Worrying is the central feature of generalized anxiety disorder . Many people worry from time to time, but in GAD the worrying is prolonged and difficult to control. Worrying is a specific way of coping with perceived threats and feared situations. Meanwhile, it is not considered to be a helpful coping strategy, and the phenomenological account developed in this paper aims to show why. It builds on several phenomenological notions and in particular on Michael Wheeler's application of these notions to (...) artificial intelligence and the cognitive sciences. Wheeler emphasizes the value of 'online intelligence' as contrasted to 'offline intelligence'. I discuss and apply these concepts with respect to worrying as it occurs in GAD, suggesting that GAD patients overrate the value of detached contemplation , while underrating their embodied-embedded adaptive skills . I argue that this phenomenological account does not only help explaining why worrying is used as a coping strategy, but also why cognitive behavioral therapy is successful in treating GAD. (shrink)

Although the role of emotion in socioeconomic decision making is increasingly recognised, the impact of specific emotional disorders, such as anxiety disorders, on these decisions has been surprisingly neglected. Twenty anxious patients and twenty matched controls completed a commonly used socioeconomic task (the Ultimatum Game), in which they had to accept or reject monetary offers from other players. Anxious patients accepted significantly more unfair offers than controls. We discuss the implications of these findings in light of recent models (...) of anxiety, in particular the importance of interpersonal factors and assertiveness in an integrated model of decision making. Finally, we were able to show that pharmacological serotonin used to treat anxious symptomatology tended to normalise decision making, further confirming and extending the role of serotonin in co-operation, prosocial behaviour, and social decision making. These results show, for the first time, a different pattern of socioeconomic behaviour in anxiety disordered patients, in addition to the known memory, attentional and emotional biases that are part of this pathological condition. (shrink)

Would metaphors used in the context of psychotherapy by people who experience various forms of anxiety disorders differ from those used by people who experience stress? We investigated this question with the help of the Motivation & Sedimentation Model (MSM), a theory of meaning-making developed within the synthetic new discipline of cognitive semiotics. The analysis of a sample of ten transcripts of psychotherapy sessions concerning the topic of anxiety, and a comparable sample concerning stress, showed a significantly stronger proportion (...) of conventionalized metaphors in the stress sample, and a marginally significant difference in the number of innovative metaphors in the anxiety sample. These results suggest that lived experience of an anxiety disorder or another form of maladaptive anxiety affects metaphorical meaning-making, and manifests itself in spontaneous metaphor use. Furthermore, as a result of the conceptual and the empirical investigations of the topic, we propose novel theoretical and operational definitions of the notion of metaphoricity. (shrink)

Individuals with social anxiety disorder engage in post-event processing, a form of perseverative thinking. Given that deficits in working memory might underlie perseverative thinking, we examined working memory in SAD with a particular focus on the effects of stimulus valence. SAD and healthy control participants either maintained or reversed in working memory the order of four emotional or four neutral pictures, and we examined sorting costs, which reflect the extent to which performance deteriorated on the backward trials compared to the (...) forward trials. Emotionality of stimuli affected performance of the two groups differently. Whereas control participants exhibited higher sorting costs for emotional stimuli compared to neutral stimuli, SAD participants exhibited the opposite pattern. Greater attention to emotional stimuli in SAD might facilitate the processing of emotional stimuli in working memory. (shrink)

Glas's article is one of several in an interesting special issue focused on applying concepts from enactivism to psychiatry; his focuses on anxiety in particular. Given ongoing developments in work on enactivism, and ongoing debates about how to progress psychiatry, this application is timely. Here, I make three general points about the application of enactivism to psychiatry; I exemplify these with occasional comments on social anxiety disorder.First, as de Haan notes in her introduction, the term enactivism encompasses a number of (...) authors and ideas. Wilson and Foglia note that enactivism falls within a broader literature on "embodied cognition." This literature is partly conceptual, but also relies on... (shrink)

