J Anxiety Disord [JOURNAL]
Sun
200 papers
A psychometric and demographic evaluation of the Hogg Eco-Anxiety Scale in a German youth sample.
Phan D, Öngören HO, Spirkl N … +4 more , Heinzel S, Metzen D, Bechtoldt M, Asbrand J
J Anxiety Disord · 2026 Apr · PMID 41763070 · Publisher ↗
Eco-anxiety refers to psychological distress arising from the anticipated impacts of planetary crises. Even though young people are at major risk for both psychopathology and the long-term consequences of planetary crise...
Eco-anxiety refers to psychological distress arising from the anticipated impacts of planetary crises. Even though young people are at major risk for both psychopathology and the long-term consequences of planetary crises, no psychometrically validated German instrument currently exists to assess eco-anxiety in this age group, and research on age differences in eco-anxiety remains limited. The present study aimed to replicate the psychometric properties of the German validation study of the Hogg Eco-Anxiety Scale (HEAS) in a younger age group (N = 414; M = 20.24, SD = 2.80, age range: 15-25) as well as the four-factor structure (Affective Symptoms, Rumination, Behavioral Symptoms, and Anxiety about Personal Impact). By combining the present sample with two additional samples, measurement invariance across two age groups (15-25 years vs. >25 years) was established, suggesting that the HEAS measures eco-anxiety similarly across ages. All hypotheses were confirmed; additionally, latent mean comparisons show that the younger group experiences higher levels of eco-anxiety than the older group. Exploratory analyses further found that participants demonstrating elevated symptoms of depression or anxiety reported significantly higher levels of eco-anxiety across all HEAS subscales. Moreover, individuals residing in metropolitan areas scored higher on the scale Anxiety about the Personal Impact compared to participants from rural regions. Enhancing the precision of eco-anxiety assessment depending on age, clinical status, and geographical contexts enables the targeted development and implementation of preventive and therapeutic interventions according to the level of severity indicated by this instrument.
Do laboratory fear extinction, avoidance and generalization predict exposure outcomes for fear of spiders?
Carpentier N, Hermans D, Leng L … +2 more , Luyten L, Scheveneels S
J Anxiety Disord · 2026 Apr · PMID 41762549 · Publisher ↗
This study assessed the predictive potential of laboratory conditioning processes (extinction, avoidance, and generalization) for exposure therapy outcomes in 112 spider-fearful women. Three aversive conditioning tasks w...
This study assessed the predictive potential of laboratory conditioning processes (extinction, avoidance, and generalization) for exposure therapy outcomes in 112 spider-fearful women. Three aversive conditioning tasks were followed by a baseline assessment of spider fear, virtual reality exposure training, a post assessment after one week and a three-month follow-up assessment. Initial analyses indicated significant positive correlations between reduced extinction, increased avoidance of a conditioned threat stimulus, and overgeneralization, particularly evident in verbal measures. In subsequent analyses, neither individual extinction and generalization indices reliably predicted exposure outcomes, contrasting prior research. Notably, excessive avoidance of the conditioned stimulus did emerge as a potential predictor of less favorable exposure outcomes, aligning with previous research on fear avoidance. Overall, our findings underscore the complexity of predicting exposure therapy outcomes. Moreover, they call for further investigation into the impact of methodological decisions on determining the relationship between basic learning processes and treatment efficacy.
Is symptom improvement similar during PTSD psychotherapy delivered by video telehealth and in-person in routine veterans health administration care?
Holder N, Batten A, Shiner B … +1 more , Maguen S
J Anxiety Disord · 2026 Apr · PMID 41762548 · Publisher ↗
One strategy to boost access to trauma-focused evidence-based psychotherapy (TF-EBP), first-line treatment for posttraumatic stress disorder (PTSD), is through video telehealth. Our goal was to determine if delivery moda...
