Generalized Anxiety Disorder Severity Research Articles

A Network Analysis of Perinatal Depression, Anxiety, and Temperaments in Women in the First, Second, and Third Trimesters of Pregnancy.

Background/Objectives: Although depression and anxiety are found to be affected by temperaments, little research has studied these relationships in pregnancy. The present study explored the associations among perinatal depression (PD), anxiety dimensions (state, trait, and generalized anxiety disorder (GAD)), and temperaments between women in the three trimesters of pregnancy through a network analysis approach. Moreover, differences in the severity of PD and anxiety between women in the three trimesters were evaluated. Methods: Women in first (N = 31), second (N = 184), and third (N = 54) trimesters of pregnancy were recruited in the present cross-sectional study. The network analysis included PD, anxiety dimensions, and temperaments. Three network models were estimated, and ANOVAs evaluated the differences in the severity of PD and anxiety, including trimesters as a between-subject factor. Results: PD and GAD were the nodes most strongly connected across the three groups. Cyclothymic, depressive, and anxious temperaments were most frequently associated with PD and GAD. Hyperthymic temperament was in the periphery of the three networks. Lastly, women in the first trimester had the highest severity of PD and GAD. Conclusions: PD and GAD showed the strongest associations. Anxiety dimensions had positive associations with PD and GAD, suggesting their role as possible risk factors. Temperaments were differently associated within the network between the three groups. Clinical interventions during pregnancy should target the central variables, considering their direct and indirect relationships.

Prevalence of Generalized Anxiety Disorder and Associated Risk Factors Among Medical Students in Sudan: A Cross-Sectional Study at Omdurman Islamic University

Background: Generalized Anxiety Disorder (GAD) is a mental illness that significantly affects various domains of daily functioning. Limited research has been conducted on GAD among medical students in Sudan, particularly during the socio-political and economic crises. This study aimed to assess the prevalence of GAD, identify risk factors, and evaluate its impact on academic performance and daily activities among Sudanese medical students. Methods: A cross-sectional study was conducted among undergraduate medical students at Omdurman Islamic University. Data were collected using a self-administered online questionnaire via Google Forms, consisting of two parts: socio-demographic information and the Generalized Anxiety Disorder Questionnaire (GAD-7), a validated tool for screening and measuring the severity of GAD. Results: A total of 374 medical students participated, with 64.7% being female. The GAD-7 scores were high (above 9), suggesting GAD among 33.7% of participants, with severity levels of 41.2% for mild anxiety, 21.4% for moderate anxiety, and 12.3% for severe anxiety. Comparison of means showed significant associations between GAD and female students (p<0.001) and students with chronic diseases (p=0.034). GAD significantly impacted daily activities (p<0.001). Multiple logistic regression analysis found that students in the final year had significantly higher GAD-7 scores (Adjusted Odds Ratio=4.25, 95% Confidence Interval=1.27-14.22). Conclusions: The higher scores on the GAD-7 measure among Sudanese medical students are concerning. This emphasizes the urgent need to raise awareness, normalize mental health discussions, and provide accessible counseling services tailored to the students' needs.

Positive reappraisal coping mediates the relationship between parental abuse and lack of affection on adulthood generalized anxiety severity

Exposure to parental abuse and lack of parental affection during childhood are risk factors for adulthood psychopathology. Tendency to engage in positive reappraisal may be a plausible mechanism underlying this relationship. The current study examined if positive reappraisal coping mediated the relationship between maternal/paternal abuse/affection and adulthood generalized anxiety disorder (GAD) symptoms. Participant data (N = 3294) from the Midlife Development in the United States study was collected in three waves, spaced nine years apart. Longitudinal structural equation mediation modeling examined whether positive reappraisal coping at Time 2 mediated the relationship between maternal/paternal abuse/affection at Time 1 and GAD symptoms at Time 3, controlling for GAD symptoms at Time 1. Positive reappraisal coping mediated maternal/paternal childhood abuse – GAD symptom severity and maternal/paternal childhood affection – GAD severity relations. Maternal and paternal abuse was associated with lower positive reappraisal tendencies, predicting increased GAD symptom severity. Conversely, higher maternal/paternal affection was associated with increased positive reappraisal, predicting lower GAD severity. Incremental prediction revealed that childhood abuse to GAD severity via positive reappraisal path was significant for maternal but not paternal abuse, whereas affection from both parents remained significant. Positive reappraisal coping may be a possible mechanism linking childhood experiences to adulthood GAD severity.

