Journal Of Anxiety Disorders[JOURNAL]
Sun
200 papers
Editorial: From algorithms to clinical reality: The next frontier in mental health AI.
Peng Y, Gan Y
J Anxiety Disord · 2026 Jun · PMID 42001778 · Publisher ↗
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Altered interoceptive-exteroceptive profile in Generalized Anxiety Disorder: Evidence from bayesian psychophysics and metacognitive modeling.
Liu P, Bai S, Wang X … +1 more , Zhou R
J Anxiety Disord · 2026 Jun · PMID 41996731 · Publisher ↗
Generalized Anxiety Disorder (GAD) is believed to involve impaired processing of external information and excessive focus on internal bodily signals. However, comparative evidence on exteroceptive and interoceptive perfo...
Generalized Anxiety Disorder (GAD) is believed to involve impaired processing of external information and excessive focus on internal bodily signals. However, comparative evidence on exteroceptive and interoceptive performance within a common experimental framework remains limited. In the present study, individuals with GAD (n = 31) and healthy controls (HC; n = 31) completed a heart rate discrimination (HRD) task, combined with Bayesian psychophysical modeling and signal detection theory-based metacognitive indices. At the first-order level, we estimated an HRD threshold parameter (α), indexing systematic tendency in cardiac judgments, and a precision parameter (β; lower β indicates greater precision), indexing the sharpness or uncertainty of those judgments. At the second-order level, we estimated metacognitive sensitivity (meta-d'), reflecting how well confidence tracked first-order task performance. We also included exploratory self-report measures of bodily awareness and bodily appraisal using the Body Awareness Questionnaire and the Body Sensations Interpretation Questionnaire. In the HC group, participants showed a relative exteroceptive advantage within the HRD framework, reflected in lower β and higher meta-d' in the exteroceptive condition than in the interoceptive condition. By contrast, this within-group exteroceptive advantage was not observed in GAD. Relative to HC participants, individuals with GAD showed greater precision in HRD-based cardiac judgments (lower β) and reduced exteroceptive metacognitive sensitivity (lower meta-d'), whereas no group differences emerged for α or the exploratory self-report measures. Taken together, these findings suggest an altered interoceptive-exteroceptive performance profile in GAD, characterized by greater precision in cardiac judgments alongside weaker exteroceptive metacognitive monitoring. These results may help refine theoretical accounts of internal-external information processing in anxiety and inform future computational approaches to assessment in GAD.
We need to start thinking about thinking: The impact of rumination on OCD symptom improvement in exposure and response prevention.
McNamara ME, Becker MS, Nota JA … +6 more , Broos HC, Nadel MH, Krompinger J, Van Kirk N, Kuckertz JM, Falkenstein MJ
J Anxiety Disord · 2026 Jun · PMID 41990425 · Publisher ↗
While rumination has been recognized in clinical settings as prevalent and problematic for individuals with obsessive compulsive disorder (OCD), its relationship to OCD symptom trajectories has been understudied. In a la...
While rumination has been recognized in clinical settings as prevalent and problematic for individuals with obsessive compulsive disorder (OCD), its relationship to OCD symptom trajectories has been understudied. In a large sample of N = 315 adults receiving exposure and response prevention (ERP) for OCD we evaluated the relationship between rumination and OCD symptoms. In our first aim, we characterized change in rumination across treatment and calculated the percentage of patients exhibiting change in rumination. In aim 2, we characterized how change in rumination impacts OCD symptom trajectories across treatment using a linear mixed-effects model. We found a significant interaction between rumination change (pre- to post-treatment) and week of treatment on weekly OCD severity measures, such that patients who experienced less improvement in rumination also experienced less weekly improvement in their OCD symptoms. In aim 3, we evaluated random-intercept cross-lagged panel models (RI-CLPMs) to assess how changes in rumination and OCD symptoms reciprocally affect each other across weeks of treatment. We found that autoregressive, cross-sectional, and cross-lagged relations between rumination and OCD symptom severity explained week-specific deviations from patient's own average symptoms independently of the between-person relations between rumination and OCD symptom severity. Rumination did not change for a significant number of patients receiving ERP, and these results demonstrate that lack of improvement in rumination affects OCD symptom trajectories. Given the hypothesized function of rumination as an emotional avoidance strategy, future research should evaluate the potential benefits of targeting rumination directly towards enhancing treatment outcomes for OCD.
The query is the theory: Why "exact-term" bibliometrics can conflate climate anxiety with broader eco-emotions.
Heeren A, Mouguiama-Daouda C
J Anxiety Disord · 2026 Apr · PMID 41965275 · Publisher ↗
Bibliometric syntheses help organize rapidly growing literatures, but their validity depends on how constructs are operationalized. Anjum et al. (2026) present an ambitious synthesis, labeled "climate anxiety scholarship...
