral neurobiological models of anxiety disorder posit a primary role for dysfunction of the amygdala and anterior cingulate cortex (ACC). This study tests the hypothesis that patients with generalized anxiety disorder (GAD) have abnormal white matter microstructure in the amygdala and ACC, as inferred from diffusion tensor imaging, compared with healthy controls. MethodsSubjects were 16 right-handed, first-episode, treatment-naive GAD patients without comorbid disorders and 26 matched, healthy comparison controls. All subjects underwent diffusion tensor imaging and structural magnetic resonance imaging brain scanning. Fractional anisotropy (FA), a robust intravoxel measure of water self-diffusion, was compared between groups on a voxel-by-voxel basis. Associations between clinical ratings of symptom severity (i.e., the Hamilton Anxiety Scale and the Penn State Worry Questionnaire) and FA were assessed. ResultsCompared with healthy volunteers, patients demonstrated significantly higher FA in the right amygdala white matter and lower FA in the caudal ACC/mid-cingulate cortex white matter. Higher right amygdala FA correlated significantly with higher Hamilton Anxiety Scale scores and higher Penn State Worry Questionnaire scores. LimitationsThe sample size was modest and may contribute to false positive effects. ConclusionsThese findings provide the first evidence of an abnormality in white matter microstructure that involves the amygdala and the cingulate cortex in the pathogenesis of GAD, and are consistent with neurobiological models that posit a defect in emotion-related brain regions.

Early Response to Psychotherapy and Long-Term Change in Worry Symptoms in Older Adults With Generalized Anxiety Disorder

To determine the association of early and long-term reductions in worry symptoms after cognitive behavior therapy (CBT) for generalized anxiety disorder (GAD) in older adults. Substudy of larger randomized controlled trial. Family medicine clinic and large multispecialty health organization in Houston, TX, between March 2004 and August 2006. Patients (N = 76) aged 60 years or older with a principal or coprincipal diagnosis of GAD, excluding those with significant cognitive impairment, bipolar disorder, psychosis, or active substance abuse. CBT, up to 10 sessions for 12 weeks, or enhanced usual care (regular, brief telephone calls, and referrals to primary care provider as needed). Penn State Worry Questionnaire (PSWQ) administered by telephone at baseline, 1 month (mid treatment), 3 months (posttreatment), and at 3-month intervals through 15 months (1-year follow-up). The authors used binary logistic regression analysis to determine the association between early (1 month) response and treatment responder status (reduction of more than 8.5 points on the PSWQ) at 3 and 15 months. The authors also used hierarchical linear modeling to determine the relationship of early response to the trajectory of score change after posttreatment. Reduction in PSWQ scores after the first month predicted treatment response at posttreatment and follow-up, controlling for treatment arm and baseline PSWQ score. The magnitude of early reduction also predicted the slope of score change from posttreatment through the 15-month assessment. Early symptom reduction is associated with long-term outcomes after psychotherapy in older adults with GAD.

Treating chronic worry: Psychological and physiological effects of a training programme based on mindfulness

The present study examines psychological and physiological indices of emotional regulation in non-clinical high worriers after a mindfulness-based training programme aimed at reducing worry. Thirty-six female university students with high Penn State Worry Questionnaire scores were split into two equal intervention groups: (a) mindfulness, and (b) progressive muscle relaxation plus self-instruction to postpone worrying to a specific time of the day. Assessment included clinical questionnaires, daily self-report of number/duration of worry episodes and indices of emotional meta-cognition. A set of somatic and autonomic measures was recorded (a) during resting, mindfulness/relaxation and worrying periods, and (b) during cued and non-cued affective modulation of defence reactions (cardiac defence and eye-blink startle). Both groups showed equal post-treatment improvement in the clinical and daily self-report measures. However, mindfulness participants reported better emotional meta-cognition (emotional comprehension) and showed improved indices of somatic and autonomic regulation (reduced breathing pattern and increased vagal reactivity during evocation of cardiac defense). These findings suggest that mindfulness reduces chronic worry by promoting emotional and physiological regulatory mechanisms contrary to those maintaining chronic worry.

Screening for Generalized Anxiety Disorder in inpatient psychosomatic rehabilitation: pathological worry and the impact of depressive symptoms.

