Journal Of Anxiety Disorders[JOURNAL]
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200 papers
Using machine learning methods to predict the outcome of psychological therapies for post-traumatic stress disorder: A systematic review.
Tait J, Kellett S, Delgadillo J
J Anxiety Disord · 2025 Jun · PMID 40132235 · Publisher ↗
BACKGROUND: A number of treatments are available for post-traumatic stress disorder (PTSD), however, there is currently a lack of data-driven treatment selection and adaptation methods for this condition. Machine learnin...
BACKGROUND: A number of treatments are available for post-traumatic stress disorder (PTSD), however, there is currently a lack of data-driven treatment selection and adaptation methods for this condition. Machine learning (ML) could potentially help to improve the prediction of treatment outcomes and enable precision mental healthcare in practice. OBJECTIVES: To systematically review studies that applied ML methods to predict outcomes of psychological therapy for PTSD in adults (e.g., change in symptoms, dropout rate), and evaluate their methodological rigour. METHODS: This was a pre-registered systematic review (CRD42022325021), which synthesised eligible clinical prediction studies found across four research databases. Risk of bias was assessed using the PROBAST tool. Study methods and findings were narratively synthesised, and adherence to ML best practice evaluated. RESULTS: Seventeen studies met the inclusion criteria, including samples derived from experimental and observational study designs. All studies were assessed as having a high risk of bias, notably due to inadequately powered samples and a lack of sample size calculations. Training sample size ranged from N < 36-397. The studies applied a diverse range of ML methods such as decision trees, ensembling and boosting techniques. Five studies used unsupervised ML methods, while others used supervised ML. There was an inconsistency in the reporting of hyperparameter tuning and cross-validation methods. Only one study performed external validation. CONCLUSIONS: ML has the potential to advance precision psychotherapy for PTSD, but to enable this, ML methods must be applied with greater adherence to best practice guidelines.
"And then one day you find ten years have got behind you": Reflections on a Decade as Editor-in-Chief.
Asmundson GJG
J Anxiety Disord · 2025 Apr · PMID 40122707 · Publisher ↗
Abstract loading — click title to view on PubMed.
Does intolerance of uncertainty predict child generalised anxiety? A longitudinal study.
Ryan ZJ, Rayson H, Morriss J … +1 more , Dodd HF
J Anxiety Disord · 2025 Jun · PMID 40121891 · Publisher ↗
Intolerance of uncertainty (IU) is the tendency to find uncertainty distressing. IU is related to anxiety in adults and youth but it is unclear whether IU plays a maintenance or causal role, particularly across childhood...
Intolerance of uncertainty (IU) is the tendency to find uncertainty distressing. IU is related to anxiety in adults and youth but it is unclear whether IU plays a maintenance or causal role, particularly across childhood. Our research examined whether: (1) IU is associated with generalised anxiety in preschool-aged children; (2) IU in preschool-aged children is associated with the trajectory of generalised anxiety into middle childhood; and (3) IU is associated with the trajectory of internalising symptoms and externalising symptoms over time. Parents completed questionnaires (child anxiety, IU, internalising and externalising symptoms) about their children at three timepoints when their child was: 3-4 years old (n = 180); 5-7 years old (n = 162); and 8-10 years old (n = 148). Those with higher IU had higher concurrent generalised anxiety, internalising and externalising symptoms at each measurement point. Preschoolers with higher IU, relative to lower IU, had, on average, higher generalised anxiety across childhood. Unexpectedly though, children who were higher in IU as preschoolers were more likely to show a decrease in generalised anxiety over time. These findings indicate that IU is a consistent correlate of generalised anxiety, internalising and externalising symptoms, but that it may not play a causal role in the onset of generalised anxiety in children.
Comparing structural models for internalizing pathology: Latent dimensions, classes, or a mix of both?
De la Rosa-Cáceres A, Wendt LP, Zimmermann J … +1 more , Díaz-Batanero C
J Anxiety Disord · 2025 Apr · PMID 40117841 · Publisher ↗
In recent decades, the conceptualization of internalizing problems has changed from categorical to dimensional and hybrid approaches. However, most studies have analyzed the structure of internalizing problems at the dis...
