Journal Of Anxiety Disorders[JOURNAL]
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200 papers
The exposure continuum model: A theoretical framework for understanding exposure across trauma-centered psychotherapies.
Rubinstein D, Korem N, Bullard DG … +1 more , Harpaz-Rotem I
J Anxiety Disord · 2026 Jan · PMID 41371190 · Publisher ↗
Exposure techniques are foundational in trauma treatment, yet their application varies significantly across psychotherapies. This theoretical paper introduces the Exposure Continuum Model (ECM), a novel comprehensive fra...
Exposure techniques are foundational in trauma treatment, yet their application varies significantly across psychotherapies. This theoretical paper introduces the Exposure Continuum Model (ECM), a novel comprehensive framework that classifies trauma-centered therapeutic approaches along two key dimensions: Closeness (implicit to explicit or indirect to direct exposure) and Standardized Cumulative Dose (repetition and duration) of exposure. These dimensions provide a map that spans across evidence-based trauma-focused therapies (e.g., Prolonged Exposure [PE], Cognitive Processing Therapy [CPT], Eye Movement Desensitization and Reprocessing [EMDR]) and other, trauma-informed modalities (e.g., Interpersonal Psychotherapy [IPT], Somatic Experiencing [SE]). The paper reviews the clinical, cognitive, and neurobiological mechanisms that underpin exposure therapy, highlighting the diversity of its application across different therapeutic modalities. It also offers a detailed description of how these therapies incorporate exposure components and locate them within the model. By offering a structured framework for understanding the exposure component matrix across therapies, this cornerstone paper lays the foundation for future research and practice. These future data-driven explorations will help clinicians refine treatment approaches based on variables such as trauma type, time from trauma, symptom severity, and individual differences among patients, therapists, and therapeutic settings.
Prospective predictors of posttraumatic stress symptoms following two "armed and dangerous person" campus lockdowns.
Friedman JB, Halverson TF, Juel EK … +3 more , Myers NS, Inozu M, Abramowitz JS
J Anxiety Disord · 2026 Jan · PMID 41371189 · Publisher ↗
The current study examined predictors of posttraumatic stress (PTS) and general distress symptoms following two campus-wide "armed and dangerous person" lockdowns at the University of North Carolina at Chapel Hill. Parti...
The current study examined predictors of posttraumatic stress (PTS) and general distress symptoms following two campus-wide "armed and dangerous person" lockdowns at the University of North Carolina at Chapel Hill. Participants (N = 287) completed baseline surveys four weeks post-lockdowns, with 115 participating in follow-ups over seven months. Utilizing the cognitive model of PTSD, we investigated posttraumatic cognitions, anxiety sensitivity (AS), and prior trauma as predictors of PTS and general distress. Results revealed that higher initial posttraumatic cognitions and AS were associated with greater PTS and distress symptom severity. Interestingly, elevated posttraumatic cognitions predicted a faster reduction in PTS symptoms over time, while AS effects remained stable. Prior trauma did not significantly predict outcomes. These findings highlight the roles of specific cognitive factors in shaping responses to trauma and emphasize the potential for targeted interventions to mitigate symptoms following collective stressful events.
Social anxiety in the context of the alternative DSM-5 model of personality disorder.
Vittengl JR, Ro E, Jarrett RB … +1 more , Clark LA
J Anxiety Disord · 2026 Jan · PMID 41352257 · Full text
BACKGROUND: Section-III of DSM-5 introduced an alternative model of personality disorder (AMPD) including both personality dysfunction and maladaptive-range traits. This study clarified relations of social anxiety sympto...
BACKGROUND: Section-III of DSM-5 introduced an alternative model of personality disorder (AMPD) including both personality dysfunction and maladaptive-range traits. This study clarified relations of social anxiety symptoms, social anxiety disorder (SAD), and Section-II avoidant personality disorder (APD) with AMPD personality pathology. METHOD: Adults (N = 600; including mental-health outpatients and non-patients at risk for personality pathology) completed self-report and interviewer-rated measures of social anxiety and AMPD constructs, including self and interpersonal functioning and trait negative affectivity, detachment, disinhibition, antagonism, and psychoticism. Most participants (n = 497) completed reassessment, on average 8 months later. We examined convergence of social anxiety with personality pathology, as well as prediction of longitudinal changes in social anxiety from baseline personality and vice versa. We focused on results replicating across self-reported social anxiety symptoms, interviewer-rated SAD and APD criterion counts, and self- and interviewer-rated personality. RESULTS: Concurrently, social anxiety related to higher negative affectivity, detachment, self dysfunction, and interpersonal dysfunction. Of these, the latter three dimensions predicted increases in social anxiety longitudinally. Social anxiety did not predict longitudinal changes in personality pathology as consistently. LIMITATIONS: Generalization of findings to other populations, settings, and methods, such as adolescents, primary care, or direct observation, is uncertain. Longitudinal analyses suggested causality but could not establish it. CONCLUSIONS: The AMPD enriches description of current social anxiety and prediction of changes in social anxiety. Assessment of personality pathology, including both personality dysfunction and maladaptive-range traits, may identify targets for prevention or treatment of social anxiety, to be tested in future research.
