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)

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)

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)

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)

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 (...) class='Hi'>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)

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)

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...

ObjectiveThe COVID-19 pandemic and government measures implemented to counter the spread of the infection may be a major stressor affecting the psychological health of university students. This study aimed to explore how anxiety symptoms changed during the pandemic.Methods676 students at Zurich University of Applied Sciences participated in the first and second survey waves. Anxiety symptoms were assessed using the Generalized Anxiety Disorder-Scale-7. Risk and protective factors were examined.ResultsGAD-7 scores decreased significantly from T0 to T1. Participants (...) with moderate-to-severe anxiety score were 20.2 and 15.6% at T0 and T1, respectively. The following positively predicted anxiety: older age, female gender, non-Swiss nationality, loneliness, participants’ concern about their own health, and interaction between time and participants’ concern about their own health. Resilience and social support negatively predicted anxiety.ConclusionsOur findings provide information for public health measures and psychological interventions supporting the mental health of university students during the COVID-19 emergency. (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)

ObjectiveTo investigate the characteristics of sleep disorders and anxiety in patients with tinnitus, their influencing factors, and the role of sleep disorders as mediators.MethodsThe general conditions and disease characteristics of 393 patients with tinnitus presented to the Changzheng Hospital of the Naval Medical University from 2018 to 2021 were collected. All patients accepted questionnaires such as Tinnitus Handicap Inventory, Pittsburgh Sleep Quality Index and Self-rating Anxiety Scale, and then the characteristics and the influencing factors of sleep disorders and (...) anxiety were analyzed.ResultsAmong the 393 tinnitus patients, 213 cases were diagnosed with sleep disorders, and 78 cases were diagnosed with anxiety, including 25 men and 53 women. Binary regression showed that gender, hearing loss, tinnitus severity, and sleep disorders severity were positively associated with anxiety. Multiple logistic regression analysis showed that female gender, hearing loss and sleep disorders were the independent risk factors of anxiety. The mediating effect of sleep disorders between tinnitus severity and anxiety accounted for 27.88% of the total effect size.ConclusionFemales patients with hearing loss, moderate to severe tinnitus, and sleep disorders were at greater risk for anxiety, with sleep disorders partially mediating the anxiety associated with tinnitus. (shrink)

The neuropsychoanalytic approach solves important aspects of how to use our understanding of the brain to treat patients. We describe the neurobiology underlying motivation for healthy behaviors and psychopathology. We have updated Freud’s original concepts of drive and instinct using neuropsychoanalysis in a way that conserves his insights while adding information that is of use in clinical treatment. Drive (Trieb) is a pressure to act on an internal stimulus. It has a motivational energic source, an aim, an object, and is (...) terminated by the satisfaction of a surge of serotonin. An instinct (Instinkt) is an inherited pattern of behavior that varies little from species to species. Drives are created by internal/ventral brain factors. Instincts require input from the outside that arrive through dorsal brain structures. In our model unpleasure is the experience of unsatisfied drives while pleasure if fueled by a propitious human environment. Motivational concepts can be used guide clinical work. Sometimes what had previously described psychoanalytically as, “Internal conflict,” can be characterized neurobiologically as conflicts between different motivational systems. These motivational systems inform treatment of anxiety and depression, addiction in general and specific problems of opioid use disorder. Our description of motivation in addictive illness shows that the term, “reward system,” is incorrect, eliminating a source of stigmatizing addiction by suggesting that it is hedonistic. Understanding that motivational systems that have both psychological and brain correlates can be a basis for treating various disorders. Over many papers the authors have described the biology of drives, instincts, unpleasure and pleasure. We will start with a summary of our work, then show its clinical application. (shrink)

Improving emotion regulation is central to borderline personality disorder (BPD) treatment, but little research indicates which emotion regulation strategies are optimally effective and when. Basic emotion science suggests that engagement emotion regulation strategies that process emotional content become less effective as emotional intensity increases, whereas disengagement strategies that disengage from it do not. This study examined whether emotional reactivity to emotional stimuli predicts the effectiveness of engagement and disengagement emotion regulation across self-report, general physiologic (heart rate), sympathetic (skin conductance (...) responses), and parasympathetic (respiratory sinus arrythmia) emotion in BPD, healthy, and clinical control (i.e. generalized anxiety disorder; GAD) groups. 120 participants (40 per group) were exposed to emotion inductions and then instructed to implement engagement (mindful awareness) and disengagement (distraction) strategies while self-report and physiological emotion measurements were taken. In the BPD and GAD groups, higher heart rate or respiratory sinus arrythmia reactivity, respectively, predicted improved mindful awareness effectiveness. Higher skin conductance reactivity predicted worsened distraction effectiveness in BPD. Higher reactivity may potentiate engagement emotion regulation, and exacerbate disengagement from emotional content, in BPD. Future research should examine other domains of emotion regulation that may be influenced by emotional intensity, and other forms of emotional intensity that may influence them. (shrink)