Bibliometric syntheses help organize rapidly growing literatures, but their validity depends on how constructs are operationalized. Anjum et al. (2026) present an ambitious synthesis, labeled "climate anxiety scholarship," that maps the growth of publications, collaboration networks, co-citation structures, and keyword patterns from 2000 to 2024. Yet the paper also illustrates a key challenge in fast-growing fields: literature syntheses built on search terms and labels can outpace the conceptual distinctions they are meant to capture. Our central claim is that the article maps a corpus labeled as "climate anxiety scholarship," even though the query and the resulting thematic structure extend beyond climate anxiety proper to include adjacent eco-emotions that are conceptually distinct from anxiety-related phenomena. "Exact-term" search strategies may be precise about strings while remaining imprecise about constructs, especially when anxiety terms are combined with eco-emotions such as grief, despair, solastalgia, and generic "climate/eco-emotions." This construct blur invites jingle-jangle problems, muddies thematic clusters, and weakens clinical interpretability by treating distinct constructs as interchangeable. Two remedies follow: sensitivity analyses contrasting climate-anxiety-specific and broader eco-emotions corpora, and stronger ontological discipline specifying which constructs are targeted and how they relate (e.g., overlaps-with, is-a, part-of). In bibliometrics, the query is the theory; disciplined queries yield interpretable maps and clinically actionable insights.
A brief ecological momentary intervention for generalized anxiety disorder: A randomized controlled trial of the worry outcome monitoring app.
Schwob JT, Newman MG
J Anxiety Disord · 2026 Jun · PMID 41946300 · Full text
BACKGROUND: Investigating specific component interventions for generalized anxiety disorder (GAD) has produced encouraging, yet understudied findings. In a prior study worry outcome monitoring strategies led to declines...
BACKGROUND: Investigating specific component interventions for generalized anxiety disorder (GAD) has produced encouraging, yet understudied findings. In a prior study worry outcome monitoring strategies led to declines in worry in individuals diagnosed with GAD (LaFreniere & Newman, 2016). The current study extended these findings tracking additional information and by examining additional outcomes within a larger clinical sample. METHOD: We compared the efficacy of a smartphone worry outcome monitoring app (WOM) against a thought recording (TR) active control. Participants were prompted 4x/day as well as at the end of each day for 10-days to engage with their respective tasks. As opposed to WOM, TR individuals were only prompted to record their thoughts without observing the outcomes or challenging the maladaptive nature of their worries. A total of 117 participants with GAD were randomly assigned to either WOM or TR. Participants completed self-report questionnaires at pre-treatment, mid-treatment, post-treatment, and 20-day follow-up. Multilevel modeling analyses were used. RESULTS: There was no difference between WOM (vs. TR) on expectancy, credibility, or treatment satisfaction. WOM (vs. TR control) produced substantially larger reductions in worry, positive beliefs about worry, and contrast avoidance. Moreover, 89.14% of feared worry outcomes did not come true and in the 10.86% of time when feared outcomes came true, WOM participants coped better than expected 84.35% of the time. CONCLUSION: Findings advance understanding of the efficacy of technology-delivered, worry outcome monitoring in a clinical sample.
Trajectories of intolerance of uncertainty in adolescents: Associations with anxiety and depression.
Ye H, Wang J, Zhang J … +7 more , Chen D, Liu K, Zhang Y, Liu Y, Yao Y, Wang D, Fan F
J Anxiety Disord · 2026 Jun · PMID 41923673 · Publisher ↗
Intolerance of uncertainty (IU), a psychological vulnerability reflecting difficulty tolerating uncertain situations, is particularly salient during adolescence, a period marked by rapid neurocognitive development, incre...
Intolerance of uncertainty (IU), a psychological vulnerability reflecting difficulty tolerating uncertain situations, is particularly salient during adolescence, a period marked by rapid neurocognitive development, increasing social and academic demands, and heightened exposure to uncertainty. IU has recently been regarded as a transdiagnostic risk factor for anxiety and depression, yet most existing studies rely on cross-sectional, variable-centered designs. This study aimed to identify distinct developmental trajectories of IU and examine their associations with anxiety and depression using a longitudinal, person-centered approach. A total of 2076 adolescents (mean age = 14.20 years, SD = 1.95; 57.6% girls) participated in a three-wave study, completing self-report measures of IU, anxiety, and depression. Latent class growth analysis identified three IU trajectories: stable (59.7%), decreasing (30.3%), and increasing (10.0%). Logistic regression analyses, adjusting for sociodemographic factors, baseline IU, and baseline anxiety and depressive symptom severity, showed that adolescents with increasing IU had significantly higher odds of anxiety (OR = 3.75, 95% CI = 2.47-5.67) and depression (OR = 3.10, 95% CI = 2.11-4.55), while those in the decreasing group had lower odds of anxiety (OR = 0.30, 95% CI = 0.16-0.57) and depression (OR = 0.31, 95% CI = 0.18-0.52). These findings highlight meaningful heterogeneity in IU development during adolescence and its implications for mental health. Regular monitoring of IU may support early identification of adolescents at risk, while interventions targeting IU reduction may help decrease the risk of developing anxiety and depression. Findings should be interpreted cautiously, as all constructs were assessed via adolescent self-report.