In recent decades, the conceptualization of internalizing problems has changed from categorical to dimensional and hybrid approaches. However, most studies have analyzed the structure of internalizing problems at the disorder level using categorical or dimensional approaches, with only a few studies examining the structure at the symptom level, or considering a hybrid approach. This study aimed to compare categorical (latent class analysis), dimensional (confirmatory factor analysis), and hybrid models (semi-parametric factor analysis) of internalizing constructs at the symptom level regarding model fit (structural validity) and prediction (concurrent validity) in four samples: community adults (n = 1072; n = 620), students (n = 378), and patients (n = 485). All participants completed the Inventory of Depression and Anxiety Symptoms-II to assess internalizing symptoms. In two samples, participants completed additional measures to test concurrent validity regarding disability, externalizing symptoms, personality traits, impairments in personality functioning, and quality of life. Dimensional models, particularly those allowing for non-normal distributions, outperformed categorical and hybrid models in terms of structural and concurrent validity (median R for dimensional models =.18-.16). Our results suggest that future studies should prefer dimensional models to better describe internalizing constructs and predict external variables. The consistent application of dimensional models of internalizing pathology would facilitate the integration of empirical findings in clinical science and enable a more valid and fine-grained assessment of individual mental health problems in clinical practice, thereby enhancing the potential to guide effective personalized interventions.
Computationally derived parent-child interaction patterns and oxytocin in children with and without OCD.
Mora-Jensen AC, Thoustrup CL, Lebowitz ER … +12 more , Hagstrøm J, Pretzmann L, Korsbjerg NLJ, Thorsen ED, Uhre VF, Christensen SH, Uhre C, Ritter M, Plessen KJ, Pagsberg AK, Clemmensen LKH, Lønfeldt NN
J Anxiety Disord · 2025 Apr · PMID 40117840 · Publisher ↗
BACKGROUND: Parent-child interactive processes are important factors in pediatric OCD. Understanding biological mechanisms of parent-child interactive behaviors could help improve treatment of pediatric OCD. Oxytocin has...
BACKGROUND: Parent-child interactive processes are important factors in pediatric OCD. Understanding biological mechanisms of parent-child interactive behaviors could help improve treatment of pediatric OCD. Oxytocin has been suggested as a biological mechanism in parent-child interactions. However, no studies in pediatric OCD exist. We used machine learning to discover latent patterns in parent-child interactive behaviors and explored associations with oxytocin in children with and without OCD. METHODS: We used parent and child salivary oxytocin levels measured with enzyme-linked immunosorbent assay (ELISA) and investigator-rated parent-child behaviors during a frustration task. Children with or without OCD and their parents - 107 mother-child and 62 father-child pairs were included. We used two machine learning techniques, principal component analysis and archetypal analysis, to generate data-driven, theory-agnostic behavioral variables, and regression to estimate their associations with oxytocin. RESULTS: Principal component and archetype analyses identified behavioral patterns describing the mother-child and father-child interactions. We found a positive association between child and mother oxytocin and the interaction patterns "overinvolved interaction" and "emotional interaction" and a negative association with "distant interaction". Additionally, mother oxytocin was positively associated with "supportive interaction" and "varied-coping interaction", and negatively associated with "conflictual interaction" and "negative-low support interaction". Father oxytocin was associated with "supportive interactions" only in the presence of child OCD. CONCLUSION: Child and mother oxytocin appear related with mother-child interactive patterns. Fathers' oxytocin was related with interaction patterns only in children with OCD. Our exploratory findings can be used to generate hypothesis for future research regarding the relationship between oxytocin and maladaptive family engagement in OCD and differences between mothers and fathers' behaviors when the child has OCD.
Temporal dynamics of costly avoidance in anxiety disorders: Faster threat and weaker reward impact during approach-avoidance decisions in patients.
