J Anxiety Disord [JOURNAL]
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200 papers
Positive and negative affect influence learning during exposure therapy: Secondary analysis from a randomized controlled trial.
Rosenberg BM, Treanor M, Zbozinek TD … +3 more , Sandman CF, Sewart A, Craske MG
J Anxiety Disord · 2026 Jun · PMID 42379132 · Publisher ↗
OBJECTIVE: The Inhibitory Retrieval model of exposure therapy emphasizes expectancy change as a core mechanism of treatment. Evidence suggests important roles for both positive and negative affect during exposure therapy...
OBJECTIVE: The Inhibitory Retrieval model of exposure therapy emphasizes expectancy change as a core mechanism of treatment. Evidence suggests important roles for both positive and negative affect during exposure therapy. The current study assesses the extent to which positive and negative affect moderate expectancy change during exposure therapy. METHOD: N = 77 adults with either social anxiety disorder or panic disorder completed a nine-session exposure therapy protocol: n = 41 were randomized to exposure therapy based on principles of extinction learning (Inhibitory Retrieval condition), during which they rated expectancy of an aversive outcome before and after each exposure; and n = 36 participants were randomized to exposure focused on fear reduction (Habituation condition), during which they rated subjective experiences of fear before and after each exposure. The Positive and Negative Affect Schedule (past month) was collected at baseline, mid-treatment and post-treatment. RESULTS: In the Inhibitory Retrieval condition, positive and negative affect each moderated the relationship between pre- and post-expectancy. Specifically, individuals with low positive affect relative to their own mean (p = .029) or high negative affect relative to other individuals (p < .001) reduced expectancies less when pre-expectancy was high. In the Habituation condition, neither positive nor negative affect moderated the relationship between pre- and post-exposure fear. CONCLUSIONS: Affect moderates expectancy change during exposure therapy modeled using Inhibitory Retrieval, such that higher negative affect and lower positive affect are associated with less expectancy change. Considering the historical emphasis on reducing negative affect, models of exposure therapy may additionally incorporate strategies to increase positive affect to maximize expectancy change.
A network analysis of disgust proneness in a clinical, adolescent sample: Implications for the treatment of OCD.
Olatunji BO, Cusack CE, Levinson CA
J Anxiety Disord · 2026 Jun · PMID 42330590 · Publisher ↗
Although disgust proneness has been implicated in the development of obsessive-compulsive disorder (OCD), studies to date have failed to identify the core symptom of disgust proneness that may be most strongly associated...
Although disgust proneness has been implicated in the development of obsessive-compulsive disorder (OCD), studies to date have failed to identify the core symptom of disgust proneness that may be most strongly associated with OCD and its treatment. Accordingly, we used network analysis to examine which symptoms are most central to disgust proneness and the extent to which such symptoms predicted OCD symptoms before and after treatment. Adolescent participants (N = 434) in a residential treatment program for severe OCD, anxiety, and mood disorders completed pre- and post-treatment measures of OCD, disgust proneness, and general mood symptoms. Network analysis was used to identify the most central symptoms (nodes) and associations between symptoms (edges) of disgust proneness. The results revealed that the most central indicator in the pre- and post-treatment network were symptoms of 'animal-reminder disgust' (i.e., seeing blood in meat at the grocery store) that remind humans of their own mortality and bodily vulnerability. However, the pre- and post-treatment networks did not significantly differ (i.e., no network invariance). Accounting for OCD diagnostic status, animal-reminder disgust symptoms that were central in the network accounted for significant variance in OCD and general mood symptoms at pre- and post-treatment. These findings suggest that aversion towards animal-reminder cues are central symptoms of disgust proneness that may have predictive validity. The implications of these findings for conceptualizing theoretical and treatment models of disgust proneness in OCD are discussed.
High sensitivity, low specificity: Validation and diagnostic accuracy study of the PCL-5 in an Arabic-speaking treatment-seeking sample.
Pettrich A, Geiling A, Böhm M … +5 more , Glaesmer H, Knaevelsrud C, Wagner B, Nesterko Y, Böttche M
J Anxiety Disord · 2026 Jun · PMID 42314405 · Publisher ↗
BACKGROUND: The PTSD Checklist for DSM-5 (PCL-5) is widely used to assess posttraumatic stress disorder (PTSD), yet validation in Arabic-speaking populations remains limited, and no guideline-based cutoff scores have bee...