Which client with generalized anxiety disorder benefits from a mindfulness ecological momentary intervention versus a self-monitoring app? Developing a multivariable machine learning predictive model

Precision medicine methods (machine learning; ML) can identify which clients with generalized anxiety disorder (GAD) benefit from mindfulness ecological momentary intervention (MEMI) vs. self-monitoring app (SM). We used randomized controlled trial data of MEMI vs. SM for GAD (N = 110) and tested three ML models to predict one-month follow-up reliable improvement in GAD severity, perseverative cognitions (PC), trait mindfulness (TM), and executive function (EF). Eleven baseline predictors were tested regarding differential reliable change from MEMI vs. SM (age, sex, race, EF errors, inhibitory dyscontrol, set-shifting deficits, verbal fluency, working memory, GAD severity, TM, PC). The final top five prescriptive predictor models of all outcomes performed well (AUC = .752 .886). The following variables predicted better outcome from MEMI vs. SM: Higher GAD severity predicted more GAD improvement but less EF improvement. Elevated PC, inhibitory dyscontrol, and verbal dysfluency predicted better improvement in most outcomes. Greater set-shifting and TM predicted stronger improvements in GAD symptoms and TM. Older age predicted more alleviation of GAD and PC symptoms. Women exhibited more enhancements in trait mindfulness and EF than men. White individuals benefitted more than non-White. PC, TM, EF, and sociodemographic data might help predictive models optimize intervention selection for GAD.

Elevated depression and anxiety predict future patterns of individualistic and collectivistic cultural values: A cross-lagged longitudinal network analysis

BackgroundSpecific components of independent and interdependent self-construal have been associated with psychopathology. However, most studies on this topic have been cross-sectional, precluding causal inferences. We used contemporaneous and temporal cross-lagged network analysis to establish weak causal effects in understanding the association between self-construal and psychopathology components. MethodsMiddle-aged and older community-dwelling adults (n = 3294) participated in the Midlife Development in the United States study across two time-points, spaced nine years apart. Six self-construal (interdependence: connection to others, commitment to others, receptiveness to influence; independence: behavioral consistency, sense of difference from others, self-reliance) and three psychopathology nodes (major depressive disorder (MDD), generalized anxiety disorder (GAD), and panic disorder (PD) symptom severity) were examined. All network analyses controlled for age, sex, race, and number of chronic illnesses as covariates. ResultsContemporaneous and temporal networks yielded relations between elevated MDD and PD and increased receptiveness to influence. Heightened GAD symptom severity was associated with future increased difference from others and decreased connection to others, commitment to others, and receptiveness to influence. Higher MDD, GAD, and PD severity were associated with future lower self-reliance. Network comparison tests revealed no consistent network differences across sex and race. LimitationsDSM-III-R measures of MDD, GAD, and PD were used. Results may not generalize to culturally diverse racial groups. ConclusionsChanges in self-construal may result from increased MDD, GAD, and PD severity. Findings suggest the importance of targeting common mental health symptoms to positively influence how individuals view the self and others in various social contexts.

A cohort study comparing the effects of medical cannabis for anxiety patients with and without comorbid sleep disturbance.