A review of the relationship between changes in trauma-related cognitions and PTSD outcome in response to trauma-focused psychotherapy: A three-level meta-analysis.
Keyan D, Garland N, Rise P … +2 more , McMahon H, Bryant R
J Anxiety Disord · 2026 Jan · PMID 41319593 · Publisher ↗
Prevailing models of posttraumatic stress disorder (PTSD) suggest that trauma-related cognitions have a critical role in influencing the persistence of posttraumatic stress symptoms. This study aimed to quantitatively sy...
Prevailing models of posttraumatic stress disorder (PTSD) suggest that trauma-related cognitions have a critical role in influencing the persistence of posttraumatic stress symptoms. This study aimed to quantitatively synthesise the strength of the relationship between changes in trauma-related cognitions and PTSD severity in response to trauma-focused psychotherapy (T-F psychotherapy). We also sought to explore potential moderators of this relationship. Four databases (PubMed (includes MEDLINE), PsycINFO, PTSDpubs (formerly PILOTS), and Cochrane library) were searched for relevant studies. Additional 'hand search' strategies were conducted to obtain relevant articles that may have been missed in the original database searches. A total of 44 studies reporting 95 effect sizes with data from 5102 participants were extracted. Primary analyses indicated that pre-post reductions in trauma-related cognitions were significantly related to pre-post reductions in PTSD severity, r = .45 (95 %CI [.40,.49], p < .0001). Additionally, mid-treatment reductions in trauma-related cognitions were significantly associated with mid-treatment reductions in PTSD severity, r = .42 (95 %CI [.34,.50], p < .0001). Exploratory moderator analyses did not yield any significant findings of this relationship between changes in trauma-related cognitions and PTSD severity. Secondary analyses revealed that reductions in trauma-related cognitions after T-F psychotherapy were similalry related to reduced PTSD severity after treatment, r = .49 (95 %CI [.40,.57], p < .0001). These findings underscore the importance of reductions in trauma-related cognitions as a potential key indicator of PTSD symptom reduction throughout varied points of T-F psychotherapy. The implications for augmenting outcomes of T-F psychotherapy are discussed.
Relationships between symptom profiles and memory in posttraumatic stress disorder.
Da Costa Silva L, Quinette P, Dayan J … +6 more , Fraisse F, Peschanski D, de La Sayette V, Gagnepain P, Eustache F, Laisney M
J Anxiety Disord · 2026 Jan · PMID 41308267 · Publisher ↗
Individuals with Posttraumatic Stress Disorder (PTSD) exhibit symptoms that affect their responsiveness to negative information. Specifically, hypervigilance heightens attention toward negative stimuli, whereas dissociat...
Individuals with Posttraumatic Stress Disorder (PTSD) exhibit symptoms that affect their responsiveness to negative information. Specifically, hypervigilance heightens attention toward negative stimuli, whereas dissociation diverts attention away from it (Chiba et al., 2021), potentially leading to differential effects on memory encoding. This study investigated the influence of prominent hypervigilant and dissociative symptomatology on the memorization of negative emotional and contextual information in individuals exposed to the November 13, 2015, Paris terrorist attacks. Participants included individuals who had been exposed to the traumatic event (N = 99; 26 met full diagnostic criteria for PTSD, 28 showed subthreshold symptoms, and 45 had no symptoms) and non-exposed individuals (N = 65). They were asked to memorize faces displaying positive, neutral, and sad emotions, each paired with a word representing a profession, which served as a non-emotional contextual cue. This task was administered at two time points: ∼1.5 years and ∼3.5 years after the attacks. An emotion-profession recognition task was used, with an index measuring whether the emotional expression or the profession was better recognized. At the first time point, among exposed individuals, a relationship was observed between the prominence of hypervigilant or dissociative symptoms and enhanced recognition of either the emotional expression or the profession, respectively, in the context of sad facial expressions. Furthermore, changes in the prominence of these symptoms between the two time points were associated with shifts in the type of content that was better recognized. Collectively, these findings suggest the presence of a memory bias-either toward or away from emotional content-among individuals exposed to traumatic events, and particularly those with full diagnostic criteria for PTSD.
Actigraphy and subjective sleep predictors of nine-year generalized anxiety disorder.
Zainal NH, Van Doren N
J Anxiety Disord · 2026 Jan · PMID 41297293 · Publisher ↗
BACKGROUND: Sleep disturbances have been linked to generalized anxiety disorder (GAD) symptoms. However, cross-sectional studies, linearity assumptions, and limited predictor sets preclude identifying which unique sleep...
