Expanding our conceptualization of excessive worry and GAD : the role of fear and avoidance of emotional experiences

Fear of emotional responding and experiential avoidance may play an important role in excessive worry and generalized anxiety disorder (GAD). The goal of the first study was to replicate previous research findings by investigating the role of fear and avoidance of emotional experiences in problematic worry and GAD. Moreover, the study served as an extension of previous research by contrasting the relationship between fear and avoidance of emotional responding and excessive worry with constructs already linked to worry and GAD, such as intolerance of uncertainty. Findings from a nonclinical sample indicated that fear of emotions, in particular fear of anxiety, and experiential avoidance were significantly related to excessive worry, which is the defining feature of GAD. Worry was also highly associated with intolerance of uncertainty. Additional analyses revealed that fear of anxiety, experiential avoidance, and intolerance of uncertainty, all made significant and unique contributions to the prediction of worry. Finally, the results suggested that the tendency to fear and avoid emotional experiences was related to GAD diagnostic criteria. The goal of the second study was to clarify the role of fear of anxiety in worry by assessing whether the experimental manipulation of fear of anxiety affected worry level. The study also assessed the combined effects of fear of anxious responding and intolerance of uncertainty on level of worry by grouping participants according to their tolerance for uncertainty. The results indicated that participants whose fear of anxiety was increased showed higher levels of worry compared to participants whose fear of anxiety was decreased. This finding provides preliminary support for the causal role of fear of anxiety in worry. Moreover, the results showed that increased fear of anxiety in combination with an intolerance for uncertainty led to the highest levels of worry, which suggests that these constructs have an additive effect on worry. The findings from the present research lend support to the integration of new conceptualizations of psychopathology with existing models of excessive worry, which could ultimately increase treatment efficacy for GAD

Examination of the relationship between intolerance of uncertainty and worry

The present paper consists of two studies intended to further the understanding of intolerance of uncertainty and its relationship to worry. The first study examined the psychometric properties of the English version of the Intolerance of Uncertainty Scale (IUS), which has already been validated in French. Factor analysis indicated that the IUS has a 4-factor structure that represents the idea that uncertainty is stressful and upsetting, uncertainty leads to the inability to act, uncertain events are negative and should be avoided, and being uncertain is not fair. The IUS has excellent internal consistency, good test-retest reliability, and convergent and divergent validity when assessed with symptom measures of worry, depression, and anxiety. The second study attempted to assess the unique relationship between intolerance of uncertainty and worry, beyond constructs already associated with worry such as perfectionism and control. Furthermore, the study assessed the distinction between intolerance of uncertainty and intolerance of ambiguity. The results suggest that worry has a stronger relationship with intolerance of uncertainty than perfectionism, control, and intolerance of ambiguity. Moreover, the results indicate that intolerance of uncertainty and intolerance of ambiguity are distinct constructs. Overall, this study suggests that the IUS is a sound measure of intolerance of uncertainty and supports the idea that intolerance of uncertainty is an important construct involved in worry

Increased Risk of Fragility Fractures among HIV Infected Compared to Uninfected Male Veterans

BACKGROUND: HIV infection has been associated with an increased risk of fragility fracture. We explored whether or not this increased risk persisted in HIV infected and uninfected men when controlling for traditional fragility fracture risk factors. METHODOLOGY/PRINCIPAL FINDINGS: Cox regression models were used to assess the association of HIV infection with the risk for incident hip, vertebral, or upper arm fracture in male Veterans enrolled in the Veterans Aging Cohort Study Virtual Cohort (VACS-VC). We calculated adjusted hazard ratios comparing HIV status and controlling for demographics and other established risk factors. The sample consisted of 119,318 men, 33% of whom were HIV infected (34% aged 50 years or older at baseline, and 55% black or Hispanic). Median body mass index (BMI) was lower in HIV infected compared with uninfected men (25 vs. 28 kg/m²; p<0.0001). Unadjusted risk for fracture was higher among HIV infected compared with uninfected men [HR: 1.32 (95% CI: 1.20, 1.47)]. After adjusting for demographics, comorbid disease, smoking and alcohol abuse, HIV infection remained associated with an increased fracture risk [HR: 1.24 (95% CI: 1.11, 1.39)]. However, adjusting for BMI attenuated this association [HR: 1.10 (95% CI: 0.97, 1.25)]. The only HIV-specific factor associated with fragility fracture was current protease inhibitor use [HR: 1.41 (95% CI: 1.16, 1.70)]. CONCLUSIONS/SIGNIFICANCE: HIV infection is associated with fragility fracture risk. This risk is attenuated by BMI