Do men and women arrive, stay, and respond differently to cognitive behavior group therapy for social anxiety disorder?” [J. Anxiety Disord. 64 (May) (2019) 64–70] Publication date: October 2019 Source: Journal of Anxiety Disorders, Volume 67 Author(s): Maya Asher, Haggai Hermesh, Shay Gur, Sofi Marom, Idan M. Aderka

Effortful control, interpretation biases, and child anxiety symptom severity in a sample of children with anxiety disorders Publication date: October 2019 Source: Journal of Anxiety Disorders, Volume 67 Author(s): Elizabeth M. Raines, Andres G. Viana, Erika S. Trent, Emma C. Woodward, Abigail E. Candelari, Michael J. Zvolensky, Eric A. Storch Abstract Introduction Effortful control—the ability to inhibit impulsive reactions in favor of more adaptive responses—is negatively related to child anxiety severity. One potential explanation is that greater effortful control may “slow down” automatic, threat-laden interpretations, thereby lowering children’s anxiety. The present investigation tested this hypothesis by examining associations between effortful control (and its subcomponents) and anxiety symptom severity, mediated by interpretation biases, in a diverse sample of clinically anxious youth. Method Participants (N = 105; Mage = 10.09 years, SD = 1.22; 56.7% female; 49% ethnic minority) completed a diagnostic interview; self-report measures of temperament, anxiety, and interpretation biases; a performance-based measure of interpretation biases; and a parent–child interaction task for which an index of behavioral anxiety was computed. Results Significant indirect effects were found for effortful control, attentional control, and inhibitory control on child self-reported anxiety severity by way of self-reported (but not behaviorally-indexed) interpretation biases. Models predicting behaviorally-indexed child anxiety severity were not significant. Discussion Greater effortful control may result in enhanced attentional capacities that allow children to assess automatic cognitions more objectively, potentially lowering their anxiety. Future work should evaluate whether targeting malleable temperamental constructs, such as effortful control, leads to clinically meaningful reductions in interpretation biases and child anxiety symptoms.

Problematic driving in former service members: An evaluation of the Driving Behavior Survey in veterans with posttraumatic stress disorder Publication date: October 2019 Source: Journal of Anxiety Disorders, Volume 67 Author(s): Joshua D. Clapp, Denise M. Sloan, William Unger, Daniel J. Lee, Janie J. Jun, Scott D. Litwack, J. Gayle Beck Abstract Despite high levels of traffic-related mortality, injury, and impairment among former service members, measures validated to assess problematic driving in this population remain limited. The current study examined characteristics of the Driving Behavior Survey (DBS) in male veterans (76.3% White; age: M = 56.4, SD = 12.3) meeting criteria for PTSD. Confirmatory factor analyses indicated acceptable fit of a 3-factor model specifying dimensions of anxiety-based performance deficits, exaggerated safety/caution, and hostile/aggressive driving behavior. Concurrent associations with indices of anxiety, depression, trauma history, and clinician-rated PTSD were consistent with small (r = .10–.29) to medium (r = .30–.49) effects. Discriminative validity was noted through elevations in performance deficit (d = .26), safety/caution (d = .50), and hostile/aggressive (d = .39) scales relative to published data from student drivers. Scores comparable to civilian motorists with accident-related PTSD help to qualify the severity of problematic driving behavior in trauma-exposed veterans.

Examining the cross-sectional and longitudinal effects of anxiety sensitivity on indicators of disease severity among patients with inflammatory arthritis Publication date: October 2019 Source: Journal of Anxiety Disorders, Volume 67 Author(s): Matthew T. Bernstein, Corey S. Mackenzie, Jitender Sareen, Brenden Dufault, Carol Hitchon, Renée El-Gabalawy Abstract Few studies have investigated anxiety sensitivity (AS) in the context of inflammatory arthritis (IA), despite evidence of a relationship between AS and pain. This study examined cross-sectional and longitudinal relationships between AS and indicators of IA severity in 148 participants with IA. AS and its factors (social, physical, cognitive) were self-reported. Arthritis severity was physician-assessed (disease activity scales) and self-reported (physical function; pain and fatigue). Cross-sectional correlations assessed the association between AS and arthritis severity outcomes. Longitudinal multivariable mixed-effect regressions assessed the association of AS total and AS factors at each visit with disease severity outcomes. All AS factors were significantly and positively correlated (at the same visit) with function, pain, and fatigue. AS total significantly predicted pain, fatigue, and function. Cognitive AS significantly predicted fatigue, and physical AS significantly predicted pain and fatigue. Social AS significantly predicted pain, fatigue, function and weighted joint count (articular burden). AS is associated with several indicators of disease severity among those with IA; unique findings emerged across factors with the broadest disease impact by social AS. The AS factors, especially social AS, may contribute to the development and severity of IA symptoms, which may have implications for interventions.