Objective: Pathological worry is considered to be a defining feature for Generalized Anxiety Disorder (GAD). The Penn State Worry Questionnaire (PSWQ) is an instrument for assessing pathological worry. Two earlier studies demonstrated the suitability of the PSWQ as screening instrument for GAD in outpatient and non-clinical samples. This study examined the suitability of the PSWQ as a screening instrument for GAD in a German inpatient sample (N=237). Furthermore, a comparison of patients with GAD and patients with depression and other anxiety disorders regarding pathological worry and depression was carried out in a sub-sample of N=118 patients.Method: Cut-off scores optimizing sensitivity, optimizing specificity and simultaneously optimizing both sensitivity and specificity were calculated for the PSWQ score by receiver operating characteristic analysis (ROC). Differences regarding pathological worry and depression measured by the PSWQ and the Beck Depression Inventory (BDI) across five diagnostic subgroups were examined by conducting one-way ANOVAs. The influence of depression on pathological worry was controlled by conducting an ANCOVA with BDI score as a covariate.Results: The ROC analysis showed an area under the curve of AUC=.67 (p=0.02) with only 54.4% of the patients correctly classified. Comparison of diagnostic subgroups showed that after controlling the influence of depression, differences referring to pathological worry between diagnostic subgroups no longer existed.Conclusions: Contrary to the earlier results we found that the use of the PSWQ as a screening instrument for GAD at least in a sample of psychotherapy inpatients is not meaningful. Instead of that, the PSWQ can be used to discriminate high from low worriers in clinical samples. Thus, the instrument can be useful in establishing e.g. symptom-oriented group interventions as they are established in behavioural-medicine inpatient settings. Furthermore, our findings stress the influence of (comorbid) depressive symptoms on the process of worrying.

Worry tendencies predict brain activation during aversive imagery

Because of its abstract nature, worrying might function as an avoidance response in order to cognitively disengage from fearful imagery. The present functional magnetic resonance imaging study investigated neural correlates of aversive imagery and their association with worry tendencies, as measured by the Penn State Worry Questionnaire (PSWQ). Nineteen healthy women first viewed, and subsequently imagined pictures from two categories, ‘threat’ and ‘happiness’. Worry tendencies were negatively correlated with brain activation in the anterior cingulate cortex, the prefrontal cortex (dorsolateral, dorsomedial, ventrolateral), the parietal cortex and the insula. These negative correlations between PSWQ scores and localized brain activation were specific for aversive imagery. Moreover, activation in the abovementioned regions was positively associated with the experienced vividness of both pleasant and unpleasant mental pictures. As the identified brain regions are involved in emotion regulation, vivid imagery and memory retrieval, a lowered activity in high PSWQ scorers might be associated with cognitive disengagement from aversive imagery as well as insufficient refresh rates of mental pictures. Our preliminary findings encourage future imagery studies on generalized anxiety disorder patients, as one of the main symptoms of this disorder is excessive worrying.

Prevalence of depression, sleep-related disturbances, and anxiety and their effect on quality of life in patients with adenocarcinoma of the pancreas

e15678 Purpose: To evaluate the prevalence of depression, sleep related disturbances and anxiety and their effect on quality of life in patients with recently diagnosed adenocarcinoma of the pancreas who present to a multidisciplinary pancreatic cancer clinic. Methods: Cross-sectional and longitudinal psychosocial distress was assessed utilizing Personal Health Questionnaire 9 (PHQ9) to screen for depression and monitor symptoms during the course of care, the Penn State Worry Questionnaire (PSWQ) for generalized anxiety, and the Sleep Problems Questionnaire 4 (SPQ4)/ University of Michigan Sleep Questionnaire to monitor sleep symptoms. Patients were evaluated at their intake consultation and at subsequent follow up visits. Results: 24 patients (pts; mean age 66 years, 48% females) consented to participate during the 6 month pilot study with longitudinal follow up for 13. The PHQ9 scores on presentation revealed mild to moderate depressive symptoms in 54% (13 pts) of pts and moderately severe depressive symptoms in only 8% (2 pts). A minority (2 pts, 8%) had PSWQ scores characteristic of an anxiety disorder, while 33% (8 pts) had moderate anxiety scores. Only 3 pts (12.5%) scores revealed a clear sleep problem; 10 pts, (41.67%) had no sleep problem and 10 pts had a potential sleep problem. Due to the limited follow up, a statistical difference in scores over time was not observed. Conclusions: Our results indicate that mild to moderate depressive symptoms, anxiety and potential sleep problems are common in patients referred to a multidisciplinary pancreatic cancer clinic. Moderately severe depressive symptoms, severe anxiety and clear sleep problems are not as prevalent as is generally believed. To better characterize the relationship of depression (and potential causes) with pancreatic cancer, additional prospective longitudinal studies are needed. No significant financial relationships to disclose.

Usefulness of Mindfulness-Based Cognitive Therapy for Treating Insomnia in Patients With Anxiety Disorders

The objective of this study was to examine the usefulness of a mindfulness-based cognitive therapy (MBCT) for treating insomnia symptoms in patients with anxiety disorder. Nineteen patients with anxiety disorder were assigned to an 8-week MBCT clinical trial. Participants showed significant improvement in Pittsburgh Sleep Quality Index (Z = -3.46, p = 0.00), Penn State Worry Questionnaire (Z = -3.83, p = 0.00), Ruminative Response Scale (Z = -3.83, p = 0.00), Hamilton Anxiety Rating Scale (Z = -3.73, p = 0.00), and Hamilton Depression Rating Scale scores (Z = -3.06, p = 0.00) at the end of the 8-week program as compared with baseline. Multiple regression analysis showed that baseline Penn State Worry Questionnaire scores were associated with baseline Pittsburgh Sleep Quality Index scores. These findings suggest that MBCT can be effective at relieving insomnia symptoms by reducing worry associated sleep disturbances in patients with anxiety disorder. However, well-designed, randomized, controlled trials are needed to confirm our findings.

