Chronic worry and the temporal dynamics of emotional processing.

Worriers avoid upsetting thoughts yet also demonstrate vigilance for aversive emotional information. Potentially, these processes coexist but are separated in time. Individuals scoring high on a measure of chronic uncontrollable worry were compared to low scorers during valence categorization of emotional stimuli with interleaved Stroop color word trials to monitor extended effects of emotional processing. High worriers were especially fast and accurate in judging the valence of emotional words compared to low worriers. Worriers also had smaller pupil diameters following personally relevant negative emotional stimuli compared to low worriers. Correlations with self-report scales indicated associations between the worrier pupil response profile and symptoms of chronic worry and depression. The combined behavioral and physiological data support theories of emotional vigilance followed by avoidance in worriers. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: Evaluation in a randomized controlled trial.

Generalized anxiety disorder (GAD) is a chronic anxiety disorder, associated with comorbidity and impairment in quality of life, for which improved psychosocial treatments are needed. GAD is also associated with reactivity to and avoidance of internal experiences. The current study examined the efficacy of an acceptance-based behavioral therapy aimed at increasing acceptance of internal experiences and encouraging action in valued domains for GAD. Clients were randomly assigned to immediate (n = 15) or delayed (n = 16) treatment. Acceptance-based behavior therapy led to statistically significant reductions in clinician-rated and self-reported GAD symptoms that were maintained at 3- and 9-month follow-up assessments; significant reductions in depressive symptoms were also observed. At posttreatment assessment 78% of treated participants no longer met criteria for GAD and 77% achieved high end-state functioning; these proportions stayed constant or increased over time. As predicted, treatment was associated with decreases in experiential avoidance and increases in mindfulness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopharmacological effects of oxycodone in volunteers with and without generalized anxiety disorder.

A number of studies have documented a relationship between anxiety disorders and opioid misuse and abuse, and there is some data to suggest that some people use opioids in an attempt to reduce their anxiety. We tested the hypothesis that volunteers with an anxiety disorder would report a more positive spectrum of subjective effects (i.e., greater ratings of drug liking and wanting to take the drug again) from oxycodone, a mu opioid agonist, than would volunteers without the disorder, and that oxycodone would have greater reinforcing efficacy in volunteers with the anxiety disorder. In addition to subjective and reinforcing effects, the psychomotor and physiological effects of oxycodone also were assessed. Individuals with generalized anxiety disorder (GAD, n = 8) and nonanxious controls (CTL, n = 8) were administered 0, 10, and 20 mg oxycodone (per os) in 3 separate sessions. Oxycodone produced a number of effects in a dose-related fashion in both groups. However, on several subjective effects measures, only CTL participants reported effects of oxycodone (e.g., high, lightheaded). Neither group had statistically significant increases in peak liking or “take drug again” ratings in the oxycodone conditions relative to the placebo condition, and in neither group did the drug function as a reinforcer, as measured by the Multiple-Choice Procedure (Griffiths, Troisi, Silverman, & Mumford, 1993). Anxiety ratings were low in the GAD group (in the absence of drug), and this may have lessened the possibility of detecting a more positive spectrum of oxycodone effects in this group than in the CTL group. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cognitive-behavioral treatment of late-life generalized anxiety disorder.

This study addressed the efficacy of cognitive-behavioral therapy (CBT), relative to minimal contact control (MCC), in a sample of 85 older adults (age 60 years and over) with generalized anxiety disorder (GAD). All participants completed measures of primary outcome (worry and anxiety), coexistent symptoms (depressive symptoms and specific fears), and quality of life. Results of both completer and intent-to-treat analyses revealed significant improvement in worry, anxiety, depression, and quality of life following CBT relative to MCC. Forty-five percent of patients in CBT were classified as responders, relative to 8% in MCC. Most gains for patients in CBT were maintained or enhanced over 1-year follow-up. However, posttreatment scores for patients in CBT failed to indicate return to normative functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Craving and physiological reactivity to trauma and alcohol cues in posttraumatic stress disorder and alcohol dependence.

