Journal Of Anxiety Disorders[JOURNAL]
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200 papers
Brain-heart coupling in response to imminent threat in panic disorder, social anxiety disorder, and healthy controls.
Unterschemmann SL, Panitz C, Petereit P … +3 more , Comtesse H, Sperl MFJ, Mueller EM
J Anxiety Disord · 2025 Sep · PMID 40976066 · Publisher ↗
BACKGROUND: Imminent threat does not only capture attention but also triggers defensive psychophysiological responses associated with fight-flight-freeze behavior. However, within-subject associations between central mar...
BACKGROUND: Imminent threat does not only capture attention but also triggers defensive psychophysiological responses associated with fight-flight-freeze behavior. However, within-subject associations between central markers of attentional stimulus processing and peripheral components of early defensive activation (e.g., cardiac acceleration) are not well understood. These associations may be especially important in understanding dynamics of anxiety disorders that are characterized by cardiovascular symptoms such as panic disorder. METHODS: We analyzed data from N = 90 participants with panic disorder (PD), social anxiety disorder (SAD), as well as healthy controls (CG) who completed a threat conditioning paradigm with face stimuli as conditioned stimuli (CS) and an aversive white noise burst as unconditioned stimulus (US). In addition to univariate analyses of ERPs and heartbeat, single-trial EEG evoked by the noise burst at centromedial sites and heart period were used to calculate intraindividual coupling of unconditioned cortico-cardiac responses. RESULTS: The noise burst evoked strong cardiac acceleration and an event-related potential with a pronounced N100 component. Importantly, the magnitude of single-trial cardiac acceleration was predicted within individuals by the preceding single-trial N100 magnitude. This cortico-cardiac coupling, but not the N100 component or cardiac acceleration per se, was enhanced in individuals with panic disorder compared to social anxiety disorder, with intermediate levels of coupling observed in healthy controls. CONCLUSION: The present results suggest a central role of early attentional stimulus processing in subsequent cardiac defensive responses. Furthermore, they indicate that cortico-cardiac defensive responses may be altered in individuals with panic disorder specifically, rather than in anxiety disorders in general.
Corrigendum to "Efficacy of imagery rescripting in treating mental disorders associated with aversive memories - An updated meta-analysis" [Journal of Anxiety Disorders 99 (2023) 102772].
Kip A, Schoppe L, Arntz A … +1 more , Morina N
J Anxiety Disord · 2025 Sep · PMID 40974760 · Publisher ↗
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Assessing reliable change, MCID, treatment response, and remission using the Pediatric Anxiety Rating Scale (PARS) in youth with anxiety disorders.
Cervin M, Kendall PC, Piacentini JC … +8 more , Gosch EA, Wood JJ, Schneider SC, Salloum A, Birmaher B, Guzick AG, Mataix-Cols D, Storch EA
J Anxiety Disord · 2025 Sep · PMID 40946358 · Full text
Youth anxiety disorders are common and heterogeneous. The Pediatric Anxiety Rating Scale (PARS) is a clinician-administered tool designed to assess overall anxiety severity, independent of specific symptoms. The threshol...
Youth anxiety disorders are common and heterogeneous. The Pediatric Anxiety Rating Scale (PARS) is a clinician-administered tool designed to assess overall anxiety severity, independent of specific symptoms. The thresholds on PARS for the reliable change index (RCI), the minimal clinically important difference (MCID), treatment response, and full and partial remission remain unclear. Using the Clinical Global Impression (CGI) scales and diagnostic interviews as benchmark measures, several thresholds for the 6-item PARS were estimated using data from 904 youth with anxiety disorders, of which 36 % had an autism diagnosis. Data were drawn from 9 clinical trials conducted in the United States. Threshold accuracy was evaluated in a holdout sample and in an independent Swedish sample (n = 49). The reliable change index (RCI) was 3.39 points. A raw score reduction of ≥ 4 points or a ≥ 20 % reduction best defined the MCID. A raw score reduction of ≥ 8 points or a ≥ 43 % reduction best defined treatment response. Scores of 0-10 after treatment accurately defined full and partial remission, and scores of 0-5 defined full remission. Threshold accuracies ranged from 74-91 % in the holdout and 67-78 % in the Swedish sample. Treatment response accuracy was similar across samples, while MCID accuracy was lower in the Swedish sample. Similar cutoffs emerged in youth with and without autism and across age groups and genders. Threshold accuracies for the 5- and 7-item PARS versions were comparable to the 6-item version. This study establishes response and remission thresholds for PARS that are applicable across age groups, genders, and autism status. We advise against using the RCI as it does not exceed the MCID.