Research on cannabis-based medicinal products (CBMPs) in anxiety remains inconclusive due to a paucity of high-quality evidence. Studies indicate a bidirectional relationship between generalized anxiety disorder (GAD) and sleep disruption, but it is unclear how this affects CBMP treatment outcomes. This study aims to compare the patient-reported outcome measures (PROMs) of patients prescribed CBMPs for GAD, with and without impaired sleep. Changes in PROMs were recorded from baseline to 1, 3, 6, and 12 months between those with impaired or unimpaired sleep. Multivariate logistic regression was applied to compare factors associated with a clinically significant improvement in GAD-7 at 12 months. Secondary outcomes included adverse event incidence and frequency. Of the 302 patients that fit the inclusion criteria, mean GAD-7, single-item sleep quality, and EQ-5D-5L index values improved at all time points (p < 0.001). A relationship between sleep impairment and clinically significant changes in GAD-7 at 1 and 3 months was identified (p ≤ 0.01). On multivariate regression, only baseline GAD severity was associated with an increased likelihood of observing a clinically significant improvement in anxiety (p < 0.001). Seven hundred and seven (234%) adverse events were reported by 55 (18.21%) participants. This study observed an association between CBMP treatment and improvements in anxiety in patients with GAD. While patients with comorbid sleep disruption had greater improvements in anxiety, the differences were not maintained in a multivariate analysis. Baseline anxiety severity may be a predictor for CBMP treatment outcomes.

Mental Health Challenges: Anxiety Among Medical Students - A Cross-Sectional Analytical Study

BACKGROUND: Generalized Anxiety Disorder (GAD) is characterized by consistent and excessive worry, significantly impacting daily functioning and academic performance. Medical students encounter various challenges during their academic years and clinical rotations that put them at a higher risk of developing anxiety. In addition, Sudan is currently experiencing a complex social and political environment characterized by political unrest and economic crises. These factors may further increase medical students' risk of developing GAD. Unfortunately, limited research has been conducted on GAD among medical students in Sudan. This study aimed to determine GAD prevalence, assess risk factors, and examine its impact on academic achievement and daily activities among Sudanese medical students. METHODS: A cross-sectional analytical study was done among undergraduate medical students at Omdurman Islamic University in Sudan from January to February 2023. A systematic random sampling technique was used to select 374 participants. Data were collected via an electronic self-administered questionnaire comprising two parts: sociodemographic information and the Generalized Anxiety Disorder Questionnaire (GAD-7), a validated tool for screening and assessing GAD severity. Descriptive statistics, t-tests, one-way ANOVA, and multivariate regression analysis were used to analyze the data. Effect sizes were measured using Cohen's d and eta-squared. The cut-off p-value for statistical significance was set at &lt; 0.05. RESULTS: The prevalence of generalized anxiety disorder (GAD) was 33.7%, with severity levels of 41.2% for mild anxiety, 21.4% for moderate anxiety, and 12.3% for severe anxiety. The mean GAD score was significantly higher among female medical students (p &lt; 0.001) and those with chronic diseases (p = 0.034). GAD significantly impacted daily activities among those who reported higher GAD scores (p &lt; 0.001). In multivariate regression analysis, medical students in the final year had almost 4.246 higher odds of having GAD [95% CI for AOR = 1.267, 14.221] (p = 0.019). Females had 2.4 times higher odds of having GAD [95% CI for AOR = 1.458, 3.946] (p &lt; 0.001). CONCLUSION: The prevalence of generalized anxiety disorder (GAD) among Sudanese medical students is relatively high and has a detrimental impact on daily activities. Medical students in the final year have a higher risk of GAD, and significant associations were found between GAD and female sex, as well as chronic diseases. The high prevalence of GAD among medical students is concerning and highlights the urgent need for increased awareness, normalizing discussions about mental health issues, and providing resources and support to students struggling with anxiety. Universities should identify and offer medical students effective anxiety relief techniques and promote a wellness culture that encourages healthy routines such as regular exercise, sufficient rest, and effective stress management. Future research should evaluate the effectiveness of different interventions in preventing and treating GAD among medical students and identify and address the barriers to accessing mental health care for medical students in Sudan.