One strategy to boost access to trauma-focused evidence-based psychotherapy (TF-EBP), first-line treatment for posttraumatic stress disorder (PTSD), is through video telehealth. Our goal was to determine if delivery modality (i.e., video telehealth vs. in-person) was associated with the likelihood of experiencing clinically meaningful improvement in PTSD symptoms among veterans receiving TF-EBP in routine care. We identified veterans who participated in TF-EBP with appropriately anchored PTSD symptom measurements in the Veterans Health Administration between 4/2022-4/2023 (n = 17,106). Using Bayesian hierarchical logistic regression, we modeled the probability of experiencing a 15-point reduction in the PTSD Checklist for DSM-5 (PCL-5) from pre- to post-treatment. We were primarily interested in the risk-adjusted differences in clinically meaningful PTSD symptom improvement across delivery modalities, accounting for relevant demographic, military, clinical, and service delivery characteristics. Overall, 38.5 % of veterans in the sample experienced clinically meaningful PTSD symptom improvement. Relative to those receiving primarily in-person TF-EBP, veterans who received primarily video telehealth TF-EBP had lower risk-adjusted odds of experiencing symptom improvement (Median Posterior Odds Ratio = 0.83, Region of Practical Equivalence = 38.3 %). Video telehealth delivery of TF-EBP was associated with a small reduction in the likelihood of experiencing clinically meaningful improvement in PTSD symptoms. While findings suggest the need for future research to understand and close this small gap, video telehealth delivery continues to provide access to care for many VHA-enrolled veterans, and clinicians should continue to engage in shared decision-making during treatment modality selection.
Examining familial risk factors for social anxiety disorder: Intolerance of uncertainty and related personality traits.
Moreau AL, Li LY, White J … +1 more , Shankman SA
J Anxiety Disord · 2026 Apr · PMID 41713205 · Full text
Intolerance of uncertainty (IU) is an individual difference dimension reflecting difficulty in tolerating aversive responses triggered by uncertainty. IU is an important etiological and maintaining mechanism of social an...
Intolerance of uncertainty (IU) is an individual difference dimension reflecting difficulty in tolerating aversive responses triggered by uncertainty. IU is an important etiological and maintaining mechanism of social anxiety disorder (SAD). However, IU's role as a familial risk factor for SAD remains unresolved. In the present study, we sought to 1) confirm that SAD runs in families (as per prior studies), 2) test if IU also runs in families, and 3) examine if IU is a familial risk factor for SAD. We also explored other related personality factors that could also be familial risk factors for SAD. Analyses were conducted in a family study of psychopathology (n = 725 siblings and parents in 246 families). SAD severity was assessed with the Inventory of Depression and Anxiety Symptoms (IDAS-II) social anxiety scale. IU was assessed with the Intolerance of Uncertainty Scale, short form (IUS-12). SAD and IU both demonstrated familial aggregation (intra-class correlation coefficients of 0.10 and 0.14, respectively). However, families' average IU scores did not predict individual's SAD history after accounting for the individual's IU. Results were similar for neuroticism, anxiousness, and detachment. In contrast, when familial analyses were restricted to exploratory intergenerational analyses only, parental SAD predicted offspring's IU but offspring IU did not predict personal SAD. These findings suggest that although IU is a known risk factor for SAD, and both IU and SAD appear to transmit in families, IU may not be a familial risk factor for SAD, although parental SAD may be a risk factor for elevated levels of offspring IU. Other risk factors, besides shared familial factors between IU and SAD, may better explain how SAD is transmitted through families.
Reciprocal association and bridge symptoms in the comorbidity between social anxiety and problematic internet use: A four-wave longitudinal study.
Wang H, Chen C
J Anxiety Disord · 2026 Apr · PMID 41707478 · Publisher ↗
OBJECTIVES: This study aimed to examine the reciprocal association between social anxiety and PIU across four time points among Chinese rural adolescents, and to explore the bridge symptoms underlying their comorbidity o...
OBJECTIVES: This study aimed to examine the reciprocal association between social anxiety and PIU across four time points among Chinese rural adolescents, and to explore the bridge symptoms underlying their comorbidity over time. METHOD: Chinese rural adolescents (42.67 % boys; M = 15.64 years, SD = 1.42 years) participated in four waves of data collection (T1: September 2022, T2: March 2023, T3: September 2023, and T4: March 2024), and completed the Chinese Version of the Adolescent Social Anxiety Scale (SAS-A) and Problematic Internet Use Questionnaire Short Form (PIUQ-SF). Random intercept cross-lagged panel model (RI-CLPM) and cross-lagged panel network (CLPN) were employed for data analysis. RESULTS: Results of RI-CLPM showed that social anxiety was positively associated with PIU at the between-person level. At the within-person level, consistent reciprocal relationships between social anxiety and PIU at all waves were found, with medium to large lagged effects. Results of CLPN showed that "obsession" and "neglect" symptoms from the PIU subnetwork, and "fear of negative evaluation" symptoms from the social anxiety subnetwork were the central bridge symptoms underlying the comorbidity between social anxiety and PIU. DISCUSSION: The findings provide novel and indicative evidence for the comorbidity between social anxiety and PIU and the underlying mechanism among marginalized rural adolescents. The central bridge symptoms may serve as potential intervention targets to help prevent the progression of social anxiety and PIU comorbidity in rural schools, potentially leading to better mental health outcomes.