BACKGROUND: Sleep disturbances have been linked to generalized anxiety disorder (GAD) symptoms. However, cross-sectional studies, linearity assumptions, and limited predictor sets preclude identifying which unique sleep disturbance markers precede GAD symptoms. We thus harnessed machine learning (ML) to determine objective and subjective sleep disturbance predictors of nine-year GAD symptoms. METHODS: Community adults (N = 1054) underwent baseline surveys, clinical interviews, and seven-day sleep actigraphy protocols. GAD symptoms were reassessed nine years later. Seven ML models were examined with 44 baseline predictors. Partial dependence and Shapley additive explanation plots were created as interpretable ML approaches with the best-performing random forest model using nested cross-validation. Sensitivity analyses included and excluded GAD sleep items. RESULTS: The final multivariable predictive algorithm performed well (R = 69.7 %, 95 % confidence interval [67.3 %-71.9 %]), thus explaining over half the variance in the outcome. These self-reported sleep disturbances predicted GAD symptoms in descending order of relative importance: sleep disturbances, poorer sleep quality, longer sleep onset latency, daytime dysfunction, habitual sleep inefficiency, and sleep medication use. These rest-phase actigraphy markers predicted nine-year GAD symptoms: higher maximum and total activity counts. Longer total sleep time during the sleep phase and higher average sleep bouts during the active phase also predicted nine-year GAD severity. CONCLUSIONS: Outcomes highlight the importance of combining actigraphy and self-report sleep assessments. Future studies should determine the degree to which these patterns extend to the within-person level to develop early prevention, treatment, and precision mental health strategies for individuals at risk of, or with, increased GAD severity.
Exploring contradicting associations between anxiety disorders, obsessive-compulsive disorder, and academic achievement: A meta-analysis.
Socratous G, Haussler SM, Finning K … +4 more , Howard DM, Hayes RD, Downs J, Wickersham A
J Anxiety Disord · 2026 Jan · PMID 41274138 · Publisher ↗
BACKGROUND: Academic achievement is an important predictor of later life outcomes, yet its relationship with anxiety disorders and obsessive-compulsive disorder (OCD) remains unclear. This systematic review and meta-anal...
BACKGROUND: Academic achievement is an important predictor of later life outcomes, yet its relationship with anxiety disorders and obsessive-compulsive disorder (OCD) remains unclear. This systematic review and meta-analysis aimed to clarify the direction and strength of these associations and is the first to synthesise evidence on moderators and mediators. METHOD: We searched Embase, PsycINFO, and PubMed from inception to 12 March 2025 for observational studies of anxiety disorders or OCD (exposure variables) and academic achievement (outcome) at any age. Study quality was assessed using the Newcastle-Ottawa Scale. Crude effects were pooled using random-effects meta-analyses, and study-level moderators explored using subgroup analyses. Evidence on confounders, within-study moderators and mediators was synthesised narratively. PROSPERO: CRD42023393935. RESULTS: Of 7610 studies screened, 23 were included. Study quality was generally low for anxiety disorders but higher for OCD. Meta-analysis of 15 studies (n = 864,729) showed a small negative association between anxiety disorders and academic achievement, Hedges' g = -0.31, 95 % CI [-0.46, -0.16], p < .001, I² = 98.1 %. All four studies examining sex/gender reported stronger negative effects among females. Adjusted estimates varied. Meta-analysis of four studies (n = 809,598) showed no evidence of an association between OCD and academic achievement, Hedges' g = -0.21, 95 % CI [-0.56, 0.14], p = .25, I² = 97.9 %. CONCLUSIONS: Anxiety disorders, but not OCD, were negatively associated with academic achievement in meta-analysis. High meta-analytic heterogeneity and inconsistent adjusted findings suggest context-dependent effects, underscoring the need for more moderation studies. Nonetheless, our findings highlight the need for coordinated efforts between educational and mental health services to better identify and support affected students.
Measurement invariance of the Straightforwardly-Worded Social Interaction Anxiety Scale and Associations with life satisfaction among emerging adults attending University in 10 countries.
Sette S, Coplan RJ, Ooi LL … +16 more , Zuffianò A, Xiao B, Wong QJJ, Rapee RM, Oh W, Liu J, Kim Y, Kim HK, Kamble S, Greco C, Dogan A, Castillo KN, Braathu N, Bølstad E, Bayram-Ozdemir S, Bowker JC
J Anxiety Disord · 2025 Dec · PMID 41252886 · Publisher ↗
The aim of the present study was to assess the measurement invariance of the long version of the straightforwardly-worded Social Interaction Anxiety Scale (S-SIAS) across 10 countries and explore links with life satisfac...