General Anxiety Disorder and Primary Hypertension: Is There a Link?

Chronic forms of morbidity, including mental disorders and hypertension, play a dominant role in determining a disease load in the developing world. This article investigates the associations between the diagnoses of primary hypertension and generalized anxiety disorder (GAD) and the severity of GAD in individuals with primary hypertension. The association of GAD and age, sex, marriage, education level, income, chronic medical conditions, family history of mental disorders, adverse life events, and hypertension was assessed in 470 patients with the diagnosis of primary hypertension. Data analysis was performed with IBM SPSS Statistics software version 16. A significant relationship was found between the prevalence of GAD and the following variables: history of mental disorders ( p < 0.0001), chronic medical conditions ( p < 0.0001), and adverse life events ( p < 0.0001). The mean anxiety score was higher among patients with uncontrolled blood pressure, and a significant relationship was observed between the prevalence of GAD and blood pressure ( p < 0.0001). Because of the significant association between GAD and primary hypertension, it is recommended that anxiety disorders be considered in patients in whom primary hypertension is not controlled easily. This may lead to more proper control of hypertension while taking fewer antihypertensive medications.

Pain catastrophizing and worry about health in generalized anxiety disorder.

Because the diagnostic criteria of generalized anxiety disorder (GAD) are not tied to specific worry domains (worry is 'generalized'), research on the content of worry in GAD is lacking. To our knowledge, no study has addressed vulnerability for specific worry topics in GAD. The goal of the current study, a secondary analysis of data from a clinical trial, is to explore the relationship between pain catastrophizing and worry about health in a sample of 60 adults with primary GAD. All data for this study were collected at pretest, prior to randomization to experimental condition in the larger trial. The hypotheses were that (1) pain catastrophizing would be positively related to the severity of GAD, (2) the relationship between pain catastrophizing and the severity of GAD would not be explained by intolerance of uncertainty and psychological rigidity, and (3) pain catastrophizing would be greater in participants reporting worry about health compared to those not reporting worry about health. All hypotheses were confirmed, suggesting that pain catastrophizing may be a threat-specific vulnerability for health-related worry in GAD. The implications of the current findings include a better understanding of the ideographic content of worry, which could help focus treatment interventions for individuals with GAD.

Trait self-acceptance mediates parental childhood abuse predicting depression and anxiety symptoms in adulthood

BackgroundBiopsychosocial models posit that experiencing parental childhood abuse increases vulnerability to psychopathology in adulthood. There are a lack of studies investigating mediators of the parental childhood abuse–adulthood psychopathology relation. The current study investigated if trait self-acceptance mediated the parental childhood abuse–adulthood major depressive disorder (MDD), generalized anxiety disorder (GAD), and panic disorder (PD) severity relations. MethodsParticipants (n = 3294) partook in the 18-year Midlife Development in the United States (MIDUS) study at three time-points. We conducted structural equation modeling analyses to test how maternal and paternal childhood abuse at Time 1 would independently positively predict MDD, GAD, and PD severity at Time 3, and if self-acceptance at Time 2 mediated those relations while controlling for adulthood MDD, GAD, and PD severity at Time 1. ResultsSelf-acceptance notably mediated the parental childhood abuse-adulthood MDD, GAD, and PD relations. Overall, higher paternal and maternal childhood abuse was associated with lower self-acceptance. Reduced self-acceptance predicted heightened adulthood MDD, GAD, and PD. ConclusionFindings highlight the importance of understanding the parental childhood abuse–adulthood psychopathology relation and the possible mechanisms of its long-term impact.