Examining the psychometric properties and network structures of the bivalent fear of evaluation model of social anxiety disorder in a Japanese population.
Noda S, Okawa S, Nishiuchi M … +3 more , Kobayashi M, Weeks JW, Hofmann SG
J Anxiety Disord · 2026 Mar · PMID 41671877 · Publisher ↗
The bivalent fear of evaluation (BFOE) model of social anxiety disorder (SAD) posits that fear of evaluation consists of two distinct valences: fear of negative evaluation (FNE) and fear of positive evaluation (FPE). Ref...
The bivalent fear of evaluation (BFOE) model of social anxiety disorder (SAD) posits that fear of evaluation consists of two distinct valences: fear of negative evaluation (FNE) and fear of positive evaluation (FPE). Reflecting this model, the BFOE Scale (BFOES) was developed by combining items from established FNE and FPE measures into a single integrated scale. This study aimed to (1) assess the psychometric properties of the Japanese version of the BFOES, and (2) examine the network structures of FNE, FPE, and SAD symptoms among Japanese individuals with and without SAD. A total of 401 individuals with a self-reported diagnosis of SAD and 373 without a self-reported diagnosis of SAD completed questionnaires assessing FNE, FPE, SAD symptoms, self-focused attention, post-event processing, and depressive symptoms. Confirmatory factor analyses supported a correlated two-factor model for the BFOES (FNE and FPE factors). Exploratory graph analyses revealed a two-dimensional structure for the BFOES. Cronbach's α and McDonald's ω coefficients indicated high internal consistency. Correlational analyses showed small to moderate positive associations between BFOES factors and SAD-related constructs. Partial correlational analyses indicated that the FNE and FPE factors were more strongly associated with SAD-related constructs than with depressive symptoms, supporting convergent and discriminant validity. A network comparison test revealed no significant differences between SAD and non-SAD groups in the global network structure and connectivity. However, central symptoms differed slightly between the groups: among individuals with SAD, "concern about others' thoughts and the impressions one leaves" and "fear of talking to strangers" were most central. In contrast, in the non-SAD group, "avoidance of embarrassment" and "distress over palpitations" were most central. These findings were discussed within the framework of the BFOE model of SAD.
Assessing the reliability and validity of the International Trauma Interview in a sample of Ukrainian soldiers.
Martsenkovskyi D, Hyland P, Shevlin M … +9 more , Bondjers K, Scherbakova A, Sulaieva O, Bibikova A, Dudin O, Savchenko A, Voznitsyna K, Maruta N, Dosenko V
J Anxiety Disord · 2026 Mar · PMID 41666501 · Publisher ↗
BACKGROUND: The International Trauma Interview (ITI) is a clinical interview used to diagnose ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). Six studies have assessed the latent structure of the IT...
BACKGROUND: The International Trauma Interview (ITI) is a clinical interview used to diagnose ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). Six studies have assessed the latent structure of the ITI and have generally advocated for models consistent with the ICD-11 description of PTSD and CPTSD, despite the common occurrence of improper solutions. Diagnostic concordance between the ITI and a self-report measure-International Trauma Questionnaire (ITQ)-has also been low. Here, the latent structure of the ITI was examined, along with tests of internal reliability, concurrent/discriminant validity, and diagnostic concordance between the ITI and ITQ. METHODS: Data were collected from 209 combat-exposed, active-duty Ukrainian soldiers. Confirmatory factor analysis was used to test seven latent structural models of the ITI. Structural equation modelling was used to test concurrent/discriminant validity. RESULTS: The two models consistent with the ICD-11 formulation of PTSD and CPTSD either had unsatisfactory fit or contained out-of-bounds parameter estimates. The latent structure of the ITI items was best explained by a correlated two-factor model representing PTSD and DSO symptoms. The PTSD and DSO scores had good internal reliability, and were correlated with depression, anxiety, insomnia, and psychological wellbeing. Diagnostic concordance between the ITI and ITQ was 'moderate'-to-'substantial'. CONCLUSION: The latent structure of the ITI in this sample was not consistent with the formulation of ICD-11 PTSD and CPTSD. The implications of the ITI not measuring the different symptom clusters of these disorders are discussed.
The lived experience of social anxiety disorder: A conceptual model focused on adolescents and young adults based on published literature and social media listening.
Schmidt AL, Staunton H, Stein MB … +5 more , Hayes AM, Rodriguez-Esteban R, Fischer K, McIver T, Suter EE
J Anxiety Disord · 2026 Mar · PMID 41650823 · Publisher ↗
Social anxiety disorder (SAD) affects up to 1 in 8 individuals over their lifetime and is characterized by an intense fear of social situations involving unfamiliar people or possible scrutiny. This retrospective observa...
