Anxiety sensitivity and subjective social status in relation to anxiety and depressive symptoms and disorders among Latinos in primary care

The present investigation examined the interactive effects of anxiety sensitivity and subjective social status in relation to anxiety and depressive symptoms and psychopathology among 143 Latinos (85.7% female; M_age = 39.0, SD = 10.9; 97.2% used Spanish as their first language) who attended a community-based primary healthcare clinic. Results indicated that the interaction between anxiety sensitivity and subjective social status was significantly associated with number of mood and anxiety disorders, panic, social anxiety, and depressive symptoms. The form of the significant interactions indicated that individuals reporting co-occurring higher levels of anxiety sensitivity and lower levels of subjective social status evidenced the greatest levels of psychopathology and panic, social anxiety, and depressive symptoms. The present findings suggest that there is merit in focusing further scientific attention on the interplay between anxiety sensitivity and subjective social status in regard to understanding, and thus, better intervening to reduce anxiety/depressive vulnerability among Latinos in primary care.     

Pain-related anxiety and anxiety sensitivity across anxiety and depressive disorders

Fear–anxiety–avoidance models posit pain-related anxiety and anxiety sensitivity as important contributing variables in the development and maintenance of chronic musculoskeletal pain [Asmundson, G. J. G, Vlaeyen, J. W. S., & Crombez, G. (Eds.). (2004). Understanding and treating fear of pain. New York: Oxford University Press]. Emerging evidence also suggests that pain-related anxiety may be a diathesis for many other emotional disorders [Asmundson, G. J. G., & Carleton, R. N. (2005). Fear of pain is elevated in adults with co-occurring trauma-related stress and social anxiety symptoms. Cognitive Behaviour Therapy, 34, 248–255; Asmundson, G. J. G., & Carleton, R. N. (2008). Fear of pain. In: M. M. Antony & M. B. Stein (Eds.), Handbook of anxiety and the anxiety disorders (pp. 551–561). New York: Oxford University Press] and appears to share several elements in common with other fears (e.g., anxiety sensitivity, illness/injury sensitivity, fear of negative evaluation) as described by Reiss [Reiss, S. (1991). Expectancy model of fear, anxiety, and panic. Clinical Psychology Review, 11, 141–153] and Taylor [Taylor, S. (1993). The structure of fundamental fears. Journal of Behavior Therapy and Experimental Psychiatry, 24, 289–299]. The purpose of the present investigation was to assess self-reported levels of pain-related anxiety [Pain Anxiety Symptoms Scale-Short Form; PASS-20; McCracken, L. M., & Dhingra, L. (2002). A short version of the Pain Anxiety Symptoms Scale (PASS-20): preliminary development and validity. Pain Research and Management, 7, 45–50] across several anxiety and depressive disorders and to compare those levels to non-clinical and chronic pain samples. Participants consisted of a clinical sample (n = 418; 63% women) with principal diagnoses of a depressive disorder (DD; n = 22), panic disorder (PD; n = 114), social anxiety disorder (SAD; n = 136), obsessive-compulsive disorder (OCD; n = 86), generalized anxiety disorder (GAD; n = 46), or specific phobia (n = 14). Secondary group comparisons were made with a community sample as well as with published data from a treatment-seeking chronic pain sample [McCracken, L. M., & Dhingra, L. (2002). A short version of the Pain Anxiety Symptoms Scale (PASS-20): preliminary development and validity. Pain Research and Management, 7, 45–50]. Results suggest that pain-related anxiety is generally comparable across anxiety and depressive disorders; however, pain-related anxiety was typically higher (p < .01) in individuals with anxiety and depressive disorders relative to a community sample, but comparable to or lower than a chronic pain sample. Results imply that pain-related anxiety may indeed be a construct independent of other fundamental fears, warranting subsequent hierarchical investigations and consideration for inclusion in treatments of anxiety disorders. Additional implications and directions for future research are discussed.     

Does successful smoking cessation reduce anxious arousal among treatment-seeking smokers?