Generalized anxiety disorder is among the world’s most prevalent psychiatric disorders and often manifests as persistent and difficult to control apprehension. Despite its prevalence, there is no integrative, formal model of how anxiety and anxiety disorders arise. Here, we offer a perspective derived from the free energy principle; one that shares similarities with established constructs such as learned helplessness. Our account is simple: anxiety can be formalized as learned uncertainty. A biological system, having had (...) persistent uncertainty in its past, will expect uncertainty in its future, irrespective of whether uncertainty truly persists. Despite our account’s intuitive simplicity—which can be illustrated with the mere flip of a coin—it is grounded within the free energy principle and hence situates the formation of anxiety within a broader explanatory framework of biological self-organization and self-evidencing. We conclude that, through conceptualizing anxiety within a framework of working generative models, our perspective might afford novel approaches in the clinical treatment of anxiety and its key symptoms. (shrink)

The future harbours the potential for myriad threats to the fitness of organisms, and many species prepare accordingly based on indicators of hazards. Here, we distinguish between defensive responses on the basis of sensed cues and those based on autocues generated by mental simulations of the future in humans. Whereas sensed threat cues usually induce specific responses with reference to particular features of the environment or generalized responses to protect against diffuse threats, autocues generated by mental simulations of the (...) future enable strategic preparation for hazards that may not require an immediate response. The overlap of these mechanisms makes defence effective and versatile, yet can manifest as contemporary anxiety disorders in humans. (shrink)

ObjectivesDepression and anxiety persist in cancer patients, creating an additional burden during treatment and making it more challenging in terms of management and control. Studies on the prevalence of depression and anxiety among cancer patients in the Middle East are limited and include many limitations such as their small sample sizes and restriction to a specific type of cancer in specific clinical settings. This study aimed to describe the prevalence and risk factors of depression and anxiety among (...) cancer patients in the inpatient and outpatient settings.Materials and MethodsA total of 1,011 patients formed the study sample. Patients’ psychological status was assessed using the Hospital Anxiety and Depression Scale, the Patient Health Questionnaire, and the Generalized Anxiety Disorder 7-item scale. The prevalence rate of depressive and anxious symptomatology was estimated by dividing the number of patients who exceeded the borderline score: 10 or more for each subscale of the HADS scale, 15 or more for the GAD-7 scale, and 15 or more in the PHQ-9 by the total number of the patients. Risk factors were identified using logistic regression.ResultsThe prevalence of depressive and anxious symptomatology among all patients was 23.4% and 19.1–19.9%, respectively. Depressive symptomatology was more prevalent across patients who were hospitalized compared with patients in the outpatient setting. Similarly, anxious symptomatology was more prevalent in the inpatient setting. In the inpatient setting, depressive symptomatology was more prevalent among patients with bladder cancer, while severe anxious symptomatology was more prevalent across patients with lung cancer. In the outpatient setting, depressive and anxious symptomatology was more prevalent among breast and prostate cancer patients, respectively. Despite that, around 42.7% and 24.8% of the patients, respectively, reported that they feel anxious and depressed, and only 15.5% of them were using medications to manage their conditions.ConclusionOur study findings demonstrated a higher prevalence of depressive and anxious symptomatology in the inpatient setting and advanced disease stages. In addition, the underutilization of antidepressant therapy was observed. There is a need to consider mental disorders as part of the treatment protocol for cancer patients. Enhanced clinical monitoring and treatment of depression and anxiety of cancer patients are required. (shrink)

This paper brings to bear empirical evidence from a sample of undergraduate students to show that perfectionism can be a fundamental cognition behind the essential symptoms of some anxiety and mood disorders, notably Generalized Anxiety Disorder and Major Depression; and it suggests that this popular “philosophy of life” may helpfully be used in diagnosing these disorders.

Background and ObjectivesThe purpose of this study was to draw the attention toward the implications of COVID-19 and the related restrictions imposed worldwide especially in Pakistan. The primary objective was to highlight the levels of psychological distress, anxiety, family violence, suicidality, and well-being due to COVID-19 and the secondary objective was to associate it to social demographic factors.Materials and MethodsIt is designed as a cross-sectional study by employing an online questionnaire in the English language and obtaining responses using a (...) snowball sampling technique. We used three validated measures including Kessler Psychological Distress Scale, Generalized Anxiety Disorder index and World Health Organization Well-Being Index.ResultsA sample of 420 participants was recruited from across Pakistan, with most participants were females, students and belonging to Punjab. Nearly one-fourth of the participants scored above the minimum value set for moderate or high psychological distress. There was a higher prevalence of distress among females and resident of province Punjab. The majority of individuals reported that they were living with their family and more than half were neutral regarding their satisfaction with their living conditions. 40.5% believed that the lockdown has had a negative impact on their mental health. 31.4% have reported that they themselves have experienced abuse from a family member. 48.6% scored high on the GAD-7 scale and low wellbeing score was found among 80.2%. Students were found to be more vulnerable to mental illness and anxiety.ConclusionWith the lockdown restrictions, psychosocial distress has become prevalent in Pakistan. (shrink)

PurposeAsian Americans comprise 21% of matriculating medical students in the United States but little is known about their mental health. With the growing focus on addressing the mental health of medical students, this systematic, nationwide survey assesses the relationship between anxiety and depression symptoms and coping skills among Asian American medical students.Materials and methodsA survey tool comprised of Patient Health Questionnaire-9, General Anxiety Disorder-7, and questions related to coping were emailed to members of the Asian Pacific American (...) Medical Students Association enrolled in a United States medical school during the 2016–2017 academic year. We evaluated associations between anxiety and coping as well as depression and coping.ResultsA total of 511 Asian American medical students completed the survey. Anxiety symptoms were positively correlated with an increase in negative coping skills. Depressive symptoms were not correlated with an increase in negative coping skills.ConclusionProfessionals and medical schools that aim to improve the mental health of medical students should be aware of the needs of specific populations. Asian American students who experience anxiety were more likely to utilize avoidant or negative coping strategies. In addition, Asian American students who experience depressive symptoms were not more likely to utilize these negative coping strategies. Further research must be done to evaluate the factors that influence the use of negative coping strategies to better address anxiety within the Asian American medical student population. (shrink)