Boschet-Lange JM, Glück VM, Pittig R … +2 more , Scherbaum S, Pittig A
J Anxiety Disord · 2025 Apr · PMID 40086366 · Publisher ↗
In anxiety disorders, approach-avoidance behavior is typically biased towards excessive, maladaptive avoidance despite costs and impairments (i.e., costly avoidance). Yet, little is known about the underlying decision dy...
In anxiety disorders, approach-avoidance behavior is typically biased towards excessive, maladaptive avoidance despite costs and impairments (i.e., costly avoidance). Yet, little is known about the underlying decision dynamics that may contribute to such imbalanced behavior. The current study tested for altered temporal decision dynamics in patients with anxiety disorders compared to matched healthy controls in a task where avoiding an aversive stimulus conflicted with obtaining rewards. Participants chose repeatedly between a fixed safe/low reward and a threat/high reward option with varying threat (probability of an aversive stimulus presentation) and reward information (reward magnitude). Structured computer mouse movements required for choosing between options were tracked to capture the temporal dynamics of the decision process (i.e., when and how strongly threat and reward information influenced decision preference). The current study replicated elevated costly threat avoidance in patients with anxiety disorders compared to matched controls. Importantly, time-continuous multiple regression of mouse movements revealed altered temporal dynamics: patients showed a faster (but not stronger) impact of threat and a weaker impact of competing rewards. These findings highlight that not only biases in threat processes but also competing rewards may guide excessive avoidance and could be important treatment targets in anxiety disorders. Future research may support the external validity of these findings in real-life decisions and try to identify therapeutic strategies that allow to specifically target the attenuated impact of rewards and the accelerated impact of threat in patients.
A randomized clinical trial investigating the clinical impact of a game-based digital therapeutic for social anxiety disorder.
de Rutte J, Myruski S, Davis E … +2 more , Findley A, Dennis-Tiwary TA
J Anxiety Disord · 2025 Apr · PMID 40068434 · Publisher ↗
The objective of this study was to determine if a novel game-based digital therapeutic intervention reduced anxiety symptom severity in adults with clinically elevated symptoms of social anxiety disorder (SAD). Participa...
The objective of this study was to determine if a novel game-based digital therapeutic intervention reduced anxiety symptom severity in adults with clinically elevated symptoms of social anxiety disorder (SAD). Participants were randomly allocated (1:1) to receive four weeks of either the active intervention, a game-based form of attention bias modification (Active ABM) for anxiety, or the sham control training (Control). Between June 2022 to June 2023, 104 participants were enrolled with 93 completing the trial per-protocol and 104 included in the final intention-to-treat analysis (54 intervention, 50 control); mean age was 38.08 (10.56) years and 79 were female. The dependent variable was reduction in SAD symptoms, measured via the Liebowitz SAD Scale (LSAS). Participants were classified as having clinically elevated SAD symptoms only, or both SAD and Generalized Anxiety Disorder (GAD) symptoms (comorbid). The Active condition induced significantly greater reductions in SAD symptoms compared to the Control condition between Baseline and Post-Treatment [Active: M = -29.71, SD = 23.68; Control: M = -14.59, SD = 21.52, d = .67, t(102) = -3.40, p < .001] across the four-week study period. While no significant between-groups differences emerged at each timepoint individually, the Active condition induced significantly greater change over time in SAD symptoms compared to the Control condition. Use of this game-based digital ABM intervention showed benefits in the reduction of anxiety symptoms.
The diagnostic utility of the PCL-5 in a traumatically injured black population.
Geier TJ, Vine K, Torres L … +2 more , Larson CL, deRoon-Cassini TA
J Anxiety Disord · 2025 Apr · PMID 39985923 · Full text
BACKGROUND: Posttraumatic stress disorder (PTSD) is common after traumatic injury, negatively impacting recovery. Black Americans face elevated PTSD risk following traumatic injury, yet diagnostic accuracy of assessments...