IntroductionThere is limited work that has examined the effect of quitting smoking on anxious arousal, an underlying dimension of anxiety symptoms and psychopathology.MethodSmokers (n = 185, 54.1% female) enrolled in a smoking cessation treatment trial were monitored post-cessation in terms of abstinence status (biochemically verified; at Weeks 1, 2, and Month 1 post-quit) and severity of panic-relevant symptoms (self-reported; at Month 1 and 3 post-quit). Structural equation models were conducted, adjusting for participant sex, age, treatment condition, and pre-cessation nicotine dependence, presence of depressive/anxiety disorders, anxious arousal, and anxiety sensitivity.ResultsAfter adjusting for covariates, participants who remained abstinent for one month (n = 80; 43.2%) relative to those who did not (n = 105; 56.8%) demonstrated significant reductions in anxious arousal at Month 1 (β = −.26, p = .04) and Month 3 post-quit (β = −.36, p = .006); abstinence status had a non-significant effect on anxious arousal severity at Month 3 after controlling for Month 1 anxious arousal (β = −.18, p = .09).DiscussionFindings align with theoretical models of smoking-anxiety interplay and suggest that smoking cessation can result in reductions in anxious arousal.     

A meta-analysis and scoping review of social cognition performance in social phobia,posttraumatic stress disorder and other anxiety disorders

Social cognition deficits are observed in a variety of psychiatric illnesses. However, data concerning anxiety disorders are sparse and difficult to interpret. This meta-analysis aims at determining if social cognition is affected in social phobia (SP) or posttraumatic stress disorder (PTSD) compared to non-clinical controls and the specificity of such deficits relatively to other anxiety disorders. The scoping review aims to identify research gaps in the field. Forty studies assessing mentalizing, emotion recognition, social perception/knowledge or attributional style in anxiety disorders were included, totalizing 1417 anxious patients and 1321 non-clinical controls. Results indicate distinct patterns of social cognition impairments: people with PTSD show deficits in mentalizing (effect size d = −1.13) and emotion recognition (d = −1.6) while other anxiety disorders including SP showed attributional biases (d = −0.53 to d = −1.15). The scoping review identified several under investigated domains of social cognition in anxiety disorders. Some recommendations are expressed for future studies to explore the full range of social cognition in anxiety disorders and allow direct comparisons between different disorders.     

Autistic traits in the general population: What mediates the link with depressive and anxious symptomatology?

The high prevalence of anxiety disorders and depression within the autism spectrum disorder (ASD) population is widely recognised. This study examined the role of three potential mediating variables in the relationship between autistic traits and depressive/anxious symptomatology in the general population. Participants included 231 university students (114 males, 117 females) ranging in age from 17 to 35 (M = 18.9, SD = 2.77). Participants completed five standardised questionnaires which measured: autistic traits, depressive/anxious symptomatology, social competence, social problem-solving ability, and teasing history. Two multiple mediation analyses were conducted using the bootstrapping method. Results revealed that social problem-solving ability and past teasing experiences were significant partial mediators in the relationship between autistic traits and depressive symptoms. However, contrary to expectations, social competence was not a significant mediator in the relationship between autistic traits and depressive symptoms. In addition, social problem-solving ability and past teasing experiences were significant partial mediators in the relationship between autistic traits and anxiety symptoms. This suggests that interventions to reduce anxious and depressive symptomatology in the ASD population should focus upon improving social problem-solving ability and reducing bullying experiences at school. These initial findings should be confirmed in the ASD population in future research.     

Cognitive behavioral therapy for youth with social anxiety: Differential short and long-term treatment outcomes

This study examined social anxiety symptoms and/or diagnosis as a predictor of differential short- and long-term cognitive-behavioral treatment (CBT) outcomes. Ninety-one anxiety-disordered youth participated in a randomized clinical trial of CBT. Semi-structured interviews provided dimensional clinical severity ratings (CSRs) for children's principal anxiety disorder at pretreatment, posttreatment, 1-year and 7.4-year follow-up assessments for youth with versus without pretreatment social anxiety. Thirty-nine youth presented with either principal (n = 17), secondary (n = 11), or tertiary social phobia diagnoses (n = 7) or subclinical social anxiety symptoms (n = 4). Hierarchal linear modeling (HLM) indicated that youth made similar gains from pretreatment to posttreatment and 1-year follow-up regardless of their social anxiety symptoms or diagnosis; however, youth with social anxiety symptoms or diagnosis were significantly less improved at 7.4-year follow-up. This pattern was distinct from that of youth with the most severe (CSR = 4) principal anxiety disorders at pretreatment. Though initially responsive to CBT, children who present with social anxiety diagnoses or symptoms may require an enhanced or extended treatment to maintain their gains into young adulthood whether or not social anxiety is considered their principal childhood difficulty.     