Safety behavior fading for social anxiety: A randomized controlled trial of a self-monitoring intervention.
Zech JM, Patel TA, Cougle JR
J Anxiety Disord · 2025 Aug · PMID 40912212 · Publisher ↗
Safety behaviors (SBs) are hypothesized to play a key role in social anxiety and present as a viable target of psychosocial treatments. While SB reduction is a component of some cognitive-behavioral therapies for social...
Safety behaviors (SBs) are hypothesized to play a key role in social anxiety and present as a viable target of psychosocial treatments. While SB reduction is a component of some cognitive-behavioral therapies for social anxiety, prior research suggests safety behavior fading also represents a viable, standalone digital treatment for social anxiety. The aim of the present study was to test a one-month self-monitoring SB treatment in individuals reporting elevated social anxiety symptoms against a credible control condition. Participants (N = 201) were randomized to either a SB fading condition (n = 99) or an unhealthy behavior fading control (n = 102). Compared to control, SB fading led to lower SB use at post but not one-month follow-up. Contrary to predictions, both conditions saw significant and comparable reductions in social anxiety and related outcomes (depression, loneliness) at posttreatment and follow-up. Treatment credibility and expectancy moderated the effect of condition, such that among participants with more positive beliefs about treatment (after being provided with the rationale), those in the SB condition reported significantly lower follow-up social anxiety than those in control. Further, in the SB condition, both higher social interaction frequency and lower loneliness at baseline were predictive of lower social anxiety at follow-up. Overall, our findings show limitations to SB fading as a standalone intervention and suggest this strategy is more effective among those who interact with others more frequently and who are more confident in this treatment approach. We discuss clinical implications and future research directions, including potential refinements to SB treatment protocols.
The role of tonic immobility during re-experiencing trauma in PTSD treatment.
van der Burg NC, Hagenaars MA, de Jongh A … +1 more , van Minnen A
J Anxiety Disord · 2025 Aug · PMID 40882493 · Publisher ↗
Tonic immobility (TI) is a profound paralysis that may occur during extreme stress. Previous studies have found that TI during trauma was associated with poorer recovery from posttraumatic stress disorder (PTSD). Importa...
Tonic immobility (TI) is a profound paralysis that may occur during extreme stress. Previous studies have found that TI during trauma was associated with poorer recovery from posttraumatic stress disorder (PTSD). Importantly, TI can re-occur during re-experiencing the trauma (TI). It is unclear whether TI also hinders recovery from PTSD or declines along with other PTSD symptoms after treatment. We examined whether pre-treatment self-reported TI would predict PTSD symptoms after trauma-focused treatment, including related constructs as depression and dissociation. and investigated pre- to post-treatment changes in TI. We also explored individual differences in TI course. A total of 257 patients with PTSD, referred to a clinic for intensive trauma-focused therapy, completed measures for PTSD symptoms and TI at pre- and posttreatment, and potential confounding variables (dissociative tendencies, somatoform dissociation, dissociative subtype, and depression) at pre-treatment. Higher pre-treatment TI predicted elevated post-treatment PTSD symptoms, but not after controlling for potentially confounding constructs. Overall, TI decreased from pre- to post-treatment, and a greater decrease in TI was associated with a greater decrease in PTSD symptoms. However, four distinct clusters could be identified, which differed in TI course: High-stable, High-decrease, Moderate and Low TI. End-state was worse for patients in the High-stable and Moderate clusters. Thus, in the general sample, pre-treatment TI was not associated with reduced recovery, and TI generally decreased after treatment, suggesting that TI may be related to the PTSD symptomatology, responding well to trauma-focused CBT treatment. However, TI may not decline in specific patient groups. Future research may address how TI can be targeted for these patients.
Predicting anxiety symptoms through gaze-directed attention: A mobile eye-tracking study of adolescents during a real-world speech task.
Hutchinson E, Huynh E, Woody M … +6 more , Chopra D, Lint A, Du E, Benoit Allen K, Ladouceur C, Silk J
J Anxiety Disord · 2025 Aug · PMID 40876320 · Publisher ↗
Adolescence is a key period in which anxiety symptoms dramatically increase, particularly among adolescent girls. Identifying potentially-modifiable risk factors that contribute to anxiety symptoms may be critical to mit...