Intergenerational symptom level transmission of comorbid anxiety and major depressive disorder: A dyadic network approach with simulated intervention modeling.
Tao Y, Guo S, Lu X … +2 more , Niu H, Liu X
J Anxiety Disord · 2026 Jun · PMID 41904905 · Publisher ↗
Anxiety and major depressive disorder (MDD) frequently co-occur and exhibit familial aggregation, yet their symptom-level intergenerational transmission between parents and their children remains unclear. From a larger c...
Anxiety and major depressive disorder (MDD) frequently co-occur and exhibit familial aggregation, yet their symptom-level intergenerational transmission between parents and their children remains unclear. From a larger community sample (N = 5697), 332 parent-child dyads (with a comorbidity prevalence of 5.8%) met criteria for comorbid anxiety and MDD based on cut-off scores of 9 on the Patient Health Questionnaire-9 and 7 on the Generalized Anxiety Disorder 7-item. Symptom-level data from these dyads were analysed using network analysis combined with computer-simulated intervention modeling to identify bridge symptoms and targets for cross-generational prevention. The network analysis results revealed "feeling afraid" shared as a bridge symptom (Z scores = 1.68 and 1.38, respectively) in both parent and adolescent networks, and overall network structures were significantly similar across generations (M = 1.90, p > .05; S = 6.50, p > .05). In the combined parent-child network, "sleep" and "concentration" were identified as cross-generational bridge symptoms (Z scores = 1.42 and 1.38, respectively). Computer-simulated intervention analyses revealed that alleviating "sad mood" significantly reduced the overall severity of comorbid anxiety and MDD in both groups. Among aggravating symptoms, "suicidal ideation" had the most destabilising effect in parents, whereas "anhedonia" had the strongest impact in adolescents. Notably, "concentration" functioned as a bridge symptom and emerged as the most influential cross-generational intervention target. These findings provide evidence for symptom-level intergenerational transmission of internalising comorbidity, highlighting both shared and age-specific mechanisms. Computer-simulated intervention modelling offers a novel framework for identifying precise targets for early and family-informed interventions.
The role of gender and child sexual abuse history in treatment response in two treatments for posttraumatic stress disorder.
Brown SE, Sloan DM, Shayani DR … +1 more , Hayes AM
J Anxiety Disord · 2026 Jun · PMID 41894887 · Full text
OBJECTIVE: This study tested whether a reported history of child sexual abuse (CSA) differentially affected treatment outcomes in men and women receiving written exposure therapy (WET) and cognitive processing therapy (C...
OBJECTIVE: This study tested whether a reported history of child sexual abuse (CSA) differentially affected treatment outcomes in men and women receiving written exposure therapy (WET) and cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD). METHOD: Participants were treatment-seeking men (n = 66) and women (n = 60) with a primary diagnosis of PTSD randomized to either WET or CPT. Approximately half of the sample (n = 60) reported a history of CSA. Masked evaluators assessed participants' PTSD symptoms and remission status at baseline and 6, 12, and 24 weeks after the first treatment session using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). An intent-to-treat linear mixed-effects model tested the association of the interaction between gender, CSA, treatment group, and time with PTSD symptom scores at 24-weeks after the first treatment session. Stratified chi-square tests of independence for each treatment group also examined the association between gender and CSA history with PTSD remission status at 24 weeks. RESULTS: The linear mixed effects model revealed a significant interaction between gender, history of CSA, treatment group, and time (B = 1.29, t[158] = 2.33, p = .021). Follow-up multiple comparison t-tests showed that women without a history of CSA randomized to CPT experienced greater reductions in PTSD symptoms than all other groups. No other statistically significant differences were observed between groups. Additionally, a larger proportion of women without CSA experienced PTSD remission at 24 weeks than women with a history of CSA (χ²(1, n = 24) = 4.00, p = .046). This pattern was not observed in WET. CONCLUSION: These findings imply a potentially meaningful difference in treatment response in women with and without CSA history receiving CPT for PTSD.
Love is a losing game: The experience of romantic love in social anxiety disorder.