BACKGROUND: The PTSD Checklist for DSM-5 (PCL-5) is widely used to assess posttraumatic stress disorder (PTSD), yet validation in Arabic-speaking populations remains limited, and no guideline-based cutoff scores have been established. This study evaluated the structural validity, reliability, and diagnostic performance of the Arabic PCL-5 in a large treatment-seeking sample. METHODS: As part of a broader treatment study, a total of 1140 participants from across the Southwest Asia and North Africa (SWANA) region completed the Arabic PCL-5 among other measures. PTSD diagnoses were established via the SCID-5-CV interview. Exploratory and confirmatory factor analyses assessed dimensionality. Reliability, convergent validity, and diagnostic utility were evaluated along STARD guidelines, with emphasis on ROC analyses and cutoff performance. RESULTS: The Anhedonia model fit the data acceptably, with good to excellent internal consistencies. ROC analyses indicated moderate diagnostic utility (AUC = 0.658), with no cutoff achieving both high sensitivity and specificity. Lower cutoffs (31-33) maximized sensitivity (0.87-0.89) and positive predictive values (0.78-0.81), while a cutoff of 38 offered a more balanced compromise (sensitivity: 0.799, specificity: 0.419). The PCL-5 algorithm performed worse than optimized cutoffs. DISCUSSION: The Arabic PCL-5 shows strong structural validity and reliability and is suitable for screening within a stepped-care approach. Its limited diagnostic accuracy likely reflects effects of the spectrum bias, sample heterogeneity and methodological differences between self-report and interviews. Based on this study, the PCL-5 is recommended for symptom monitoring and screening with clinical follow-up rather than as a stand-alone diagnostic tool in Arabic-speaking treatment-seeking individuals.
Symptom trajectories in intensive outpatient treatment exposure and response prevention for obsessive-compulsive disorder.
Qiu T, Tang M, Rogers K … +2 more , Hadlock S, Lin T
J Anxiety Disord · 2026 Jun · PMID 42302424 · Publisher ↗
BACKGROUND: Intensive Outpatient Program Exposure and Response Prevention (IOP EX/RP) is a highly effective intervention for obsessive-compulsive disorder (OCD), especially for those with greater support needs than outpa...
BACKGROUND: Intensive Outpatient Program Exposure and Response Prevention (IOP EX/RP) is a highly effective intervention for obsessive-compulsive disorder (OCD), especially for those with greater support needs than outpatient therapy but less than residential treatment. However, patients exhibit heterogeneity in their treatment response to IOP EX/RP. This study aimed to characterize distinct patterns of obsessive-compulsive symptom change during IOP EX/RP and to identify clinical predictors of trajectory membership. METHODS: We explored weekly obsessive-compulsive symptom trajectories among 566 adults who had a diagnosis of OCD and received IOP EX/RP treatment. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was conducted at each week to assess patients' OCD symptoms. We conducted latent growth mixture modeling to explore the patterns of OCD symptom change across eight weeks of IOP EX/RP. Demographic characteristics, treatment modality, and psychiatric comorbidity were evaluated as predictors of trajectory membership using multinomial logistic regression. RESULTS: Three distinct symptom trajectories emerged during the eight weeks of IOP, including a slow improvement trajectory (64.3%) characterized by gradual symptom reduction, a rapid improvement trajectory (22.3%) marked by pronounced gains, and a worsening trajectory (13.4%) characterized by symptom worsening over the same treatment window. Anxiety-, mood-, and OCD-related comorbidities significantly predicted less favorable early trajectories. CONCLUSIONS: Despite the overall effectiveness of IOP EX/RP, patients follow distinct trajectories of symptom change during eight weeks of IOP EX/RP, evidencing the heterogeneity in affective and behavioral responses to evidence-based treatment. The findings underscore the importance of trajectory-informed monitoring to support personalized and adaptive treatment in intensive OCD care.
A continuum is not a hammer: Response to Lowell and Markowitz (2026) on the exposure continuum model.
Rubinstein D, Korem N, Bullard DG … +1 more , Harpaz-Rotem I
J Anxiety Disord · 2026 Jun · PMID 42297653 · Publisher ↗
The Exposure Continuum Model (ECM; Rubinstein et al., 2026) is a framework for identifying and measuring the exposure component across diverse trauma-centered psychotherapies. We respond to Lowell and Markowitz's (2026)...
The Exposure Continuum Model (ECM; Rubinstein et al., 2026) is a framework for identifying and measuring the exposure component across diverse trauma-centered psychotherapies. We respond to Lowell and Markowitz's (2026) commentary on the ECM, which raises important concerns about exposure-centrism in PTSD treatment, concerns we share. However, their commentary critiques a claim the ECM does not make: that exposure is the sole mechanism of PTSD recovery or that this component supersedes other therapeutic processes. We clarify what the ECM does and does not claim, address the extended discussion of Interpersonal Psychotherapy, and argue that identifying a component is not equivalent to replacing a therapy's theory of change. We welcome this debate as part of building shared, empirically testable language for trauma treatment research. The ECM advances this effort by operationalizing two exposure dimensions, Closeness and Standardized Cumulative Dose, which can be empirically tested across treatment modalities.