Adolescence is a key period in which anxiety symptoms dramatically increase, particularly among adolescent girls. Identifying potentially-modifiable risk factors that contribute to anxiety symptoms may be critical to mitigate anxiety symptoms and disorders among youth. Attention biases are one set of cognitive risk factors implicated in the development and maintenance of anxiety disorders. Yet previous research remains mixed as to what pattern of attention bias characterizes adolescents at-risk for developing anxiety. Further, prior literature has largely relied on indirect measures of attention (e.g., reaction time) and tasks with low ecological validity. The present study investigated how attention to social evaluative feedback contributed to concurrent and prospective anxiety symptoms in adolescent girls (n = 90, baseline M = 12.31, SD =.83). The present study used a novel speech task and mobile eye-tracking technology to assess gaze-directed attention in an ecologically valid context that adolescents encounter daily. We hypothesized that adolescents who engage in vigilance, avoidance, and the combination of vigilance-avoidance of potentially critical social evaluative feedback would report greater concurrent and prospective anxiety symptoms. We also explored the association between gaze-directed attention to positive social feedback. Contrary to our hypotheses, adolescents who exhibited both initial and sustained avoidance of potentially critical social feedback reported the greatest anxiety three-years later, controlling for baseline anxiety symptoms. Findings highlight the importance of avoidance in real-world socially threatening scenarios in contributing to and maintaining anxiety. Findings also highlight the value of studying attention biases that contribute to anxiety symptoms among adolescents using reliable methods and in real-world contexts.
Prevalence and correlates of alcohol, cannabis, and tobacco use disorder in DSM-5 generalized anxiety disorder: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions-III.
Zech JM, Patel TA, Cougle JR
J Anxiety Disord · 2025 Aug · PMID 40865185 · Publisher ↗
Substance use disorders have been linked to Generalized Anxiety Disorder (GAD), though much of this research predates DSM-5 diagnostic criteria. Further, little prior work has examined the demographic correlates of speci...
Substance use disorders have been linked to Generalized Anxiety Disorder (GAD), though much of this research predates DSM-5 diagnostic criteria. Further, little prior work has examined the demographic correlates of specific substance use disorders among individuals with GAD. These demographic correlates, as well as the presence of comorbid substance use disorder, may also impact treatment seeking in individuals with GAD. In the present study, we explored the relationship between GAD and common substance use disorders (Alcohol Use Disorder, Cannabis Use Disorder, and Tobacco Use Disorder), as well as the demographic factors associated with these disorders among individuals with GAD in a large, nationally representative sample. We also tested whether each of these substance use disorders were associated with GAD-related treatment seeking. Controlling for demographics and comorbidities, lifetime GAD was positively associated with lifetime Alcohol and Cannabis Use Disorder, but not Tobacco Use Disorder, whereas past-year GAD was positively associated with past year Cannabis and Tobacco Use Disorder but not past year Alcohol Use Disorder. Lastly, lifetime Alcohol Used Disorder but not Cannabis or Tobacco Use Disorder was associated with higher rates of GAD-related treatment seeking. Collectively, these findings reflect an updated examination of GAD and disordered substance use using DSM-5 diagnostic criteria and indicate the importance substance use comorbidities in the context of GAD.
Covert or connected: Motivations for online and interpersonal reassurance-seeking in OCD.
Parsons CA, Kim HJ, Singh S … +3 more , Lkhagva T, Wang J, Alden LE
J Anxiety Disord · 2025 Aug · PMID 40795489 · Publisher ↗
Interpersonal reassurance-seeking is a common anxiety-management strategy used by individuals with a range of disorders, but can be particularly repetitive and exacting among individuals with obsessive-compulsive disorde...