Social anxiety disorder (SAD) affects up to 1 in 8 individuals over their lifetime and is characterized by an intense fear of social situations involving unfamiliar people or possible scrutiny. This retrospective observational study reviewed published literature from PubMed and analyzed data from Reddit using social media listening (SML) to understand the lived experience of individuals with SAD. SML offers a complement to traditional methods such as semi-structured interviews, particularly for individuals for whom interacting with strangers is challenging. A stepwise analysis, aligned with US Food and Drug Administration Patient-Focused Drug Development guidelines, was performed to develop a conceptual model for SAD focused on adolescents and young adults. A conceptual model provides a visual overview of the interrelationships between disease-related symptoms and their impact from patients' perspective. Natural language processing techniques and machine learning approaches were employed to extract symptoms and impacts from SML posts. After a targeted literature search, eleven qualitative research publications and 535,544 posts from 118,040 Reddit users were included. Clinical and patient experts then confirmed the content in the conceptual model covering three key symptom domains (physical, negative automatic thoughts, and emotions) and two impact domains (social functioning and occupational/educational functioning). This study captures the value of SML by eliciting spontaneous insights that may not emerge in traditional approaches and proposes a comprehensive conceptual model to support future research and the optimization of Clinical Outcome Assessments in SAD clinical trials.
Where is the 'Anxious' in climate anxiety? Evidence from Chinese social media big data.
Tan L, Yang Z, Xu Z … +2 more , Xu Y, Wu X
J Anxiety Disord · 2026 Mar · PMID 41643241 · Publisher ↗
Climate anxiety has emerged as a significant global psychological and social response to climate change, potentially shaping public engagement and support for climate-related technologies and policies. Here we develop a...
Climate anxiety has emerged as a significant global psychological and social response to climate change, potentially shaping public engagement and support for climate-related technologies and policies. Here we develop a framework for analyzing online climate anxiety using social media data from China based on 177,232 geo-referenced Weibo posts from 2010 to 2024. The analysis began with the investigation of climate anxiety themes using climate-anxious dictionaries and machine learning methods. Next, the emotional intensity of climate anxiety was assessed through the semantic similarity-based scoring approach. Finally, statistical models were applied to measure the factors influencing climate anxiety. Four major findings are arrived. First, extreme weather events (52.36 %) and livelihood and resource insecurity (22.87 %) were the most discussed and concerning themes, with a notable increase in discussions during summer and autumn. Second, the intensity of climate anxiety has risen significantly. The average intensity increased from 4.42 during the period of 2010-2017 to 7.08 during 2018-2024, with a further notable rise to 7.49 in the more recent period from 2020 to 2024. Third, regions such as Beijing (8.70), Guangdong (8.31), and Zhejiang (7.94) exhibited the highest levels of climate anxiety. Fourth, the intensity of climate anxiety is associated with key demographic and regional factors. Specifically, younger individuals and those residing in climate-vulnerable or informationally developed regions exhibited stronger emotional responses. The framework provides a scalable method for tracking the spatiotemporal dynamics of collective climate anxiety online. The findings demonstrate that digital expressions of climate anxiety constitute a measurable indicator of public concern and carry significant implications for anticipating societal responses and designing targeted communication within climate governance.
Socialsatiation: Social anxiety alters belongingness dynamics?
Hay DE, Porat-Butman S, Kivity Y … +2 more , Levy-Gigi E, Gilboa-Schechtman E
J Anxiety Disord · 2026 Mar · PMID 41637871 · Publisher ↗
BACKGROUND: Social interactions and stable individual differences shape an individual's sense of belongingness -a core need of being accepted by others. Indeed, a sense of belonging is postulated-and found-to affect and...
BACKGROUND: Social interactions and stable individual differences shape an individual's sense of belongingness -a core need of being accepted by others. Indeed, a sense of belonging is postulated-and found-to affect and be affected by socializing. A diminished sense of belonging and reduced socializing characterizes social anxiety (SA). However, the impact of SA on the temporal dynamics between socializing and belongingness remains unclear. METHOD: Using ecological momentary assessment (EMA), we examined the impact of SA on socializing-belongingness dynamics. Participants (N = 116) provided real-time reports on social interactions (three times a day) and belongingness (five times a day) across a 15-17-day period. RESULTS: SA moderated the relationship between socializing and belongingness. Individuals with low SA exhibited a maximizing pattern, with belongingness increasing continuously as socializing increased. In contrast, individuals with high SA showed a satiation effect, in which belongingness plateaued after a certain amount of socializing. Finally, both SA and socializing prospectively predicted perceived belongingness. CONCLUSIONS: Our findings reveal person-specific dynamics of belongingness, with high levels of SA associated with reduced benefits from social engagement. These findings suggest that enhancing social opportunities and assisting individuals in recognizing optimal levels of socializing may jointly contribute to more fulfilling intra- and interpersonal functioning in SA.