Autobiographical reasoning following the November 2015 Paris attacks: To the roots of meaning-making.
Mengin AC, Quibeuf L, Orselli P … +9 more , Dayan J, Laisney M, Heiden S, Peschanski D, Gagnepain P, Vidailhet P, Berna F, Eustache F, Quinette P
J Anxiety Disord · 2026 Jun · PMID 42296636 · Publisher ↗
INTRODUCTION: Autobiographical reasoning is the mental process of making sense of life experiences by connecting them to one's sense of self and life story. After a traumatic event, individuals may engage in ruminations...
INTRODUCTION: Autobiographical reasoning is the mental process of making sense of life experiences by connecting them to one's sense of self and life story. After a traumatic event, individuals may engage in ruminations and coping strategies but the relations between these processes and autobiographical reasoning remain poorly understood. Furthermore, autobiographical reasoning encompasses several dimensions that may reflect different mental health outcomes. Our objectives are to compare three dimensions of autobiographical reasoning (interpretations, exploratory processing, and meaning-making) between exposed and non-exposed individuals after a traumatic event and to examine their links to (1) ruminations and coping strategies and (2) post-traumatic mental health outcomes. METHODS: We analyzed autobiographical reasoning levels in the narratives of 153 individuals (86 exposed and 67 non-exposed) 8-11 months after the November 13, 2015, attacks in Paris and Saint-Denis using a semi-automated approach. We explored the association of each autobiographical reasoning dimension (measured on 4-levels Likert scales) with ruminations (brooding or reflection), four coping strategies, post-traumatic stress symptoms (PTSS), post-traumatic growth and well-being, measured by self-administered scales. RESULTS: Exposed participants showed greater levels of autobiographical reasoning across all dimensions, with the strongest effect for meaning-making. Among the exposed participants, interpretations were positively related to reflection and adaptive coping, and negatively to brooding. Exploratory processing was positively related to reflection and PTSS, and negatively to well-being. Meaning-making was positively related to adaptive coping and post-traumatic growth. CONCLUSIONS: While traumatic events generate intense autobiographical reasoning in those exposed, identifying the different dimensions it encompasses in trauma narratives is critical, as they reveal specific issues, from higher distress and ruminations to higher adaptive coping and growth.
Emotional body odors alter autonomic nervous activity during mindfulness training in social anxiety.
Dal Bò E, Cecchetto C, Zurlo L … +11 more , Lavezzo L, Eliasson ET, Vigna E, Scilingo EP, Greco A, Nardelli M, Di Francesco F, Hadlaczky G, Lundström JN, Carli V, Gentili C
J Anxiety Disord · 2026 Jun · PMID 42287960 · Publisher ↗
Chemosignals found in human body odors (BOs) convey information about a person's emotional state and elicit observable responses in others. While mindfulness typically enhances parasympathetic tone and reduces anxiety, l...
Chemosignals found in human body odors (BOs) convey information about a person's emotional state and elicit observable responses in others. While mindfulness typically enhances parasympathetic tone and reduces anxiety, little is known about how BOs modulate these effects. This study investigated how emotional and non-emotional human BOs influence autonomic nervous system activity - heart rate variability (HRV) and electrodermal activity (EDA) - during mindfulness practice in individuals with social anxiety. The role of baseline HRV as a predictor of intervention outcome was explored. Ninety-eight women with social anxiety received two mindfulness sessions over two consecutive days, while allocated to one of four conditions: fear BO, happiness BO, neutral BO, clean air. Due to technical issues, final samples were reduced (n = 69-85 per analysis). Individuals in the fear and happiness BOs conditions, but not those in the neutral BO and clean air conditions, showed HRV reduction during the mindfulness. EDA decreased in all conditions on day 1, but on day 2, only the clean air and neutral BO groups maintained this reduction. Baseline HRV predicted the magnitude of anxiety reduction in the fear BO group; participants with higher initial HRV exhibited greater anxiety reduction. No associations were found for other odor conditions. These results suggest that emotional BOs, particularly fear BO, may enhance mindfulness efficacy by creating a socially salient and ecologically valid context. For socially anxious individuals, practicing mindfulness under a subtle social-emotional challenge may train adaptive regulation. Baseline HRV emerges as a biomarker of such regulatory flexibility and intervention responsiveness.
