Adaptation of the State Trait Anxiety Inventory in Arabic: A Comparison with the American STAI

The main goal of the present study was to develop an Arabic adaptation of the State Trait Anxiety Inventory (STAI, Form Y, Spielberger, 1983). In addition, cultural and linguistic influences on the experience and expression of anxiety were assessed. The American STAI and fifty initial Arabic items were administered to 286 university students at the American University of Beirut, Lebanon. The American STAI was also administered to 336 university students at the University of South Florida. Item and factor analyses were conducted on responses of the calibration sample to obtain the final set of Arabic items, which was validated using the responses of the validation sample. In conducting item selection and validation of the Arabic STAI, internal consistency coefficients for subscales, corrected item-total correlations, alpha coefficients if-item-deleted, item-factor loadings, and theoretical meaningfulness were all used as criteria for selection of the best 10 Arabic items to be included in each subscale of the STAI: S-Anxiety Absent, S-Anxiety Present, T-Anxiety Absent, T-Anxiety present. The two-factor solution for the Arabic STAI yielded a simple solution with two distinct factors: Anxiety Present and Anxiety Absent for each of S-Anxiety and T-Anxiety, lending more support to the theoretical distinction of state and trait anxiety. Lebanese students reported significantly higher anxiety levels than their American peers on S-Anxiety Present, T-Anxiety Absent, and T-Anxiety Present, S-Anxiety and T-Anxiety of the American STAI. For S-Anxiety Absent, scores for the Lebanese sample were lower than American students but did not reach significance levels. S-Anxiety Absent and T-Anxiety Absent subscales assessed lower levels of anxiety rather than the higher levels of anxiety assessed by S-Anxiety Present and T-Anxiety Present. Females tend to experience and express higher levels of mild and severe anxiety symptoms as compared to males in both samples. Factor analyses of the American STAI for the American and Lebanese samples revealed similar two and three- factor solutions. For each of the State and trait subscales, three factors emerged: Anxiety Absent, Worry, and Emotionality factors, denoting the importance of cognitions and feelings in the experience and expression of anxiety

Systematic review and meta-analysis: anxiety and depressive disorders in offspring of parents with anxiety disorders

Objective: We conducted meta-analyses to assess risk of anxiety disorders among offspring of parents with anxiety disorders and to establish whether there is evidence of specificity of risk for anxiety disorders as opposed to depression in offspring, and whether particular parent anxiety disorders confer risks for particular child anxiety disorders. We also examined whether risk was moderated by offspring age, gender, temperament and the presence of depressive disorders in parents. Method: We searched PsycINFO, PubMed and Web of Science in June, 2016 and July, 2017 (PROSPERO CRD42016048814). Study inclusion criteria: published in peer-reviewed journals; contained at least one group of parents with anxiety disorders and at least one comparison group of parents who did not have anxiety disorders; reported rates of anxiety disorders in offspring, and used validated diagnostic tools to ascertain diagnoses. We used random and mixed-effects models and evaluated study quality. Results: We included 25 studies (7285 offspring). Where parents had an anxiety disorder, offspring were significantly more likely to have anxiety (RR: 1.76, 95% CI = 1.58-1.96) and depressive disorders (RR: 1.31, 95% CI = 1.13-1.52) than offspring of parents without anxiety disorders. Parent Panic Disorder and Generalized Anxiety Disorder appeared to confer particular risk. Risk was greater for offspring anxiety than depressive disorders (RR: 2.50, 95% CI = 1.50-4.16), and specifically for offspring Generalized Anxiety Disorder, Separation Anxiety Disorder and Specific Phobia, but there was no evidence that children of parents with particular anxiety disorders were at increased risk for the same particular anxiety disorders. Moderation analyses were possible only for offspring age, gender and parental depressive disorder; none were significant. Conclusions: Parent anxiety disorders pose specific risks of anxiety disorders to offspring. However, there is limited support for transmission of the same particular anxiety disorder. These results support the potential for targeted prevention of anxiety disorders

Clinically Significant Anxiety in Children with Autism Spectrum Disorder and Varied Intellectual Functioning.