The impact of the COVID-19 pandemic on individuals with generalized anxiety disorder: assessing COVID-19 media source exposure and behaviour changes

BackgroundThe COVID-19 pandemic that has resulted in social distancing, lockdowns, and increase in media posts has taken a toll on the mental health of many people especially those living with Generalized Anxiety Disorder (GAD). The main objective of this study is to understand whether the source of information people use to receive information about COVID-19 and increase or decrease in personal weekly habits during the pandemic were associated with severity of GAD. MethodsThis study was a cross sectional design and was based on data from Canada. The Canadian Perspective Survey Series (CPSS) 4, 2020: Information Sourced Consulted During the Pandemic was used for the study. The outcome variable was severity of GAD. Multivariate logistic regression was carried out using STATA IC 13.ResultsSeverity of GAD was significantly associated with being a female, the type of information source used to find out about COVID-19 and change in weekly habits (consuming alcohol, consuming cannabis spending time on the internet and eating junk foods or sweets).ConclusionThe results indicate that getting information from credible sources about the pandemic, staying connected with family and friends, seeking virtual mental health services, and learning positive coping strategies can help reduce the severity of GAD.

249 MINIMALLY-EFFECTIVE PHYSICAL ACTIVITY DOSE FOR GENERALIZED ANXIETY DISORDER AMONG OLDER ADULTS: PRELIMINARY FINDINGS FROM THE IRISH LONGITUDINAL STUDY ON AGEING

Abstract Background Among older adults, Generalized Anxiety Disorder (GAD), a debilitating condition characterized by persistent excessive worry, is associated with poorer quality of life and estimated cost to the individual of €1,864 annually. Meeting recommended Physical Activity (PA) levels has been associated with lower odds of GAD; however, the minimally-sufficient dose associated with benefits is currently unknown. Herein, we quantified the association between different PA doses and worry symptoms and GAD status among older adults across 10 years (waves 1-5) as part of The Irish Longitudinal Study on Ageing. Methods PA was measured at each wave using the short-form International Physical Activity Questionnaire. Five dose categories were examined (0, 1-&amp;lt;600, 600-&amp;lt;1,200, 1,200-&amp;lt;2,400, and ≥2,400 MET.min.week-1). At all waves, worry symptoms were assessed using the abbreviated Penn State Worry Questionnaire continuous score; a score of ≥23 classified GAD status. Additionally, for Waves 2-5, the CIDI GAD quantified diagnosis of GAD during the past 12 months. Poisson regression with Stata quantified associations between PA dose and GAD and worry symptoms, adjusted for age, health/lifestyle variables and antipsychotics/anxiolytic medication. Results Among 2,200 participants, compared to lowest PA dose, only the highest PA dose (i.e., ≥2,400 MET.min.week-1) was significantly associated with 35% lower odds of GAD (OR=0.65; 95%CI: 0.51, 0.82; p≤0.001). For continuous worry symptoms, meeting the recommendation of at least 600 MET.min.week-1 was significantly, inversely associated with worry symptoms (coefficient= –0.02; 95%CI: –0.033, –0.005; p≤0.009). Female sex, less education, taking anxiolytics, and current smoking were also associated with greater odds of GAD and greater worry severity. Conclusion High physical activity dose was associated with lower odds of GAD over 10 years among older adults. Present findings suggest that older adults, particularly females and smokers, may need to exceed recommended physical activity levels to protect against GAD.

A Multisite Non-Inferiority Randomized Controlled Trial of the Efficacy of Cognitive-Behavior Therapy for Generalized Anxiety Disorder Delivered by Videoconference.