The high comorbidity of posttraumatic stress disorder (PTSD) and alcohol dependence (AD) has been firmly established. Although laboratory studies have examined self-reported craving in response to trauma and alcohol cues, no studies have reported on alcohol-related physiological responding in response to trauma cues in PTSD-AD individuals. Using a cue reactivity paradigm, this study examined the impact of personalized trauma-image cues and in vivo alcohol cues on alcohol-related responding (e.g., salivation, craving) in individuals with PTSD and AD (n = 40). Participants displayed reactivity to both trauma and alcohol cues when compared to neutral cues, including increased self-reported craving and distress, as well as greater salivation. These findings suggest that through repeated pairings of trauma memories and alcohol consumption, salivation may become classically conditioned to trauma cues. Moreover, the fact that the trauma-alcohol cue combination elicited greater alcohol craving, salivary responding, distress, and arousal than either the trauma-neutral or neutral-alcohol cue combinations suggests that effects of the trauma and alcohol cues were additive in nature. Evidence that AD individuals with PTSD report increased alcohol craving and display greater salivation in response to trauma memories, supplements prior research indicating that PTSD-related negative emotion and trauma-related alcohol craving may play an important role in the maintenance of AD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of generalized anxiety disorder in older adults.

Older adults with generalized anxiety disorder (GAD; N=75; M age=67.1 years) were randomly assigned to cognitive-behavioral therapy (CBT), a discussion group (DG) organized around worry provoking topics, or a waiting period. Participants in both active conditions improved relative to the waiting list. Although CBT participants improved on more measures than DG participants, the authors found only 1 significant difference immediately after treatment and no differences at 6-month follow-up. Effect sizes were smaller than in younger samples, but CBT showed large effects and DG showed medium-sized effects. Overall, results indicate that brief treatment of late-life GAD is beneficial, but they provide only limited support for the superiority of CBT to a credible comparison intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age and gender differences in cardiac reactivity and subjective emotion responses to emotional autobiographical memories.

This research reports age and gender differences in cardiac reactivity and subjective responses to the induction of autobiographical memories related to anger, fear, sadness, and happiness. Heart rate (HR) and subjective state were assessed at baseline and after the induction of each emotion in 113 individuals (61 men, 52 women; 66% European American, 34% African American) ranging in age from 15 to 88 years (M = 50.0; SD = 20.2). Cardiac reactivity was lower in older individuals; however, for anger and fear, these age effects were significantly more pronounced for the women than the men. There were no gender differences in subjective responses, however, suggesting that the lower cardiac reactivity found among older people is dependent on gender and the specific emotion assessed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal pathoplasticity in individuals with generalized anxiety disorder.

Recent theories of generalized anxiety disorder (GAD) have emphasized interpersonal and personality functioning as important aspects of the disorder. We examined heterogeneity in interpersonal problems in 2 studies of individuals with GAD (n = 47 and n = 83). Interpersonal subtypes were assessed with the Inventory of Interpersonal Problems–Circumplex (Alden, Wiggins, & Pincus, 1990). Across both studies, individuals with GAD exhibited heterogeneous interpersonal problems, and cluster analyses of these patients' interpersonal characteristics yielded 4 replicable clusters, identified as intrusive, exploitable, cold, and nonassertive subtypes. Consistent with our pathoplasticity hypotheses, clusters did not differ with GAD severity, anxiety severity, or depression severity. Clusters in Study 2 differed on rates of personality disorders, including avoidant personality disorder, further providing support for the validity of interpersonal subtypes. The presence of interpersonal subtypes in GAD may have important implications for treatment planning and efficacy. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

An open trial of integrative therapy for generalized anxiety disorder.

Cognitive-behavioral therapy (CBT), although effective, has the lowest average effect size for generalized anxiety disorder (GAD), when compared to effect sizes of CBT for other anxiety disorders. Additional basic and applied research suggests that although interpersonal processes and emotional avoidance may be maintaining GAD symptomatology, CBT has not sufficiently addressed interpersonal issues or emotion avoidance. This study aimed to test the feasibility and preliminary efficacy of an integrative psychotherapy, combining CBT with techniques to address interpersonal problems and emotional avoidance. Eighteen participants received 14 sessions of CBT plus interpersonal emotional processing therapy and three participants (for training and feasibility purposes) received 14 sessions of CBT plus supportive listening. Results showed that the integrative therapy significantly decreased GAD symptomatology, with maintenance of gains up to 1 year following treatment. In addition, comparisons with extant literature suggested that the effect size for this new GAD treatment was higher than the average effect size of CBT for GAD. Results also showed clinically significant change in GAD symptomatology and interpersonal problems with continued gains during the 1-year follow-up. Implications of these results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

DSM-IV criteria for generalized anxiety disorder in older adults: Distinguishing the worried from the well.