Cramer et al. persuasively conceptualize major depressive disorder (MDD) and generalized anxiety disorder (GAD) as network disorders, rejecting latent variable accounts. But how does their radical picture generalize across the suite of mental and personality disorders? Addictions are Axis I disorders that may be better characterized by latent variables. Their comorbidity relationships could be captured by inserting them as nodes in a super-network of Axis I conditions.

Adequate measurement is an essential component of the assessment of mental health disorders and symptoms such as depression and anxiety. The present study investigated sex-specific differences in the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. This comprehensive cross-sectional design study pursued four objectives: measurement invariance of PHQ-9 and GAD-7 between male and female; depression and anxiety prevalence differences; cross-sex differences in the relationship between depression and anxiety; and a comparison of symptom heterogeneity. A sample (...) of 1966 students from South Africa completed the PHQ-9 and the GAD-7. Data analyses for measurement invariance, latent class analysis, inter-variable correlations and group comparisons were conducted in Mplus. The two-dimensional PHQ-9 achieved scalar invariance, while the GAD-7 yielded metric invariance. The somatic and non-somatic latent dimensions of depression were compared and showed no significant difference between male and female groups. The positive relationship between depression and anxiety was also not significantly different between the two groups. While the PHQ-9 symptoms formed three classes in the male group, and four classes in the female group, the GAD-7 had the same number of classes and a similar pattern between the two groups. These findings hold implications for the measurement, assessment and understanding of symptom manifestation and distribution, as well as the treatment of depression and anxiety in South Africa. (shrink)

This study aims to explore the influence mechanism of COVID-19 risk perception on anxiety in emerging adulthood in the context of public health events of the second round of COVID-19 outbreaks and provide support for exploring the path of mental health after the normalization of the epidemic situation. An online questionnaire, combined with community social work, was used in this study, and data of 522 emerging adults were collected in February 2021. The Perceived Risk of COVID-19 pandemic scale, the (...) generalized anxiety disorder 7-item scale, the scale of affect balance, and the connor-davidson resilience scale were used to investigate. The results showed that: first, the risk perception of COVID-19 in early adulthood was positively predictive of anxiety symptoms [B = 0.110, p < 0.05, 95%CI = ]. Second, the affective quality of life plays a mediating role between the risk perception of COVID-19 and anxiety [B = 0.108, 95%CI = ]. Thirdly, resilience plays a moderating role between the risk perception of COVID-19 and anxiety, the higher the resilience of emerging adulthood, the weaker effects of the risk perception of COVID-19 negative prediction of anxiety [B = −0.110, p < 0.001, 95%CI = ]. Therefore, to control the anxiety of emerging adulthood in public health events, we should pay attention to the propaganda and management of epidemic information, improve the quality of life, and attention should be paid to the emerging adulthood with low resilience. (shrink)

BackgroundThe Coronavirus 2019 outbreak has led to a considerable proportion of adverse psychological symptoms in different subpopulations. This study aimed to investigate the status of anxiety and depression and their associated factors in the adult, working-age population in Mainland China at the early remission stage of the COVID-19 pandemic.MethodsAn online study was conducted among 1,863 participants in 29 provinces in Mainland China from March 23 to 31, 2020. Their mental health was evaluated by the generalized anxiety (...) class='Hi'>disorder scale and the patient health questionnaire. Descriptive analysis, Chi-square, and multiple logistic regressions were applied.ResultsAbout 44.5% of the participants had anxiety, 49.2% had depression, and 37.9% showed a combination of depression and anxiety. Around 83.7% of the participants claimed that the pandemic had a negative impact on their medical needs, which was the primary predictor of mental health, the degree of impact being positively related to the prevalence of anxiety and depression. More chronic diseases, moderate to bad self-rated health, severe perceived infection risk, and younger age group were the common risk factors for anxiety and depression. Having no children, unemployment, and a college-level educational background were associated with higher anxiety prevalence, whereas unmarried participants were correlated with higher depression prevalence.ConclusionThe working-age population showed a relatively high risk of anxiety and depression in Mainland China at the early remission stage of the pandemic. To improve medical services capacity for routine and delayed medical service needs should be a part of policy-makers’ priority agenda during this period of crisis. (shrink)