Neural responses to social evaluation: The role of fear of positive and negative evaluation Publication date: October 2019 Source: Journal of Anxiety Disorders, Volume 67 Author(s): Samantha L. Birk, Arielle Horenstein, Justin Weeks, Thomas Olino, Richard Heimberg, Philippe R. Goldin, James J. Gross Abstract One of the core features of social anxiety disorder (SAD) is the persistent fear of being evaluated. Fear of evaluation includes fear of negative evaluation (FNE) and fear of positive evaluation (FPE). Few studies have examined the relationship between self-reported FNE and FPE and neural responses to simulated negative and positive social evaluation. In the current study, 56 participants, 35 with SAD and 21 healthy controls, completed questionnaires to assess dimensions of social anxiety including FNE and FPE, as well as symptoms of anxiety and depression. Participants also completed a social evaluation task, which involved viewing people delivering criticism and praise, and a control task, which involved counting asterisks, during functional magnetic resonance imaging. Although whole-brain analyses did not reveal significant associations between self-reported constructs and neural responses to social evaluation, region of interest analyses for the sample as a whole revealed that both FNE and social anxiety symptoms were associated with greater neural responses to both criticism and praise in emotion-processing brain regions, including the amygdala and anterior insula. There were no significant associations between FPE or depressive symptoms and neural responses to criticism or praise for the sample as a whole. Future research should examine the relationship between FNE, FPE, and neural responses to self-referent social evaluation in an unselected sample to assess a full range of fear of evaluation.

Processes in cognitive behavior therapy for social anxiety disorder: Predicting subsequent symptom change Publication date: October 2019 Source: Journal of Anxiety Disorders, Volume 67 Author(s): Fredrik Santoft, Sigrid Salomonsson, Hugo Hesser, Elin Lindsäter, Brjánn Ljótsson, Mats Lekander, Göran Kecklund, Lars-Göran Öst, Erik Hedman-Lagerlöf Abstract Although cognitive behavior therapy (CBT) is an effective treatment for social anxiety disorder, little is known about the processes during treatment that bring about change. The aim of this study was to investigate whether the proposed processes of change according to the cognitive model of social anxiety disorder predicted subsequent symptom reduction in CBT delivered as therapist-guided bibliotherapy. We analyzed data from patients with social anxiety disorder (N = 61) who participated in an effectiveness trial of CBT in primary care. Seven putative processes and outcome (i.e., social anxiety) were assessed on a weekly basis throughout treatment. We used linear mixed models to analyze within-person relations between processes and outcome. The results showed a unidirectional effect of reduced avoidance on subsequent decrease in social anxiety. Further, we found support for reciprocal influences between four of the proposed processes (i.e., estimated probability and cost of adverse outcome, self-focused attention, and safety behaviors) and social anxiety. The remaining two processes, (i.e., anticipatory and post-event processing) did not predict subsequent social anxiety, but were predicted by prior symptom reduction. The findings support that several of the change processes according to the cognitive model of social anxiety disorder are involved in symptom improvement.