BACKGROUND: Posttraumatic stress disorder (PTSD) is common after traumatic injury, negatively impacting recovery. Black Americans face elevated PTSD risk following traumatic injury, yet diagnostic accuracy of assessments in trauma center settings serving this population is unknown. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) exhibits strong psychometric properties but optimal cut-scores by race require examination. METHODS: Data were combined from three ongoing projects of injured Black American adults (N = 270). Participants completed the PCL-5 and Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) six months post-injury. Receiver operating characteristic analysis determined the PCL-5's diagnostic utility against the CAPS-5. Sensitivity, specificity, predictive values, and diagnostic efficiency were calculated across cut scores. RESULTS: Prevalence of CAPS-5 PTSD at 6-months post-injury was 34.4 %. The PCL-5 demonstrated good accuracy in detecting PTSD (AUC=.931). A PCL-5 cut-score of > 33 maximized diagnostic efficiency (89.1 %), with sensitivity of 89.1 % and specificity of 87.6 %. CONCLUSIONS: The PCL-5 is an accurate PTSD screening tool for injured Black Americans using an appropriate threshold. Findings have implications for improving mental health care access in trauma settings serving marginalized groups.
A temporal investigation of the relationship between difficulty concentrating and perseverative thought.
DeGennaro PL, Blendermann M, Alberts B … +3 more , Silk JS, Gianaros PJ, Hallion LS
J Anxiety Disord · 2025 Apr · PMID 39954589 · Publisher ↗
Perseverative thought (also known as repetitive thought) is an established transdiagnostic mechanism of internalizing psychopathology characterized primarily by its repetitive, difficult to control quality. Subjective di...
Perseverative thought (also known as repetitive thought) is an established transdiagnostic mechanism of internalizing psychopathology characterized primarily by its repetitive, difficult to control quality. Subjective difficulty concentrating frequently coincides with perseverative thought and may function as both mechanism and clinical consequence of perseverative thought. Although cognitive theories suggest a bidirectional relationship between perseverative thought and difficulty concentrating, experimental and longitudinal investigations provide mixed evidence. The current study addresses this gap by testing a bidirectional relationship between momentary perseverative thought and difficulty concentrating using ecological momentary assessment (EMA) (8 surveys per day for 14 days) with 200 adult community participants (N = 155 with compliance ≥ 70 %) oversampled for moderate/severe perseverative thought. Multilevel modeling tested concurrent and time-lagged associations. Difficulty concentrating and perseverative thought were concurrently and prospectively related within-person: higher difficulty concentrating at T-1 predicted higher perseverative thought at T, and higher perseverative thought at T-1 predicted higher difficulty concentrating at T (β =.19 -.20, p < .001). Findings held when controlling for the outcome at T-1 (β =.02 - .06, p < .001). These findings demonstrate covariation between difficulty concentrating and perseverative thought within-person in daily life consistent with theoretical models that predict bidirectional relationships. Findings suggest that intervening on difficulty concentrating and/or perseverative thought may reduce the "vicious cycle" of perseverative thought episodes.
Fear of positive evaluation and the bivalent fear of evaluation model of social anxiety: An Integration.
Hofmann SG
J Anxiety Disord · 2025 Apr · PMID 39951864 · Publisher ↗
Humans have an inherent need to belong to a social group, and ostracism can lead to significant personal costs. Therefore, the fear of negative evaluation by others, along with its associated consequence of social anxiet...
Humans have an inherent need to belong to a social group, and ostracism can lead to significant personal costs. Therefore, the fear of negative evaluation by others, along with its associated consequence of social anxiety, appears to be evolutionarily adaptive. Numerous studies have demonstrated that social anxiety, as well as its clinical manifestation, social anxiety disorder (SAD), is not only linked to an intense fear of negative evaluation but also to a fear of positive evaluation. This phenomenon has been termed the Bivalent Fear of Evaluation (BFOE) model of social anxiety. While the fear of negative evaluation can be understood from an evolutionary standpoint, the fear of positive evaluation poses a challenge for such an account. Clarifying the relationship between these two fears-positive and negative evaluation-may provide new insights into the nature of social anxiety and SAD. After summarizing and reviewing studies comprising this special issue, I will conclude that any form of evaluative feedback rising self-focused attention-whether positive, negative, or even neutral-can cause distress due to heightened sensitivity to social feedback in general. However, different mechanisms and contextual factors are implicated. In line with cognitive models of SAD, the self and self-perception are central to both social anxiety and SAD. This has significant theoretical and clinical implications.