This study reviews the existing literature on psychiatric interventions for individuals affected by the COVID-19 epidemic. My article cumulates previous research on how extreme stressors associated with COVID-19 may aggravate or cause psychiatric problems. The unpredictability of the COVID-19 epidemic progression may result in significant psychological pressure on vulnerable populations. Persons with psychiatric illnesses may experience worsening symptoms or may develop an altered mental state related to an increased suicide risk. The inspected findings prove that psychological intervention measures for patients (...) affected by the epidemic should be designed and personalized adequately. Preventive measures seek to decrease infection rates and cut down the risk of the public healthcare system to eventually be overburdened. Throughout the COVID-19 crisis, people with psychiatric illnesses may confront a decrease in mental health services. As limitations in the current review, by focusing only on articles published in journals indexed in Web of Science, Scopus, and ProQuest, I inevitably disregarded other valuable sources. Subsequent research directions should clarify the effectiveness of online mental health services in providing remote psychiatric interventions to individuals affected by the COVID-19 epidemic. (shrink)

The use of placebo as a control condition in clinical trials of major depressive disorder and anxiety disorders continues to be an area of ethical concern. Typically, opponents of placebo controls argue that they violate the beneficent-based, “best proven diagnostic and therapeutic method” that the original Helsinki Declaration of 1964 famously asserted participants are owed. A more consequentialist, oppositional argument is that participants receiving placebo might suffer enormously by being deprived of their usual medication(s). Nevertheless, recent findings of potential (...) for suicidality in young people treated with antidepressants, along with meta-analyses suggesting that antidepressants add no significant clinical benefit over placebos, warrant a re-evaluation of the arguments against placebo. Furthermore, the nature of placebo treatment in short-term clinical trials is often not well understood, and lack of understanding can foster opposition to it. This paper will show how scientific justifications for placebo use are morally relevant. The fundamental ethical importance of placebo controls is discussed in relation to several aspects of clinical trials, including detection of adverse events, accurate assessment of clinical benefit, advancing understanding of the heterogeneity of depression and anxiety disorders and respecting informed consent requirements. Prohibiting the use of placebo controls is morally concerning in that such prohibitions allow for the possibility of serious adverse public health consequences. Moral worries that research participants receiving placebo are being unduly jeopardised will be shown to be exaggerated, especially in relation to the net benefits for end-users to be gained from the quality of data resulting from using placebo controls. (shrink)

The study had two main goals: Firstly, the authors aimed to verify the validity and reliability of the Slovak adaptation of the Coronavirus Anxiety Scale. Secondly, the authors examined the associations between the CAS and mental health indicators – depression, insomnia and generalized anxiety disorder. The representative sample consisted of 1625 Slovak participants from the general population. The data were collected in October 2020. The data were analyzed using confirmatory factor analysis and multiple hierarchical regression analysis. The authors confirmed that (...) the psychometric properties of the CAS were adequate. Furthermore, they identified predictors of depression, generalized anxiety disorder and insomnia. The results may contribute to our understanding of the pandemic’s impact on mental health. (shrink)

Enactive approaches to emotion are rare and to anxiety and anxiety disorder even more. This article aims to show how an enactive paradigm might be helpful in solving some problems in the clinical and scientific understanding of anxiety and anxiety disorder. I begin by pointing at a number of relevant clinical features of anxiety and anxiety disorder and by sketching how and why anxiety theories have difficulties with doing justice to these features. I specifically focus on two themes: a) how (...) to conceptualize anxiety as the expression of a dynamical interaction with the environment instead of as just a reaction to the environment (or to... (shrink)

Generalized anxiety disorder (GAD) and social phobia (SP) are major anxiety disorders identified by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). They are comorbid, overlap in symptoms, yet present with distinct features (worry in GAD and fear of embarrassment in SP). Both have also been explained in terms of conditioning-based models. However, there is little reasoning currently to believe that GAD in adulthood reflects heightened conditionability or heightened threat processing—though patients with SP may show (...) heightened processing of social threat stimuli. Moreover, the computational architectures that maintain these disorders in adulthood are different. For GAD this may reflect the development of an inefficient “worrying” strategy of emotional regulation. For SP this appears to reflect the atypical processing of self-referential information. (shrink)