Background: Previous systematic review indicated the prevalence of prenatal anxiety as 14–54%. Pregnant women are a high-risk population for COVID-19. However, the prevalence of anxiety symptoms and related factors is unknown in Chinese pregnant women during COVID-19 outbreak.Objective: To investigate the prevalence of anxiety symptoms and the related factors in Chinese pregnant women who were attending crisis intervention during the COVID-19 pandemic.Methods: The data of this cross-sectional study were collected in about 2 months. Data analysis was performed (...) from April to May 2020. Participants completed a set of questionnaires via the Wechat Mini-program before starting the online self-help crisis intervention for COVID-19 epidemic. A total of 2,120 Chinese pregnant women who were attending a self-help crisis intervention participated in this study. A survey was developed to address possible stress-related factors in pregnant women during the COVID-19 outbreak, including demographic, socioeconomic, and pregnancy-related factors, as well as COVID-19 related factors. Generalized Anxiety Disorder-7 scale and the 10-item perceived stress scale were, respectively, employed to measure anxiety and stress-related factors.Results: A total of 21.7% of pregnant women reported at least mild anxiety, and only 82 women reported moderate to severe anxiety. Factors associated with at least mild anxiety included living in Hubei province, nobody providing everyday life support, pelvic pain or vaginal bleeding, and higher perceived stress. Having relatives or neighbors with a diagnosis of COVID-19 was not associated with anxiety.Conclusions and Relevance: Our findings indicate that evaluation and intervention for maternal and infant health are necessary in pregnant women with anxiety during COVID-19 epidemic, especially those with higher perceived stress, less everyday life support, or vaginal bleeding. Interactions among these related medical, social and psychological factors need to be investigated in future studies. (shrink)

Objectives: This study explored a multidimensional model of the relationships between social media use, gender, peer bullying victimization experiences, and the onset of anxiety symptoms among children. We hypothesized that greater experience of bullying would be associated with greater onset of anxiety. We also expected that gender and social media use would be linked with anxiety among elementary school children. To test this hypothesis, a structural equation modeling approach was used.Methods: A total of 456 elementary children aged (...) 11–13 years from nine schools were recruited for this research. We used two psychological measures: The Screen for Child Anxiety Related Emotional Disorders and the Personal Experience Checklist as well as a sociodemographic questionnaire.Results: The social media usage survey found that all participants used social media. Instagram and YouTube were the platforms most used by the participants. The Structural Equation Model results suggest that bullying victimization and gender predicted the onset of anxiety in elementary school children. The model explained 32.1% of the variance of the outcome with very adequate fit indicators based on most indices, χ2 = 173.56, df = 52, p < 0.001; CFI = 0.92; TLI = 0.94; RMSEA = 0.07. Instagram use was correlated positively with generalized anxiety disorder. Gender was negatively correlated with Instagram use and positively correlated with YouTube use. Girls were found to use Instagram more and boys were found to use YouTube more. It was also found that girls had higher scores onSCARED dimensions, except for school avoidance. Girls were more prone to onset of anxiety than boys, except for school avoidance, which was not related to gender. Boys were found to experience significantly more physical bullying than girls. On the other hand, girls were found to experience more panic disorder, generalized anxiety disorder, separation anxiety disorder, and social anxiety than boys.Conclusion: This study found that bullying victimization significantly influences the onset of anxiety in children. Particular attention should be paid to cyberbullying in this context. This study also found a link between gender and anxiety—girls had a greater tendency to experience the onset of various types of anxiety, including panic disorder, generalized anxiety disorder, separation anxiety disorder, and social anxiety. Gender was also correlated with the form of bullying victimization. The findings of this study suggest that boys were more likely to experience physical bullying than girls. Interestingly, we found that Instagram use was significantly correlated with developing separation anxiety. In particular, children demonstrated school avoidance when experiencing cyberbullying. Limitations and future directions are discussed. (shrink)

This study examined psychopathological correlates of implicit and explicit shame and guilt in 30 clinical and 129 non-clinical youths aged 8–17 years. Shame and guilt were measured explicitly via two self-reports and a parent report, and implicitly by means of an Implicit Association Test (IAT), while a wide range of psychopathological symptoms were assessed with questionnaires completed by children, parents, and teachers. The results showed no differences of implicit and explicit shame and guilt between the clinical and non-clinical group, implying (...) that dysregulation of these self-conscious emotions is not per definition associated with psychopathology. Correlational analyses indicated that self-reported explicit shame was positively associated with a broad range of internalizing psychopathology, while self-reported explicit guilt was associated with higher levels of anxiety and to some extent lower levels of externalizing psychopathology. Correlations with parent-rated shame and guilt revealed the same pattern of results but were in general weaker. Furthermore, implicit shame and guilt did not show significant correlations with the various measures of psychopathology. It can be concluded that the link between shame and guilt and psychopathology is complex, and partly dependent on the disorder under study and context-related factors defining the maladaptive nature of these self-conscious emotions. (shrink)