Association between generalized anxiety levels and pain in a community sample: Evidence for diagnostic specificity

BackgroundIt is unclear whether generalized anxiety disorder (GAD) has a specific relationship to pain syndromes, going beyond the established association of pain with anxiety syndromes in general.MethodsMental disorders were assessed in a community sample (N = 4181; 18–65 years) using the DSM-IV/M-CIDI. Several threshold definitions were used to define GAD and medically unexplained pain.ResultsThe association between pain and GAD (odds ratio, OR = 5.8 pain symptoms; OR = 16.0 pain disorder) is stronger than the association between pain and other anxiety disorders (OR = 2.4 pain symptoms; OR = 4.0 pain disorder). This association extends to subthreshold level definitions of GAD with some indication for a non-linear dose–response relationship. The GAD-pain link cannot sufficiently be explained by demographic factors, comorbid mental or physical disorders.ConclusionsThe association of pain and generalized anxiety is not artifactual. Compared to other anxiety syndromes, it appears to be stronger and more specific suggesting the need to explore clinical and public health implications.     

Unique relations among anxiety sensitivity factors and anxiety,depression, and suicidal ideation

Anxiety sensitivity (AS) is composed of three lower-order dimensions, cognitive concerns, physical concerns, and social concerns. We examined the relations between AS dimensions using a more adequate assessment of subscales (ASI-3) than has previously been used, and measures of anxiety and mood disorders as well as suicidal ideation in a sample of 256 (M age = 37.10 years, SD = 16.40) treatment-seeking individuals using structural equation modeling. AS cognitive concerns was uniquely associated with generalized anxiety disorder (GAD), obsessive–compulsive disorder (OCD), major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and suicidal ideation. AS physical concerns was uniquely associated with OCD, social anxiety disorder (SAD), panic disorder (PD), and specific phobia. AS social concerns was uniquely associated with SAD, GAD, OCD, and MDD. These results highlight the importance of considering the lower-order AS dimensions when examining the relations between AS and psychopathology.     

Early maladaptive schemas and social anxiety in adolescents: The mediating role of anxious automatic thoughts

Cognitive models state that cognitions are organized hierarchically, so that the underlying schemas affect behavior via more automatic, superficial cognitive processes. This study aimed to demonstrate that early maladaptive schemas predict anxious automatic thoughts, and to show that such automatic thoughts act as mediators between schemas and prospective changes in social anxiety symptoms. The study also examined an alternative reverse model in which schemas acted as mediators between automatic thoughts and social anxiety. A total of 1052 adolescents (499 girls and 553 boys; M_age = 13.43; SD_age = 1.29) completed measures of early maladaptive schemas, socially anxious automatic thoughts, and social anxiety symptoms at Times 1, 2, and 3. The results revealed bidirectional longitudinal relationships among schemas and automatic thoughts that were consistent in content (e.g., the disconnection/rejection schemas and automatic thoughts of negative self-concept). Furthermore, the automatic thoughts of anticipatory negative evaluation by others at Time 2 mediated the relationship between the other-directedness schemas at Time 1 and social anxiety symptoms at Time 3. These findings are consistent with hierarchical cognitive models of social anxiety given that deeper schemas predict more surface-level thoughts. They also support that these more surface-level thoughts contribute to perpetuating schemas. Finally, results show that early maladaptive schemas of the other-directedness domain play a relevant role in the development and maintenance of social anxiety.     

Risk profiles for poor treatment response to internet-delivered CBT in people with social anxiety disorder

In social anxiety disorder (SAD) co-morbid depressive symptoms as well as avoidance behaviors have been shown to predict insufficient treatment response. It is likely that subgroups of individuals with different profiles of risk factors for poor treatment response exist. This study aimed to identify subgroups of social avoidance and depressive symptoms in a clinical sample (N = 167) with SAD before and after guided internet-delivered CBT, and to compare these groups on diagnostic status and social anxiety. We further examined individual movement between subgroups over time. Using cluster analysis we identified four subgroups, including a high-problem cluster at both time-points. Individuals in this cluster showed less remission after treatment, exhibited higher levels of social anxiety at both assessments, and typically remained in the high-problem cluster after treatment. Thus, in individuals with SAD, high levels of social avoidance and depressive symptoms constitute a risk profile for poor treatment response.     