IntroductionGeneralized Anxiety Disorder is a prevalent emotional disorder associated with increased dysfunctionality, which has a lasting impact on the individual’s quality of life. Besides medication, Cognitive-Behavioral Therapy represents the golden standard psychotherapeutic approach for GAD, integrating multilevel techniques and various delivery formats that enable the development of tailored treatment protocols. The objective of this study was to compare the efficiency of a standard CBT protocol targeting worries, dysfunctional beliefs, and intolerance of uncertainty with an integrative and multimodal CBT intervention augmented (...) with Virtual Reality.Materials and methodsThis study included 66 participants with moderate GAD symptoms that were randomized to the standard CBT group and the Integrative and Multimodal CBT augmented with VR group. The interventions comprised 10 weekly sessions conducted by trained CBT therapists, including cognitive restructuring, problem-solving, behavioral exposure, and relaxation techniques. Baseline and post-assessments were conducted with both groups. Primary outcome measures included the Hamilton Anxiety Rating Scale and Penn-State Worry Questionnaire to evaluate the severity of GAD symptoms and worries, respectively. Secondary outcomes involved the administration of Automatic Thoughts Questionnaire, Dysfunctional Attitudes Scale and Unconditional Self-Acceptance Questionnaire.ResultsBoth interventions determined statistically significant effects on both primary and secondary outcomes in the expected direction. However, CBTs was associated with higher effect sizes for anxiety and worries, in contrast to IM-VRCBT. Also, secondary analyses revealed positive correlations between changes in anxiety and worries level and the reduction of dysfunctional cognitive processes.ConclusionThis research emphasized the effectiveness of CBT interventions for treating adults with moderate GAD symptomatology. Specifically, both interventions were efficient for reducing anxiety symptomatology present at individuals with GAD. However, regarding cognitive dysfunctions like worries, the standard CBT protocol performed better, as compared to the IM-VRCBT. In addition, we conclude that VR could be integrated within CBT interventions in a single protocol for GAD treatment. (shrink)

Social anxiety disorders are among the most prevalent mental disorders, with high impact on the life of an affected social system and its individual social system members. We developed a manualized disorder-specific integrative systemic and family therapy for SAD, and evaluated its feasibility in a pilot randomized controlled trial. The ISFT is inspired by Helm Stierlin’s concept of related individuation developed during the early 1980s, which has since continued to be refined. It integrates solution-focused language, social network diagnostics, (...) and genogram work, as well as resource- and problem orientation for both case conceptualization and therapy planning. Post-Milan symptom prescription to fluidize the presented symptoms is one of the core interventions in the ISFT. Theoretically, the IFST is grounded in radical constructivism and “Cybern-Ethics,” multi-directional partiality, and a both/and attitude toward a disorder-specific vs. non-disorder-specific therapy approach. SAD is understood from the viewpoint of social systems theory, especially in adaptation to a socio-psycho-biological explanatory model of social anxiety. In a prospective multicenter, assessor-blind pilot RCT, we included 38 clients with SAD : 18 patients participated in the ISFT, and 20 patients in Cognitive Behavioral Therapy. Within-group, simple-effect intention-to-treat analyses showed significant reduction in social anxiety, while intention-to-treat mixed-design ANOVA demonstrated the advantage of ISFT. Per-protocol analyses supported these results. The remission rate based on blind diagnosticians’ ratings was good to satisfactory ; this has yet to be verified in a subsequent confirmatory RCT. The article will present the ISFT rationale and manual, including a special focus on multi-person settings, and the central findings from our pilot RCT. (shrink)

Generalized anxiety disorder can cause significant socioeconomic burden and daily life dysfunction; hence, therapeutic intervention through early detection is important. This study was the final stage of a 3-year anxiety screening tool development project that evaluated the psychometric properties and diagnostic screening utility of the Mental Health Screening Tool for Anxiety Disorders, which measures GAD. A total of 527 Koreans completed online and offline versions of the MHS: A, Beck Anxiety Inventory, Generalized Anxiety Disorder-7, and Penn State Worry Questionnaire. (...) The participants had an average age of 38.6 years and included 340 females. Participants were also administered the Mini-International Neuropsychiatric Interview. Internal consistency, convergent/criterion validity, item characteristics, and test information were assessed based on the item response theory, and a factor analysis and cut-off score analyses were conducted. The MHS: A had good internal consistency and good convergent validity with other anxiety scales. The two versions of the MHS: A were nearly identical. It had a one-factor structure and showed better diagnostic accuracy for GAD detection than the GAD-7 and BAI. The IRT analysis indicated that the MHS: A was most informative as a screening tool for GAD. The MHS: A can serve as a clinically useful screening tool for GAD in Korea. Furthermore, it can be administered both online and offline and can be flexibly used as a brief mental health screener, especially with the current rise in telehealth. (shrink)