Why do individuals with generalized anxiety disorder and depression engage in worry and rumination? A momentary assessment study of positive contrast enhancement.
Baik SY, Newman MG
J Anxiety Disord · 2025 Apr · PMID 39947018 · Full text
The contrast avoidance model suggests that individuals with generalized anxiety disorder (GAD) use worry to sustain negative emotionality and thus avoid a sharp increase in negative emotion. Maintenance of negative mood...
The contrast avoidance model suggests that individuals with generalized anxiety disorder (GAD) use worry to sustain negative emotionality and thus avoid a sharp increase in negative emotion. Maintenance of negative mood increases the probability of subsequent decreased negative and increased positive affect (positive emotional contrast; PEC) when worrisome outcomes are better than expected. However, occurrence of PECs via increased positive affect and its application to rumination are unclear. Using a momentary assessment design, we examined effects of worry/rumination on PECs associated with relief and positive events. Participants with GAD and/or major depressive disorder (MDD; N = 76), or without psychopathology (N = 85) rated the occurrence of relief and positive events, emotions, and repetitive thought 8x/day for 8 days. Higher vs. lower worry and rumination were associated with greater decreased anxiety and sadness, and greater increased happiness pre-to-post positive and relief events. Greater GAD and MDD symptoms predicted ongoing higher ratings on intentionally thinking pessimistically to be pleasantly surprised if something good happened. Results suggest that worry/rumination led to enhanced PECs via decreased negative and increased positive affect pre-to-post positive and relief events. Individuals with higher GAD and depression symptoms reported intentionally using worry/rumination to increase PECs in daily life.
The Bivalent fear of evaluation model of social anxiety: The state of the science and future directions.
Weeks JW, De Los Reyes A
J Anxiety Disord · 2025 Apr · PMID 39938212 · Publisher ↗
Abstract loading — click title to view on PubMed.
Understanding emotion dysregulation in PTSD - GAD comorbidity.
Allbaugh LJ, Marinack L, Pickover AM … +4 more , Powers A, Marshall Lee ED, Cloitre M, Kaslow NJ
J Anxiety Disord · 2025 Mar · PMID 39929116 · Full text
Posttraumatic stress disorder (PTSD) frequently co-occurs with myriad mood and anxiety disorders including generalized anxiety disorder (GAD). Despite this comorbidity's prevalence, mechanisms underlying the co-occurrenc...
Posttraumatic stress disorder (PTSD) frequently co-occurs with myriad mood and anxiety disorders including generalized anxiety disorder (GAD). Despite this comorbidity's prevalence, mechanisms underlying the co-occurrence of PTSD and GAD remains understudied. An emotion dysregulation framework routinely is used to understand both PTSD and GAD but has not been applied to the PTSD-GAD comorbidity. Using MANOVA, the present study tested domains of emotion dysregulation (DERS) and of positive emotion regulation (AEQ) as differentiators of PTSD alone versus PTSD with GAD using pre-intervention data from a randomized controlled trial including 292 women with PTSD secondary to interpersonal violence. Five of six emotion dysregulation domains differentiated the two groups: fewer regulation strategies, nonacceptance of emotional responses, impulse control difficulties, lack of emotional awareness, and lack of emotional clarity were associated with comorbidity. Of three positive emotion regulation domains, participants with PTSD alone reported more positive emotionality than those with PTSD and GAD, and those with comorbid PTSD and GAD reported more negative affective interference than those with PTSD only. Rather than specific domains underlying unique presentations, findings indicate a general dysregulation factor, where PTSD-GAD comorbidity is supported by an overall higher level of emotion dysregulation as compared to PTSD alone.
Association of social and life threats with symptoms of posttraumatic stress disorder and social anxiety disorder.