Fear acquisition and extinction in offspring of mothers with anxiety and depressive disorders

Maternal anxiety and depression are significant risk factors for the development of these disorders in offspring. The pathways through which risk is conferred remain unclear. This study examined fear acquisition and extinction in 26 children at high risk for emotional disorders by virtue of maternal psychopathology (n = 14 with a mother with a principal anxiety disorder and n = 12 with a mother with a principal unipolar depressive disorder) and 31 low risk controls using a discriminative Pavlovian conditioning procedure. Participants, aged between 7 and 14 years, completed 16 trials of discriminative conditioning of two geometric figures, with (CS+) and without (CS−) an aversive tone (US), followed by 8 extinction trials (4 × CS+, 4 × CS−). In the context of comparable discriminative conditioning, children of anxious mothers showed larger skin conductance responses during extinction to the CS+ compared to the CS−, and to both CSs from the first to the second block of extinction trials, in comparison with low risk controls. Compared to low risk controls, children of depressed mothers showed smaller skin conductance responses to the CS+ than the CS− during acquisition. These findings suggest distinct psychophysiological premorbid risk markers in offspring of anxious and depressed mothers.     

The trajectories of adolescent anxiety and depressive symptoms over the course of a transdiagnostic treatment

Anxiety and depressive disorders commonly co-occur during adolescence, share multiple vulnerability factors, and respond to similar psychosocial and pharmacological interventions. However, anxiety and depression may also be considered distinct constructs and differ on some underlying properties. Prior research efforts on evidence-based treatments for youth have been unable to examine the concurrent trajectories of primary anxiety and depressive concerns across the course of treatment. The advent of transdiagnostic approaches for these emotional disorders in youth allows for such examination. The present study examined the separate trajectories of adolescent anxiety and depressive symptoms over the course of a transdiagnostic intervention, the Unified Protocol for the Treatment of Emotional Disorders in Adolescence (UP-A; Ehrenreich et al., 2008), as well as up to six months following treatment. The sample included 59 adolescents ages 12–17 years old (M = 15.42, SD = 1.71) who completed at least eight sessions of the UP-A as part of an open trial or randomized, controlled trial across two treatment sites. Piecewise latent growth curve analyses found adolescent self-rated anxiety and depressive symptoms showed similar rates of improvement during treatment, but while anxiety symptoms continued to improve during follow-up, depressive symptoms showed non-significant improvement after treatment. Parent-rated symptoms also showed similar rates of improvement for anxiety and depression during the UP-A to those observed for adolescent self-report, but little improvement after treatment across either anxiety or depressive symptoms. To a certain degree, the results mirror those observed among other evidence-based treatments for youth with anxiety and depression, though results hold implications for future iterations of transdiagnostic treatments regarding optimization of outcomes for adolescents with depressive symptoms.     

Training implicit social anxiety associations: An experimental intervention

The current study investigates an experimental anxiety reduction intervention among a highly socially anxious sample (N = 108; n = 36 per Condition; 80 women). Using a conditioning paradigm, our goal was to modify implicit social anxiety associations to directly test the premise from cognitive models that biased cognitive processing may be causally related to anxious responding. Participants were trained to preferentially process non-threatening information through repeated pairings of self-relevant stimuli and faces indicating positive social feedback. As expected, participants in this positive training condition (relative to our two control conditions) displayed less negative implicit associations following training, and were more likely to complete an impromptu speech (though they did not report less anxiety during the speech). These findings offer partial support for cognitive models and indicate that implicit associations are not only correlated with social anxiety, they may be causally related to anxiety reduction as well.     