Predicting outcomes from cognitive behavioural therapy for social anxiety disorder: A Bayesian network analysis.
Rogerson E, Simmonds-Buckley M, Kellett S … +1 more , Delgadillo J
J Anxiety Disord · 2026 Mar · PMID 41621171 · Publisher ↗
The identification of predictors of treatment response in cognitive behavioural therapy (CBT) for social anxiety disorder (SAD) could help to improve treatment outcomes. This study sought to identify which specific socia...
The identification of predictors of treatment response in cognitive behavioural therapy (CBT) for social anxiety disorder (SAD) could help to improve treatment outcomes. This study sought to identify which specific social anxiety symptoms measured pre-treatment were associated with post-treatment outcomes. A pre-registered retrospective cohort study was conducted including a sample of N = 1315 patients treated with CBT for SAD in routine clinical practice. The sample was partitioned into training and test subsets (random 50:50 split) to evaluate the model's out-of-sample performance. The outcome was a reliable and clinically significant improvement (RCSI) in anxiety after treatment. A Bayesian network model based on symptoms measured by the Social Phobia Inventory (SPIN) was developed in the training sample (n = 658) using 10-fold cross-validation for variable selection. Predictive accuracy was evaluated in an external test sample (n = 657) using an area under the receiver operating characteristic curve (AUC). Predictive accuracy reduced when comparing performance in the training (AUC = 0.67) to test samples (AUC = 0.58) with moderate out-of-sample prediction shrinkage (6.76 %). The variable selection process yielded a network of four key interrelated SAD symptoms: avoiding public speaking, fear of embarrassment, avoiding criticism and fear of being observed. Identifying important SAD symptoms at assessment enables these to be targeted during CBT to potentially help maximise treatment efficiency and effectiveness.
Efficacy of transdiagnostic cognitive-behavioral treatment for anxiety disorders on insomnia.
Provencher MD, Dubé L, Norton PJ … +2 more , Carrier N, Roberge P
J Anxiety Disord · 2026 Mar · PMID 41576827 · Publisher ↗
INTRODUCTION: The efficacy of transdiagnostic cognitive-behavioral therapy (tCBT) for anxiety disorders (AD) is well established. Few studies have investigated the role of insomnia in the context of tCBT for AD. Consider...
INTRODUCTION: The efficacy of transdiagnostic cognitive-behavioral therapy (tCBT) for anxiety disorders (AD) is well established. Few studies have investigated the role of insomnia in the context of tCBT for AD. Considering the high prevalence of insomnia symptoms in individuals with AD, this study aims to explore the effects of tCBT on insomnia, as well as to examine the predictive or moderating role of insomnia on the efficacy of tCBT for AD. METHOD: The present study consists of a secondary analysis of data from a randomized clinical trial of tCBT for AD (Roberge et al., 2022). The 231 participants with panic disorder, agoraphobia, generalized anxiety disorder and/or social anxiety disorder were randomized to an experimental group tCBT condition (Norton, 2012) combined with usual care (TAU) compared with a TAU-only control condition. RESULTS: The efficacy of tCBT for insomnia symptoms is supported by linear mixed regression analysis, where participants receiving tCBT achieved significantly lower insomnia symptoms at post-treatment than TAU-only participants (unadjusted mean at post-treatment, 9.98 ± 6.72 vs. 13.13 ± 6.41, p < .001, Cohen's d = 0.48), with progress maintained through 12-month follow-up. Results showed a moderator role of ISI where participants with high insomnia symptoms at pre-treatment had higher anxiety symptoms at post-treatment in all conditions, with stronger improvement over time in the tCBT condition. CONCLUSION: The study highlights the importance of considering insomnia symptoms in the clinical context of tCBT for AD and of developing and evaluating intervention modalities that would optimally address this frequent comorbidity.
Behavioural experiments for intolerance of uncertainty: A brief intervention delivered via videoconference for adults with generalised anxiety disorder.