Hardarson JP, Gudmundsdottir B, Jonsson GS … +8 more , Johannesdottir BM, Thorarinsdottir K, Tomasson G, Holmes EA, Hauksdottir A, Valdimarsdóttir U, Asmundson G, Bjornsson AS
J Anxiety Disord · 2025 Mar · PMID 39923688 · Publisher ↗
BACKGROUND: This study examined psychological reactions to perceived threats, viewed within the context of human evolutionary history. We compared the relative weight of perceived threat to life or physical harm versus s...
BACKGROUND: This study examined psychological reactions to perceived threats, viewed within the context of human evolutionary history. We compared the relative weight of perceived threat to life or physical harm versus social threat, i.e., humiliation and/or rejection, in symptoms of posttraumatic stress disorder (PTSD) and social anxiety disorder (SAD). METHODS: Participants were 50 women with clinically significant posttraumatic stress symptoms (PTSS) and 59 women with little or no PTSS (control group) selected from a large, population-based cohort of women in Iceland, the SAGA Cohort. Participants rated (1) life threat, (2) physical threat, (3) humiliation, and (4) rejection during their worst trauma or stressor. RESULTS: Rates of both life and social threats were higher in the PTSS than control group. Among the PTSS participants, 4 % (n = 2) reported primarily life threats (vs. 6.8 %, n = 4 in controls), 36 % (n = 18) reported primarily social threats (vs. 33.9 %, n = 20 in controls), and 60 % (n = 30) reported both types of threats (vs. 15.3 %, n = 9 in controls). Those who reported dual life and social threats exhibited elevated PTSS compared to those who experienced a single type of threat. The highest levels of life or physical threat, along with humiliation, predicted PTSS severity, but rejection did not. Nearly half of the PTSS group (approximately 50 %, n = 25) also met criteria for SAD compared to roughly 14 % (n = 8) in the control group, and humiliation predicted SAD symptom severity. Notably, 18 % of the PTSS group (n = 9) linked the onset of their SAD and PTSS to a singular trauma or stressor involving a social threat. CONCLUSIONS: The findings underscore the role of social threat in PTSD and SAD, with implications for theoretical models of both disorders.
A meta-analytic review of cognitive processing therapy with and without the written account.
Sager JC, DeJesus CR, Kearns JC … +4 more , Thompson-Hollands J, Trendel SL, Marx BP, Sloan DM
J Anxiety Disord · 2025 Mar · PMID 39922105 · Full text
There are two versions of the Cognitive Processing Therapy (CPT) protocol: one that includes a trauma narrative and one that does not. Despite both versions being used in clinical practice, to date, there has not been a...
There are two versions of the Cognitive Processing Therapy (CPT) protocol: one that includes a trauma narrative and one that does not. Despite both versions being used in clinical practice, to date, there has not been a comprehensive comparison of posttraumatic stress disorder (PTSD) treatment outcomes associated with these two protocols. The current study is a meta-analytic review of 29 randomized controlled trials of CPT+A (k = 13) and CPT-C (k = 16) in which we investigated whether there are differences in treatment outcome effect sizes and treatment dropout between the two protocol versions. Sample type (military/veteran versus non-military/non-veteran) as a moderator was examined, given that less robust PTSD treatment outcomes have been typically observed in military and veteran samples. Meta-regression analyses revealed that there were no significant differences between the two CPT protocol versions in pre-post PTSD treatment effect sizes, t(26) = -0.743, p = .463. As expected, studies that enrolled a military or veteran sample reported an average smaller symptom reduction (g = 0.95) than studies that enrolled a non-military or non-veteran sample (g = 1.41), t(26) = 2.48, p = .019. There were also no significant differences between the two CPT protocols for treatment dropout, t(26) = 1.69, p = .104, or between studies enrolling military/veteran and non-military/non-veteran samples t(26) = -1.10, p = .282. The findings support the use of either CPT protocol in practice, but also demonstrate that veterans and service members may be less responsive to either CPT protocol than other trauma samples.
Emotional growth mindsets and stress controllability buffer the link between stress intensity and anxiety symptoms: An ecological momentary assessment study.