Clinical characteristics of anxiety disordered youth

Reports the characteristics of a large, representative sample of treatment-seeking anxious youth (N = 488). Participants, aged 7–17 years (mean 10.7 years), had a principal DSM-IV diagnosis of separation anxiety disorder (SAD), generalized anxiety disorder (GAD), or social phobia (SP). Although youth with a co-primary diagnosis for which a different disorder-specific treatment would be indicated (e.g., major depressive disorder, substance abuse) were not included, there were few other exclusion criteria. Participants and their parent/guardian underwent an extensive baseline assessment using a broad array of measures capturing diagnostic status, anxiety symptoms and severity, and areas of functional impairment. Means and standard deviations of the measures of psychopathology and data on diagnostic status are provided. The sample had moderate to severe anxiety disorder and was highly comorbid, with 55.3% of participants meeting criteria for at least one non-targeted DSM-IV disorder. Anxiety disorders in youth often do not present as a single/focused disorder: such disorders in youth overlap in symptoms and are highly comorbid among themselves.     

Prediabetes,depressive and anxiety symptoms,and risk of type 2 diabetes: A community-based cohort study

ObjectiveTo examine the potential synergistic associations between prediabetes, depressive and anxiety symptoms, and the risk of incident type 2 diabetes.MethodsData were from the Emotional Well-Being, Metabolic Factors and Health Status (EMHS) study and included 2486 adults between 40 and 69 years without diabetes at baseline. Hemoglobin A1c levels and measures of depressive and anxiety symptoms were collected at baseline and mutually exclusive groups were formed based on the presence/absence of prediabetes and high/low depressive and anxiety symptoms. A follow-up telephone interview conducted approximately 4.6 years later inquired about new diabetes diagnoses.Results86 participants developed diabetes during the follow-up period. After accounting for sociodemographic, lifestyle, and metabolic characteristics, participants with prediabetes and elevated depressive symptoms had an increased risk of developing diabetes compared to those without prediabetes and with low depressive symptoms (OR = 10.65, 95% CI = 4.60, 24.66). The joint effect of prediabetes and depressive symptoms on diabetes risk was synergistic (Synergy Index = 2.57, 95% CI = 1.02, 6.49). Similar results were found for participants with prediabetes and high symptoms of anxiety (OR = 8.95, 95% CI = 3.54, 22.63), however the joint effect of prediabetes and anxiety symptoms did not significantly exceed additive risk after adjusting for covariates (Synergy Index = 2.39, 95% CI = 0.83, 6.87).ConclusionThe combination of prediabetes and depressive or anxiety symptoms was associated with an increased risk of developing diabetes. This study underscores the importance of mental health in the progression from prediabetes to type 2 diabetes.     

Positive emotion dysregulation and posttraumatic stress disorder symptoms: Investigating the role of anxiety sensitivity

ObjectivePosttraumatic stress disorder (PTSD) symptoms are prevalent and deleterious among individuals who have experienced a sexual assault. Although an emerging field of research has established a link between positive emotion dysregulation and PTSD symptoms, there is a limited understanding of mechanisms underlying this relation. Individuals who have experienced a sexual assault may begin to fear any arousal-related sensations via stimulus generalization, including that associated with positive emotions, which, in turn, may amplify PTSD symptoms. Thus, the current study examined the role of anxiety sensitivity in the association between positive emotion dysregulation and PTSD symptoms.MethodsA sample of 500 community members reporting a history of sexual assault (M_age = 34.54, 54.4% male, 79.0% white) completed measures of positive emotion dysregulation, anxiety sensitivity, and PTSD symptoms.ResultsFindings detected a significant indirect effect of anxiety sensitivity in the relation between positive emotion dysregulation and PTSD symptoms (β = 0.28, SE = 0.03, 95% CI [0.22, 0.34]). Supplementary analyses revealed that effects held for subscales of anxiety sensitivity (i.e., cognitive, physical, social concerns) and PTSD symptom clusters (i.e., intrusions, avoidance, negative alternations in cognitions and mood, alternations in arousal and reactivity).ConclusionsThis study offers preliminary empirical support for the assertion that fear of arousal-related sensations associated with positive emotions may partially explain the link between positive emotion dysregulation and PTSD symptoms among those who have experienced a sexual assault. Information from this study could advance future research and treatment.     