Interpersonal reassurance-seeking is a common anxiety-management strategy used by individuals with a range of disorders, but can be particularly repetitive and exacting among individuals with obsessive-compulsive disorder (OCD). Although this strategy yields short-term relief, it also comes at a cost, creating frustration and straining relationships. Non-interpersonal sources of reassurance-such as the internet-have been less thoroughly studied, but may offer unique advantages. In this mixed-methods study, we explored the differentiating benefits and drawbacks of interpersonal and online reassurance-seeking for individuals with and without OCD. Participants (n = 62 OCD, n = 58 control) completed an imaginal exposure task, after which they indicated their reassurance source preference (interpersonal vs. online) and their primary reasons for this preference. Participants also answered two general questions about their usual motivations for seeking reassurance from each source at the exclusion of the other. We used content analysis to identify patterns in participants' responses, and quantitative methods to examine the most common motivations as well as any between-group differences. Common reasons for seeking reassurance interpersonally included desires for emotional support and personalization, and these findings did not differ between groups. Common reasons for online reassurance typically involved interpersonal concerns, and participants with OCD were more likely to specifically express concern about the personal consequences of revealing one's worries to others. Motivations related to trust and seeking shared experiences were common for both reassurance types. These findings are discussed in the context of the broader literature on reassurance-seeking and obsessive-compulsive symptomatology.
Perinatal PTSD and the mother-infant bond: A systematic review and meta-analysis.
Rehberg F, Rihm L, Göbel A … +4 more , Thiel F, Büechl VCS, Even M, Garthus-Niegel S
J Anxiety Disord · 2025 Aug · PMID 40784250 · Publisher ↗
BACKGROUND: Despite a growing body of literature, understanding of the relationship between maternal symptoms of perinatal posttraumatic stress disorder (PTSD) and the emerging mother-infant bond (MIB) remains limited. T...
BACKGROUND: Despite a growing body of literature, understanding of the relationship between maternal symptoms of perinatal posttraumatic stress disorder (PTSD) and the emerging mother-infant bond (MIB) remains limited. This systematic review and meta-analysis elucidates this association considering both general PTSD (gPTSD) symptoms (i.e., not originating from childbirth) as well as childbirth-related PTSD (CB-PTSD) symptoms. METHODS: A comprehensive literature search screening for articles published until 10/03/2024 was conducted. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled effect sizes were estimated with random effects models. RESULTS: The systematic review includes 22 studies (9472 participants) and indicates a positive association between perinatal PTSD symptoms and impaired MIB. However, the relationship might be explained by confounding factors (e.g., depressive symptoms, general psychological distress). Meta-analyses suggest a small to moderate positive association (r = .32) between postnatal gPTSD symptoms and impaired MIB (n = 8) and a moderate positive association (r = .38) between CB-PTSD symptoms and impaired MIB (n = 15). Additional exploratory meta-analyses indicate that within the CB-PTSD construct, general rather than childbirth-related PTSD symptoms are more strongly related to MIB (n = 5). LIMITATIONS: Heterogeneity across studies, methodological complexities in distinguishing perinatal PTSD subtypes, and a small number of studies should be noted. CONCLUSIONS: The results indicate differential associations between gPTSD versus CB-PTSD and MIB. However, further research is required to fully elucidate the relationship between maternal perinatal PTSD and MIB and the role of individual symptom domains to inform the targeted development of interventions.
Assessing executive functioning in individuals with social anxiety disorder (SAD) across the lifespan: A systematic literature review and meta-analysis.
Harrison AA, Nguyen L, Murphy K … +1 more , Neumann D
J Anxiety Disord · 2025 Jul · PMID 40752129 · Publisher ↗
Social anxiety disorder is a pervasive clinical disorder characterised by intense fear and/or avoidance of one or more social situations, and has been linked to deficits in executive functioning performance. However, met...
Social anxiety disorder is a pervasive clinical disorder characterised by intense fear and/or avoidance of one or more social situations, and has been linked to deficits in executive functioning performance. However, methodological differences and mixed results have made it difficult to draw definitive conclusions from individual studies. The current systematic review and meta-analysis collated the results from 49 studies to examine the link between social anxiety disorder and executive functioning across the lifespan. Findings revealed that individuals with social anxiety performed significantly worse than healthy controls or low social anxiety groups on measures of executive functioning (r = -.15), specifically cognitive flexibility (r = -.20), inhibitory control (r = -.18), and global executive functioning (r = -.17). No significant association was evident between working memory and social anxiety (r = -.06). In addition, the type of measure (self-report vs cognitive task) moderated the relationship between social anxiety and executive functioning. Although age did not moderate the overall relationship, the association between the individual domains of executive functioning and social anxiety differed between youth and adults, which may reflect the different developmental timelines between the domains across the lifespan. The findings offer valuable insight into our understanding of the development of executive functions for individuals with social anxiety and could assist with forming new strategies or interventions to improve daily functioning in this clinical population.
Memory and identity processes in ICD-11 complex posttraumatic stress disorder: Tests of a new theory.