Wilson EJ, Abbott MJ, Norton AR … +2 more , Riley J, Berle D
J Anxiety Disord · 2026 Mar · PMID 41558458 · Publisher ↗
Accessing psychological treatment is often met with barriers of time, cost, and availability. Focused brief interventions delivered via videoconference can overcome some of these barriers. We sought to evaluate the effic...
Accessing psychological treatment is often met with barriers of time, cost, and availability. Focused brief interventions delivered via videoconference can overcome some of these barriers. We sought to evaluate the efficacy and feasibility, as well as processes of exposure-based learning for a brief intervention for treating generalised anxiety disorder (GAD), utilising behavioural experiments delivered via videoconference. Participants (N = 40) with a primary diagnosis of GAD were assessed via clinical interview and randomised to either the treatment condition (n = 20) or waitlist condition (n = 20). Treatment consisted of two weekly 1-hour sessions where participants utilised behavioural experiments to test negative beliefs about uncertainty. The primary outcomes were worry, safety behaviours, avoidance, depression, anxiety, physiological tension, and intolerance of uncertainty (IU). Linear mixed models indicated that the treatment group was only superior to the waitlist group on change from pre- to post-treatment for worry. The combined group (once waitlisted participants received treatment) evidenced significant reduction across all outcomes from pre- to post-treatment, except for anxiety. Additionally, there was evidence that expectancy violation and habituation occurred, suggesting that behavioural experiments facilitate different processes of exposure-based learning. The intervention was also found to be acceptable, appropriate, and feasible by adults with GAD. Thus, the remotely delivered brief intervention shows promise as an effective option for individuals with GAD.
Factor structure, measurement invariance, and clinical change benchmarks of the Generalized Anxiety Disorder-7 (GAD-7) in pregnancy and postpartum.
Stefana A, Mirabella F, Gigantesco A … +2 more , Camoni L, Perinatal Mental Health Network group
J Anxiety Disord · 2026 Mar · PMID 41547078 · Publisher ↗
INTRODUCTION: The Generalized Anxiety Disorder-7 (GAD-7) scale is widely used to measure anxiety symptom severity during the perinatal period. However, measurement invariance between pregnant and postpartum women is unde...
INTRODUCTION: The Generalized Anxiety Disorder-7 (GAD-7) scale is widely used to measure anxiety symptom severity during the perinatal period. However, measurement invariance between pregnant and postpartum women is under-studied, differential item functioning has not been assessed, and score precision across the anxiety continuum is unknown in perinatal samples. The objective was to examine the factor structure and measurement properties of the GAD-7 in perinatal women, a METHODS: Data were drawn from an ongoing investigation in Italy that began in 2021. Dimensionality was assessed using exploratory graph analysis and confirmatory factor analysis (CFA); measurement invariance and differential item functioning were evaluated via item-level effect size (d) and iterative multigroup CFA across perinatal phases and trimesters; and item response theory was applied to examine scale information and reliability. RESULTS: The GAD-7 demonstrated strict one-dimensionality, scalar measurement invariance across the two perinatal phases and across five finer-grained perinatal phases (trimesters 1-3, early and late postpartum), and excellent classical and IRT reliability. Score precision and clinical change benchmarks have been provided. LIMITATIONS: The results are restricted to Italian (92 %) or Italian-speaking (8 %) and may not generalize to other cultures. Participants have predominantly high levels of education. CONCLUSION: The GAD-7 possesses a unidimensional latent structure that is invariant across the entire perinatal continuum and can be used in perinatal research, mental-health surveillance, intervention trials, and routine obstetric care.
Disrupting posttrauma networks: Identifying candidate intervention targets to improve military veterans' mental health and well-being.
Vogt D, Kumar SA, Caine ED … +3 more , Gamble S, Karras E, Borowski S
J Anxiety Disord · 2026 Mar · PMID 41544370 · Full text
Trauma exposure is widespread within the U.S. and around the world. Although researchers have examined the mental health and functional challenges that can result from these experiences, knowledge regarding which symptom...
Trauma exposure is widespread within the U.S. and around the world. Although researchers have examined the mental health and functional challenges that can result from these experiences, knowledge regarding which symptoms and domains of functioning are most central in maintaining poor mental health and functioning is limited. Using data from The Veterans Metrics Initiative (TVMI) study, we conducted a series of network analyses to identify factors that are most central to mental health (depression, posttraumatic stress disorder [PTSD], anxiety, and suicidal ideation) and functional challenges (health, social, vocational, and financial) experienced by U.S. military veterans (N = 2150). Depression symptoms and health functioning were most strongly linked to other factors in the network of associations among and between mental health and functioning domains, with similar associations observed for those with minimal versus elevated symptom levels. Collectively, these findings suggest that interventions targeting depression, alongside efforts to increase engagement in health-promoting behaviors, may have greatest potential to disrupt these networks. Future research is needed to confirm the causal impact that these factors have on other aspects of mental health and functioning, and to evaluate whether interventions that target these factors can improve the mental health and well-being of military veterans and other trauma-exposed populations.