Delivering psychotherapy by videoconference has been studied in a number of clinical trials, but no large controlled trial has involved generalized anxiety disorder (GAD). This multicenter randomized controlled non-inferiority trial was conducted to test if cognitive-behavior psychotherapy delivered by videoconference (VCP) is as effective as cognitive-behavior psychotherapy delivered face-to-face, using a strict margin of tolerance for non-inferiority. A total of 148 adults received a 15-session weekly manualized program. The treatment was based on the intolerance of uncertainty model of GAD. The impact of treatment was assessed using primary (GAD severity), secondary (worry, anxiety, and intolerance of uncertainty) and tertiary (general functioning) variables measured before and after treatment and at 6-month and 12-month follow-ups. Results showed that: (a) the treatment was effective; (b) VCP for GAD was statistically non-inferior to face-to-face psychotherapy on primary, secondary and tertiary measures at all assessment points; (c) change in intolerance of uncertainty significantly predicted change in the primary outcome measure over and above important clinical factors common to all psychotherapies (motivation, working alliance, perceived therapist competence, and client satisfaction). These findings support the use of VCP as a promising treatment option for adults with GAD. Clinical trial registry: ISRCTN#12662027.

Behavioral Experiments for Intolerance of Uncertainty: A Randomized Clinical Trial for Adults With Generalized Anxiety Disorder

Sophisticated multicomponent treatments for adults with generalized anxiety disorder (GAD) have been developed over the past three decades. Although these comprehensive treatments have produced encouraging results, they appear to be less efficacious than treatments for other anxiety disorders. The goal of this randomized controlled trial is to test a newly developed, highly focused treatment for adults with GAD: Behavioral Experiments for Intolerance of Uncertainty. Sixty (60) participants (51 women, 9 men), with a mean age of 34.60 years (range: 19 to 67 years), were randomized to either treatment (n = 30) or wait-list control (n = 30). Treatment consisted of 12 weekly 1-hour sessions in which participants learned to use behavioral experiments to test their catastrophic beliefs about uncertainty. Assessments were conducted at pre-, mid- and postcondition, and at 6- and 12-month follow-up. The primary outcome was the severity of GAD, and secondary outcomes were worry, depression, somatic anxiety, and intolerance of uncertainty. Using growth curve modeling, we found that (1) the treatment group was superior to the wait-list group in terms of change from pre- to posttest on all outcomes; (2) the combined sample (once wait-listed participants received treatment) evidenced large and significant decreases on all outcomes; and (3) treatment gains were either maintained or increased over the 12-month follow-up period of the study. The new treatment is a promising treatment option for adults with GAD considering that it may be as efficacious as more comprehensive evidence-based psychological treatments for GAD.

Prevalence of Generalized Anxiety Disorder among Adults in Primary Health Care in Qatar: A Cross-Sectional Study

Background: Generalized Anxiety Disorder (GAD) has distinctive features of excessive anxiety, worries, and tension. People with GAD have a considerable degree of impairment and often have a poor quality of life besides increased health care costs. Our aim is to determine the prevalence of GAD among adults and the associated factors. Subjects and methods: A cross-sectional study with a sample size of 385 was conducted on adults aged 18 - 65 years at Primary Health Care Corporation in Qatar. We used probability, cluster sampling technique and written consents were secured from participants who met inclusion and exclusion criteria. Considering the COVID-19 current pandemic, measures were considered at interviews to complete GAD-7 questionnaire which is a seven-item instrument that is used to measure the severity of GAD. A total score ranges from 0 to 21. Scores of 5, 10, 15 represent cut-points for mild, moderate, and severe anxiety respectively. Moderate and severe anxiety are considered worthy of clinical attention. We used SPSS version 23 for data analyses. Approval notice was obtained from the Research Committee. Results: The prevalence of clinically significant GAD (moderate to severe) in the study sample was 5.2%. One half of the group with moderate to severe anxiety felt that their life is tough (very or extremely difficult). One third of the participants diagnosed with clinically significant GAD related it to COVID-19 pandemic. A multiple logistic regression model used to predict GAD showed association with: female gender, Northern Africa/South-eastern Asia nationalities, having a positive family history of anxiety disorders, age less than 30 years, illiterate/primary education level, a very high income, and being a smoker. The primary model that included all the explanatory variables was statistically significant with a 95.6% overall predictive accuracy for the outcome. Conclusion: This prevalence highlights the importance of regular screening of GAD, especially for those at high risk. The study was conducted during the COVID-19 pandemic. Key words: Generalized anxiety disorder, prevalence, Qatar.