Lazarovich H, Oren-Yagoda R, Aderka IM
J Anxiety Disord · 2026 Jun · PMID 41875619 · Publisher ↗
The present study aimed to examine the temporal relationship between the experience of love and subsequent anxiety among individuals with social anxiety disorder (SAD, n = 44), panic disorder (PD, n = 29), and a control...
The present study aimed to examine the temporal relationship between the experience of love and subsequent anxiety among individuals with social anxiety disorder (SAD, n = 44), panic disorder (PD, n = 29), and a control group with neither disorder (n = 43). Using a daily diary design, participants completed measures of emotions for 21 consecutive days. Using multilevel linear modeling, we found that individuals with SAD reported significantly lower levels of love compared to the other groups (B = 0.623; SE = 0.053; p < .001; 95% Bootstrapped CI = 0.513-0.722; Cohen's d = 0.34). Consistent with our preregistered hypotheses, in the SAD group, daily experiences of love significantly predicted increased anxiety on the following day (B = 0.071; SE = 0.037; p = .018; 95% Bootstrapped CI = 0.020-0.124; Cohen's d = 0.69). In contrast, for the PD group, daily love predicted a decrease in subsequent anxiety (B = -0.063; SE = 0.042; p = .041; 95% Bootstrapped CI = -0.149 to -0.009; Cohen's d = 0.53). No significant temporal association was found for the control group (p > .05). Findings suggest that individuals with SAD may perceive love as a threat or a sign of weakness, leading to elevated anxiety. Our results highlight the importance of addressing the fear of positive emotions, specifically love, in clinical interventions for SAD.
Prospective prediction of first-onset generalized and social anxiety disorders in adolescent girls.
Liu J, Yao N, Perlman G … +3 more , Klein DN, Kotov R, Mu W
J Anxiety Disord · 2026 Jun · PMID 41865656 · Publisher ↗
BACKGROUND: Generalized Anxiety Disorder (GAD) and Social Anxiety Disorder (SAD) are common in adolescents, yet few studies have comprehensively examined their risk factors for first onset during adolescence, limiting in...
BACKGROUND: Generalized Anxiety Disorder (GAD) and Social Anxiety Disorder (SAD) are common in adolescents, yet few studies have comprehensively examined their risk factors for first onset during adolescence, limiting insights into risk profiles and prevention strategies. METHOD: Data were drawn from the Adolescent Development of Emotion and Personality Traits (ADEPT) project. Anxiety disorders were assessed at 18-month intervals over 3 years, using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children. Adolescents without lifetime GAD (481 girls, mean age 14.37, SD = 0.62) or SAD (449 girls, mean age =14.39, SD = 0.63) at baseline were included for analysis. Thirty- six baseline risk factors spanning personality, interpersonal and academic functioning, psychopathology, and family history were analyzed for first-onset GAD (n = 47) and SAD (n = 67). We used multivariate logistic regression to identify unique predictors for each disorder. We also employed path analysis to explore the associations between risk factors and the onset of GAD and SAD, distinguishing between shared versus disorder-specific relationships. RESULTS: Anxiousness emerged as a robust unique predictor for GAD, while low assertiveness, poor academic performance, and a history of depression were stable unique predictors for SAD. Both shared and disorder-specific associations were identified, suggesting overlapping and specific vulnerabilities. CONCLUSION: This study identified distinct risk profiles for GAD and SAD, providing insights that may guide targeted screening and prevention efforts.
The meta-inner humor therapy: Insights from a three-arm randomized controlled trial for comorbid emotional disorders.
Akbari M, Sheikhi S, Forootan R … +1 more , Asmundson GJG
J Anxiety Disord · 2026 Jun · PMID 41864065 · Publisher ↗
BACKGROUND: Meta-Inner Humor Therapy (MIHT) was developed to cultivate active mindfulness by integrating humor-based metacognition with mindful awareness. We evaluated this treatment protocol in a feasibility pilot (Stud...