Dimensional anxiety scales for DSM-5: Sensitivity to clinical severity

PurposePsychometric properties and clinical sensitivity of brief self-rated dimensional scales to supplement categorical diagnoses of anxiety disorders in the DSM-5 were recently demonstrated in a German treatment seeking sample of adults. The present study aims to demonstrate sensitivity of these scales to clinical severity levels.MethodsThe dimensional scales were administered to 102 adults at a university outpatient clinic for psychotherapy. Diagnostic status was assessed using the Munich-Composite International Diagnostic Interview. To establish a wide range of clinical severity, we considered subthreshold (n = 83) and threshold anxiety disorders (n = 49, including Social Phobia, Specific Phobia, Agoraphobia, Panic Disorder, and Generalized Anxiety Disorder).ResultsIndividuals with either subthreshold or threshold anxiety disorder scored higher on all dimensional scales relative to individuals without anxiety. In addition, individuals with a threshold anxiety disorder scored higher on the dimensional scales than individuals with a subthreshold anxiety disorder (except for specific phobia). Disorder-related impairment ratings, global functioning assessments and number of panic attacks were associated with higher scores on dimensional scales. Findings were largely unaffected by the number of anxiety disorders and comorbid depressive disorders.ConclusionThe self-rated dimensional anxiety scales demonstrated sensitivity to clinical severity, and a cut-off based on additional assessment of impairment and distress may assist in the discrimination between subthreshold and threshold anxiety disorders. Findings suggest further research in various populations to test the utility of the scales for use in DSM-5.     

Perception matters for clinical perfectionism and social anxiety

Despite research documenting a relationship between social anxiety and perfectionism, very little research has examined the relationship between social anxiety and clinical perfectionism, defined as the combination of high personal standards and high maladaptive perfectionistic evaluative concern. In the current studies we examined whether clinical perfectionism predicted social anxiety in a large sample of undergraduates (N = 602), in a clinical sample of participants diagnosed with social anxiety disorder (SAD; N = 180), and by using a variance decomposition model of self- and informant-report of perfectionism (N = 134). Using self-report, we found that an interaction of personal standards and evaluative concern predicted both social interaction anxiety and fear of scrutiny, but not in the theorized direction. Specifically, we found that self-report of low standards and high evaluative concern was associated with the highest levels of social anxiety, suggesting that when individuals with SAD hold low expectations for themselves combined with high concerns about evaluation, social anxiety symptoms may increase. Alternatively, when an informants’ perspective was considered, and more consistent with the original theory, we found that the interaction of informant-only report of personal standards and shared-report (between both primary participant and informant) of concern over mistakes was associated with self-reported social anxiety, such that high concern over mistakes and high personal standards predicted the highest levels of social anxiety. Theoretical, clinical, and measurement implications for clinical perfectionism are discussed.     

The Disqualification of Positive Social Outcomes Scale: A novel assessment of a long-recognized cognitive tendency in social anxiety disorder

Socially anxious individuals frequently tend to disqualify positive social experiences and outcomes. However, no formal measure of Disqualificationof Positive Social Outcome (DPSO)-related tendencies has yet been reported. The purpose of the present series of studies was to develop the Disqualification ofPositive Social Outcomes Scale (DPSOS) and examine its psychometric profile across several independent samples, including a large (n = 585) undergraduate sample; a clinical sample of individuals diagnosed with social anxiety disorder (n = 14), and a demographically-equivalent sample of non-socially anxious control participants (n = 14). The factorial validity, internal consistency, and construct validity of the DPSOS subscales were examined. Results provide preliminary support for the psychometric properties of the DPSOS. Implications of DPSO as to assessment and treatment of social anxiety disorder are discussed.     

Headache symptoms consistent with migraine and tension-type headaches in children with anxiety disorders

ObjectiveTo examine the incidence of headache symptoms consistent with migraine and tension-type headache (TTH) in children with anxiety disorders.Method.Parents of children with anxiety disorders (n = 27) and children without anxiety disorders (n = 36) completed a headache questionnaire based on the International Classification of Headache Disorders (2nd edition) criteria.ResultsChildren with anxiety disorders had a higher incidence of headache symptoms consistent with migraine and TTH compared to children without anxiety disorders. Girls with anxiety disorders and children with separation anxiety disorder had a higher incidence of headaches compared to girls without anxiety disorders and children with other anxiety disorders respectively. Children with anxiety disorders and headaches had higher self-reported anxiety symptom severity compared to children with anxiety disorders without headaches and children without anxiety disorders.ConclusionFindings highlight an overlap in anxiety and headaches in children and warrant further research on factors that contribute to the etiology and maintenance of these co-occurring problems.