The aim of the present study was to assess the measurement invariance of the long version of the straightforwardly-worded Social Interaction Anxiety Scale (S-SIAS) across 10 countries and explore links with life satisfaction in a large sample of emerging adults attending university. Participants were N = 4284 university students (M = 19.89 years, SD = 1.83; 65 % females) from 10 countries (i.e., Argentina, Australia, Canada, China, India, Italy, South Korea, Norway, Turkey, and the United States), who completed self-report assessments of social anxiety and life satisfaction. Findings from a multiple-group factor analysis alignment method indicated approximate measurement invariance for the S-SIAS across the 10 country sites. University students from Norway reported the highest mean level of social anxiety of all groups, whereas participants from Argentina reported the lowest social anxiety. Results from multigroup regression analysis indicated that social anxiety was negatively associated with life satisfaction in all samples (except for Argentina and Australia, where the life satisfaction measure was not collected), but the strength of the association was stronger in Norway compared to samples from other countries. Results are discussed in terms of the meaning and implication of social anxiety across cultures.
On the non-inferiority of metacognitive therapy for OCD: Clarifying the methodology and rationale.
Exner C, Kleiman A, Haberkamp A … +3 more , Hansmeier J, Milde C, Glombiewski JA
J Anxiety Disord · 2025 Dec · PMID 41242024 · Publisher ↗
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Tailored strategies to increase the use of an evidence-based psychotherapy for posttraumatic stress disorder: A stepped-wedge randomized trial in military clinics.
Rosen CS, Peterson AL, Riggs DS … +30 more , Haddock CK, Fong C, Young-McCaughan S, Cook J, Comtois KA, Borah EV, Davis CA, Dondanville KA, Finley EP, Jahnke SA, Mistretta M, Neitzer A, Wiltsey-Stirman S, Frick ER, Hayes O, Clayton S, Conforte AM, Flores A, Jinkerson J, Jones ZK, Kim HJ, Letendre M, Link JS, Nofziger D, Ringdahl EN, Waggoner JW, Woodworth C, Ho E, McLean CP, TACTICS Research Group
J Anxiety Disord · 2025 Dec · PMID 41202565 · Publisher ↗
Clinician training is often not sufficient to increase the adoption of evidence-based psychotherapies (EBPs). To address organizational barriers that may limit use of EBPs, a tailored implementation strategy-Targeted Ass...
Clinician training is often not sufficient to increase the adoption of evidence-based psychotherapies (EBPs). To address organizational barriers that may limit use of EBPs, a tailored implementation strategy-Targeted Assessment and Context-Tailored Implementation of Change Strategies (TACTICS)-was developed. TACTICS involved external facilitation (appointing a local implementation team and external coach, conducting need assessment interviews, creating site-specific implementation plans, and weekly coaching for the site champion) augmented with a planning rubric and resources for making operational changes. The effect of adding TACTICS after clinician training was evaluated in a cluster-randomized stepped-wedge trial across eight military treatment facilities. Psychotherapists (n = 212) received training in prolonged exposure (PE) therapy. TACTICS was subsequently introduced with timing randomized by site. PE utilization was measured via natural language processing of notes from 26,429 psychotherapy encounters across 3459 patients. After accounting for time effects, TACTICS increased PE use compared to training alone (OR = 1.05-2.21, p < .03). Nonetheless, overall use of PE declined over time (OR = 0.067-0.316, p < .001). In post-hoc analyses, declining use of PE over time was strongly associated with a decreasing supply of psychotherapy appointments per patient (r = .98). These findings suggest that local implementation support improves EBP adoption beyond training alone. However, lasting use may require broader system supports such as adequate staffing and policies that encourage use of EBPs.
Cross-cultural network structures of social anxiety, body dysmorphic, and major depressive disorder symptoms in individualistic vs. collectivistic societies: A comparison between American, German, and Japanese populations.
Noda S, Kasch C, Lindsay CE … +1 more , Hofmann SG
J Anxiety Disord · 2025 Dec · PMID 41197413 · Publisher ↗
Social anxiety disorder (SAD), body dysmorphic disorder (BDD), and major depressive disorder (MDD) are highly comorbid, which may be influenced by cultural variables associated with individualism vs. collectivism with pa...