BACKGROUND: Meta-Inner Humor Therapy (MIHT) was developed to cultivate active mindfulness by integrating humor-based metacognition with mindful awareness. We evaluated this treatment protocol in a feasibility pilot (Study 1) and a three-arm randomized controlled trial (RCT; Study 2). METHOD: In Study 1, 27 adults with comorbid emotional disorders completed ten weekly 90-minute group sessions of MIHT. In Study 2, 93 adults (59% female; mean age=32.6; SD= 9.9), each with at least one primary DSM-5 anxiety, depressive, or obsessive-compulsive disorder (mean comorbidity diagnosis = 2.4), were randomized to MIHT, a Health-Enhancement Program (HEP), or waitlist. Outcomes were measured at baseline, post-treatment, and 9-month follow-up. RESULTS: Study 1 showed high feasibility (92.5% retention) and strong therapist fidelity (91%), with preliminary within-group symptom reductions. In Study 2, MIHT produced significantly greater improvements than HEP and waitlist across all primary and secondary outcomes. Primary outcomes were emotional symptoms, including anxiety, depression, stress, and obsessive-compulsive symptoms. Secondary outcomes included repetitive negative thinking, mindfulness, and adaptive/maladaptive meta-inner humor beliefs. Changes in adaptive and maladaptive meta-inner humor beliefs (MIHBs) uniquely predicted reductions in emotional symptoms after accounting for mindfulness-related improvements. Mediation analyses indicated that MIHB change was associated with reductions in repetitive negative thinking and psychological inflexibility which, in turn, contributed to reductions in anxious, depressive, and obsessive-compulsive symptoms. Treatment effects remained significant following multiplicity correction and were robust across all clustering sensitivity checks, confirming the stability and reliability of MIHT advantages. CONCLUSIONS: Across a pilot and an RCT, MIHT demonstrated strong feasibility, acceptability, and clinical efficacy. By transforming passive observation into engaged, compassionate inner playfulness, MIHT may represent a scalable transdiagnostic intervention for targeting cognitive-emotional rigidity.
Trends and determinants of childhood anxiety disorders burden in Asia, 1990-2023.
Zhang K, Kan C, Han F … +5 more , Li X, Zheng T, Hou N, Xue Y, Sun X
J Anxiety Disord · 2026 Jun · PMID 41864064 · Publisher ↗
BACKGROUND: Childhood anxiety disorders are a growing public health challenge in Asia, yet long-term trends, regional disparities, and system-level determinants remain poorly understood. This study quantifies the burden...
BACKGROUND: Childhood anxiety disorders are a growing public health challenge in Asia, yet long-term trends, regional disparities, and system-level determinants remain poorly understood. This study quantifies the burden of childhood anxiety across 47 Asian countries and territories from 1990 to 2023, identifying regional trends and key determinants. METHODS: We used Global Burden of Disease 2023 data to assess childhood anxiety burden across Asia from 1990 to 2023. We calculated incidence, disability-adjusted life year (DALY) rates, annual percent change, and bullying-attributable disability burden. Temporal and spatial patterns were examined, and key determinants of burden variation were identified using an XGBoost model interpreted with SHAP values. RESULTS: In 2023, South Asia had the largest number of childhood anxiety cases (3.32 million) and disability adjusted life years (2.70 million), while East Asia had the highest incidence (1275 per 100,000) and disability burden (646 per 100,000). From 1990-2023, South Asia showed the fastest rise in disability burden (annual percent change 3.44%), with a marked surge between 2018 and 2021. Cyprus, Iran, Lebanon, and China reported the highest incidence, while Iran, Afghanistan, Iraq, and Saudi Arabia had the highest disability burden. Bullying-attributable disability adjusted life years increased across all regions, especially in South Asia (146%). CONCLUSIONS: Childhood anxiety disorders are rising across Asia, with the fastest growth in South Asia and persistently high rates in East Asia. Despite greater detection and intervention, the burden persists, highlighting the need for policy changes and the identification of culturally and contextually informed strategies to reduce it.
Pilot study of an anxiety induction method applying generative artificial intelligence and mixed reality.
Badeja D, Schier F, Straka HC … +2 more , McGinity M, Hoyer J
J Anxiety Disord · 2026 Apr · PMID 41861569 · Publisher ↗
Worry is theorized to be a predominantly verbal, abstract thinking style that suppresses vivid mental imagery and blunts affect, thus serving avoidance. In order to test a new way to circumvent this avoidance, we examine...
Worry is theorized to be a predominantly verbal, abstract thinking style that suppresses vivid mental imagery and blunts affect, thus serving avoidance. In order to test a new way to circumvent this avoidance, we examined whether personalized, AI-generated depictions of worry scenarios can elicit anxiety. These images were presented in a mixed reality worry gallery, arranged spatially and embedded in the physical environment using a mixed reality head-mounted display. Applying a within-subject repeated-measures design, we assessed subjective state anxiety and affect, as well as physiological responses (heart rate and skin conductance level) of 34 healthy adults (70.6% female, 24.47 years on average). Additional measures included representation accuracy and realism of worry depictions. Multivariate analyses of variance revealed higher, but only medium-sized anxiety ratings for AI-generated worry versus neutral images. Negative affect increased and positive affect decreased after worry-image presentation. Higher perceived realism and alignment were associated with greater anxiety. Physiological indices did not show significant increases. Our results suggest that AI-generated worry imagery can induce subjective anxiety and modulate state affect in mixed reality settings. Further work should improve stimulus reliability, include clinical samples, and benchmark mixed reality against other presentation modalities such as imaginal worry exposure to clarify equivalence and incremental value.