The history of mental illnesses is as old as human history. Mental disorders are affected by changing social and cultural factors during the historical process, and have been conceptually restructured and their definitions and classifications have been changed. The evolution of obssessive-compulsive disorders with roots as old as human history into modern concepts took place in the 19th century. The first scientific views on the spiritual origin of OCD belong to S. Freud. Freud observed that mental causes in OCD are (...) different from other mental disorders, and he examined obsession as a separate and specific disorder. Over time, it has been understood that OCD is a very common disorder. The American Psychiatric Association (APA) has classified OCD under an independent title in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by removing it from the category of anxiety disorders. OCD is a mental disorder caused by mental actions such as obsessive thoughts (obsessions) and / or repetitive and compulsive behaviors (compulsion). The patient is often aware that such thoughts and behaviors are irrational and absurd. For this reason, he tries to get away obsessive thoughts that he finds contrary to his beliefs, opinions, moral values and logic from his mind. However, as he tries, obsessive thoughts become more and more frequent and create a great anxiety in the person. This time, the patient resorts to compulsions to alleviate the anxiety he feels or to get rid of it completely. As his compulsions repeat, his anxiety increases and he goes into a vicious circle. There are many symptom subgroups of OCD that seriously worsen the quality of life of the individual. One of these, and even the most overwhelming, is religious obsessions. It has been thought that there has been a relationship between religion and OCD for a long time in the psychology literature, and some remarkable studies have been conducted to clarify this relationship. Although there are many research findings showing that religion is an indispensable element in the protection of the mental health integrity of the individual, some forms of religious understanding and some experiences gained as a result of religious experiences may affect the concerns about OCD. This stage of religiosity is closely related to some sub-symptom groups of OCD. The explanations of the founder of the psychoanalytic method, Freud psychoanalytic method, and his followers made a great contribution to the understanding of OCD. However, since the psychoanalytic method exhibits a theoretically reductionist approach to religion, it is possible that the individual's devotion to religion is initially evaluated as a pathology or at least an important obstacle to insight. Today, cognitive behavioral psychotherapies are considered the most effective psychological treatment method for OCD, but their success rates in the treatment of religious OCD are low. Since religious OCD concerns often involve spiritual issues rather than concrete repeatable situations, behavioral methods can be quite difficult to apply in the treatment of religious OCD. Therefore, traditional psychotherapy approaches, even if they are not openly against religions, are insufficient to relieve the suffering in the lives of individuals with religious obsessions, as they generally neglect the religious dimension. Due to the vacuum that arises from restricting spiritual treatments to secular approaches, religious patients are threatened by the illegal practices of people who abuse religious feelings. Clinically, religious obsessions are more worrying and overwhelming. Therefore, their treatment is more difficult than others. Selective approaches that use different scientific disciplines together in the treatment of OCD and can stretch around religious beliefs and values can create more effective treatment models. Thus, the success rate in the treatment of religious OCD can be carried to higher levels thanks to the appropriate cooperation of the disciplines of medicine, psychology and theology. There is a rich religious cultural heritage that can support this collaboration in terms of theological disciplines. As an example, Abū Zayd al-Balkhī (d. 322/934), in his Maṣāliḥ al-abdān wa-l-anfus, probably made a clear distinction between neuroses and psychosis and classified neurotic disorders for the first time about ten centuries before Freud. In this study, the importance of approaching to religious obsessions as both a psychological disorder and a theological problem is emphasized. For this reason, cooperation of psychiatric and psychological approaches with spiritual counseling and guidance is recommended in the treatment of religious OCD. The difficulty in distinguishing whether the symptoms seen in a religious person are normal, natural religious thoughts and behaviors of religious life or abnormal appearances in the religious guise necessitates this interdisciplinary cooperation. (shrink)

ObjectivesResearch has linked mindfulness to improved mental health, yet the mechanisms underlying this relationship are not well understood. This study explored the mediating role of emotion regulation strategies and sleep in the relationship between mindfulness and symptoms of depression, anxiety and psychological distress during the COVID-19 pandemic.MethodsAs detailed in this study’s pre-registration, a cross-sectional research design was used to investigate the impact of mindfulness on mental health and the mediating role of emotion regulation strategies and insomnia. A total of (...) 493 participants from the general population answered an online survey and were included in the final analysis. The online survey consisted of the short form of the Five-Facets Mindfulness Questionnaire, the Impact of Event Scale-revised, the Generalised Anxiety Disorder Scale, the Patient Health Questionnaire, the Emotion Regulation Questionnaire, the short form of the Rumination Response Scale, and the Insomnia Severity Index.ResultsStructural equation modelling revealed that mindfulness was related to lower symptoms of depression, anxiety and psychological distress, both directly and indirectly. Mindfulness was negatively associated with rumination and insomnia. As hypothesised, models revealed that the associations between mindfulness and depression, anxiety and psychological distress were significantly mediated by its negative associations with rumination and insomnia. Our findings also demonstrated that rumination was related to increased insomnia symptoms, which in turn was associated with increased mental health problems, indicating a mediated mediation. Mindfulness was also positively associated with cognitive reappraisal and negatively associated with suppression, which were, respectively, negatively and positively associated with depressive symptoms, and thus functioned as specific mediators of the association between mindfulness and depression.ConclusionOur findings suggest that rumination and insomnia operate transdiagnostically as interrelated mediators of the effects of mindfulness on mental health, whereas cognitive reappraisal and suppression function as specific mediators for depression. These insights emphasise the importance of targeting emotion regulation and sleep in mindfulness interventions for improving mental health. Limitations and implications for practice are discussed. (shrink)