Hyland P, Broughill M, Shevlin M … +1 more , Brewin CR
J Anxiety Disord · 2025 Aug · PMID 40738010 · Publisher ↗
BACKGROUND: This study empirically tested several predictions arising from the Memory and Identity (M&I) Theory of ICD-11 Complex PTSD (CPTSD). Specifically, it examined the psychometric properties of two measures-the Ex...
BACKGROUND: This study empirically tested several predictions arising from the Memory and Identity (M&I) Theory of ICD-11 Complex PTSD (CPTSD). Specifically, it examined the psychometric properties of two measures-the Experiences of Traumatic Memories Questionnaire (ETMQ) and the Trauma Identity Questionnaire (TIQ)-and tested relationships between different types of trauma exposure, disturbances in memory and identity, and CPTSD symptoms. METHODS: Data were collected from a non-probability based representative sample of the general adult population of the United Kingdom (N = 975), and latent variable modelling was used to test all hypotheses. RESULTS: Confirmatory factor analytic results provided support for the psychometric properties of the ETMQ and TIQ as measures of traumatic memories and negative identities. Multiple traumatization and interpersonal forms of trauma were associated with more disturbances in trauma memories and negative identities. Seven of the nine model-predicted associations between trauma memories, negative identities, and CPTSD symptoms were observed, including a link between a fragmented sense of self and emotional numbing. CONCLUSIONS: Results support core elements of the M&I Theory, highlighting trauma memory and identity disturbances as key mechanisms in CPTSD.
Sleep disturbances predict nine-year panic disorder chronicity: The sleep-panic nexus theory with machine learning insights.
Zainal NH, Van Doren N
J Anxiety Disord · 2025 Aug · PMID 40716300 · Full text
BACKGROUND: Panic disorder (PD) is a chronic and impairing anxiety disorder. Individuals with more sleep disturbances might be predisposed to nine-year PD chronicity. However, linearity assumptions, small predictor sets,...
BACKGROUND: Panic disorder (PD) is a chronic and impairing anxiety disorder. Individuals with more sleep disturbances might be predisposed to nine-year PD chronicity. However, linearity assumptions, small predictor sets, and analytic and design limitations have hindered optimal identification of which sleep disturbance variables are distal risk factors for PD chronicity. We thus used machine learning (ML) to predict nine-year PD chronicity using high-dimensional data. METHOD: Community-dwelling adults (N = 1054) completed clinical interviews, self-reports, and seven-day sleep actigraphy at Wave 1 (W1) and the same clinical interview at Wave 2 (W2) nine years later. The baseline data comprised 43 actigraphy, self-reported sleep disturbances, clinical, and demographic variables. Seven ML models were examined. Gradient boosting machine (GBM) was the best-performing algorithm. PD chronicity was defined as the presence of a PD diagnosis at both W1 and W2. RESULTS: The GBM accurately predicted PD chronicity (area under the receiver operating characteristic curve [AUC] =.764). Shapley additive explanation analysis showed that the top W1 predictors of PD chronicity were comorbid major depressive disorder, low healthcare utilization, sleep medication use, lengthier wake after sleep onset, and sleep-wake circadian disruptions based on actigraphy and self-reports. Lower household income and younger age were also top predictors. Additionally, the final multivariate model was well-calibrated. CONCLUSIONS: As proposed in our sleep-panic nexus theory, actigraphy and subjective sleep disturbances have essential prognostic value in predicting long-term PD chronicity. Harnessing ML facilitates accurate prediction by identifying complex, nonlinear relations across high-dimensional datasets, possibly improving prevention and treatment tailoring.
Savoring meditation for emotional disorders: Targeting positive emotion regulation deficits.
Kishimoto T, Hao X, Qian J
J Anxiety Disord · 2025 Aug · PMID 40714519 · Publisher ↗
Deficits in positive emotion regulation (PER) contribute to emotional disorders but are less studied than negative emotion regulation (NER). One maladaptive PER strategy, positive emotion contrast-seeking (PEC-seeking),...