Validity and factor structure of the Czech GAD-7 across twenty samples and four independent translations.
Cígler H, Pátková Daňsová P, Javůrková A … +2 more , Raudenská J, Prikner O
J Anxiety Disord · 2026 Jun · PMID 41856008 · Publisher ↗
The Generalized Anxiety Disorder 7-item questionnaire (GAD-7) is a widely used screening tool for anxiety symptoms; however, its psychometric properties have not yet been comprehensively evaluated in the Czech population...
The Generalized Anxiety Disorder 7-item questionnaire (GAD-7) is a widely used screening tool for anxiety symptoms; however, its psychometric properties have not yet been comprehensively evaluated in the Czech population, where at least four independent and competing translations are commonly used. This study examined the factor structure, measurement invariance, reliability, and sensitivity to change of the Czech GAD-7 across 20 adult samples (N = 5529), including both general population and psychiatric patients. Two samples contained repeated measurements over two or four time points. Confirmatory factor analyses supported a unidimensional structure, consistent with the scale's original conceptualization and widespread use. Measurement invariance up to the residual level was established across gender, clinical status, and time, and-except for one translation containing a wording issue-also across translations, indicating that item functioning is highly robust to differences in wording. The GAD-7 demonstrated good internal consistency (median α =.86), moderate test-retest stability across major life events (r = .46-.53), and clear sensitivity to change during psychotherapy (ΔSE = 2.65; reliable change threshold ±5.2 points). Percentile-based Czech norms were developed for both general and psychiatric populations based on convenient samples. Overall, these findings provide strong empirical support for the GAD-7 as a reliable and valid measure of anxiety symptoms in Czech clinical and research contexts, enabling meaningful comparisons across populations and existing translations. The demonstrated robustness across translations and minimal sensitivity to specific wording informs future cross-linguistic adaptations and validation efforts.
Investigating the Use of Large Language Models for the Detection of Trauma-Related Symptoms: An Exploratory Study Using Trauma Narratives.
Marengo D, Hoeboer CM, Olff M
J Anxiety Disord · 2026 Apr · PMID 41849988 · Publisher ↗
This study explores whether Large Language Models (LLMs) can analyze brief trauma narratives in ways that align with self-reported trauma-related symptoms and probable Post-Traumatic Stress Disorder (PTSD) based on a rec...
This study explores whether Large Language Models (LLMs) can analyze brief trauma narratives in ways that align with self-reported trauma-related symptoms and probable Post-Traumatic Stress Disorder (PTSD) based on a recommended cut-off. We investigate Gemini 1.5 Pro and GPT-4o's ability to score 1000 trauma narratives for severity of PTSD symptoms comparing various prompting strategies. Prompts ranged from basic instructions requesting a binary or graded (5-point) inference based solely on the narrative, to more complex prompts incorporating demographic information (age, gender), time since the traumatic event, and extended instructions detailing PTSD symptomatology. Accuracy of inferences was evaluated using Pearson correlations and Area Under the Curve (AUC) metrics computed between LLM inferences and self-reported measures. Results showed small-to-moderate positive correlations across all prompting strategies, with correlations as high as r = .42 with self-report symptoms. Graded inferences yielded stronger correlations with self-reported symptoms than binary inferences. The AUC for probable PTSD peaked at 0.713 using Gemini 1.5 Pro, with a sensitivity of 0.712 and a specificity of 0.662 in detecting PTSD symptoms. Of note, providing extended instructions on PTSD symptoms did not reliably improve performance beyond basic demographic and temporal context. The performance of LLMs was comparable to that achieved by traditional machine learning methods trained on large datasets but without requiring extensive training data; however, the emerging moderate associations underscore the need for continued refinement. Findings are limited by brief, self-selected English-language web narratives and self-reported symptoms and should be considered preliminary pending validation in clinically verified samples.
Development and validation of experimental induction tasks for worry and rumination: A comparison of personalized and scripted approaches.
Kim H, Newman MG
J Anxiety Disord · 2026 Apr · PMID 41849987 · Full text
BACKGROUND: Worry and rumination are two forms of repetitive negative thinking. Whereas prior research has highlighted both their distinct and overlapping characteristics, the experimental induction of these states provi...