Context and AimsAlthough some exercise-based interventions have been associated with lower levels of pain and performance-related musculoskeletal disorders among musicians, the evidence is still mixed. Furthermore, little is known about musicians’ general engagement in physical activity, their knowledge of PA guidelines, or the relevant training they receive on pain prevention and the sources of such training. Similarly, little is known about the relationship between PA and PRMDs and other risk factors for PRMDs.MethodsFollowing a cross-sectional correlational study design, both standardized andad (...) hocmeasurements were used to investigate self-reported PA [International Physical Activity Questionnaire – Short Form ], knowledge of PA guidelines, and barriers to engaging in PA [Centers for Disease Control ; Determinants of Physical Activity Questionnaire ]; sedentary behavior [Sedentary Behavior Questionnaire ]; pain [36-Item Short Form Survey Instrument ] and PRMDs ; reported physical exertion ; anxiety [Hospital Anxiety and Depression Scale ]; practice behaviors ; and relevant training among conservatoire students in the United Kingdom. The entire set of questionnaires was administered both online and via hard copies between June 2017 and April 2018.ResultsDemographic information was obtained from 111 respondents, mostly undergraduate students from seven conservatoires. They reported high levels of engagement in PA, despite poor knowledge of PA guidelines. Teachers were the most frequently mentioned source of pain prevention information, and 62% agreed that they had received advice on why they should engage in cardio PA. Sedentary behavior was comparable to normative data. Levels of bodily pain and PRMDs were low, but 43% showed “abnormal” clinical anxiety and found playing their instruments “somewhat hard” on average. Bodily pain interfering with practice and performance was positively correlated with frequency and severity of PRMDs, anxiety, and RPE. Frequency and severity of PRMDs were also associated with sedentary behavior at the weekend. Anxiety was associated with RPE. No association was found between PA and PRMDs.ConclusionThe relationship between PA and PRMDs and pain remains unclear and needs further investigation. While health education needs to be improved, other pathways may need to be taken. Given the high levels of anxiety, the ideology of Western classical music itself may need to be challenged. (shrink)

Emotional disorder symptoms are highly prevalent and a common cause of disability among children and adolescents. Screening and early detection are needed to identify those who need help and to improve treatment outcomes. Nowadays, especially with the arrival of the COVID-19 outbreak, assessment is increasingly conducted online, resulting in the need for brief online screening measures. The aim of the current study was to examine the reliability and different sources of validity evidence of a new web-based screening questionnaire for (...) emotional disorder symptoms, the DetectaWeb-Distress Scale, which assesses mood, anxiety, obsessive–compulsive disorder, post-traumatic stress disorder, suicidality, and global distress. A total of 1,499 participants completed the DetectaWeb-Distress Scale and specific questionnaires for emotional disorder symptoms, suicidal behaviors, and well-being through a web-based survey. Results indicated that a structural model of 10 correlated factors fits reasonably better in comparison to the remaining models; measurement invariance for age and gender; good internal consistency ; and significant positive correlation with other measures of anxiety, depression, PTSD, or distress, and negative correlation with well-being measures, displaying support for convergent-discriminant validity. We also found that girls scored higher than boys on most of the subscales, and children had higher scores for social anxiety, specific phobia, panic disorder, and obsessive–compulsive symptoms, whereas adolescents scored higher on depressive symptoms, suicidality, and generalized anxiety, but the effect sizes were small to medium for all comparisons. The DetectaWeb-Distress Scale is a valid, innovative, and useful online tool for the screening and evaluation of preventive programs for mental health in children and adolescents. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Pathology of the Mind: Disorder Versus DisabilityRichard G. T. Gipps (bio)Keywordsorder, disorder, ability, disability, mental illnessAlfredo Gaete (2008) describes mental disorders as impairments in intentionality, phenomenal consciousness, and intelligence that cause harm to the affected person. I found persuasive Gaete’s claim that the concept of ‘mental disorder’ is best understood as nontheoretical and nontechnical. I also find compelling his argument that a previous contribution of my (...) own—which relied in part on specifying different senses of ‘disorder’ in psychological, physiological, and social cases—was misguided. Further, his suggestion that we ought at least to attempt analysis in terms of necessary and sufficient conditions before we seek out less definitive characterizations (in terms of family resemblances) also persuades me, although I find myself less sanguine than he about the general possibility of achieving such analyses.One of Gaete’s principal claims is that mental disorder is helpfully understood in terms of an absence of a capacity—that is, as a disability. There are two related objections—or two aspects of the same objection—that I would like to offer the author with respect to this claim. These may well not be conclusive, but will I hope at least function as foils against which the author can usefully sharpen his argument. One objection suggests that there is a viable distinction between the concepts of mental disorder and mental disability, as commonly used in clinical contexts, which the account offered seems unable to respect. The second suggests that the account may not be able to theorize what is argued to be the essential contribution of the concepts of order and disorder (as opposed to ability and disability) to the everyday concept of mental disorder. Accordingly, it questions the power of a disability approach such as Gaete’s to capture the essential nature of mental disorder.In his paper, Gaete classifies mental retardation and developmental, or (what in the United Kingdom are known as) learning, disabilities (autism, etc.) as cases of mental disorder. I found this surprising because it is not common linguistic practice in the psychological circles in which I operate. It would also seem to make a nonsense of commonly accepted ideas like: “Mental disorders are more likely to occur in patients with developmental disabilities (e.g., in autism, Asperger, or Down syndrome) than in the general population.” (For an example, see Campbell and Malone [1991]). On Gaete’s classification, it would appear that people with autism eo ipso have a mental disorder, and [End Page 341] hence the commonly accepted idea would need to be interpreted as merely a statement about comorbidities of different disorders of the same general (i.e., mental) type. But that is not, I believe, how the term is commonly used, and Gaete’s suggestion must therefore be treated as revisionary rather than descriptively analytical.One way of reconstructing a rationale underlying the distinction between mental disabilities and mental disorders is as follows. A developmental disability involves a failure of (certain aspects of) the mind to grow and reach an expected level or type of organization. A mental disorder by contrast involves a disturbance or disorganization (not simply an impoverishment) within the mind at whichever level of organization it has reached. As the mind develops, and reaches new levels or types of organization, the forms which mental disorders may take accordingly change.Autism and schizophrenia provide helpful illustrations of this distinction. Autism represents a failure of (among other things) the social mind to develop in childhood. The person with moderate to severe autism may attain at best a very shaky grasp on the realities of other minds and social conventions. That is, the degree of mental structure they obtain—their social competencies or capacities—will likely remain limited. It is this fundamental deficit that marks out the disability, and not the social anxieties or other such disturbances that can beset the autistic person.Schizophrenia, by contrast, tends to occur at late adolescence, when the individual has developed higher levels of—albeit often fragile—mental structure. Yet it is not the fragility of such mental structure, but rather the disruptions that can occur within such structures as have developed, that mark them out... (shrink)