Social anxiety disorder (SAD), body dysmorphic disorder (BDD), and major depressive disorder (MDD) are highly comorbid, which may be influenced by cultural variables associated with individualism vs. collectivism with particular emphasis on shame. This study investigated the network structures comprising symptoms of SAD, BDD, MDD, and shame across three countries typically associated with either a high tendency of collectivism (Japan), a high tendency of individualism (USA), or in between (Germany). Participants included 319 Japanese, 440 US Americans, and 308 Germans from the general populations of their respective countries, who completed questionnaires assessing the aforementioned symptoms as well as individualistic and collectivistic tendencies. Psychometric network analyses were conducted using Gaussian Graphical Models to separately examine the network structures of (a) individualistic and collectivistic tendencies and (b) symptoms of SAD, BDD, MDD, and shame. A Network Comparison Test (NCT) was used to assess the overall consistency of these networks across countries. The NCT revealed significant cross-cultural differences in the network structures of individualistic and collectivistic tendencies across countries, as well as in the networks of symptoms of SAD, BDD, MDD, and shame between Japan and Germany and between Japan and the USA. Although certain central symptoms were shared across all countries, others differed. These findings underscore the coexistence of cultural homogeneity and heterogeneity in the manifestation and organization of SAD, BDD, and MDD symptoms, emphasizing the importance of culturally sensitive, targeted interventions.
Treating young adult generalized anxiety disorder with text-message delivered cognitive behavioral therapy: A randomized clinical trial testing efficacy and clinical mechanisms.
Mason MJ, Coatsworth JD, Brown A … +3 more , Zaharakis N, Russell M, Mennis J
J Anxiety Disord · 2025 Dec · PMID 41166782 · Publisher ↗
Approximately one in five (19.5 %) young adults have experienced generalized anxiety disorder (GAD) in the past year. Compared with other age groups, they are least likely to receive mental health treatment despite repor...
Approximately one in five (19.5 %) young adults have experienced generalized anxiety disorder (GAD) in the past year. Compared with other age groups, they are least likely to receive mental health treatment despite reporting greater need for these services. To address these issues, we conducted a randomized clinical trial with 102 young adults using an 8-week, automated text-message delivered cognitive behavioral therapy (CBT-txt-A) to treat GAD. We examined treatment engagement, tested treatment efficacy, and tested 3 clinical mechanisms of change. Participants were from 33 states, recruited from Instagram and Facebook who presented with at least moderate GAD symptomatology. Assessments occurred at baseline prior to randomization and at 1, 2, and 3 months after enrollment. The primary outcome, severity of GAD symptoms, was assessed using the GAD-7 measure. Behavioral activation, perseverative thinking, and cognitive distortions were hypothesized clinical mechanisms. Participants were randomized to CBT-txt-A or a waitlist control condition. Results indicated that participants in the CBT-txt-A group significantly reduced their GAD symptoms over time compared to the control condition, producing a large effect size (Cohen d = 0.83). One quarter of the treatment group moved into the high-end state functioning level, representing no or minimal GAD symptoms, compared to 5.5 % of the controls. Mediation analyses indicated that CBT-txt-A increased behavioral activation, and reduced perseverative thinking and cognitive distortion, at 2 months, which in turn, was then associated with reductions in GAD symptoms at 3 months. Results provide evidence for the efficacy of CBT-txt-A in reducing GAD symptoms through three hypothesized clinical mechanisms.
Psychometric evaluation of the Posttraumatic Stress Disorder Checklist for DSM-5 in daily surveys: An item response theory and longitudinal measurement invariance analysis.
Messman BA, Wang S, Batley P … +3 more , Weiss NH, Newberry JA, Contractor AA
J Anxiety Disord · 2025 Dec · PMID 41075322 · Publisher ↗
The Posttraumatic Stress Disorder (PTSD) Checklist for the DSM-5 (PCL-5) has demonstrated excellent psychometric qualities across cross-sectional studies, yet the scale's performance in intensive longitudinal studies is...
The Posttraumatic Stress Disorder (PTSD) Checklist for the DSM-5 (PCL-5) has demonstrated excellent psychometric qualities across cross-sectional studies, yet the scale's performance in intensive longitudinal studies is less known. Using data from the PCL-5 administered daily for 9 days, we (a) conducted item analysis of the PCL-5 using the graded response model to examine item characteristics (thresholds and discrimination parameters) and (b) examined differential item functioning (DIF) to evaluate whether the PCL-5 measured the PTSD latent trait identically across daily surveys (i.e., longitudinal measurement invariance). Methodologically, 256 trauma-exposed university students (Mage = 21.01 ± 4.24; 85.8 % women; 41.0 % probable PTSD) completed the 20-item PCL-5 for 9 consecutive days. Across days, results indicated lower but acceptable discrimination for PCL-5 items 8 (traumatic amnesia), 16 (reckless or self-destructive behaviors), and 17 (hypervigilance). Further, 14 % of participants exhibited person misfit at least once across the 9 days. DIF analysis indicated that Item 2 (nightmares) exhibited DIF across days indicating potential bias; however, the effect sizes for DIF were negligible. In conclusion, the results broadly provide psychometric support for using the 20-item PCL-5 in intensive longitudinal studies. Future replication of study results across diverse and clinical populations could help to further strengthen these findings.
Prevalence, correlates, and treatment gap of generalized anxiety disorder among adults in Bangladesh: Results from a nationally representative survey.