Pre-deployment sleep duration predicts longitudinal posttraumatic stress disorder symptom trajectories in US Army soldiers deployed to the Iraq war zone.
Bottari SA, Pless Kaiser A, Lee LO … +2 more , Aslan M, Vasterling JJ
J Anxiety Disord · 2026 Jun · PMID 42284953 · Publisher ↗
War zone deployment increases risk for posttraumatic stress disorder (PTSD) symptoms, but symptom development and course varies across individuals. Thus, identifying modifiable pre-exposure risk and protective factors is...
War zone deployment increases risk for posttraumatic stress disorder (PTSD) symptoms, but symptom development and course varies across individuals. Thus, identifying modifiable pre-exposure risk and protective factors is critical to improving prevention. Pre-exposure sleep is a modifiable factor known to influence risk for PTSD development, but its relationship to the long-term course of PTSD symptoms remains unclear. In the present study, we examined pre-deployment sleep duration as a predictor of longitudinal PTSD symptom trajectories in 1059 US Army soldiers who deployed to Iraq and were followed prospectively from pre-deployment to > 5 years post-deployment. Participants self-reported sleep duration prior to deployment. PTSD symptom trajectories (asymptomatic, mild, post-deployment worsening, high chronic) were previously established using latent growth mixture modeling based on PTSD Checklist-Civilian Version summary scores obtained at pre-deployment and multiple post-deployment assessments. Multinomial logistic regression was used in the current study to examine associations of pre-deployment sleep duration with odds of membership in the four PTSD trajectory classes after adjusting for relevant covariates. Results indicated that participants with one additional hour of pre-deployment sleep were 1.27 times more likely to belong in the asymptomatic trajectory class than the post-deployment worsening trajectory class (OR=0.79, 95% CI: 0.63-0.98). Effects on high chronic (OR=0.87, 95% CI: 0.75-1.02) and mild (OR=0.91, 95% CI: 0.78-1.06) trajectory class membership were non-significant. Findings suggest an association between pre-deployment sleep duration and post-deployment development and worsening over time of PTSD symptoms, highlighting pre-deployment sleep as a potentially important factor to consider when assessing risk for post-deployment PTSD onset and worsening.
An online single-session intervention for intrusive thoughts in young adults: Preliminary findings.
Serody MR, Beatty CC, Szkody E … +2 more , Schleider JL, Mohanty A
J Anxiety Disord · 2026 Jun · PMID 42259130 · Publisher ↗
Intrusive thoughts are prevalent across the lifespan and can be particularly distressing during adolescence and young adulthood. Despite their high prevalence, many individuals lack access to effective strategies for man...
Intrusive thoughts are prevalent across the lifespan and can be particularly distressing during adolescence and young adulthood. Despite their high prevalence, many individuals lack access to effective strategies for managing these thoughts. Brief, accessible, and evidence-based interventions are needed to help individuals cope with intrusive thought-related distress. The present study aimed to pilot the effectiveness of a brief online Acceptance and Commitment Therapy (ACT)-based single-session intervention (SSI) that provided psychoeducation on intrusive thoughts and strategies for managing distress arising from negative appraisals in young adults. We recruited individuals aged 18-25 who reported that they experienced distressing thoughts in the last week. Distress associated with intrusive thoughts and hopelessness was measured at pre-intervention, post-intervention, and at two-week follow-up. Within-subject ANOVAs revealed significant reductions in intrusive thought-related distress and hopelessness from pre- to post-intervention across all time points for both groups. The active SSI group had a significant reduction in distress compared to the active control group. There were no other significant interaction effects observed, either when considering hopelessness or at the follow-up time point. These preliminary findings highlight the importance of single-session interventions in helping youth understand and cope with intrusive thoughts. Future research should explore the relative contributions of different intervention components and the long-term effects on mental health outcomes.
Mapping relative proximity within an internalizing symptoms network.
Reimann GE, Allee B, Derr T … +6 more , Jeong HJ, Archer C, Durham EL, Ellis KE, Chang C, Kaczkurkin AN
J Anxiety Disord · 2026 Jun · PMID 42251811 · Publisher ↗
Understanding how symptom domains relate to one another (e.g., whether generalized anxiety is more similar to depression than to panic) is central to psychiatric classification. We demonstrate a procedure for quantifying...