Intolerance of uncertainty and climate change experience as driving forces of climate anxiety: Insights from a network perspective.
Mouguiama-Daouda C, McNally RJ, Heeren A
J Anxiety Disord · 2026 Mar · PMID 41534228 · Publisher ↗
Recent evidence indicates that sizeable segments of the global population experience marked anxiety about climate change. Yet important questions remain about the psychological processes that sustain climate anxiety and...
Recent evidence indicates that sizeable segments of the global population experience marked anxiety about climate change. Yet important questions remain about the psychological processes that sustain climate anxiety and about how this anxiety can translate into adaptive responses (i.e., pro-environmental behaviors) versus maladaptive outcomes (i.e., impairments in daily functioning). In the present study, we explicitly build on decades of basic research identifying intolerance of uncertainty-a dispositional difficulty in tolerating the unknown-as a decisive mechanism in the emergence and maintenance of anxiety-related dysfunction. Accordingly, we investigated how intolerance of uncertainty, the experience of climate change, and climate anxiety are interconnected, along with climate anxiety's (mal)adaptive outcomes. We analyzed data from an international unselected sample (n = 728) using computational tools from the network analytical framework. Specifically, we estimated a Gaussian Graphical Model (GGM) to characterize the network's structure, identify potential clusters of variables, and detect influential nodes, and we estimated a directed acyclic graph (DAG) to examine the probabilistic dependencies among variables. Our results indicate that both intolerance of uncertainty and the experience of climate change function as driving forces within the overall network structure.
Efficacy of combined low-frequency rTMS and cognitive behavioral therapy for unmedicated panic disorder: A randomized controlled trial.
Yang X, Zhang X, Luo J … +6 more , Wang P, He F, Meng L, Qin Q, Wu T, Yang X
J Anxiety Disord · 2026 Mar · PMID 41529423 · Publisher ↗
BACKGROUND: Cognitive behavioral therapy (CBT) is a first-line intervention for panic disorder (PD), yet a subset of patients exhibits suboptimal response. This randomized controlled trial investigated whether low-freque...
BACKGROUND: Cognitive behavioral therapy (CBT) is a first-line intervention for panic disorder (PD), yet a subset of patients exhibits suboptimal response. This randomized controlled trial investigated whether low-frequency repetitive transcranial magnetic stimulation (rTMS) augments the efficacy of CBT in unmedicated PD patients. METHODS: Fifty patients with PD were randomly assigned to receive either active or sham rTMS combined with standardized CBT. Outcomes were assessed using the Panic Disorder Severity Scale (PDSS), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD-17), Clinical Global Impression-Severity (CGI-S), Symptom Checklist-90 (SCL-90), and Personal and Social Performance scale (PSP). Bayesian linear mixed-effects model (LMM) was employed to analyze changes in clinical scores over time, accounting for repeated measures and baseline severity. Sensitivity analysis was also performed to evaluate the robustness of the findings. RESULTS: LMM analysis revealed a significant group × time interaction for both PDSS and HAMA scores. The active rTMS group showed significantly greater reduction in panic and anxiety symptoms compared to the sham group from week 2 onward. At the 12-week endpoint, both groups demonstrated significant improvements in overall psychopathological symptoms (SCL-90), depressive symptoms (HAMD-17), illness severity (CGI-S), and psychosocial functioning (PSP). However, the active rTMS group demonstrated significantly greater improvement in PSP scores compared to the sham control group, while no superior improvement was observed in SCL-90, CGI-S, or HAMD-17 scores. Both treatments were well tolerated. CONCLUSIONS: Active rTMS significantly accelerated and enhanced early anxiety and panic symptom reduction when combined with CBT, demonstrating its potential as an effective adjunctive strategy in the initial phase of treatment. The combination was safe and feasible, supporting further investigation into optimized sequencing and long-term outcomes in PD management.
Climate anxiety scholarship: A global bibliometric synthesis (2000-2024).
Anjum G, Aziz M, Nawaz AR
J Anxiety Disord · 2026 Mar · PMID 41518892 · Publisher ↗
Climate anxiety research has emerged as a significant interdisciplinary scholarship linking mental health, environmental science, and social justice. Despite its growing prominence, no comprehensive bibliometric analysis...