Sarkar AA, Alam MF, Ahmed HU … +2 more , Alam MT, Khan NM
J Anxiety Disord · 2025 Dec · PMID 41061374 · Publisher ↗
This study presents nationally representative findings on the epidemiology of generalized anxiety disorder (GAD) among Bangladeshi adults, based on data from a nationwide household survey. Participants were initially scr...
This study presents nationally representative findings on the epidemiology of generalized anxiety disorder (GAD) among Bangladeshi adults, based on data from a nationwide household survey. Participants were initially screened using the Self-Reporting Questionnaire (SRQ), and those screening positive underwent face-to-face clinical interviews by trained psychiatrists. Diagnoses were established using DSM-5 criteria. A total of 7270 adults completed all measures used in this survey. The weighted lifetime prevalence of GAD was 3.5 % (95 % CI: 2.9-4.2), with higher rates observed among women (4.2 %) and rural residents (3.7 %) compared to men (2.7 %) and urban residents (2.8 %). Significant correlates included female sex (OR = 1.62, p = 0.012), lower educational attainment (OR = 2.42-3.49, p < 0.05), and a family history of mental illness (OR = 2.56, p = 0.004). Despite the substantial burden, the treatment gap remained alarmingly high, with only 3.9 % of individuals with GAD seeking professional help. Individuals with a family history of mental illness were significantly more likely to seek treatment (OR = 8.32, p < 0.001) for GAD, while no significant associations were found with other sociodemographic factors. These findings highlight the need for community-based awareness programs, the integration of mental health services into primary care, a focus on high-risk groups, and the strengthening of the mental health workforce to address the substantial burden of GAD and reduce the pervasive treatment gap in Bangladesh.
Antisaccade performance in spider phobia and its association with multimodal correlates of fear.
Breuer F, Hildebrand AS, Finke JB … +5 more , Bucher L, Dannlowski U, Klucken T, Roesmann K, Leehr EJ
J Anxiety Disord · 2025 Dec · PMID 41056901 · Publisher ↗
INTRODUCTION: This study explored inhibitory control in spider phobic (SP) and healthy control (HC) individuals using an emotional antisaccade task. Attentional control theory (ACT) suggests anxiety related deficits in i...
INTRODUCTION: This study explored inhibitory control in spider phobic (SP) and healthy control (HC) individuals using an emotional antisaccade task. Attentional control theory (ACT) suggests anxiety related deficits in inhibitory control, yet studies on antisaccade performance in anxiety disordered patients are sparse. This study addressed this research gap and additionally aimed to explore putative associations of antisaccade performance with multimodal measures of fear of spiders. METHODS: A sample of 76 participants (41 SP, 35 HC) completed an antisaccade task, employing schematic pictures of spiders and flowers. We measured antisaccade latencies and error rates, respectively. In a free-viewing task, we obtained psychophysiological and subjective fear responses to pictures of spiders. Self-rated fear of spiders was assessed via questionnaires and avoidance behavior was assessed in a behavioral avoidance test. RESULTS: Contrary to ACT predictions, SP exhibited shorter antisaccade latencies irrespective of stimulus category, indexing more efficient inhibitory control, while showing no differences in antisaccade error rates when compared to HC. Consistent with prior findings, SP participants showed elevated psychophysiological responding, fear ratings and avoidance behavior. No significant associations emerged between inhibitory control performance and these measures of fear. DISCUSSION: Our findings suggest enhanced inhibitory control efficiency in SP compared to HC, contrasting impairments predicted by ACT and observed in subclinical anxiety. These findings may indicate a compensatory adaptation in anxiety disorders, enabling rapid attentional avoidance of threat. Our results also imply that inhibitory control may be differentially affected across various anxiety disorders, depending on their predisposition towards fear or anxiety, while also being independent from diverse measures of fear and anxiety.
Exploring the symptomatology and assessment of emetophobia: A comprehensive scoping review.
Harbor MS, Jenkins PE, Harvey K
J Anxiety Disord · 2025 Dec · PMID 41045749 · Publisher ↗
Emetophobia, the specific fear of vomiting, is a poorly understood anxiety disorder. Despite a growing body of research, comprehensive reviews on its presentation and assessment are limited and dated. This scoping review...