Deficits in positive emotion regulation (PER) contribute to emotional disorders but are less studied than negative emotion regulation (NER). One maladaptive PER strategy, positive emotion contrast-seeking (PEC-seeking), involves sustaining negative affect to enhance later positive emotions, reinforcing anxiety and depression. This study developed and tested a savoring-based, transdiagnostic intervention to reduce PEC-seeking and alleviate emotional disorder symptoms. A single-blind RCT with 59 Chinese college students with elevated depression and anxiety (majority meeting depression criteria) compared a two-week group savoring meditation intervention to waitlist control. Changes in depression, anxiety, savoring beliefs, and PEC-seeking were assessed at Baseline (T0), MidTest (T1), PostTest (T2), and one-month Follow-up (T3). The experimental group also reported positive and negative affect before and after each group session and individual practice. Savoring meditation significantly reduced depression (T1, d = -1.11, p = .005; T2, d = -1.60, p < .001) with effects maintained at follow-up (T3, p < .001). Negative affect also declined significantly (Session 5, p < .001), though changes in positive affect were not statistically significant. The intervention increased savoring beliefs (T1, d = 1.42, T2, d = 1.41, ps =.003) and reduced PEC-seeking (T1, d = -0.92, p = .027), which in turn mediated reductions in depression. Although anxiety symptoms declined within the experimental group over time, between-group differences did not reach statistical significance. Nonetheless, the effect size was larger for the experimental group (T2, d = 0.34) than for the waitlist group (d = 0.01), suggesting a potential anxiolytic effect of the intervention. These findings suggest that targeting maladaptive PER strategies, especially PEC-seeking, via savoring meditation may effectively reduce emotional disorder symptoms. This study highlights PER's role in transdiagnostic interventions and provides novel insights into PER-focused therapies.
Emetophobia (fear of vomiting): A meta-analysis.
Meule A, Seufert L, Kolar DR
J Anxiety Disord · 2025 Aug · PMID 40700922 · Publisher ↗
Emetophobia refers to a specific fear of vomiting. There are only few original research studies on this condition and no study that has meta-analytically synthesized findings to describe the characteristics of persons wi...
Emetophobia refers to a specific fear of vomiting. There are only few original research studies on this condition and no study that has meta-analytically synthesized findings to describe the characteristics of persons with emetophobia. To this end, we extracted data from 31 reports and-as we examined different dependent variables-each meta-analysis was based on five to 21 samples. The pooled mean age of persons with emetophobia was 29 years but was reduced to 21-27 years when adjusting for publication bias. The pooled mean age of disorder onset was 10 years. The pooled proportion of females was 91 %. The pooled proportions of reporting fear of vomiting oneself, fear of seeing others vomit, or both, were 47 %, 11 %, and 39 %. The most common comorbid mental disorders were social anxiety disorder, depression, and generalized anxiety disorder. The pooled point prevalence of emetophobia was 5 %. Higher emetophobic symptomatology moderately related to higher disgust propensity and higher anxiety, and weakly related to higher depressive symptomatology. This meta-analysis is the first to quantify that most adults with emetophobia are in early adulthood but the disorder started in childhood, almost all are women, the primary locus of fear is vomiting oneself, the most common comorbid mental disorders are other anxiety and affective disorders, and higher emetophobic symptomatology relates to a more general tendency to be easily disgusted and to be anxious. Studies based on representative samples to obtain reliable estimates on the prevalence of emetophobia are needed.
Bidirectional associations between PTSD symptoms and pain in daily life among women survivors of sexual assault.
Brockdorf AN, Simpson LE, DiLillo D
J Anxiety Disord · 2025 Aug · PMID 40645022 · Full text
The co-occurrence between pain and posttraumatic stress disorder (PTSD) is commonly explained by the mutual maintenance model, which proposes that each condition exacerbates the other. We tested this model by examining w...
The co-occurrence between pain and posttraumatic stress disorder (PTSD) is commonly explained by the mutual maintenance model, which proposes that each condition exacerbates the other. We tested this model by examining within-day associations between pain and PTSD using a three-week ecological momentary assessment (EMA) design. Young adult cisgender women (N = 82) who experienced sexual assault and reported PTSD symptoms and probable alcohol misuse completed three self-report surveys per day assessing momentary pain intensity and PTSD symptoms. Results from a dynamic structural equation model supported hypotheses, such that pain predicted greater PTSD symptoms four hours later and PTSD symptoms predicted greater pain. However, exploratory follow up analyses revealed differential findings by cluster, such that intrusions, negative alterations in cognition and mood, and hyperarousal each predicted subsequent pain, whereas pain predicted only later hyperarousal. Findings add nuance to our understanding of the mutual maintenance model and point to hyperarousal symptoms as a key symptom cluster linking daily pain and PTSD among women who have experienced sexual assault. Findings underscore the potential value of targeting hyperarousal symptoms in integrative interventions.