ObjectiveThe presence of two or more chronic diseases results in worse clinical outcomes than expected by a simple combination of diseases. This synergistic effect is expected to be higher when combined with some conditions, depending on the number and severity of diseases. Multimorbidity is a relatively new term, with the first fundamental definitions appearing in 2015. Studies usually define it as the presence of at least two chronic medical illnesses. However, little is known regarding the relationship between mental disorders and (...) other non-psychiatric chronic diseases. This review aims at investigating the association between some mental disorders and non-psychiatric diseases, and their pattern of association.MethodsWe performed a systematic approach to selecting papers that studied relationships between chronic conditions that included one mental disorder from 2015 to 2021. These were processed using Covidence, including quality assessment.ResultsThis resulted in the inclusion of 26 papers in this study. It was found that there are strong associations between depression, psychosis, and multimorbidity, but recent studies that evaluated patterns of association of diseases had heterogeneous results. Quality assessment of the papers generally revealed low quality among the included studies.ConclusionsThere is evidence of an association between depressive disorders, anxiety disorders, and psychosis with multimorbidity. Studies that tried to examine the patterns of association between diseases did not find stable results.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021216101, identifier: CRD42021216101. (shrink)

Narratives structure and inform how we understand our experiences and identity, especially in instances of suffering. Suffering in mental disorder (e.g. bipolar disorder) is often uniquely distressing as it impacts capacities central to our ability to make sense of ourselves and the world—and the role of narratives in explaining and addressing these effects is well-known. For many with a mental disorder, spiritual/religious narratives shape how they understand and experience it. For most, this is because they are spiritual (...) and/or religious. For others, spiritual/religious narratives still often influence secular approaches to mental disorder, more than approaches to other disabilities (e.g. intellectual, physical) or causes of suffering (e.g. physical disease). Such narratives are often harmful, especially insofar as they ‘over-spiritualize’ mental disorder; and undercut ‘spiritual meaning-making’. Here I address the impact of spiritual/religious narratives that helpfully avoid over-spiritualizing mental disorder while enabling spiritual meaning-making about it. First, I address the role of narratives in meaning-making more generally; then, I present results from my recent empirical study testing the impact of such narratives on participants’ meaning-making about their mental disorder. I conclude by addressing implications and potential worries. (shrink)

Motor proficiency reflects the ability to perform precise and coordinated movements in different contexts. Previous research suggests that different profiles of motor proficiency may be associated with different cognitive functioning characteristics thus suggesting an interaction between cognitive and motor processes. The current study investigated this interaction in the general population of healthy adults with different profiles of motor proficiency by focusing on error-related cognitive control and behavioral adaptation mechanisms. In addition, the impact of these processes was assessed in terms of (...) trait anxiety and worries. Forty healthy adults were divided into high and low motor proficiency groups based on an assessment of their motor skills. Using electroencephalography during a flanker task, error-related negativity was measured as the neural indicator of cognitive control. Post-error slowing was measured to represent behavioral adaptation. Participants also completed an anxiety assessment questionnaire. Participants in the high motor proficiency group achieved better task accuracy and showed relatively enhanced cognitive control through increased ERN. Contrastingly, individuals in the lower motor proficiency group achieved poorer accuracy whilst showing some evidence of compensation through increased PES. Trait anxiety reflecting general worries was found to be correlated with motor functioning, but the study could not provide evidence that this was related to cognitive or behavioral control mechanisms. The interaction between cognitive and motor processes observed in this study is unique for healthy and sub-clinical populations and provides a baseline for the interpretation of similar investigations in individuals with motor disorders. (shrink)

Isolated sleep paralysis is a common parasomnia characterized by an inability to move or speak and often accompanied by hallucinations of a sensed presence nearby. Recent research has linked ISP, and sensed presence more particularly, with social anxiety and other psychopathologies. The present study used a large sample of respondents to an internet questionnaire to test whether these associations are due to a general personality factor, affect distress, which is implicated in nightmare suffering and hypothesized to involve dysfunctional social (...) imagery processes. A new measure, ISP distress, was examined in relation to features of ISP experiences, to self-reported psychopathological diagnosis, to scores on the Leibowitz Social Anxiety Scale and to scores on a new questionnaire subscale assessing social imagery in a variety of waking states. Three main results were found: ISP experiences are only weakly associated with a prior diagnosis of mental disorder, sensed presence during ISP is associated preferentially with ISP distress, and ISP distress is associated with dysfunctional social imagery. A general predisposition to affective distress may influence the distress associated with ISP experiences; overly passive social imagery may, in turn, be implicated in this affect distress influence. (shrink)