Emetophobia, the specific fear of vomiting, is a poorly understood anxiety disorder. Despite a growing body of research, comprehensive reviews on its presentation and assessment are limited and dated. This scoping review maps, synthesises and explores existing literature on the assessment measures and symptomatology of emetophobia. Its purpose is to inform future clinical practices by identifying reliable assessment instruments and facilitating more accurate diagnosis, treatment planning, and research comparisons. Five online databases (PubMed, SCOPUS, PsycINFO, Google Scholar, PsyArXiy) were searched using terms related to emetophobia. In total, 483 unique articles were located of which 38 were eligible for inclusion (35 described symptomatology; 3 described assessment measures). Among studies exploring symptoms, 17 were single case studies, 11 were cross-sectional surveys and 7 were other designs (e.g., case series, retrospective studies). Findings indicate that emetophobia is a multifaceted condition consisting of physical, psychological and behavioural symptoms. Avoidance behaviours are the most frequently reported symptom, described in 91 % of included literature. There is little research exploring the differences in child and adult symptom presentation which may result in misdiagnosis if an adult-centric criteria is applied. Two self-report questionnaires have been created and their psychometric properties assessed but, given numerous studies relied on longer, unvalidated assessment measures, these two measures appear to need further development. This review establishes that emetophobia is a complex and debilitating condition impacting multiple domains of life. Its findings will inform future research into the development and evaluation of tailored interventions targeting the specific presentation of emetophobia.
Intensive 7-day internet-delivered cognitive behavioural therapy for social anxiety disorder: A randomized controlled trial.
Steele KR, Upton E, Holden M … +7 more , Regan A, Coleshill MJ, Li S, Joubert AE, Mahoney AEJ, Millard M, Newby JM
J Anxiety Disord · 2025 Sep · PMID 41045679 · Publisher ↗
This is the first randomised controlled trial (RCT) to examine the efficacy of intensive internet-delivered CBT (iCBT) for social anxiety disorder (SAD). Adults (mean age: 44.77 years, 75.4 % female) diagnosed with SAD w...
This is the first randomised controlled trial (RCT) to examine the efficacy of intensive internet-delivered CBT (iCBT) for social anxiety disorder (SAD). Adults (mean age: 44.77 years, 75.4 % female) diagnosed with SAD were randomly allocated to iCBT (n = 33) or a waitlist control group (WLC; n = 28). The iCBT group received a clinician-guided, six lesson program delivered online over seven days. Participants completed self-report measures of social anxiety and depression symptoms, and functional impairment at two- (post-treatment) and six-weeks post-baseline (one-month follow-up), and a diagnostic interview to assess SAD and major depressive disorder (MDD) at baseline and one-month follow-up. The iCBT group reported significantly lower social anxiety symptoms (Hedges' g's > .96), and functional impairment at post and one-month follow-up (g's > .59), but there were no significant differences in depression symptoms (g's = .42). Participants in the iCBT group were less likely to continue to meet criteria for SAD (47.6 %) at follow-up compared to WLC (96.4 %). Adherence (83.9 % completion) and program satisfaction (85.2 % reported being 'mostly' or 'very satisfied') were promising. Delivering iCBT over an intensive treatment period is feasible and acceptable to participants with SAD and showed promise for reducing social anxiety and functional impairment. Further research is needed to compare intensive iCBT with active control groups, using a larger and more diverse sample and longer-term outcomes.
Physical activity moderates the relationship between PTSD symptom severity and approach-avoidance conflict decision-making.
Crombie KM, Sato M, Chatham SA … +3 more , Leri J, Richardson MT, Cisler JM
J Anxiety Disord · 2025 Dec · PMID 41033112 · Full text
Avoidance of potentially dangerous contexts is beneficial for survival (i.e., adaptive avoidance), but the generalization of avoidance behavior to other generally safe contexts (i.e., maladaptive avoidance) can lead to d...
Avoidance of potentially dangerous contexts is beneficial for survival (i.e., adaptive avoidance), but the generalization of avoidance behavior to other generally safe contexts (i.e., maladaptive avoidance) can lead to detrimental mental health consequences, including diminished potential for reward. Decisions around pursuing reward in the presence of threat or avoiding threat at the cost of obtaining greater reward presents an approach-avoidance conflict (AAC). Although AAC is expected to be biased among trauma-exposed adults, especially those with posttraumatic stress disorder (PTSD), there have only been two prior behavioral investigations of AAC among adults with PTSD or experiencing PTSD symptoms. While greater levels of physical activity (PA) contribute to enhanced cognitive performance during reward-based decision-making tasks, it remains unknown whether greater PA also offers a protective effect or rather dampens the potential for greater AAC and sacrifice of reward in the presence of threat. The current study administered a trauma-related AAC behavioral task to trauma-exposed adults with varying PTSD symptom severity (N = 93), to examine potential interactive relationships between PTSD symptom severity, PA, and AAC decision-making under threat. The task involved a total of 150 trials and was divided into two phases: congruent (the option with the highest probability of a positive point outcome was also the option that was least likely to result in the presentation of a trauma-related image), and conflict (the option with the highest probability of a positive point outcome was also the option that was most likely to result in the presentation of a threat-related image). Results from linear mixed effects models revealed that PA moderated the relationship between PTSD symptom severity and AAC, as we observed a positive relationship between PTSD symptom severity and AAC for lower PA volume (i.e., greater conflict), and a more negative relationship between PTSD symptom severity and AAC as PA volume increased (i.e., less conflict). These results suggest that greater PA may promote a greater propensity to engage in goal-directed behavior and seek reward in the presence of threat in those with greater PTSD symptom severity.