Reassurance seeking in the anxiety disorders and OCD: Construct validation, clinical correlates and CBT treatment response Publication date: October 2019 Source: Journal of Anxiety Disorders, Volume 67 Author(s): Neil A. Rector, Danielle E. Katz, Lena C. Quilty, Judith M. Laposa, Kelsey Collimore, Tatjana Kay Abstract Background Reassurance seeking has been hypothesized to be a key factor in the maintenance of anxiety and obsessive-compulsive disorders according to contemporary cognitive-behavioural therapy (CBT) approaches. The present study sought to examine the structure, clinical correlates, and malleability of reassurance seeking in the context of CBT treatment. Methods Treatment-seeking participants (N = 738) with DSM-IV-TR (American Psychiatric Association, 2000) panic disorder with agoraphobia (PD/A), social anxiety disorder (SAD), generalized anxiety disorder (GAD), and obsessive compulsive disorder (OCD) completed the Reassurance Seeking Scale (RSS) with other symptom measures prior to and following CBT treatment. Results A confirmatory factor analysis supported a three factor solution: the need to seek excessive reassurance regarding decisions, attachment and the security of relationships, and perceived general threat and anxiety. The RSS was moderately correlated with general measures of anxiety and depression as well as disorder-specific symptom scales. Further, CBT was found to produce changes in reassurance seeking across CBT treatments and these reductions were significantly associated with disorder-specific clinical improvement. Conclusion Reassurance seeking appears to be a common factor across anxiety disorders and its reduction in CBT treatment is associated with improved clinical outcomes.

Editorial Board Publication date: October 2019 Source: Journal of Anxiety Disorders, Volume 67 Author(s):

Examining military population and trauma type as moderators of treatment outcome for first-line psychotherapies for PTSD: A meta-analysis Publication date: October 2019 Source: Journal of Anxiety Disorders, Volume 67 Author(s): Casey L. Straud, Jedidiah Siev, Stephen Messer, Alyson K. Zalta Abstract There is conflicting evidence as to whether military populations (i.e., veteran and active-duty military service members) demonstrate a poorer response to psychotherapy for posttraumatic stress disorder (PTSD) compared to civilians. Existing research may be complicated by the fact that treatment outcomes differences could be due to the type of trauma exposure (e.g., combat) or population differences (e.g., military culture). This meta-analysis evaluated PTSD treatment outcomes as a function of trauma type (combat v. assault v. mixed) and population (military v. civilian). Unlike previous meta-analyses, we focused exclusively on manualized, first-line psychotherapies for PTSD as defined by expert treatment guidelines. Treatment outcomes were large across trauma types and population; yet differences were observed between trauma and population subgroups. Military populations demonstrated poorer treatment outcomes compared to civilians. The combat and assault trauma subgroups had worse treatment outcomes compared to the mixed trauma subgroup, but differences were not observed between assault and combat subgroups. Higher attrition rates predicted poorer treatment outcomes, but did not vary between military populations and civilians. Overall, manualized, first-line psychotherapies for PTSD should continue to be used for civilians and military populations with various trauma types. However, greater emphasis should be placed on enhancing PTSD psychotherapies for military populations and on treatment retention across populations based on findings from this meta-analysis.

Patient Adherence to Cognitive Behavioural Therapy for Obsessive-Compulsive Disorder: A Systematic Review and Meta-analysis Publication date: Available online 28 August 2019 Source: Journal of Anxiety Disorders Author(s): Tamara Leeuwerik, Kate Cavanagh, Clara Strauss Abstract Whilst Cognitive Behavioural Therapy (CBT) is the treatment of choice for obsessive-compulsive disorder (OCD), around half of the participants do not experience remission following treatment. As yet, there is no comprehensive systematic review of the extent to which patient non-adherence presents a challenge to the overall benefit of CBT for OCD. The aim of this systematic review and meta-analysis was to identify the magnitude, moderators and reasons for poor patient adherence to CBT for OCD in terms of: (1) treatment refusal; (2) treatment dropout; (3) session attendance/module completion, and (4) between-session CBT task adherence. Sociodemographic and clinical variables, treatment and study design characteristics were examined as moderators of adherence. The systematic search identified 123 studies including 5627 participants taking part in CBT or control conditions. A pooled rate of 15.6% of eligible patients refused CBT and a further 15.9% of treatment starters dropped out from treatment. Group CBT had significantly lower dropout rates than individually-delivered CBT. No other significant moderators were found. Most studies reported moderate to good adherence to between-session CBT tasks, which had a significant medium to large association with post-treatment OCD symptom reduction. Recommendations for enhanced measurement and reporting of patient adherence to CBT for OCD are made along with clinical implications of findings.