Terri L. Barrera

Quality of life impairment in generalized anxiety disorder, social phobia, and panic disorder

Interest in the assessment of quality of life in the anxiety disorders is growing. The present study examined quality of life impairments in individuals with generalized anxiety disorder (GAD), social phobia, and panic disorder. Results showed that individuals with these disorders reported less satisfaction with their quality of life than non-anxious adults in the community. However, the degree of quality of life impairment is similar across these three disorders. Additionally, comorbid depression, but not anxiety, was found to negatively impact quality of life in these individuals. Finally, diagnostic symptom severity was not found to influence quality of life, indicating that subjective measures of quality of life offer unique information on the effects of anxiety disorders.

Transdiagnostic versus diagnosis-specific cbt for anxiety disorders: a preliminary randomized controlled noninferiority trial.

Transdiagnostic cognitive–behavioral treatments for anxiety disorders have been gaining increased attention and empirical study in recent years. Despite this, research on transdiagnostic anxiety treatments has, to date, relied on open trials, or comparisons to waitlist conditions, published benchmarks, or relaxation‐based interventions.

A meta-analytic review of exposure in group cognitive behavioral therapy for posttraumatic stress disorder.

Although the efficacy of exposure is well established in individual cognitive behavioral treatments for posttraumatic stress disorder (PTSD), some clinicians and researchers have expressed concerns regarding the use of in-session disclosure of trauma details through imaginal exposure in group cognitive behavioral therapy (GCBT) for PTSD. Thus, the aim of the present study was to conduct a systematic review of the empirical support for GCBT in the treatment of PTSD and to compare GCBT protocols that encourage the disclosure of trauma details via in-session exposure to GCBT protocols that do not include in-session exposure. Randomized controlled trials that assessed the efficacy of GCBT for PTSD were included in the meta-analysis. A total of 651 participants with PTSD were included in the 12 eligible GCBT treatment conditions (5 conditions included in-group exposure, 7 conditions did not include in-group exposure). The overall pre-post effect size of GCBT for PTSD (ES=1.13 [SE=0.22, 95% CI: 0.69 to 1.56, p<.001]). suggests that GCBT is an effective intervention for individuals with PTSD. No significant differences in effect sizes were found between GCBT treatments that included in-group exposure and those that did not. Although the attrition rate was higher in treatments that included exposure in-group, this rate is comparable to attrition rates in individual CBT treatments and pharmacotherapy for PTSD. The results from this meta-analysis suggest that concerns about the potentially negative impact of group exposure may be unwarranted, and support the use of exposure-based GCBT as a promising treatment option for PTSD.

Test anxiety inventory: 30 years later

Abstract Research suggests that test anxiety is associated with a number of maladaptive factors. The majority of test anxiety research includes the Test Anxiety Inventory (TAI) as a primary outcome variable. However, the TAI was normed on college undergraduates in 1980. The academic landscape has altered in a variety of ways in the past 30 years, which may result in out-of-date norms. This study examined changes in TAI scores in college undergraduates (n =437) as well as convergent validity with measures of trait anxiety and academic performance. Results indicated increases in TAI scores for females while holding constant for males. Additionally, females and males displayed positive correlations between the TAI and state-trait anxiety inventory, while only females displayed a significant negative correlation between the TAI and grade point average. Data provide evidence of changes in TAI scores. As a result, researchers should be careful when drawing conclusions based on original TAI norms, especially in the case of female undergraduates.

Diagnostic specificity and mental health service utilization among veterans with newly diagnosed anxiety disorders

OBJECTIVE This study examined rates of specific anxiety diagnoses (posttraumatic stress disorder, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, social anxiety disorder, and specific phobia) and anxiety disorder not otherwise specified (anxiety NOS) in a national sample of Veterans and assessed their mental health service utilization. METHOD This study used administrative data extracted from Veteran Health Administration outpatient records to identify patients with a new anxiety diagnosis in fiscal year 2010 (N = 292,244). Logistic regression analyses examined associations among diagnostic specificity, diagnostic location, and mental health service utilization. RESULTS Anxiety NOS was diagnosed in 38% of the sample. Patients in specialty mental health were less likely to receive an anxiety NOS diagnosis than patients in primary care (odds ratio [OR] = 0.36). Patients with a specific anxiety diagnosis were more likely to receive mental health services than those with anxiety NOS (OR = 1.65), as were patients diagnosed in specialty mental health compared with those diagnosed in primary care (OR = 16.29). CONCLUSION Veterans diagnosed with anxiety NOS are less likely to access mental health services than those with a specific anxiety diagnosis, suggesting the need for enhanced diagnostic and referral practices, particularly in primary care settings.

An evaluation of the brief multidimensional measure of religiousness/spirituality in older patients with prior depression or anxiety

The Primary objective of the study was to examine the psychometric properties of the Brief Multidimensional Measure of Religiousness and Spirituality (BMMRS) in older adults. Older adults (N = 66) completed a survey in-person or over the phone. Measures included the BMMRS, Religious Problem Solving Scale, Brief Religious Coping Scale, Functional Assessment of Chronic Illness Therapy – Spiritual Well-being, Satisfaction with Life Scale, Geriatric Anxiety Inventory, and Geriatric Depression Scale. Cronbachs alphas evaluated internal consistency, zero-order correlations tested construct validity, and multiple regressions assessed the association of BMMRS domains with well-being. Most BMMRS domains were reliable and valid. Collectively, they explained 26% to 68% of the variance in well-being and psychological symptoms. Daily spiritual experiences uniquely predicted spiritual well-being, satisfaction with life, and depressive symptoms. The BMMRS is useful in older populations and may help identify those who could benefit from religious or spiritually integrated therapy.