Understanding how symptom domains relate to one another (e.g., whether generalized anxiety is more similar to depression than to panic) is central to psychiatric classification. We demonstrate a procedure for quantifying relative proximity, defined as whether one symptom domain is statistically closer to another compared to other domains. As a motivating application, we examine the structure of internalizing symptoms characterized by fear, distress, avoidance, and heightened arousal. Using a network approach, we analyzed data from six questionnaires assessing depression, generalized anxiety disorder (GAD), social anxiety disorder, panic disorder, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD) symptoms. In a community sample of young adults (n = 2051; ages 17-23), we estimated a symptom-level Gaussian graphical model, used community detection to characterize the network's modular structure, and derived shortest path length to quantify the relative proximity of predefined symptom domains. We then used permutation testing to determine whether distress-related symptom domains (depression, GAD, and PTSD) showed greater empirical proximity to one another compared to fear-related domains (social anxiety, panic, and OCD). Results indicated reciprocal proximity between the depressive and GAD symptom domains compared to other internalizing domains. PTSD showed its greatest relative proximity to depression and GAD. Panic, social anxiety, and OCD did not form a cohesive fear community and showed variable relative proximity to both distress- and fear-related domains. Overall, these findings lend support for a distress-based internalizing dimension encompassing depression, GAD, and possibly PTSD, while providing limited evidence for a fear-based dimension including social anxiety, panic, and OCD.
Posttraumatic cognitions and PTSD symptom change in massed prolonged exposure: The impact of treatment delivery on mechanisms of change.
Burton M, Haft S, Fiskeaux M … +3 more , Rothbaum BO, Loucks L, Rauch SAM
J Anxiety Disord · 2026 May · PMID 42247921 · Publisher ↗
BACKGROUND: Prolonged Exposure (PE) is an effective treatment for PTSD and clarification of mechanisms of change can inform training and continued improvements. Posttraumatic cognitions have been shown to predict subsequ...
BACKGROUND: Prolonged Exposure (PE) is an effective treatment for PTSD and clarification of mechanisms of change can inform training and continued improvements. Posttraumatic cognitions have been shown to predict subsequent symptom change in PTSD treatment. The objective of the current study was to examine how cognitions related to symptom change in massed-delivered PE. METHODS: The current study used cross-lagged regression analyses to examine the relationship between change in posttraumatic cognitions and PTSD and depression severity in a two-week massed PE program for Veterans with PTSD. RESULTS: Results showed that PTSD symptom change predicted subsequent posttraumatic cognition change but posttraumatic cognition change did not predict subsequent PTSD symptom change. Depression severity and posttraumatic cognition change showed a reciprocal relationship where both predicted subsequent change in the other. CONCLUSIONS: These findings suggest that when PE is delivered in a massed format, rapid PTSD symptom change may occur through different mechanisms of change compared to weekly delivered PE.
Still fearing the unknown: Development and initial validation of an ultra-brief intolerance of uncertainty scale.
Carleton RN, Teckchandani TA, Norton PJ … +1 more , Asmundson GJG
J Anxiety Disord · 2026 May · PMID 42229033 · Publisher ↗
The 12-item Intolerance of Uncertainty Scale (IUS-12) is a widely used measure in anxiety disorders research and clinical practice, although recent research efforts have recommended the development of a briefer measure t...
The 12-item Intolerance of Uncertainty Scale (IUS-12) is a widely used measure in anxiety disorders research and clinical practice, although recent research efforts have recommended the development of a briefer measure to reduce response burdens. The current study was designed to develop a short form of the IUS-12. We administered the IUS-12 to two samples (cross-sectional, n = 3952; longitudinal, n = 190) of Canadian Public Safety Personnel through an online self-report survey. Exploratory (EFA) and confirmatory (CFA) factor analyses assessed the factor structure of the IUS-12 and facilitated item reduction and optimization. Convergent and concurrent validity, as well as pre-post rank-order consistency were also assessed. The IUS-12 was reduced to a two-factor, six-item short form (i.e., IUS-6) that retains the factor structure of the IUS-12 with statistically comparable validity and consistency, which appears to retain the intended latent content for each subscale. Very strong statistically significant positive correlations were observed between IUS-6 and IUS-12 subscales (rs = .90-.94) and total scores (r = .95) for all samples, suggesting excellent construct validity. Moderate to strong statistically significant associations were also observed among the IUS-6 and IUS-12 total and subscales and measures of generalized anxiety, social anxiety, and anxiety sensitivity, suggesting good convergent validity (rs = .23-.64), with only small differences in correlation strengths (i.e., r < .14). The IUS-6 may be used as an ultra-short version of the IUS-12 for assessing self-reported intolerance of uncertainty in both cross-sectional and longitudinal research designs, potentiating reduced response burdens, which may be important in various research and clinical settings.
A pragmatic randomized trial of brief clinician- and web-administered skills training in affective and interpersonal regulation (STAIR) for posttraumatic stress disorder in safety net primary care.