Promoting recovery has become more and more important in the care of patients with severe mental disorders such as psychosis. Recovery is a personal process of growth involving hope, self-identity, meaning in life, and responsibility. Obviously, these components pertain, at least in part, to a psychotherapeutic care perspective. Yet, up to now, recovery has mainly been taken into account in transforming health services and as a general framework for supportive therapy. Existential phenomenology abdicates a theoretical stance and considers issues such (...) as death anxiety, isolation, responsibility, and meaning. Thus, it is likely to provide some insight into the psychotherapeutic aspects of recovery. Furthermore, existential psychotherapy allows powerful insights for adopting a recovery-oriented attitude and to provide useful themes for discussing issues allowing patients to gain meaning and hope. This paper describes these elements to give clinicians insights into this complex topic. (shrink)

Background: An association between gaming disorder and the symptoms of common mental disorders is unraveled yet. In this preregistered study, we quantitatively synthesized reliability, convergent and discriminant validity of GD scales to examine association between GD and other constructs.Methods: Five representative GD instruments were chosen based on recommendations by the previous systematic review study to conduct correlation meta-analyses and reliability generalization. A systematic literature search was conducted through Pubmed, Proquest, Embase, and Google Scholar to identify studies that reported information (...) on either reliability or correlation with related variables. 2,124 studies were full-text assessed as of October 2020, and 184 were quantitatively synthesized. Conventional Hedges two-level meta-analytic method was utilized.Results: The result of reliability generalization reported a mean coefficient alpha of 0.86 and a mean test-retest estimate of 0.86. Estimated effect sizes of correlation between GD and the variables were as follows: 0.33 with depression, 0.29 with anxiety, 0.30 with aggression, –0.22 with quality of life, 0.29 with loneliness, 0.56 with internet addiction, and 0.40 with game playtime, respectively. The result of moderator analyses, funnel and forest plots, and publication bias analyses were also presented.Discussion and Conclusion: All five GD instruments have good internal consistency and test-retest reliability. Relatively few studies reported the test-retest reliability. The result of correlation meta-analysis revealed that GD scores were only moderately associated with game playtime. Common psychological problems such as depression and anxiety were found to have a slightly smaller association with GD than the gaming behavior. GD scores were strongly correlated with internet addiction. Further studies should adopt a rigorous methodological procedure to unravel the bidirectional relationship between GD and other psychopathologies.Limitations: The current study did not include gray literature. The representativeness of the five tools included in the current study could be questioned. High heterogeneity is another limitation of the study.Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42020219781]. (shrink)

BackgroundCognitive Behavioral Therapy is delivered in most of the early intervention services for psychosis in different countries around the world. This approach has been demonstrated to be effective in decreasing or at least delaying the onset of psychosis. However, none of them directly affect the comorbidity of these types of patients that is often the main cause of distress and dysfunctionality. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders is a psychological intervention that combines cognitive-behavioral and third-generation techniques (...) that address emotional dysregulation as an underlying mechanism that these disorders have in common. The application of this intervention could improve the comorbid emotional symptoms of these patients.Materials and methodsThe study is a randomized controlled trial in which one group receives immediate UP plus standard intervention and the other is placed on a waiting list to receive UP 7 months later, in addition to standard care in one of our early psychosis programs. The sample will be 42 patients with UHR for psychosis with comorbid emotional symptoms. The assessment is performed at baseline, at the end of treatment, and at 3-months’ follow-up, and includes: general psychopathology, anxiety and depression, positive and negative emotions, emotional dysregulation, personality, functionality, quality of life, cognitive distortions, insight, and satisfaction with the UP intervention.DiscussionThis will be the first study of the efficacy, acceptability, and viability of the UP in a sample of young adults with UHR. The results of this study may have clinical implications, contributing to improving the model of care for young people who consult for underlying psychotic, anxiety, and/or depressive symptoms that can lead to high distress and dysfunctionality.Clinical trial registration[https://clinicaltrials.gov/], identifier [NCT04929938]. (shrink)

ObjectivesThe aim of this study was to assess coronavirus disease 2019 anxiety and posttraumatic stress disorder symptoms in the hospital staff, as well as to identify protective factors of COVID-19 anxiety once the coronavirus pandemic was announced in Poland.Methods90 healthcare workers from the hospital in Poland completed validated self-report questionnaires assessing self-efficacy, emotional control, and PTSD symptoms; a questionnaire assessing COVID-19 anxiety; and a socio-demographic questionnaire. A multiple linear regression was conducted to assess the effects of (...) gender, being directly vs indirectly exposed to patients, and general self-efficacy on COVID-19 anxiety.ResultsThe analysis showed that female healthcare professionals indirectly exposed to patients and those who reported lower levels of general self-efficacy have a stronger tendency to experience COVID-19 anxiety [R2 = 0.301, F = 12.34, p < 0.01].ConclusionThe findings show the importance of self-efficacy for dealing with COVID-19 anxiety. The internal coping strategies should be introduced to healthcare workers. (shrink)