BACKGROUND: Worry and rumination are two forms of repetitive negative thinking. Whereas prior research has highlighted both their distinct and overlapping characteristics, the experimental induction of these states provides a valuable means of investigating their mechanisms. Two induction methods have been used: personalized based on self-relevant content, and scripted using standardized prompts. However, no studies have directly compared these methods, and it remains unclear whether they elicit equally pronounced responses. Additionally, the moderating role of symptom profiles, such as elevated anxiety or depression symptoms, has not been well characterized. METHOD: This study systematically compared personalized and scripted induction methods for eliciting worry and rumination, and whether outcomes varied across induction focus (worry vs. rumination) and symptom-based groups. A total of 355 participants were categorized into three groups: individuals meeting the GAD-Q-IV criteria for generalized anxiety (n = 118), individuals with elevated depression symptoms on the BDI-II (n = 113), and individuals with low symptoms (n = 124). Participants were assigned to one of four conditions (personalized vs. scripted × worry vs. rumination). RESULTS: Personalized induction methods elicited the targeted cognitive states more effectively than scripted methods, regardless of group. Additionally, the effect was strongest for target-specific outcomes relative to non-target outcomes. Results were robust to dimensional symptom modeling and demographic covariate adjustment. CONCLUSIONS: These findings highlight that personalized induction methods may provide a more ecologically valid and responsive tool than scripted induction approaches for experimentally eliciting worry and rumination. Implications for induction selection and study design are discussed.
Gender-specific networks in the relationship between fear of evaluation and mental problems among Chinese adolescents.
Chen D, Zhang J, Shen Y … +3 more , Zhou X, Ying J, Liu Y
J Anxiety Disord · 2026 Apr · PMID 41819681 · Publisher ↗
Fear of evaluation (FE), encompassing fear of negative evaluation (FNE) and fear of positive evaluation (FPE), is a prevalent psychological phenomenon among adolescents and has been linked to a range of mental problems,...
Fear of evaluation (FE), encompassing fear of negative evaluation (FNE) and fear of positive evaluation (FPE), is a prevalent psychological phenomenon among adolescents and has been linked to a range of mental problems, including anxiety, stress, and interpersonal difficulties. The present study investigated the dynamic relationships between FE and mental problems among Chinese adolescents. Using a cross-lagged panel network (CLPN) approach, we analyzed longitudinal self-report data collected from 1768 high school students (53.0% females; M=16.20 years, SD = 0.83) in China over one-year period. The results suggested: (1) FE and mental problems exhibited significant bidirectional associations, with "Psychological Imbalance", "Interpersonal Tension and Sensitivity", and "FPE" emerging as central predictors within the network; (2) gender differences were evident, with girls reporting higher levels of anxiety and boys experiencing greater academic stress; and (3) the strongest cross-lagged associations differed by gender, with the pathway from Hostility to FNE being most prominent among girls, and the pathway from FPE to Maladaptation being strongest among boys. These findings underscore the importance of considering gender-specific dynamics in the relationship between FE and mental problems in adolescents and highlight potential targets for gender-tailored interventions.
Dynamic changes in metacognitive mechanisms and symptoms during the attention training technique: Insights from ecological momentary assessment.
Snuggerud TR, Ulitzsch E, Nordahl H … +6 more , Vrabel K, Hoffart A, Ebrahimi OV, Lüdtke O, Nestler S, Johnson SU
J Anxiety Disord · 2026 Apr · PMID 41780315 · Publisher ↗
BACKGROUND: Anxiety disorders are prevalent and associated with substantial distress and impairment. Within the metacognitive model of emotional disorders, the cognitive attentional syndrome (CAS) and associated metacogn...
BACKGROUND: Anxiety disorders are prevalent and associated with substantial distress and impairment. Within the metacognitive model of emotional disorders, the cognitive attentional syndrome (CAS) and associated metacognitions maintain anxiety. The Attention Training Technique (ATT) targets the CAS and related metacognitions. However, less is known about how symptoms and metacognitive mechanisms evolve across treatment phases. OBJECTIVE: The study aimed to explore temporal dynamics in emotional symptoms and metacognitive mechanisms during group ATT by estimating mean levels, variability, and coupling across the pre-, during-, and post-treatment phases using ecological momentary assessment (EMA). METHOD: Nineteen young adults with social anxiety disorder, panic disorder with agoraphobia, or generalized anxiety disorder participated. EMA was completed four times daily over six weeks: two weeks before treatment, two weeks during treatment, and two weeks after treatment. Each assessment included ten items measuring emotional symptoms (e.g., nervousness) and metacognitive mechanisms (e.g., worry, uncontrollability). RESULTS: Three patterns of change emerged: (1) reduced mean levels without change in variability (nervousness, self-consciousness, and worry); (2) reduced mean levels and reduced variability (threat monitoring); and (3) reduced mean levels and reduced variability during treatment, followed by an increase in variability after treatment (uncontrollability, difficulty collecting thoughts, and meta-worry). CONCLUSIONS: The findings provide new insights into dynamic patterns of change in symptoms and metacognitive mechanisms before, during, and after ATT. Patterns of change in both intensity and stability may be relevant for understanding treatment response and vulnerability following treatment, suggesting the potential clinical relevance of monitoring these mechanisms.