Valentine SE, Alshabani N, Gil J … +6 more , Godfrey L, Oblath R, Fuchs C, Elwy AR, Fortuna LR, Cloitre M
J Anxiety Disord · 2026 Jul · PMID 42190295 · Publisher ↗
Brief, effective treatments for posttraumatic stress disorder (PTSD) may broaden access to treatment. Brief treatments may fit well within stepped care approaches to treatment, reserving more intensive therapies for thos...
Brief, effective treatments for posttraumatic stress disorder (PTSD) may broaden access to treatment. Brief treatments may fit well within stepped care approaches to treatment, reserving more intensive therapies for those who need them. To assess a first step option for PTSD treatment, we randomized primary care patients to one of two brief formats of Skills Training in Affective and Interpersonal Regulation (STAIR), a psychoeducation and coping skills treatment. Participants were randomized to a clinician (Brief STAIR) or web (webSTAIR) administered version of the treatment. Patients were recruited from primary care clinics that primarily serve low income, publicly insured, and racial and ethnic-minoritized patients. The primary clinical outcome, change in PTSD symptom severity, was assessed using the PTSD Checklist for the DSM-5 (PCL-5) administered at 0, 3, and 9 months. We used linear mixed models for intent to treat analysis (N = 60), imputing missing data with most recent available values. ANCOVA was used to analyze the main effects of treatment. Participants reported significant improvements in PTSD symptoms with large effect sizes (partial η) at 3 (0.57) and 9 months (0.56), as well as large effect sizes for improvements in overall mental functioning (0.19) and depression (0.18) at 9 months, measured by the Brief Symptom Inventory (BSI-18). There was a large effect for group differences in retention (Brief STAIR [73%] > webSTAIR [30%]; η2 = 0.28). Though inferior to Brief STAIR retention, webSTAIR retention was higher than most digital mental health interventions. Treatments may be suitable early step treatments.
Perfectionism as a transdiagnostic process in depression and generalized anxiety disorder: Evidence from a longitudinal study of young women.
Zotschew T, Claus N, Egan SJ … +5 more , Shafran R, Ehring T, Takano K, Limburg K, Cludius B
J Anxiety Disord · 2026 Jul · PMID 42190294 · Publisher ↗
Perfectionism has been proposed as a transdiagnostic process in the development and maintenance of various mental disorders, including major depressive disorder and generalized anxiety disorder (GAD). Although the relati...
Perfectionism has been proposed as a transdiagnostic process in the development and maintenance of various mental disorders, including major depressive disorder and generalized anxiety disorder (GAD). Although the relationship between perfectionism and depression is well established, longitudinal studies examining the presence and direction of effects between perfectionism and GAD remain scarce. This study investigates temporal relations between perfectionism and depressive and GAD symptoms in a 12-month longitudinal design. A community sample of 499 women aged 18-30 years completed measures of perfectionistic concerns, perfectionistic strivings, and depressive and GAD symptoms in a three-wave online study. Structural equation modeling with a cross-lagged panel design revealed that perfectionistic concerns predicted subsequent depressive and GAD symptoms and vice versa, indicating a reciprocal relationship. Contrary to our hypothesis, perfectionistic strivings did not predict depressive symptoms, suggesting that perfectionistic strivings may not necessarily be a vulnerability factor for depression. GAD symptoms predicted subsequent perfectionistic strivings, implying that individuals with elevated anxiety may subsequently engage in striving for high standards, potentially as a coping strategy. Our findings support the transdiagnostic relevance of perfectionism. Importantly, our study provides more evidence on the understudied temporal relationship of perfectionism and GAD.
Can positive affect buffer PTSD?: A comparison of dynamic networks during active conflict versus relative calm in war-exposed civilians.
McGhie SF, Herzog P, Dicker-Oren SD … +2 more , Gelkopf M, Greene T
J Anxiety Disord · 2026 Jul · PMID 42176662 · Publisher ↗
In conflict-affected regions, civilians are often exposed to traumatic events, leading to acute stress reactions and possibly posttraumatic stress disorder (PTSD). While negative emotions during and shortly after trauma...
In conflict-affected regions, civilians are often exposed to traumatic events, leading to acute stress reactions and possibly posttraumatic stress disorder (PTSD). While negative emotions during and shortly after trauma are known predictors of PTSD, the role of positive affect as a potential protective factor remains underexplored. This study examines PTSD symptoms and positive affect in 65 participants during two distinct periods: acute conflict (2014 Israel-Gaza war) and 3.5 years later during relative calm. Using two-step multilevel longitudinal network analysis, we examined how temporal and contemporaneous relationships between PTSD symptom clusters and positive affect differ between periods. Results revealed significant predictive relationships during conflict that were absent at follow-up in the temporal networks. Notably, positive affect predicted reduced severity in negative cognitions and mood during conflict (partial r = -.24 contemporaneously; b = -.1 temporally), suggesting a possible protective role under acute stress. Arousal predicted other PTSD symptom clusters in the temporal network during conflict (b =.01 -.08). These findings highlight the importance of studying peritraumatic dynamics to better understand resilience and risk in trauma-exposed populations.
