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

The Role of Anger in Generalized Anxiety Disorder

Background: Little is known about the role of anger in the context of anxiety disorders, particularly with generalized anxiety disorder (GAD). The goal of the current study was to examine the relations between specific dimensions of anger and GAD. Method: Participants (N = 381) completed a series of questionnaires, including the Generalized Anxiety Disorder Questionnaire (GAD-Q-IV; Newman et al., 2002), the State-Trait Anger Expression Inventory (STAXI-2; Spielberger, 1999), and the Aggression Questionnaire (AQ; Buss & Perry, 1992). The GAD-Q-IV identifies individuals who meet diagnostic criteria for GAD (i.e., GAD-analogues) and those who do not (non-GAD). The STAXI-2 includes subscales for trait anger, externalized anger expression, internalized anger expression, externalized anger control, and internalized anger control. The AQ includes subscales for physical aggression, verbal aggression, anger, and hostility. Results: The GAD-Q-IV significantly correlated with all STAXI-2 and AQ subscales (r’s ranging from .10 to .46). Multivariate analyses of variance revealed that GAD-analogues significantly differed from non-GAD participants on the combined STAXI-2 subscales (η² = .098); high levels of trait anger and internalized anger expression contributed most to GAD group membership. GAD-analogue participants also significantly differed from non-GAD participants on the combined AQ subscales (η² = .156); high levels of anger (affective component of aggression) and hostility contributed most to GAD group membership. Within the GAD-analogue group, the STAXI-2 and AQ subscales significantly predicted GAD symptom severity (R2 = .124 and R2 = .198, respectively). Conclusions: Elevated levels of multiple dimensions of anger characterize individuals who meet diagnostic criteria for GAD

Generalized anxiety disorder publications: Where do we stand a decade later?

The purpose of this study was to extend previous work examining publication rates for the anxiety disorders and publication topics for generalized anxiety disorder (GAD). Specifically, we examined anxiety disorder publication rates in MEDLINE and PsycINFO from 1998 to 2008. The results show: 1) that with the exception of panic disorder, there was a significant increase in the annual rate of publications for every anxiety disorder; 2) that GAD had the second lowest annual rate of publications in every year – with no more than 8% of anxiety disorder publications devoted to GAD in any given year; and 3) that GAD publications focused more often on treatment (44%) than on descriptive issues (26%), process issues (22%), and general reviews (8%). Given that citation analysis appears to be a valid indicator of research progress, the current findings suggest that research on GAD continues to lag behind research on most other anxiety disorders

A Randomized Clinical Trial of Cognitive-Behavioral Therapy and Applied Relaxation for Adults With Generalized Anxiety Disorder

This randomized clinical trial compared cognitive-behavioral therapy (CBT), applied relaxation (AR) and wait-list control (WL) in a sample of 65 adults with a primary diagnosis of generalized anxiety disorder (GAD). The CBT condition was based on the intolerance of uncertainty model of GAD, whereas the AR condition was based on general theories of anxiety. Both manualized treatments were administered over 12 weekly one-hour sessions. Standardized clinician ratings and self-report questionnaires were used to assess GAD and related symptoms at pretest, posttest, and at 6-, 12- and 24-month follow-ups. At posttest, CBT was clearly superior to WL, AR was marginally superior to WL, and CBT was marginally superior to AR. Over follow-up, CBT and AR were equivalent, but only CBT led to continued improvement. Thus, direct comparisons of CBT and AR indicated that the treatments were comparable; however, comparisons of each treatment with another point of reference (either waiting list or no change over follow-up) provided greater support for the efficacy of CBT than AR

When it's at: An examination of when cognitive change occurs during cognitive therapy for compulsive checking in obsessive-compulsive disorder

Abstract Background and objectives The cognitive theory of compulsive checking in OCD proposes that checking behaviour is maintained by maladaptive beliefs, including those related to inflated responsibility and those related to reduced memory confidence. This study examined whether and when specific interventions (as part of a new cognitive therapy for compulsive checking) addressing these cognitive targets changed feelings of responsibility and memory confidence. Methods Participants were nine adults with a primary or secondary diagnosis of OCD who reported significant checking symptoms (at least one hour per day) on the Yale-Brown Obsessive-Compulsive Scale. A single-case multiple baseline design was used, after which participants received 12 sessions of cognitive therapy. From the start of the baseline period through to the 1 month post-treatment follow-up assessment session, participants completed daily monitoring of feelings of responsibility, memory confidence, and their time spent engaging in compulsive checking. Results Results revealed that feelings of responsibility significantly reduced and memory confidence significantly increased from baseline to immediately post-treatment, with very high effect sizes. Multilevel modelling revealed significant linear changes in feelings of responsibility (i.e., reductions over time) and memory confidence (i.e., increases over time) occurred following the sessions when these were addressed. Finally, we found that improvements in these over the course of the treatment significantly predicted reduced time spent checking. Limitations The small sample size limits our ability to generalize our results. Conclusions Results are discussed in terms of a focus on the timing of change in cognitive therapy

Strategies and impacts of patient and family engagement in collaborative mental healthcare: protocol for a systematic and realist review

INTRODUCTION: Collaborative mental healthcare (CMHC) has garnered worldwide interest as an effective, team-based approach to managing common mental disorders in primary care. However, questions remain about how CMHC works and why it works in some circumstances but not others. In this study, we will review the evidence on one understudied but potentially critical component of CMHC, namely the engagement of patients and families in care. Our aims are to describe the strategies used to engage people with depression or anxiety disorders and their families in CMHC and understand how these strategies work, for whom and in what circumstances. METHODS AND ANALYSIS: We are conducting a review with systematic and realist review components. Review part 1 seeks to identify and describe the patient and family engagement strategies featured in CMHC interventions based on systematic searches and descriptive analysis of these interventions. We will use a 2012 Cochrane review of CMHC as a starting point and perform new searches in multiple databases and trial registers to retrieve more recent CMHC intervention studies. In review part 2, we will build and refine programme theories for each of these engagement strategies. Initial theory building will proceed iteratively through content expert consultations, electronic searches for theoretical literature and review team brainstorming sessions. Cluster searches will then retrieve additional data on contexts, mechanisms and outcomes associated with engagement strategies, and pairs of review authors will analyse and synthesise the evidence and adjust initial programme theories. ETHICS AND DISSEMINATION: Our review follows a participatory approach with multiple knowledge users and persons with lived experience of mental illness. These partners will help us develop and tailor project outputs, including publications, policy briefs, training materials and guidance on how to make CMHC more patient-centred and family-centred

Plasmonic DNA: Towards Genetic Diagnosis Chips

"Plasmonics and DNA" special issueInternational audienc