Generalized anxiety disorder is under-treated yet prevalent among young adults. Identifying early risk factors for GAD would contribute to its etiological model and identify potential targets for intervention. Insecure attachment patterns, specifically ambivalent and disorganized, have long been proposed as childhood risk factors for GAD. Similarly, childhood behavioral inhibition has been consistently associated with anxiety disorders in adulthood, including GAD. Intolerance of uncertainty, the tendency to react negatively to uncertain situations, has also been shown to be a crucial component (...) of GAD. Furthermore, maternal anxiety is an important feature of developmental models of anxiety including GAD. Yet, to date, no study has examined, within a comprehensive model, how attachment and behavioral inhibition in childhood, maternal anxiety in adolescence, and IU in emerging adulthood contribute to GAD in adulthood. The present study thus examines these links using a longitudinal design with 62 Canadian participants and their mothers. At age 6, participants' attachment and behavioral inhibition were assessed observationally. Maternal anxiety was measured when participants were 14 years of age. IU and GAD were assessed when participants were 21 and 23 years of age, respectively. Structural equation modeling showed that IU mediates the relationships between behavioral inhibition and GAD, while controlling for maternal anxiety. Ambivalent and disorganized-controlling attachment patterns are also indirectly associated with increased GAD symptoms via greater IU scores. Furthermore, a direct and positive effect of behaviorally disorganized attachment was found on GAD symptoms. This longitudinal study supports integrating attachment, behavioral inhibition, and IU in a model of GAD. (shrink)

Illness anxiety disorder, formerly known as hypochondria, has been conceptualised in the psychological literature as an anxiety disorder, and its dimensional correlate is usually referred to as hea...

Researchers have postulated that deficits in cognitive control are associated with, and thus may underlie, the perseverative thinking that characterises generalised anxiety disorder. We examined associations between cognitive control and levels of spontaneous state rumination following a stressor in a sample of healthy control participants and participants with GAD. We assessed cognitive control by measuring working memory capacity, defined as the ability to maintain task-relevant information by ignoring task-irrelevant information. To this end, we used an affective version of the reading (...) span task with valenced distractors. Lower WMC in the presence of negative distractors was associated with greater state rumination in the GAD group, but not in the CTL group. These findings suggest that difficulty maintaining task-relevant information due to interference from negative distractors contributes to perseverative thinking in GAD. (shrink)

ABSTRACTAlthough attention bias toward threat has been associated with Social Anxiety Disorder, concerns regarding the ability of current measures to detect change in AB following treatm...

We investigated the association between cognitive control and individual differences in cortisol response to stress in participants with generalised anxiety disorder and in never-disordered c...

The short version of the Bielefeld Partnership Expectations Questionnaire assesses the partner-related attachment dimensions fear of rejection, readiness for self-disclosure, and conscious need for care. The presented study investigated the factor structure in two samples and evaluated the convergent validity of scales. The sample included N = 175 patients with panic disorder and/or agoraphobia and N = 143 healthy controls. Besides, the BPEQ, the Experiences in Close Relationships Questionnaire, and the Brief Symptom Inventory were assessed as well, and the Adult (...) Attachment Prototype Rating was conducted. A confirmatory factor analysis of the three factor model revealed an acceptable model fit for the entire sample, patients and controls in terms of low RMSEA and SRMR. We found metric, scalar, and strict measurement invariance for the presence of anxiety disorder. However, only for fear of rejection and readiness for self-disclosure the reliability was acceptable, and convergent validity in terms of large correlations with the ECR scales was found in both samples. The scale conscious need for care had a questionable reliability and correlated only slightly with ECR-R scales. We conclude that fear of rejection and readiness for self-disclosure of the BPEQ-12 are reliable and valid scales for measuring partner-related attachment in healthy and clinical samples. (shrink)