Clinician guidance in digital therapeutics for panic disorder: Meta-analytic dissection and implications for regulatory framing and scalable deployment.
Cho I, Kim BH, Lee H … +4 more , Song YK, Chang MJ, Kim J, Han E
J Anxiety Disord · 2025 Sep · PMID 40997676 · Publisher ↗
BACKGROUND: Digital therapeutics (DTx) have emerged as scalable and accessible treatment modalities for panic disorder. OBJECTIVE: This study aimed to identify the extent to which clinician guidance impacts the digital i...
BACKGROUND: Digital therapeutics (DTx) have emerged as scalable and accessible treatment modalities for panic disorder. OBJECTIVE: This study aimed to identify the extent to which clinician guidance impacts the digital intervention effectiveness for panic disorder across multiple clinical outcomes. METHODS: This study included 40 randomized controlled trials of digital intervention for panic disorder published up to March 2025. Eligible studies enrolled adults with a primary diagnosis of panic disorder (with or without agoraphobia) and compared a digital therapeutic intervention against active (therapist-led or treatment-as-usual) or passive (waitlist or no-treatment) controls. Outcomes were the Panic Disorder Severity Scale (PDSS), Agoraphobic Cognitions Questionnaire (ACQ), and Body Sensations Questionnaire (BSQ). Random-effects meta-analyses, subgroup analyses, sensitivity analyses, and mixed-effects meta regressions were conducted. The moderator variables included the comparator type, guidance format (clinician-guidance or self-guided), intervention modality, and region. RESULTS: Self-guided DTx demonstrated a moderate effect size on PDSS (Hedges' g =0.31, 95 % confidence interval [CI]: 0.05-0.68), whereas clinician-guided interventions exhibited stronger effects (g =0.95, 95 % CI: 0.44-1.46). These findings indicate that well-structured self-guided interventions can address symptom domains, involving panic frequency and physiological distress. Conversely, cognitive-focused outcome assessment using ACQ and BSQ revealed that only clinician-guided interventions yielded statistically significant and clinically meaningful improvements (ACQ: g =0.46, 95 % CI: 0.15-0.76; BSQ: g =0.67, 95 % CI: 0.30-1.05), whereas self-guided formats exhibited negligible effects (ACQ: g =0.11; BSQ: g =0.27). CONCLUSIONS: This meta-analysis revealed that self-guided digital interventions effectively reduce the overall symptom severity in panic disorder, whereas clinician involvement exerts a notably stronger influence on cognition-related outcomes. These findings support a domain-specific and context-sensitive understanding of guidance. Accordingly, the DTx design and policy should match the mechanistic pathways through which psychological change will occur.
The screen for child anxiety related emotional disorders scale: A longitudinal validation study based on Chinese children and adolescents.
Li X, Shek DTL, Zhang X
J Anxiety Disord · 2025 Sep · PMID 40992165 · Publisher ↗
As anxiety disorders are common and clinically significant psychiatric disorders in children and adolescents linked to a broad spectrum of psychiatric problems, we need valid assessment instruments of anxiety. The Screen...
As anxiety disorders are common and clinically significant psychiatric disorders in children and adolescents linked to a broad spectrum of psychiatric problems, we need valid assessment instruments of anxiety. The Screen for Child Anxiety Related Emotional Disorders (SCARED) is widely used to assess anxiety symptoms. However, its factor structure remains debated, and its psychometric properties are underexplored in China. This study examined the factor structure of the SCARED and its measurement invariance across gender, age, and time among Chinese students. Specifically, this study used a two-wave longitudinal design, with a six-month interval (Time 1: December 2019-January 2020; Time 2: June 2020-July 2020). Data included 6176 children and adolescents aged 8-19 years (51.6 % boys; mean age = 11.52, SD = 1.62) from Sichuan, China. Confirmatory factor analyses supported a five-factor model as the best fit. Measurement invariances across gender, age, and time were established at the configural, metric, scalar, error variance, factor variance, and factor covariance levels, as supported by changes in the comparative fit index (CFI ≤ 0.004) and root mean square error of approximation (RMSEA ≤ 0.002). Furthermore, structured means modeling analyses showed that girls experienced more anxiety than did boys. Children experienced higher separation anxiety but lower general anxiety and school phobia than did adolescents. Moreover, participants experienced fewer anxiety symptoms at Time 2. Overall, the SCARED was valid and reliable for measuring anxiety symptoms in Chinese children and adolescents, confirming its utility as an objective outcome measure.
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