Inflammation mediates depression and generalized anxiety symptoms predicting executive function impairment after 18 years

IntroductionScar theories propose that elevated depression and anxiety can predispose people to future decreased executive function (EF) via heightened inflammation across decades. However, more longitudinal (versus cross-sectional) research on this topic is needed. ObjectiveWe thus investigated if increased major depressive disorder (MDD), generalized anxiety disorder (GAD), and panic disorder (PD) severity predicted EF decrement 18 years later via heightened inflammation. MethodCommunity-dwelling adults participated in this study. Time 1 (T1) MDD, GAD, and PD severity (Composite International Diagnostic Interview–Short Form), T2 inflammation (interleukin-6, C-reactive protein, and fibrinogen blood levels concentration), and T2 and T3 EF (Brief Test of Adult Cognition by Telephone) were measured. The waves of assessment were spaced approximately 9 years apart. Structural equation modeling was conducted. ResultsHigher T1 MDD and GAD (but not PD) severity forecasted elevated T2 inflammation (Cohen's d = 0.116–0.758). Greater T2 inflammation level predicted lower T3 EF following 9 years (d = -0.782–-0.636). The T1 MDD–T3 EF and T1 GAD–T3 EF negative associations were mediated by T2 inflammation, and explained 38% and 19% of the relations, respectively. Direct effects of higher T1 GAD and MDD predicting lower T3 EF were also observed (d = -0.585–-0.560). Significant effects remained after controlling for socio-demographic, lifestyle, medication use, various illness variables across time, and T2 EF. ConclusionsInflammation may be a mechanism explaining the T1 MDD–T3 EF and T1 GAD–T3 EF relations. Treatments that target inflammation, worry, and/or depression may prevent future EF decline.

The role of the level of personality organization in emotional processing in Generalized Anxiety Disorder

The main problems in Generalized Anxiety Disorder (GAD) are emotional difficulties, which are usually explained without taking into account the personality pathology in the context of which GAD occurs. The approach described here proposes a deeper understanding of the emotional problems associated with GAD, and presents the psychodynamic concept of the level of personality organization (LPO). The aim of this research was to identify the significance of the level of personality organization for emotional processing in GAD. It was expected: 1) that emotional processing difficulties in generalized anxiety would be more severe among those with lower personality organization than among those with higher personality organization; 2) and that the level of personality organization would mediate the link between emotional difficulties and the severity of GAD. The Generalized Anxiety Disorder Questionnaire IV, the Borderline Personality Inventory, and the Emotional Processing Scale were applied to a sample of 287 undergraduates. The results showed significantly greater emotional dysregulation in GAD when it is comorbid with a lower level of personality organization, and a significant mediating role of personality between emotional processing and generalized anxiety. The results are discussed, emphasizing the significance of bringing together the phenomenological and structural levels of description.

Self-help guided by trained lay providers for generalized anxiety disorder in older adults: study protocol for a randomized controlled trial