Phase-based treatment versus immediate prolonged exposure for childhood abuse-related PTSD: The role of emotion regulation improvement in predicting PTSD symptom reduction.
Oprel DAC, Hoeboer CM, de Kleine RA … +3 more , Schoorl M, Does WV, Minnen AV
J Anxiety Disord · 2026 Jul · PMID 42140099 · Publisher ↗
OBJECTIVE: Among phase-based treatments for adults with childhood abuse-related posttraumatic stress disorder (CA-PTSD), one commonly used format combines Skills Training for Affective and Interpersonal Regulation (STAIR...
OBJECTIVE: Among phase-based treatments for adults with childhood abuse-related posttraumatic stress disorder (CA-PTSD), one commonly used format combines Skills Training for Affective and Interpersonal Regulation (STAIR) in the first half of treatment with trauma-focused treatment (Prolonged Exposure; PE) in the second half. The present study tested two key assumptions of this format: that STAIR improves Emotion Regulation (ER) more than PE in the first half of treatment, and that such ER improvement predicts greater PTSD symptom reduction during PE in the second half. METHOD: Participants with CA-PTSD (N = 96) were randomly assigned to phase-based treatment (8 STAIR sessions followed by 8 PE sessions; n = 49) or PE-only (16 PE sessions; n = 47). Both treatments consisted of 16 weekly sessions. ER difficulties and PTSD symptoms were assessed every session. Mixed-effects models were used to compare ER change during sessions 1-8 (STAIR vs PE) and to examine whether this change predicted PTSD symptom change in sessions 9-16. RESULTS: Both treatments resulted in significant ER improvements during Sessions 1-8 and PTSD symptom reductions during Sessions 9-16, with no significant difference between treatment conditions. Neither ER difficulty changes during sessions 1-8 nor mid-treatment ER difficulties predicted PTSD symptom change during sessions 9-16, and ER did not mediate treatment effects. CONCLUSION: These findings do not support the assumptions underlying phase-based treatment that ER skills training enhances ER beyond PE or that ER improvement contributes to subsequent PTSD symptom reduction, indicating that adults with CA-PTSD may benefit equally from starting PE immediately.
The self through the social mirror: Negative updating of self beliefs in social anxiety disorder.
Klein Z, Zabag R, Hay DE … +3 more , Doron A, Gilboa-Schechtman E, Levy-Gigi E
J Anxiety Disord · 2026 Jul · PMID 42134286 · Publisher ↗
Social anxiety disorder (SAD) is a highly prevalent and impairing condition characterized by negative self-beliefs and interpersonal difficulties. Enhanced updating of self-beliefs in response to negative social feedback...
Social anxiety disorder (SAD) is a highly prevalent and impairing condition characterized by negative self-beliefs and interpersonal difficulties. Enhanced updating of self-beliefs in response to negative social feedback is theorized to play a critical role in the persistence of SAD. A widely established framework in personality psychology, the "Big Two" suggests that the dimensions of agency and communion underlie the structure of self-beliefs. Previous research that overlooks this distinction has revealed inconsistent findings. The current study examined belief updating in a highly self-relevant context: feedback about personality traits. Clinically diagnosed individuals with SAD (n = 95) and non-clinical controls (NCC, n = 87) completed a social feedback task. In this task, participants learned how others perceived their agentic (e.g., competent, charismatic) and communal (e.g., warm, sensitive) traits while receiving mostly negative feedback. Compared to NCCs, individuals with SAD showed enhanced negative updating of agentic, but not communal- self-beliefs. This effect remained significant after controlling for depression severity and initial self-beliefs. In the SAD group and across the sample, depression severity was linked to enhanced updating in both domains. These updating patterns may perpetuate intrapersonal and interpersonal cycles that maintain negative self-beliefs in these conditions. Integrating the research on the "Big Two" personality dimensions with cognitive and evolutionary theories may help characterize biased cognitive processing in SAD.
Prevalence and factors associated with post-traumatic stress disorder among internally displaced populations due to gang violence in Haiti.