Pathological worry, anxiety disorders and the impact of co-occurrence with depressive and other anxiety disorders

The Penn State Worry Questionnaire (PSWQ) was administered to 123 outpatients with principal diagnoses of generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder with agoraphobia, and panic disorder without agoraphobia (PD) to examine the specificity of pathological worry for GAD. The mean PSWQ scores in patients with GAD and SAD were significantly higher than the mean PSWQ scores in patients with PD, while not differing significantly in the subgroups without any co-occurring depressive or anxiety disorders. Patients with any co-occurring depressive or anxiety disorder scored significantly higher on the PSWQ. In a logistic regression analysis, high PSWQ scores independently predicted only GAD and SAD diagnoses. The study suggests that pathological worry is specific not only for GAD, and indicates that a significant relationship exists between pathological worry, GAD and SAD, and that depressive and anxiety disorders co-occurrence increases levels of pathological worry in patients with anxiety disorders.

Decreased choline and creatine concentrations in centrum semiovale in patients with generalized anxiety disorder: Relationship to IQ and early trauma

We have demonstrated, using proton magnetic resonance spectroscopy imaging ( 1H-MRSI), elevations of N-acetyl-aspartate/creatine (NAA/CR) in right dorsolateral prefrontal cortex (DLPFC) in patients with generalized anxiety disorder (GAD) in comparison to healthy volunteers. A recent study indicates that the volume of prefrontal cortical white matter may be disproportionately increased in man in comparison to other primate species, with evolutionary implications. We therefore re-analyzed the identical scans with a specific focus on the centrum semiovale (CSO) as a representative region of interest of cerebral white matter. The central hypothesis was, in accordance with our gray matter findings, that patients with GAD, in comparison to healthy controls, would exhibit either an increase in NAA in CSO, or alternatively demonstrate reductions in concentrations of choline (CHO)-containing compounds and/or creatine + phosphocreatine (CR). MRSI scans that were obtained from an earlier [Mathew, S.J., Mao, X., Coplan, J.D., Smith, E.L., Sackeim, H.A., Gorman, J.M., Shungu, D.C., 2004. Dorsolateral prefrontal cortical pathology in generalized anxiety disorder: a proton magnetic resonance spectroscopic imaging study. American Journal of Psychiatry 161, 1119–1121] sample of 15 patients with GAD [6 with early trauma (ET)] and 15 healthy age- and sex-matched volunteers were analyzed further for CSO metabolite alterations. Self-reported worry was scored using the Penn State Worry Questionnaire (PSWQ) and intelligence was assessed using the Wechsler Abbreviated Scale of Intelligence (WASI). Serial multislice/multivoxel MRSI scans had been performed on a 1.5-T MRI. Using absolute quantification methods for metabolite concentrations, we examined NAA, CHO and CR. GAD patients without ET exhibited bilaterally decreased concentrations of CHO and CR in CSO in comparison to healthy volunteers, whereas GAD patients with ET were indistinguishable from controls. In patients with GAD, high IQ was paired with greater worry, whereas in healthy volunteers, high IQ was associated with less worry. In all subjects, IQ inversely predicted left and right CSO CHO concentrations, independent of age, sex, group assignment and PSWQ scores. The CSO may therefore represent a neural substrate that exhibits reductions in CHO and CR metabolite concentrations that are inversely associated with GAD symptomatology and, in the case of CHO, with intelligence. These conclusions are deemed preliminary due to small sample size, with further study of cerebral WM in anxiety disorders suggested.

Worry and eating disorders: A psychopathological association

Worry is a mental process associated with anxiety disorders. The key feature of worry is the predominance of a negative-type and preoccupied thought about possible threatening future events. Objective Some studies have shown that worry may be a feature of eating disorders. This study aims to measure whether worry is significantly higher in eating disordered individuals than in a normal control group and whether worry is associated with the Eating Disorders Inventory. Methods Sixty-three individuals affected by an eating disorder (34 anorexics and 29 bulimics) completed the Penn State Worry Questionnaire, the Structured Clinical Interview for DSM, and the Eating Disorder Inventory. Thirty normal controls completed the Penn State Worry Questionnaire. Results Penn State Worry Questionnaire scores were significantly higher in eating disordered individuals than in controls. It was associated with all the symptoms of eating disorders and was correlated with all the EDI subscales, except for the subscale ‘bulimia’. These findings suggest that worry is important for understanding the psychopathology of eating disorders.