This study compared 36 older adults with generalized anxiety disorder (GAD), 22 older adults with subsyndromal anxiety symptoms, and 32 normal controls on criteria of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) for GAD. GAD patients reported more frequent and uncontrollable worry, somewhat different worry content, higher prevalence of most associated symptoms, and more distress or impairment than the subsyndromal group or normal controls. Individuals with subsyndromal anxiety reported more excessive, frequent, and uncontrollable worry than asymptomatic individuals, along with more sleep disturbance, fatigue, and distress or impairment. Results indicate that the key features of late-life GAD are distress and impairment, frequency and uncontrollability of worry, muscle tension, and sleep disturbance and that clinicians treating older adults with GAD should monitor and treat residual symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The structure of distress following trauma: Posttraumatic stress disorder, major depressive disorder, and generalized anxiety disorder.

The current report used confirmatory factor analysis to examine the latent structures of both key features and associated symptoms of three disorders that commonly develop following a traumatic event: posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD). Participants were 228 motor-vehicle accident survivors who sought treatment for emotional difficulties. PTSD, MDD, and GAD were assessed with a combination of self-report and interview-based measures. The results of construct level analyses suggested that PTSD, MDD, and GAD are distinguishable but highly correlated disorders following a traumatic event. Symptom level analyses supported a model where the Reexperiencing, Avoidance, and Hypervigilance factors were subsumed under the PTSD construct. However, in this model the Dysphoria factor was a higher order construct correlated with the PTSD, MDD, and GAD factors, suggesting that the Dysphoria cluster may not be unique to PTSD. Diagnostic and theoretical implications of these results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Specificity of treatment effects: Cognitive therapy and relaxation for generalized anxiety and panic disorders.

[Correction Notice: An erratum for this article was reported in Vol 76(5) of Journal of Consulting and Clinical Psychology (see record 2008-13625-021). In the article, "Specificity of Treatment Effects: Cognitive Therapy and Relaxation for Generalized Anxiety and Panic Disorders," by Jedidiah Siev and Dianne L. Chambless (Journal of Consulting and Clinical Psychology, 2007, Vol. 75, No. 4, pp. 513-522), the individual measures were not listed in the domains labeled "Panic" and "Cognitive" for the ?st and Westling (1995) citation in Table 3. The corrected table is included, with the added text appearing in bold font.] The aim of this study was to address claims that among bona fide treatments no one is more efficacious than another by comparing the relative efficacy of cognitive therapy (CT) and relaxation therapy (RT) in the treatment of generalized anxiety disorder (GAD) and panic disorder without agoraphobia (PD). Two fixed-effects meta-analyses were conducted, for GAD and PD separately, to review the treatment outcome literature directly comparing CT with RT in the treatment of those disorders. For GAD, CT and RT were equivalent. For PD, CT, which included interoceptive exposure, outperformed RT on all panic-related measures, as well as on indices of clinically significant change. There is ample evidence that both CT and RT qualify as bona fide treatments for GAD and PD, for which they are efficacious and intended to be so. Therefore, the finding that CT and RT do not differ in the treatment of GAD, but do for PD, is evidence for the specificity of treatment to disorder, even for 2 treatments within a CBT class, and 2 disorders within an anxiety class. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differentiating anxiety and depression in older adults with generalized anxiety disorder.

To examine affect and cognition in differentiating anxiety and depression, 83 older participants with generalized anxiety disorder completed the Cognitive Checklist (CCL) and the Positive and Negative Affect Schedule (PANAS). A 3-factor solution was found for the PANAS: positive affect (PA), anxiety and anger (Negative Affect 1 [NA-1]), and guilt and shame (Negative Affect 2 [NA-2]). A 2-factor structure was noted for the CCL. Correlations with anxiety and depression measures suggested that the CCL Depression (CCL-D) subscale showed stronger correlations with depression, whereas the CCL Anxiety subscale did not uniquely correlate with anxiety. The NA-1 subscale correlated positively with measures of depression and anxiety, whereas the PA subscale showed negative correlations. Hierarchical regression suggested that the CCL-D subscale was a significant predictor of self-reported depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems.