Hu J, Liu J, Meng M … +1 more , Gan Y
J Anxiety Disord · 2025 Mar · PMID 39919436 · Publisher ↗
Anxiety is highly prevalent among adults. Evidence suggests that perceived stress controllability and emotional growth mindsets are associated with decreased anxiety. However, whether these positive factors synergistical...
Anxiety is highly prevalent among adults. Evidence suggests that perceived stress controllability and emotional growth mindsets are associated with decreased anxiety. However, whether these positive factors synergistically contribute to reducing the impact of stress on anxiety remains unclear, especially within everyday stress contexts. Multilevel models were used to investigate how perceived stress controllability and emotional growth mindsets interacted to mitigate the adverse impact of daily stress on anxiety, differentiating within- and between-person effects. Overall, 198 participants completed ecological momentary assessments of perceived stress intensity and controllability, emotional growth mindsets, and anxiety four times daily over 10-12 consecutive days. The within-person analyses showed that high emotional growth mindsets buffer the link between perceived stress intensity and anxiety. More importantly, the between-person and cross-level results suggested that the synergistic effect of emotional growth mindsets and perceived stress controllability maximally buffered the correlation between perceived stress intensity and anxiety. Additionally, these results highlighted that the positive association between perceived stress intensity and anxiety was most pronounced among participants with low emotional growth mindsets and perceived stress controllability. These findings further support a synergistic intervention approach that emphasizes anxiety alleviation through enhanced perceived stress controllability and the development of emotional growth mindsets.
Development of a machine learning-based multivariable prediction model for the naturalistic course of generalized anxiety disorder.
Basterfield C, Newman MG
J Anxiety Disord · 2025 Mar · PMID 39904097 · Full text
BACKGROUND: Generalized Anxiety Disorder (GAD) is a chronic condition. Enabling the prediction of individual trajectories would facilitate tailored management approaches for these individuals. This study used machine lea...
BACKGROUND: Generalized Anxiety Disorder (GAD) is a chronic condition. Enabling the prediction of individual trajectories would facilitate tailored management approaches for these individuals. This study used machine learning techniques to predict the recovery of GAD at a nine-year follow-up. METHOD: The study involved 126 participants with GAD. Various baseline predictors from psychological, social, biological, sociodemographic and health variables were used. Two machine learning models, gradient boosted trees, and elastic nets were compared to predict the clinical course in participants with GAD. RESULTS: At nine-year follow-up, 95 participants (75.40 %) recovered. Elastic nets achieved a cross-validated area-under-the-receiving-operator-characteristic-curve (AUC) of .81 and a balanced accuracy of 72 % (sensitivity of .70 and specificity of .76). The elastic net algorithm revealed that the following factors were highly predictive of nonrecovery at follow-up: higher depressed affect, experiencing daily discrimination, more mental health professional visits, and more medical professional visits. The following variables predicted recovery: having some college education or higher, older age, more friend support, higher waist-to-hip ratio, and higher positive affect. CONCLUSIONS: There was acceptable performance in predicting recovery or nonrecovery at a nine-year follow-up. This study advances research on GAD outcomes by understanding predictors associated with recovery or nonrecovery. Findings can potentially inform more targeted preventive interventions, ultimately improving care for individuals with GAD. This work is a critical first step toward developing reliable and feasible machine learning-based predictions for applications to GAD.
Is metacognitive therapy really non-inferior to exposure with response prevention in obsessive-compulsive disorder? - Methodological issues of non-inferiority testing.
Leichsenring F, Heim N, Steinert C
J Anxiety Disord · 2025 Mar · PMID 39893976 · Publisher ↗
There is evidence that exposure and response prevention (ERP) is efficacious in the treatment of obsessive-compulsive disorder (OCD). As an alternative to ERP metacognitive therapy (MCT) was developed. Two previous rando...