Objective: To evaluate how distinct presentations of anxiety symptoms and intellectual impairment influence the measurement and estimated rate of clinically significant anxiety in autism spectrum disorder (ASD).Method: The sample included 75 children (ages 9-13 years) with ASD and varied IQ and 52 typically developing (TD) controls and parents. Parents completed anxiety symptom scales and a diagnostic interview, designed to (1) differentiate anxiety and ASD and (2) examine DSM-specified and unspecified ("distinct") anxiety presentations in each child, including fears of change, special interests, idiosyncratic stimuli and social confusion rather than evaluation. Children completed standard intellectual and ASD diagnostic assessments.Results: 69% of those with ASD had clinically-significant anxiety, including 21% DSM-specified anxiety disorders, 17% distinct anxiety, and 31% both. Only 8% of TD children had clinically-significant anxiety, all DSM-specified. DSM-specified anxiety disorders in children with ASD and intellectual impairment (IQ<70) were predominantly specific phobias. DSM-specified anxiety other than specific phobia was significantly less common in children with, versus without, intellectual impairment; this was not the case for distinct anxiety. The sensitivities of anxiety scales were moderate to poor, particularly in cases with intellectual impairment.Conclusions: ASD is associated with more frequent and varied presentations of clinical anxiety, which may align with and differ from the specified anxiety disorders of the DSM. Standard parent report anxiety scales have reduced sensitivity to detect clinical anxiety in ASD, particularly in children with intellectual impairment

Temperament and family environment in the development of anxiety disorder: Two-year follow-up.

Objective: Behavioural inhibition (BI) in early childhood is associated with increased risk for anxiety. The present research examines BI alongside family environment factors, specifically maternal negativity and overinvolvement, maternal anxiety and mother-child attachment, with a view to providing a broader understanding of the development of child anxiety. Method: Participants were 202 children classified at age 4 as either behaviourally inhibited (N=102) or uninhibited (N=100). Family environment, BI and child anxiety were assessed at baseline and child anxiety and BI were assessed again two-years later when participants were aged 6 years. Results: After controlling for baseline anxiety, inhibited participants were significantly more likely to meet criteria for a diagnosis of social phobia and generalized anxiety disorder at follow-up. Path analysis suggested that maternal anxiety significantly affected child anxiety over time, even after controlling for the effects of BI and baseline anxiety. No significant paths from parenting or attachment to child anxiety were found. Maternal overinvolvement was significantly associated with BI at follow-up. Conclusions: At age 4, BI, maternal anxiety and child anxiety represent risk factors for anxiety at age 6. Furthermore, overinvolved parenting increases risk for BI at age 6, which may then lead to the development of anxiety in later childhood

Path analysis examining relationships among antecedents of anxiety, multidimensional state anxiety, and triathlon performance

The official published version of this article can be found at the link below. This is a authors’ draft of the paper: Copyright @ Perceptual and Motor Skills, 1995The study explored predictive paths for antecedents of anxiety, state anxiety responses, and performance. Male triathletes (N = 175) completed a modified Competitive State Anxiety Inventory-2 which included the original intensity scale and a direction scale of Jones and Swain. They also completed a 23-item Prerace Questionnaire which measured antecedents of anxiety among triathletes. Factor analysis of intercorrelations for the Prerace Questionnaire identified six factors similar to those found in 1995 by the present authors. Path analysis to predict state anxiety from antecedents of anxiety indicated that rated intensity of anxiety was predicted by the perceived difficulty of race goals and by perceived readiness. Direction of anxiety was predicted by coach's influence, recent form, and perceived readiness. Path analysis to predict performance from state-anxiety scores and antecedents of anxiety indicated that recent form predicted performance directly without mediation of anxiety responses. Anxiety scores did not predict performance. The findings support the notion that intensity and direction of anxiety responses have different antecedents

Recent trends in the incidence of anxiety diagnoses and symptoms in primary care.

Anxiety is common, with significant morbidity, but little is known about presentations and recording of anxiety diagnoses and symptoms in primary care. This study aimed to determine trends in incidence and socio-demographic variation in General Practitioner (GP) recorded diagnoses of anxiety, mixed anxiety/depression, panic and anxiety symptoms