Clients with generalized anxiety disorder (GAD) received either (1) applied relaxation and self-control desensitization, (2) cognitive therapy, or (3) a combination of these methods. Treatment resulted in significant improvement in anxiety and depression that was maintained for 2 yrs. The large majority no longer met diagnostic criteria; a minority sought further treatment during follow-up. No differences in outcome were found between conditions; review of the GAD therapy literature suggested that this may have been due to strong effects generated by each component condition. Finally, interpersonal difficulties remaining at posttherapy, measured by the Inventory of Interpersonal Problems Circumplex Scales (L. E. Alden, J. S. Wiggins, & A. L. Pincus, 1990) in a subset of clients, were negatively associated with posttherapy and follow-up improvement, suggesting the possible utility of adding interpersonal treatment to cognitive-behavioral therapy to increase therapeutic effectiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of cognitive-behavioral therapy for generalized anxiety disorder with integrated techniques from emotion-focused and interpersonal therapies.

Objective: Recent models suggest that generalized anxiety disorder (GAD) symptoms may be maintained by emotional processing avoidance and interpersonal problems. Method: This is the first randomized controlled trial to test directly whether cognitive-behavioral therapy (CBT) could be augmented with the addition of a module targeting interpersonal problems and emotional processing. Eighty-three primarily White participants (mean age = 37) with a principle diagnosis of GAD were recruited from the community. Participants were assigned randomly to CBT plus supportive listening (n = 40) or to CBT plus interpersonal and emotional processing therapy (n = 43) within a study using an additive design. Doctoral-level psychologists with full-time private practices treated participants in an outpatient clinic. Using blind assessors, participants were assessed at pretreatment, posttreatment, 6-month, 1-year, and 2-year follow-up with a composite of self-report and assessor-rated GAD symptom measures (the Penn State Worry Questionnaire; T. J. Meyer, M. L. Miller, R. L. Metzger, & T. D. Borkovec, 1990; Hamilton Anxiety Rating Scale; M. Hamilton, 1959; assessor severity rating; State–Trait Anxiety Inventory-Trait Version; C. D. Spielberger, R. L. Gorsuch, R. Lushene, P. R. Vagg, & G. A. Jacobs, 1983) as well as with indices of clinically significant change. Results: Mixed models analysis of all randomized participants showed very large within-treatment effect sizes for both treatments (CI = [?.40, ?.28], d = 1.86) with no significant differences at post (CI = [?.09, .07], d = .07) or 2-year follow-up (CI = [?.01, .01]), d = .12). There was also no statistical difference between compared treatments on clinically significant change based on chi-square analysis. Conclusions: Interpersonal and emotional processing techniques may not augment CBT for all GAD participants. Trial Registry name: Clinical Trials.gov, Identifier: NCT00951652. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

"Specificity of treatment effects: Cognitive therapy and relaxation for generalized anxiety and panic disorders": Correction.

Reports an error in "Specificity of treatment effects: Cognitive therapy and relaxation for generalized anxiety and panic disorders" by Jedidiah Siev and Dianne L. Chambless (Journal of Consulting and Clinical Psychology, 2007[Aug], Vol 75[4], 513-522). The individual measures were not listed in the domains labeled "Panic" and "Cognitive" for the ?st and Westling (1995) citation in Table 3. The corrected table is included, with the added text appearing in bold font. (The following abstract of the original article appeared in record 2007-11558-001.) The aim of this study was to address claims that among bona fide treatments no one is more efficacious than another by comparing the relative efficacy of cognitive therapy (CT) and relaxation therapy (RT) in the treatment of generalized anxiety disorder (GAD) and panic disorder without agoraphobia (PD). Two fixed-effects meta-analyses were conducted, for GAD and PD separately, to review the treatment outcome literature directly comparing CT with RT in the treatment of those disorders. For GAD, CT and RT were equivalent. For PD, CT, which included interoceptive exposure, outperformed RT on all panic-related measures, as well as on indices of clinically significant change. There is ample evidence that both CT and RT qualify as bona fide treatments for GAD and PD, for which they are efficacious and intended to be so. Therefore, the finding that CT and RT do not differ in the treatment of GAD, but do for PD, is evidence for the specificity of treatment to disorder, even for 2 treatments within a CBT class, and 2 disorders within an anxiety class. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differential subjective and psychophysiological responses to socially and nonsocially generated emotional stimuli.