Climate anxiety research has emerged as a significant interdisciplinary scholarship linking mental health, environmental science, and social justice. Despite its growing prominence, no comprehensive bibliometric analysis has systematically mapped its intellectual structure and global dynamics. This study presents a bibliometric synthesis of 579 publications on climate anxiety indexed in Scopus and Web of Science from 2000 to 2024. Using Biblioshiny (the graphical interface for the R package "bibliometrix") and VOSviewer, we analyzed co-authorship, co-citation, and keyword co-occurrence networks to examine patterns in scientific production, thematic development, and institutional and geographic distribution. Citation trend analysis and keyword mapping traced thematic evolution across three phases: 2003-2015, 2016-2020, and 2021-2024. Results indicate exponential growth in climate anxiety research since 2019, with 242 publications in 2024 alone. The field is largely shaped by prominent scholars from the Global North and over the years thematic clusters have expanded from foundational constructs such as solastalgia and eco-anxiety to broader concerns including ecological grief, place attachment, and pro-environmental behavior. However, research remains geographically concentrated in high-income countries, with limited representation from climate-vulnerable regions, underscoring persistent epistemic disparities. Overall, the field demonstrates rapid development and growing interdisciplinary reach, yet continues to reflect inequities in global authorship and knowledge production. Advancing a more inclusive and context-sensitive climate anxiety scholarship requires centering Global South perspectives, decolonizing research agendas, and promoting equitable collaboration.
Social anxiety in online social interactions: Examining the effects of self and audience images on anxiety, self-awareness and performance evaluations.
Özhan N, Graf EW, Garner M
J Anxiety Disord · 2026 Mar · PMID 41518891 · Publisher ↗
BACKGROUND: Few studies have examined social anxiety symptoms during online social interactions. We examined self-report symptoms in individuals with elevated social anxiety in online interactions in the presence/absence...
BACKGROUND: Few studies have examined social anxiety symptoms during online social interactions. We examined self-report symptoms in individuals with elevated social anxiety in online interactions in the presence/absence of virtual audience images and the presence/absence of live videos of the self. METHOD: Participants with elevated social anxiety who were not treatment-seeking gave a short impromptu talk via an online social communication platform. Participants were randomised to present with their camera on or off, and to audience images that were visible or not. We recorded participants' self-reported anxiety, perspective taken, evaluations of speech performance, and post-event processing. RESULTS: Anxiety increased during the online social interaction. Furthermore, participants whose camera was on, but the audience was not visible, evaluated their own performance as worse and engaged in more severe negative post-event processing compared with the other conditions. DISCUSSION: Online videoconferencing tasks can induce anxiety and activate negative self-images and post-event evaluations of social performance. Our findings support the use of online social interactions to research social anxiety, maladaptive cognitive-behavioural biases and to develop novel interventions.
Development and validation of the eight item contrast avoidance questionnaire-general emotion scale (CAQ-GE-8): An item-response theory analysis.
Llera SJ, Zainal NH, Newman MG
J Anxiety Disord · 2026 Mar · PMID 41512712 · Full text
GOAL: We developed and validated an 8-item version of the 25-item Contrast Avoidance Questionnaire-General Emotion (CAQ-GE) scale, named the CAQ-GE-8. METHOD: Using unselected university undergraduates (N = 8432), we con...
GOAL: We developed and validated an 8-item version of the 25-item Contrast Avoidance Questionnaire-General Emotion (CAQ-GE) scale, named the CAQ-GE-8. METHOD: Using unselected university undergraduates (N = 8432), we conducted item-response theory (IRT) analyses with a confirmatory graded response model. We then examined the ability of the CAQ-GE-8 to predict probable generalized anxiety disorder (GAD) and major depressive disorder (MDD). With two other student samples, we examined the scale's convergent/discriminant validity (N = 410) as well as retest reliability (N = 124). RESULTS: The CAQ-GE-8 contained the same 2 factors as the CAQ-GE (F1: Create and Sustain Negative Emotions to Avoid Negative Contrasts [SNE], 5 items; and F2: Discomfort with Emotional Shifts [DES], 3 items). Both factors demonstrated strong internal consistency. The brief scale predicted probable GAD using a cut-point score of ≥ 15 (area under the receiver operating characteristic curve [AUC]:.794), and probable MDD using a cut-point score of ≥ 13 (AUC:.782). The CAQ-GE-8 and its two subscales also demonstrated good convergent and discriminant validity, and good to excellent retest reliability over 1 week (r = .737-.879). CONCLUSION: These findings support the use of the CAQ-GE-8, both in research and in treatment, to assess the construct of contrast avoidance.
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