Patterns and frequency of anxiety in women undergoing gynaecological surgery

Patterns and frequency of anxiety in women undergoing gynaecological surgery Aims. Within a gynaecological surgical setting to identify the patterns and frequency of anxiety pre- and postoperatively; to identify any correlation between raised anxiety levels and postoperative pain; to identify events, from the patients’ perspective, that may increase or decrease anxiety in the pre- and postoperative periods. Background. It is well documented that surgery is associated with increased anxiety, which has an adverse impact on patient outcomes. Few studies have been conducted to obtain the patient’s perspective on the experience of anxiety and the events and situations that aggravate and ameliorate it. Method. The study used a mixed method approach. The sample consisted of women undergoing planned gynaecological surgery. Anxiety was assessed using the State Trait Anxiety Inventory. Trait anxiety was measured at the time of recruitment. State anxiety was then assessed at six time points during the pre- and postoperative periods. Postoperative pain was also measured using a 10 cm visual analogue scale. Taped semi-structured telephone interviews were conducted approximately a week after discharge. Results. State anxiety rose steadily from the night before surgery to the point of leaving the ward to go to theatre. Anxiety then increased sharply prior to the anaesthetic decreasing sharply afterwards. Patients with higher levels of trait anxiety were more likely to experience higher levels of anxiety throughout their admission. Elevated levels of pre- and postoperative anxiety were associated with increased levels of postoperative pain. Telephone interviews revealed a range of events/situations that patients recalled distressing them and many were related to inadequate information. Conclusion. This study found higher rates of anxiety than previously reported and anxiety levels appeared raised before admission to hospital. This has important clinical and research implications.Relevance to clinical practice. Patients with high levels of anxiety may be identified preoperatively and interventions designed to reduce anxiety could be targeted to this vulnerable group. Patient experiences can inform the delivery of services to meet their health needs better

What Do You Want to Be When You Grow Up? Cognitive Flexibility Influences Career Decision Making and Related Anxiety

Career indecision is a stage most individuals pass through during their lifetime, but it is often accompanied by anxiety. While anxiety can have a positive influence on decision making by focusing attention and cognitive resources, excess anxiety can disrupt the career decision-making process. Existing literature links anxiety to cognitive flexibility, an individual’s ability to efficiently switch between thoughts and ideas and adapt to evolving situations, with young adults higher in cognitive flexibility typically experiencing less anxiety than their less flexible peers. However, no studies to date have examined cognitive flexibility as it relates to career indecision or career-indecision-related anxiety. This study examines the relationships between cognitive flexibility, career indecision, and anxiety in undergraduate students. 156 undergraduate students (72% female, 91% Caucasian, 63% juniors and seniors) completed an online Qualtrics survey assessing career indecision, career anxiety, cognitive flexibility, and general demographic information including academic trajectory, career confidence, and personal characteristics. The previously documented relationship between career indecision and anxiety was supported, but the discovery that both career indecision and anxiety share significant relationships with cognitive flexibility augments prior research by examining cognitive flexibility in the context of career decision-making. While cognitive flexibility did relate to both career-indecision-related anxiety and career indecision, it did not directly mediate the relationship between these two variables, and once its relationship with career indecision was partialled, it no longer significantly correlated with career-indecision-related anxiety. This suggests cognitive flexibility could serve as a mechanism to promote career decision-making, thereby reducing career-indecision-related anxiety

Does diagnostic complexity predict response to online interventions for youth anxiety?

Purpose: There is now substantial evidence to demonstrate the efficacy of online, cognitive-behavioural therapy (CBT) for the treatment of youth anxiety disorders. However, approximately 30% of youth will retain an anxiety diagnosis at 12-months following treatment. There has been some suggestion that internet-based interventions may not be suitable for more complex diagnostic presentations, however, there has been no empirical examination of predictors of outcome for youth receiving online CBT. The aim of this paper was to determine whether diagnostic profile predicted response to online CBT for youth anxiety. Methods: Participants were 154 youth (aged 7 to 18 years) diagnosed with a principal anxiety disorder who participated in an online cognitive-behavior intervention (BRAVE-ONLINE) as part of two randomized controlled trials. Measures included diagnostic interviews as well as a number of self-report measures of anxiety. Youth receiving online CBT were assessed prior to treatment, at 12 weeks following baseline assessment, and at 12-month follow-up. Diagnostic profile at baseline is described by type of principal anxiety diagnosis, severity of anxiety and presence of comorbid anxiety and non-anxiety. Treatment outcome was conceptualized as treatment 'response' (loss of primary diagnosis) and as 'remission' (loss of all anxiety diagnoses/ symptoms). Results and Conclusions: Results indicate that the majority of youth respond well to online CBT at 12-month follow-up. Comorbidity with other anxiety disorders was the most robust predictor of poorer response and remission, however only for those youth with 3 or more comorbid anxiety disorders. While youth with comorbid anxiety do respond to internet interventions, it seems that the presence of multiple anxiety disorders may limit its impact. The findings of this study have the potential to identify the types of patients for whom online CBT may be most appropriate and the circumstances under which it should not be offered as first line of treatment