Cénat JM, Moshirian Farahi SMM, Clorméus LA … +5 more , Jean L, Lafleur N, Dalexis RD, Cénat A, Derivois D
J Anxiety Disord · 2026 Jul · PMID 42119540 · Publisher ↗
BACKGROUND: Since 2018, escalating armed gang violence in Haiti has caused thousands of deaths and kidnappings, the collapse of essential services, and the internal displacement of over 1.3 million people. This study doc...
BACKGROUND: Since 2018, escalating armed gang violence in Haiti has caused thousands of deaths and kidnappings, the collapse of essential services, and the internal displacement of over 1.3 million people. This study documents the prevalence of post-traumatic stress disorder (PTSD) symptoms and associated factors among internally displaced people due to armed gang violence, providing essential evidence to inform clinical care and guide targeted humanitarian and mental health interventions. METHODS: We conducted a cross-sectional survey among 1541 internally displaced adults (mean age=36.4, 60.6% women). PTSD symptoms, community violence exposure, traumatic life events, and resilience were assessed. Hierarchical logistic regression examined associations between PTSD symptoms, trauma exposure, and resilience, adjusting for sociodemographic factors. RESULTS: 57.2% of participants reported severe PTSD symptoms, with higher prevalence in women (62.4%), individuals displaced to rural areas (69.3%), older adults, and those with lower education. Three logistic regression models examined PTSD symptoms. Life events initially increased PTSD risk (victimized: aOR=1.12; witnessed: aOR=1.07), explaining 29.8% of variance. Adding community violence raised explained variance to 49.7%, with victimization remaining significant (aOR=1.05) and witnessing non-significant. In the final model, higher resilience slightly reduced PTSD risk (aOR=0.98), while victimization and witnessing community violence increased it (aOR=1.22 and 1.06), accounting for 50.7% of variance. CONCLUSIONS: Chronic armed gang violence drives high PTSD rates among Haiti's internally displaced persons, with resilience offering limited protection. Addressing this crisis requires integrating mental health into humanitarian efforts, strengthening community support, prioritizing vulnerable groups, ensuring that psychological wellbeing becomes a central pillar of recovery and social stability.
Efficacy and mechanisms of internet-delivered mindfulness-based cognitive therapy for Adjustment Disorder: A randomized controlled trial.
Holas P, Wardęszkiewicz J, Grochowska M … +1 more , Hofmann SG
J Anxiety Disord · 2026 Jul · PMID 42107153 · Publisher ↗
BACKGROUND: Adjustment Disorder (AjD) is a common stress-related condition, yet evidence-based interventions remain scarce. Mindfulness-Based Cognitive Therapy (MBCT) targets transdiagnostic mechanisms such as cognitive...
BACKGROUND: Adjustment Disorder (AjD) is a common stress-related condition, yet evidence-based interventions remain scarce. Mindfulness-Based Cognitive Therapy (MBCT) targets transdiagnostic mechanisms such as cognitive fusion and low self-compassion, which may be particularly relevant for AjD. OBJECTIVE: This randomized controlled trial tested the efficacy of a brief, guided, asynchronous internet-delivered MBCT (iMBCT) for AjD during the COVID-19 pandemic, compared with internet-delivered progressive muscle relaxation (iPMR) and a waitlist control (WLC). METHODS: Adults meeting ICD-11 criteria for AjD (N = 301) were randomized to iMBCT, iPMR, or WLC for four weeks. Primary outcomes were changes in AjD symptoms (ADNM-20) and remission rates. Secondary outcomes were changes in depression, anxiety, cognitive fusion, experiential avoidance, and self-compassion. Outcomes were assessed at baseline, post-intervention, and one-month follow-up. Mediation analyses tested cognitive defusion and self-compassion as mechanisms. RESULTS: iMBCT produced greater reductions in AjD symptoms than WLC (η² =.17) and higher remission rates. Compared with iPMR, iMBCT yielded larger decreases in depression and anxiety. Cognitive defusion fully mediated iMBCT effects on depression and anxiety. Some improvements were maintained at follow-up; however, findings were mixed and should be interpreted cautiously due to substantial attrition. CONCLUSIONS: A brief, minimally guided, asynchronous iMBCT is an effective and scalable intervention for AjD that targets cognitive and self-regulatory mechanisms. Findings support the use of online mindfulness-based programs for stress-related disorders during large-scale crises.
Corrigendum to "The lived experience of social anxiety disorder: A conceptual model focused on adolescents and young adults based on published literature and social media listening"[Journal of Anxiety Disorders 118 (2026) 1-11/103129].
Schmidt AL, Staunton H, Stein MB … +5 more , Hayes AM, Rodriguez-Esteban R, Fischer K, McIver T, Suter EE
J Anxiety Disord · 2026 Jun · PMID 42066559 · Publisher ↗
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