Sociality may determine the subjective experience and physiological response to emotional stimuli. Film segments induced socially and nonsocially generated emotions. Comedy (social positive), bereavement (social negative), pizza scenes (nonsocial positive), and wounded bodies (nonsocial negative) elicited four distinct emotional patterns. Per subjective report, joy, sadness, appetite, and disgust were elicited by the targeted stimulus condition. The social/nonsocial dimension influenced which emotional valence(s) elicited a skin conductance response, a finding that could not be explained by differences in subjective arousal. Heart rate deceleration was more responsive to nonsocially generated emotions. Taken together, these findings suggest that sociality affects the physiological profile of responses to emotional valence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder symptoms, physiological reactivity, alcohol problems, and aggression among military veterans.

This study examined the association between posttraumatic stress disorder (PTSD) symptomatology and aggressive behavior among a sample of male Vietnam veterans (N = 1,328). Results indicated that the hyperarousal PTSD symptom cluster evidenced the strongest positive association with aggression at the bivariate level when compared with the other PTSD symptom clusters. When the PTSD symptom clusters were examined together as predictors, hyperarousal symptoms evidenced a significant positive relationship with aggression, and avoidance/numbing symptoms were negatively associated with aggression. Examination of potential mediators indicated that hyperarousal symptoms were directly associated with aggression and indirectly related to aggression via alcohol problems. Reexperiencing symptoms were associated with aggression only indirectly and through their positive association with physiological reactivity and negative association with alcohol problems. Study results highlight the complexity of the relationship between PTSD symptoms and aggression, and suggest possible mechanisms explaining this association. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group cognitive-behavioral therapy for generalized anxiety disorder: Treatment outcome and long-term follow-up.

A recently developed cognitive-behavioral treatment for generalized anxiety disorder (GAD) targets intolerance of uncertainty by the reevaluation of positive beliefs about worry, problem-solving training, and cognitive exposure. As previous studies have established the treatment's efficacy when delivered individually, the present study tests the treatment in a group format as a way to enhance its cost-benefit ratio. A total of 52 GAD patients received 14 sessions of cognitive-behavioral therapy in small groups of 4 to 6 participants. A wait-list control design was used, and standardized clinician ratings and self-report questionnaires assessed GAD symptoms, intolerance of uncertainty, anxiety, depression, and social adjustment. Results show that the treatment group, relative to the wait-list group, had greater posttest improvement on all dependent variables and that treated participants made further gains over the 2-year follow-up phase of the study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal subtypes and change of interpersonal problems in the treatment of patients with generalized anxiety disorder: A pilot study.

Interpersonal problems are highly relevant to the treatment of generalized anxiety disorder (GAD) patients. Previous studies using the Inventory of Interpersonal Problems identified several interpersonal subtypes in GAD patients. In this study, we wanted to replicate earlier findings of interpersonal subtypes in GAD. We investigated whether these interpersonal subtypes are characterized by different types of interpersonal problems and different levels of interpersonal distress, and we further examined whether they differed with regard to improvement of interpersonal problems after short-term treatment. This study is based on results from a randomized controlled trial that investigated short-term treatments in GAD outpatients. For secondary analysis, interpersonal subtypes were identified by cluster analysis and Inventory of Interpersonal Problems profiles were calculated for both the total sample (N = 52) and the interpersonal subtypes using the Structural Summary Method for Circumplex Data. This study confirmed previous results demonstrating the existence of interpersonal subtypes in GAD. Four interpersonal subtypes were identified: Overly Nurturant, Intrusive, Socially Avoidant, and Nonassertive. Short-term treatment significantly improved interpersonal problems (d = 0.46) within the total GAD sample. Interestingly, the effect sizes of the four clusters differed considerably (d = 0.19–1.24) and the clusters displayed different changes in the two circumplex axes Dominance and Nurturance. Our study indicates that change of interpersonal problems needs to be specifically analyzed, even within homogenous diagnostic groups. (PsycINFO Database Record (c) 2011 APA, all rights reserved)