Influence of Trauma History on Panic and Posttraumatic Stress Disorder in Returning Veterans

The current study examined the role of predeployment sexual and physical abuse, combat exposure, and postdeployment social support in predicting panic disorder and PTSD diagnoses in a large sample of returning veterans. A chart review was conducted for 1740 OEF/OIF veterans who received mental health screenings at a large VA hospital between May 24, 2004 and March 26, 2008. Assessments included psychosocial evaluations conducted by psychiatrists, psychologists, and social workers in addition to self-report measures. Results suggested that the prevalence of panic disorder (6.1%) and PTSD (28.7%) are elevated among OEF/OIF veterans. Veterans reporting higher levels of combat experience were likely to be diagnosed with PTSD (odds ration [OR], 1.17; 95% confidence interval [CI], 1.10-1.25; p < .001) or comorbid panic disorder and PTSD (OR, 1.18; 95% CI, 1.04-1.33; p < .001). Veterans endorsing predeployment sexual abuse were likely to be diagnosed with comorbid panic disorder and PTSD (OR, 3.05; 95% CI, 1.15-8.08; p < .05), as were veterans endorsing predeployment physical abuse (OR, 0.47; 95% CI, 0.22-1.00; p < .05). Panic disorder was also found to be associated with greater risk for suicide attempts than PTSD (χ² = 16.38, p = .001). These findings indicate a high prevalence of panic disorder among returning veterans and highlight the importance for clinicians to assess returning veterans routinely for panic disorder in addition to PTSD.

The Appraisal of Intrusive Thoughts in Relation to Obsessional–Compulsive Symptoms

Research has shown that although intrusive thoughts occur universally, the majority of individuals do not view intrusive thoughts as being problematic (Freeston, Ladouceur, Thibodeau, & Gagnon, 1991; Rachman & de Silva, 1978; Salkovskis & Harrison, 1984). Thus, it is not the presence of intrusive thoughts that leads to obsessional problems but rather some other factor that plays a role in the development of abnormal obsessions. According to the cognitive model of obsessive–compulsive disorder (OCD) put forth by Salkovskis (1985), the crucial factor that differentiates between individuals with OCD and those without is the individuals appraisal of the naturally occurring intrusive thoughts. This study aimed to test Salkovskiss model by examining the role of cognitive biases (responsibility, thought–action fusion, and thought control) as well as distress in the relationship between intrusive thoughts and obsessive–compulsive symptoms in an undergraduate sample of 326 students. An existing measure of intrusive thoughts (the Revised Obsessional Intrusions Inventory) was modified for this study to include a scale of distress associated with each intrusive thought in addition to the current frequency scale. When the Yale-Brown Obsessive-Compulsive Scale was used as the measure of OCD symptoms, a significant interaction effect of frequency and distress of intrusive thoughts resulted. Additionally, a significant three-way interaction of Frequency × Distress × Responsibility was found when the Obsessive Compulsive Inventory–Revised was used as the measure of OCD symptoms. These results indicate that the appraisal of intrusive thoughts is important in predicting OCD symptoms, thus providing support for Salkovskiss model of OCD.

The experience of panic symptoms across racial groups in a student sample

While there is general agreement that, across cultures, panic disorder appears to be characterized by sudden onset of bodily sensations, such as dizziness and heart palpitations, followed by catastrophic misinterpretations of these symptoms, there remains a need for research investigating ethnic/cultural differences in the experience of panic attacks. In addition to investigating ethnic differences in the experience of panic, it is important to assess whether increased endorsement of panic symptoms translates into increased dysfunction. The present study investigated differences in the experience of panic attacks and examined the relation between symptom endorsement and overall distress and impairment in a large multiracial/ethnic student population. Preliminary analyses indicated that although overall endorsement of panic symptoms was similar across groups, differences did emerge on specific symptoms. Participants identifying as Asian tended to endorse symptoms such as dizziness, unsteadiness, choking, and feeling terrified more frequently than those identifying as Caucasian, and individuals identifying as African American reported feeling less nervous than those identifying as Caucasian. Participants of Hispanic/Latino(a) descent showed no differences from any other group on symptom endorsement. Panic symptom severity was not found to differ across racial/ethnic groups; however, the correlation between panic symptoms and panic severity was stronger for Asian and Caucasian participants than for African Americans. These results suggest that symptoms of panic may be experienced differently across racial/ethnic groups, and highlight the need for clinicians and researchers to assess panic symptoms within the context of culture.

Cognitive-behavioral therapy for late-life anxiety: Similarities and differences between Veteran and community participants.

Cognitive-behavioral therapy (CBT) is an evidence-based treatment for anxiety; however, a growing body of research suggests that CBT effect sizes are smaller in Veteran samples. The aim of this study was to perform secondary data analyses of a randomized controlled trial of CBT for late-life generalized anxiety disorder compared with treatment as usual (TAU) in a Veteran (n = 101) and community-based (n = 122) sample. Veterans had lower income and less education than community participants, greater severity on baseline measures of anxiety and depression, poorer physical health, and higher rates of psychiatric comorbidity. Treatment effects were statistically significant in the community sample (all ps < 0.01), but not in Veterans (all ps > 0.05). Further analyses in Veterans revealed that poorer perceived social support significantly predicted poorer outcomes (all ps < 0.05). Our results underscore the complexity of treating Veterans with anxiety, and suggest that additional work is needed to improve the efficacy of CBT for Veterans, with particular attention to social support.