Trajectories of grief-related psychopathology: A decade after the MH17 plane disaster.
Nijborg LCJ, Westerhof GJ, Pociūnaitė-Ott J … +3 more , Kunst MJJ, de Keijser J, Lenferink LIM
J Anxiety Disord · 2025 Aug · PMID 40570706 · Publisher ↗
Violent losses increase the risk for prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD). Little is known about the course of grief-related psychopathology in the lon...
Violent losses increase the risk for prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD). Little is known about the course of grief-related psychopathology in the long term. Hence, we examined their latent trajectories, overlap, and predictors to enhance our understanding of differential long-term responses to violent loss. MH17-bereaved people (N = 299) completed annual self-report measures from one to nine years post-loss. Prolonged grief (PG), posttraumatic stress (PTS), and major depression (MD) symptom trajectories were identified using latent class growth modeling. Overlap in trajectory membership was examined using frequencies. Predictors of trajectory membership were examined using multinomial regression analyses. Four PG symptom trajectories emerged: low (41.0 %), moderate decreasing (34.2 %), high (13.5 %), and recovered (11.3 %). Four PTS symptom trajectories emerged: low (56.2 %), recovered (19.6 %), moderate increasing (17.6 %), and high (6.6 %). Four MD symptom trajectories emerged: low (55.7 %), moderate (19.6 %), moderate decreasing (15.1 %), and high (9.5 %). The findings indicate that if people report psychopathology, this often entails PGD by itself, and sometimes in combination with PTSD and MDD, yet rarely PTSD or MDD by itself. Around one in 20 people was assigned to all three high symptom trajectories. Different predictors were found across disorders. To conclude, most MH17-bereaved people reported low grief-related psychopathology, yet one in six reported high grief-related psychopathology levels (i.e., at least probable PGD, PTSD, or MDD) nearly a decade later. There is no indication of a delayed onset of grief-related psychopathology.
Affective forecasting during a horror attraction: Insights into Intolerance of Uncertainty.
FitzGibbon L, Morriss J, Clasen M … +4 more , Wake S, Nesbit R, Malmdorf Andersen M, Dodd HF
J Anxiety Disord · 2025 Aug · PMID 40554070 · Publisher ↗
In this field study, we examined for the first time how Intolerance of Uncertainty influences expectations about negative, positive, and anxiety-related affect alongside the accuracy of those expectations. The study was...
In this field study, we examined for the first time how Intolerance of Uncertainty influences expectations about negative, positive, and anxiety-related affect alongside the accuracy of those expectations. The study was conducted at a horror attraction, which offers an immersive, uncertain and threat-related experience. Participants (n = 1029) completed a measure of forecasted negative, positive and anxiety-related affect prior to the experience. Immediately after the experience, they rated their actual subjective experience of each of these affective states. Additionally, confidence ratings were reported for each forecasted emotion so that metacognitive awareness of forecasting accuracy could be assessed. Results showed that participants high in IU anticipated and actually experienced less positive affect, more anxiety-related affect and more negative-affect compared to those low in IU. IU predicted bias (overestimations) in emotional forecasts for negative affect, but not for positive or anxiety-related affect. The findings demonstrate that IU may be related to affective forecasting, which has implications for transdiagnostic models and treatment of psychopathology.
Understanding climate anxiety and potential impacts on pro-environment behaviours.
Coates Z, Brown S, Kelly M
J Anxiety Disord · 2025 Aug · PMID 40540828 · Publisher ↗
Previous studies have identified harmful social, physical, and mental impacts due to climate change. Anxiety due to climate change or "climate anxiety" may be an adaptive or reasonable response to a real threat; however,...
Previous studies have identified harmful social, physical, and mental impacts due to climate change. Anxiety due to climate change or "climate anxiety" may be an adaptive or reasonable response to a real threat; however, it may also be associated with considerable functional impairment of associated behaviours. In this study, we examined the relationship between climate anxiety and pro-environment behaviours, via an online discrete choice experiment, with 374 participants recruited from prolific academic and undergraduate university recruitment program. This experiment included our discrete choice measure of pro-environment behaviours and self-report survey items examining climate anxiety, general anxiety, death anxiety, and locus of control. We found that a moderate level of climate anxiety may be optimal for making pro-environmental choices, with this group having significantly more eco-friendly choices than participants in the low or high climate anxiety groups. We also examined the relationships between climate anxiety and three other psychological concepts, locus of control, general anxiety, and death anxiety, and found that these 3 factors were positively related to climate anxiety. These findings may indicate that some additional negative mental health outcomes are associated with high levels of climate anxiety. This study provides evidence for the use of discrete choice experiments when examining pro-environment behaviours, which may allow future studies to further examine various other trade-offs or factors such as the cost that participants are willing to "pay" for an eco-friendly option.