Challenging heights: Findings from a proof-of-principle randomized controlled trial testing interpretation bias modification as an adjunct to exposure therapy for acrophobic patients.
Macit B, Lipp A, Zlomuzica A … +5 more , Engler H, Blackwell SE, Würtz F, Margraf J, Woud ML
J Anxiety Disord · 2026 Apr · PMID 41775020 · Publisher ↗
Exposure is highly effective for treating acrophobia and there is growing consensus that cognitive mechanisms play an important role in exposure-based therapies. The present randomized controlled trial investigated wheth...
Exposure is highly effective for treating acrophobia and there is growing consensus that cognitive mechanisms play an important role in exposure-based therapies. The present randomized controlled trial investigated whether adding a Cognitive Bias Modification - Interpretation (CBM-I) training to a single-session exposure therapy further facilitates cognitive change. The sample included diagnosed acrophobia patients (N = 81), all of whom received exposure therapy. One day later they were randomized to receive either CBM-I or a sham training. The CBM-I trained patients to interpret and appraise ambiguous, height-related scenarios in a less threatening and adaptive manner, whereas the sham training comprised ambiguous, neutral scenarios. Outcomes included changes in interpretational biases (Encoding Recognition Task, Heights Interpretation Questionnaire, Scrambled Sentences Task), acrophobia-related symptoms (Acrophobia Questionnaire), and behavioral avoidance (Behavioral Approach Test). In intention-to-treat analyses patients receiving CBM-I showed a greater reduction in interpretational biases post-training compared to the sham condition (primary outcome). However, group differences were not sustained at follow-up, with both groups demonstrating improvements across all outcomes, except for the Scrambled Sentences Task. No significant group differences in reductions in other acrophobia-related cognitions, symptoms, or behavior emerged over time. Exploratory analyses revealed strong associations between the assessed cognitive, behavioral, and subjective outcomes, but not with the hormonal measures (progesterone, estradiol). To conclude, our findings suggest that while CBM-I can temporarily facilitate cognitive change in the context of exposure, its long-term benefits and downstream effects may require further optimization. Future research should refine CBM-I protocols to maximize its efficacy as a potential adjunct to exposure therapy.
Efficacy and safety of etifoxine versus alprazolam in generalized anxiety disorders with somatic symptoms: A randomized, double-blind, comparative study.
Prabhakar K, Ganesan G, Chaudhari D … +20 more , Dalaya N, Mohide A, Thaker S, Dutta M, Patil B, Mukhopadhyay A, Neeli UJ, Kumar A, Rajendra R, Shaikh R, Saha S, Sonowal S, Behera S, Devkare P, Pandit S, Patil D, Ghadge P, Lakhwani L, Mehta S, Joglekar S
J Anxiety Disord · 2026 Apr · PMID 41763071 · Publisher ↗
Etifoxine, a non-benzodiazepine anxiolytic, is useful for managing anxiety symptoms. However, its role in managing somatic symptoms in generalized anxiety disorder (GAD) remains unclear. Hence, we aimed to compare the ef...
Etifoxine, a non-benzodiazepine anxiolytic, is useful for managing anxiety symptoms. However, its role in managing somatic symptoms in generalized anxiety disorder (GAD) remains unclear. Hence, we aimed to compare the efficacy and safety of Etifoxine with Alprazolam in adults with GAD with somatic symptoms. This phase 3, randomized, double-blind, double-dummy study included 260 patients aged 18-65 years with GAD with somatic symptoms who received either Etifoxine 50 mg TID or Alprazolam 0.5 mg TID (1:1) for 4 weeks. The primary outcome was the change from baseline to day 28 in the Hamilton Anxiety Rating Scale (HAM-A) total score. Secondary efficacy outcomes included changes from baseline to days 7 and 14 in HAM-A total score, changes from baseline to days 7, 14, and 28 in HAM-A psychic and somatic sub-scores, clinical global impression-severity score, and percentage of patients with clinical and patient global impression-improvement scale responses. Our study results indicated that both Etifoxine and Alprazolam demonstrated significant improvements in mean change in HAM-A total scores at day 28 from baseline [mean (SD): -13.5 (4.21) and -13.4 (4.64), respectively; p < 0.0001 for both]. The adjusted mean difference (95% CI) was -0.18 (-1.08, 0.72), indicating non-inferiority of Etifoxine. Changes in secondary efficacy parameters were also comparable between groups. Treatment-emergent AEs were mild and observed in 10% and 7.7% of patients in the Etifoxine and Alprazolam groups, respectively. Etifoxine was non-inferior to Alprazolam in reducing anxiety symptoms in GAD, was well-tolerated, and can be a promising alternative for anxiety management without drug dependence risk.
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