There is evidence that exposure and response prevention (ERP) is efficacious in the treatment of obsessive-compulsive disorder (OCD). As an alternative to ERP metacognitive therapy (MCT) was developed. Two previous randomized controlled trials (RCTs) did not find significant differences between MCT and ERP. However, from non-significant results, non-inferiority of a treatment cannot be concluded. For this purpose, non-inferiority studies are required. Exner and colleagues carried out such a non-inferiority study whose results were recently published in this journal. The authors concluded from their results that MCT is a viable alternative treatment with efficacy similar to the standard ERP. However, this study raises several concerns, among them problems of transparency and of non-inferiority testing. These issues are critically discussed here in more detail. Taking all of these issues into account, the conclusions that can be drawn from the available studies are less clear. Further research is needed to decide whether MCT can really be considered as non-inferior to ERP or even as efficacious at all. Future studies need to fulfill the criteria of non-inferiority trials, that is (a) a priori define and (b) empirically justify a non-inferiority margin, (c) a preregistered sample size calculation ensuring a sufficient statistical power to confirm non-inferiority of the test treatment and (d) include a non-active control condition against which the standard and the test treatment are tested. Recommending a treatment prematurely as non-inferior to a standard treatment may prevent patients from receiving the most efficacious treatment.
Choosing certainty over risk: Associations of PTSD symptom severity with memory sampling during experiential decision making.
Verfaellie M, Patt V, Lafleche G … +2 more , Jones D, Vasterling JJ
J Anxiety Disord · 2025 Mar · PMID 39889322 · Full text
The current study sought to examine whether lifetime PTSD symptom severity is associated with a bias toward sampling extreme negative events from memory when making decisions involving uncertainty. To this end, 40 trauma...
The current study sought to examine whether lifetime PTSD symptom severity is associated with a bias toward sampling extreme negative events from memory when making decisions involving uncertainty. To this end, 40 trauma-exposed warzone veterans performed a decision task in which information about outcomes was learned through experience and making choices required sampling memories of past experiences. On each trial, participants made choices between certain and uncertain gains and between certain and uncertain losses. Uncertain outcomes were equally likely to yield a relatively positive or relatively negative outcome. After accounting for overall willingness to take risks, lifetime PTSD symptom severity was associated with less frequent choice of the uncertain option for gains and for losses, a pattern consistent with a memory sampling bias for all negative experiences rather than only extreme negative experiences. The overweighting of negative experiences as a function of lifetime PTSD symptom severity, however, was not observed in a subsequent explicit memory task in which participants estimated the frequency with which different outcomes had occurred during the decision task. These findings suggest that the memory mechanism responsible for the PTSD-associated memory bias in decision making is distinct from that mediating explicit memory performance.
A comparison of virtual reality and verbal imaginal exposure for childhood anxiety disorders.
Biggs BK, Whiteside SPH, Knutson M … +7 more , Seifert S, Hofschulte DR, Geske JR, Lass AN, Vickers KS, Gloe LM, Reneson-Feeder ST
J Anxiety Disord · 2025 Mar · PMID 39879857 · Full text
Virtual reality is a promising tool for improving efficacy of exposure therapy for childhood anxiety disorders (CADs), particularly for exposures that are challenging to orchestrate in vivo. The present study compared vi...
Virtual reality is a promising tool for improving efficacy of exposure therapy for childhood anxiety disorders (CADs), particularly for exposures that are challenging to orchestrate in vivo. The present study compared virtual reality exposure (VRE) to verbal imaginal exposure (IE) on anxiety elicited, homework completion, and preparation for subsequent exposures. Forty-five youth with CADs completed both types of exposure in session (order randomly assigned), practiced one form of exposure as homework (randomly assigned), and returned a week later to repeat both exposures (in randomized order), provide user feedback, and complete a related in vivo exposure. Both VRE and IE elicited moderate anxiety that decreased to mild during the exposure and were associated with lower initial anxiety ratings in subsequent exposures. These patterns did not differ across exposure type. The two techniques did not differ on homework completion. VRE was associated with greater simulator (motion) sickness symptoms. Participants rated VRE as more realistic than IE and noted pros and cons for both approaches. The present study supported use of VRE and IE in treatment of CADs without demonstrating superiority of either technique in effectiveness or homework completion.
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