Altered resting-state amygdala-cerebellar functional connectivity is associated with intolerance of uncertainty in patients with obsessive-compulsive disorder: A longitudinal study.
Guo Q, Zhu R, Zhou H … +2 more , Wang D, Zhang X
J Anxiety Disord · 2025 Aug · PMID 40540827 · Publisher ↗
OBJECTIVES: Intolerance of uncertainty (IU) plays an important role in the pathology of obsessive-compulsive disorder (OCD). The amygdala and anterior insula (AI) appear to be important neural correlates of IU. However,...
OBJECTIVES: Intolerance of uncertainty (IU) plays an important role in the pathology of obsessive-compulsive disorder (OCD). The amygdala and anterior insula (AI) appear to be important neural correlates of IU. However, the relationship between altered resting-state functional connectivity (rsFC) and IU in OCD patients has not been reported. METHODS: This study recruited 39 patients with OCD and 45 healthy controls (HC). IU was measured using the Intolerance of Uncertainty Scale (IUS). The seed-to-voxel method was used to construct rsFC maps. Between-group differences in rsFC and their correlations with IU were analyzed. Following an eight-week psychological intervention, OCD patients underwent a second assessment. The association between rsFC changes and IU changes was investigated. RESULTS: OCD patients exhibited significantly higher IUS scores. Significant alterations in rsFC were observed between the left amygdala and the left cerebellum posterior lobe (CPL), as well as between the left AI and the left cuneus in OCD patients. In the OCD group, only the left amygdala - left CPL rsFC significantly correlated with IUS scores. No significant correlations were found between rsFC and IUS scores in the HC group. Longitudinal analysis revealed that changes in the left amygdala - left CPL rsFC were significantly associated with changes in IUS scores. CONCLUSIONS: This study establishes amygdala-cerebellar rsFC as a specific neural signature of IU in patients with OCD, patterns absent in healthy controls. Moreover, the amygdala-cerebellar rsFC displayed longitudinal coupling with IU changes. These findings provide novel insights into the neural mechanisms of OCD pathology.
Conditional probability of posttraumatic stress disorder in the Canadian Armed Forces: A longitudinal study.
Kowall SM, Mota N, Perera E … +2 more , Muthumuni N, Bolton SL
J Anxiety Disord · 2025 Aug · PMID 40532425 · Publisher ↗
BACKGROUND: Posttraumatic stress disorder (PTSD) can be impacted by the type of trauma exposure. This is important to consider when evaluating the likelihood of having PTSD among Canadian veterans, which previous literat...
BACKGROUND: Posttraumatic stress disorder (PTSD) can be impacted by the type of trauma exposure. This is important to consider when evaluating the likelihood of having PTSD among Canadian veterans, which previous literature has not examined. The aim of this study was to: 1) Examine the prevalence and conditional probability of PTSD over a 16 year period by trauma type, differentiating by sex, and 2) Explore this relationship by worst trauma type. METHODS: We examined the prevalence of PTSD by sex among those with any exposure to 26 traumatic events, and used logistic regressions to examine trauma type and PTSD. The conditional probability of having PTSD over the 16-year follow-up period (2002-2018) and in the past year was calculated using population attributable fractions (PAFs). Identical analyses were used to examine the conditional probability of PTSD related to a self-reported 'worst event'. RESULTS: Over the 16-year follow-up, we found that males showed higher conditional likelihood of developing PTSD from exposure to sexual trauma while females showed a higher conditional likelihood of developing PTSD from exposure to an accidentrelated trauma. For the probability of PTSD conditional on the worst event, accidentrelated or sexual trauma in females, and sexual and deployment-related trauma in males showed the highest PAF and strongest relationship. CONCLUSION: This research supports differences in PTSD prevalence depending on the type of traumatic exposure. Importantly, different patterns of conditional probability of PTSD emerged by sex. These findings can provide important information for mental health providers within the military treating multiple traumas.
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