In this paper, I develop a phenomenological account of social anxiety disorder (SAD) as a disturbance of lived time through an analysis of first-person accounts informed by Minkowski’s notion of disordered temporality. The core psychopathology of the patient, I argue, is a constricted sense of relational time. Instead of the ordinary sense of a taken-for-granted shared future, the patient experiences time as running a predetermined course toward their social death. This manifests itself in a relational life lived as if it (...) might end at any moment or has already done so. Patients describe the end of their current relationships as self-evident and struggle against it by attempting to evade its immediate occurrence and to postpone it into the less eminent future. At times, patients succumb to passivity and self-blame, revelatory of a sense of an entirely lacking relational future. This phenomenological conceptualization provides an alternative to the predominant cognitive-behavioral (CBT) account of SAD. The CBT approach conceptualizes the core disorder as a set of dysfunctional beliefs about other people’s opinion of the patient. The phenomenological account elucidates a part of the subjective background on which these beliefs come to make sense to the patient. Further, with its concept of social death, the phenomenological account captures the existential contexts, which makes the intensity of the patient’s fear of rejection comprehensible. This way of understanding the patient and their psychopathology has important implications for diagnostic and psychotherapeutic practice. (shrink)

Studies have supported the effectiveness of the From Timid to a Tiger and Supportive Parenting for Anxious Childhood Emotions program in reducing childhood anxiety. This study is the first to compare the effectiveness of the two programs in the treatment of childhood anxiety disorder and reducing family accommodations levels. Parents of children aged 6 to 9 were randomly allocated to either FTTT or SPACE groups, and each attended ten online sessions following the manuals of the interventions. Throughout the study, 9 (...) participants dropped out, resulting in a total of 49 participants, and we performed statistical analyses based on data from these 49 participants. The assessment took place pre- and post-treatment and at a ten-week follow-up on parent-rated child anxiety and family accommodation measures. Analyses of variance and gain scores were conducted to examine the data. The results indicated that both treatments approaches produced significant reductions in outcome measures, and the post-treatment gains of both treatments were maintained at a ten-week follow-up, though when considering the mean differences and effect sizes across the assessment scores and between groups, overall, the FTTT was significantly more effective in reducing child anxiety scores and family accommodation levels. Our results demonstrated that FTTT significantly outperformed the SPACE program in reducing childhood anxiety problems and family accommodation levels. (shrink)

Being in the bodily presence of others facilitates important perceptual, social, and informational advantages. For example, it enables direct access to other subjects’ embodied perspectives, motivates intersubjective engagements, and is involved in the construction of shared experiences and joint actions. These advantages are based on and gained through attending to and with others, i.e. they rely on social attention. It is no surprise, therefore, that a growing body of empirical data indicates that social attention is a special attentional state that (...) involves specific behavioral and neural-cognitive properties. Another important feature of the human capacity for social attention, which is highlighted in this article is that in everyday environments social attention considerably extends and enriches the subject’s attentional field. This idea draws on phenomenological considerations and on findings from cognitive science research that suggest that subjects can attend to more than in the center of their attention and that under normal conditions we can gain more features and more situations when attending to the movements, gestures, and facial expressions of others. The influence of others on the structure of our attentional field is evident from situations where others are absent from our daily surroundings. In these circumstances our attentional field narrows and the world transforms into an unfamiliar and sometimes uncanny place. Intriguingly, the same most likely occurs in social pathologies such as BPD and SAD, in which the bodily presence of others does not generate the emotional response we see in healthy humans even though the subject’s basic capacity for social attention is intact. (shrink)

Background: There is a growing interest in using cognitive behavioural therapy with people who have Asperger Syndrome and comorbid mental health problems. Aims: To examine whether modified group CBT for clinically significant anxiety in an AS population is feasible and likely to be efficacious. Method: Using a randomised assessor-blind trial, 52 individuals with AS were randomised into a treatment arm or a waiting-list control arm. After 24 weeks, those in the waiting-list control arm received treatment, while those initially randomised to (...) treatment were followed-up for 24 weeks. Results: The conversion rate for this trial was high, while attrition was 13%. After 24 weeks, there was no significant difference between those randomised to the treatment arm compared to those randomised to the waiting-list control arm on the primary outcome measure, the Hamilton Rating Scale for Anxiety. Conclusions: Trials of psychological therapies with this population are feasible. Larger definitive trials are now needed. Declaration of Interest: None Trial Registration: ISRCTN 30265294, UKCRN 8370. (shrink)