BackgroundOnly a small proportion of older patients with generalized anxiety disorder (GAD) seek professional help. Difficulties in accessing treatment may contribute to this problem. Guided self-help based on the principles of cognitive-behavioral therapy (GSH-CBT) is one way of promoting access to psychological treatment. Moreover, because the therapist’s role in GSH-CBT is limited to supporting the patient, this role could be assumed by trained and supervised lay providers (LPs) instead of licensed providers. The main goal of this study is to evaluate the efficacy of GSH-CBT guided by LPs for primary threshold or subthreshold GAD in older adults.MethodsWe will conduct a multisite randomized controlled trial comparing an experimental group receiving GSH-CBT guided by LPs (n = 45) to a wait-list control group (n = 45). Treatment will last 15 weeks and will be based on a participant’s manual. Weekly telephone sessions with LPs (30 min maximum) will be limited to providing support. Data will be obtained through clinician evaluations and self-assessment questionnaires. Primary outcomes will be the tendency to worry and severity of GAD symptoms. Secondary outcomes will be anxiety symptoms, sleep difficulties, functional deficit, diagnosis of GAD, and cognitive difficulties. For the experimental group, measurements will take place at pre- and post-treatment and at 6 and 12 months post-treatment. For the control group, three evaluations are planned: two pre-treatment evaluations (before and after the waiting period) and after receiving treatment (post-treatment). The efficacy of GSH-CBT will be established by comparing the change in the two groups on the primary outcomes.DiscussionThis project will provide evidence on the efficacy of a novel approach to treat GAD in older adults. If effective, it could be implemented on a larger scale and provide many older adults with much needed mental health treatment through an expanded workforce.Trial registrationThe trial was registered at ClinicalTrials.gov, number NCT03768544, on December 7, 2018.

Trait anger expression mediates childhood trauma predicting for adulthood anxiety, depressive, and alcohol use disorders

BackgroundGeneral aggression and evolutionary models posit that more severe early exposure experiences to trauma (physical, emotional, sexual abuse and/or neglect) place one at risk for adulthood psychopathology through heightened trait anger expression–internal (Anger-In) and external (Anger-Out). However, there are a dearth of empirical studies explaining the longitudinal childhood maltreatment–adulthood psychopathology relation. ObjectiveTherefore, this study investigated if childhood maltreatment exposure severity predicted elevated adulthood major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder (PD), and alcohol use disorder (AUD). Moreover, we tested if trait anger expression – internal and external – mediated the childhood maltreatment–adulthood MDD, GAD, PD, and AUD symptom associations. MethodParticipants took part in two waves of measurement spaced approximately 9 years apart. Time 1 childhood trauma severity (retrospectively-reported Childhood Trauma Questionnaire), Time 2 Anger-In and Anger-Out (State-Trait Anger Expression Inventory), and Time 3 adulthood MDD, GAD, PD (Composite International Diagnostic Interview–Short Form), and AUD (Alcohol Screening Test) diagnoses were measured. ResultsAnger-Out and Anger-In partially mediated the relations between childhood trauma severity and adulthood psychopathology diagnoses after adjusting for Time 2 symptoms. Higher Time 1 childhood trauma severity was related to greater Time 2 Anger-Out and Anger-In, and increased Time 2 Anger-Out and Anger-In were thereby related to elevated Time 3 adulthood MDD, PD and AUD, but not GAD severity. Trait anger accounted for 14 to 50% of the variance of childhood trauma–adulthood MDD, PD and AUD relations. DiscussionTheoretical and clinical implications, such as the need for trauma-informed care, are discussed.

Treating Pediatric Generalized Anxiety Disorder with Mindfulness: A Case Series

ABSTRACT Mindfulness interventions have been shown to be effective in the treatment of anxiety for both adolescent and adult populations. However, little research has investigated and tested the use of mindfulness as an intervention for child anxiety. This may be in part due to the question of the developmental appropriateness of mindfulness techniques for this age group, given children’s limited capacity for attention and abstract thinking. This case series discusses the format and effectiveness of a pilot mindfulness intervention for children ages 9 to 12 with Generalized Anxiety Disorder (GAD). The treatment is comprised of developmentally tailored, concrete exercises using the senses to teach mindful awareness of the present moment. This case series describes four children who received a 6-session, individual intervention with parental involvement. Outcome data and qualitative case descriptions are presented. Results indicated improvements in the clinical severity of GAD from pre- to post-treatment, as well as at the 8-week follow-up assessment, for each participant. The treatment also demonstrated high feasibility and acceptability to families. Overall, the study provides promising preliminary support for a mindfulness-based pilot treatment specifically tailored for children with GAD.