scholarly journals Moderators of Change in Social Anxiety during CBT in a Transdiagnostic, Naturalistic Treatment-Seeking Sample

2016 ◽  
Vol 7 (4) ◽  
pp. 655-670 ◽  
Author(s):  
Anu Asnaani ◽  
Antonia N. Kaczkurkin ◽  
Hallie Tannahill ◽  
Hayley Fitzgerald
Keyword(s):  
Social Anxiety ◽  
Anxiety Disorders ◽  
Anxiety Sensitivity ◽  
Behavioral Therapy ◽  
Model Potential ◽  
Treatment Seeking ◽  
Fee For Service ◽  
Moderation Effect ◽  
Time Lagged ◽  
Moderate Change

Background There are a number of hypothesized underlying factors that, while present across a range of anxiety and fear-based disorders, are proposed to be specifically influential in the maintenance of social anxiety (SA) symptoms. Aims This study examined the influence of specific constructs (i.e., anxiety sensitivity, ruminative thinking, and depressive symptoms) on reduction of SA symptoms during a course of cognitive behavioral therapy (CBT). To better model potential causal relationships between observed moderators and social anxiety, time-lagged analyses between SA and significant moderators were also explored. Methods Participants (N = 107) were patients seeking treatment in a fee-for-service clinic specializing in CBT for anxiety disorders, OCD and PTSD. Participants were repeatedly assessed for a variety of symptoms and potential moderators throughout treatment. Results Even though anxiety sensitivity regarding social concerns, rumination, reflection, and depression showed significant within-and between-person relationships with SA symptoms, only rumination was found to uniquely moderate change in SA symptoms over the course of treatment. Specifically, those with higher average levels of ruminative thinking tended to improve greater on SA symptoms than those with lower levels throughout treatment. Further, this observed moderation effect was not found to significantly influence OCD, generalized anxiety, or PTSD symptoms. Finally, a bi-directional relationship was found between rumination and SA with rumination predicting subsequent changes in SA and vice versa. Conclusions High levels of ruminative thinking do not appear to be an impediment to improvement in SA symptoms in a naturalistic, treatment-seeking sample of individuals with anxiety disorders.

A longitudinal examination of psychosocial impairment across the anxiety disorders

2013 ◽  
Vol 44 (8) ◽  
pp. 1691-1700 ◽  
Author(s):  
K. Naragon-Gainey ◽  
M. W. Gallagher ◽  
T. A. Brown
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Anxiety Disorders ◽  
Behavioral Therapy ◽  
Clinical Sample ◽  
Anxiety Symptoms ◽  
Latent Growth ◽  
Psychosocial Impairment ◽  
Co Morbidity

BackgroundAnxiety disorders are highly prevalent disorders associated with substantial psychosocial impairment, but few studies have examined impairment within specific anxiety disorders. Furthermore, it is unclear how change in different types of anxiety has an impact on change in impairment, particularly given high rates of co-morbidity. The current study assessed the temporal associations of impairment and symptoms of three common anxiety disorders in a large, diagnostically heterogeneous clinical sample.MethodData were collected from 606 treatment-seeking individuals at an anxiety clinic, most of whom subsequently enrolled in cognitive-behavioral therapy. Symptoms of panic, social anxiety and generalized anxiety disorder (GAD), as well as levels of impairment, were assessed three times over 2 years. In addition to examining levels of impairment across diagnostic groups, latent growth modeling was used to evaluate the longitudinal associations of anxiety symptoms and impairment.ResultsThose with a principal diagnosis of GAD reported higher levels of impairment in some domains at baseline; however, at follow-up assessments individuals with social anxiety disorder reported greater impairment than those with panic disorder. Anxiety symptoms and impairment both declined over time. Change in all three anxiety symptoms was closely associated with change in impairment, but only GAD remained a significant (positive) predictor of change in impairment after accounting for co-morbidity.ConclusionsImpairment and all three anxiety disorders were closely associated, both cross-sectionally and longitudinally. Because change in GAD was most specifically related to change in impairment, treatment for those with multiple anxiety disorders could focus on treating GAD symptoms first or treating transdiagnostic processes.

Clinical Management of Anxiety Disorders

2018 ◽  
Author(s):  
Shona Vas ◽  
Pooja N Dave
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Panic Disorder ◽  
Anxiety Disorders ◽  
Generalized Anxiety Disorder ◽  
Social Anxiety Disorder ◽  
Mood State ◽  
Behavioral Therapy ◽  
Skills Training ◽  
Generalized Anxiety

Anxiety disorders are characterized by excessive fear and anxiety accompanied by associated behavioral disturbances that cause significant impairment in social and occupational functioning. Anxiety is a complex mood state that involves physiologic, cognitive, and behavioral components. This review describes the five anxiety disorders most commonly diagnosed in adults: social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder, and specific phobia. Diagnostic criteria for these disorders are presented along with empirically supported psychological and pharmacologic treatment approaches. Decades of evidence have indicated that for anxiety disorders of mild to moderate severity, cognitive-behavioral therapy (CBT) should be first-line treatment. CBT interventions for anxiety, including psychoeducation, cognitive restructuring, exposure, applied relaxation/breathing retraining, and skills training, are presented with descriptions of how they may be adapted to particular diagnoses, along with data for their efficacy. Data suggest that selective serotonin and norepinephrine reuptake inhibitors are pharmacologic treatments of choice for anxiety and may be used in combination with CBT for moderate to severe symptoms. d-Cycloserine is an emerging treatment that may enhance outcomes in anxiety disorders by optimizing exposure therapy through the facilitation of fear extinction. This review contains 7 figures, 12 tables, and 105 references. Key words: agoraphobia, anxiety, generalized anxiety disorder, panic disorder, phobias, social anxiety disorder

Clinical Management of Anxiety Disorders

2017 ◽  
Author(s):  
Shona Vas ◽  
Pooja N Dave
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Panic Disorder ◽  
Anxiety Disorders ◽  
Generalized Anxiety Disorder ◽  
Social Anxiety Disorder ◽  
Mood State ◽  
Behavioral Therapy ◽  
Skills Training ◽  
Generalized Anxiety

Anxiety disorders are characterized by excessive fear and anxiety accompanied by associated behavioral disturbances that cause significant impairment in social and occupational functioning. Anxiety is a complex mood state that involves physiologic, cognitive, and behavioral components. This review describes the five anxiety disorders most commonly diagnosed in adults: social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder, and specific phobia. Diagnostic criteria for these disorders are presented along with empirically supported psychological and pharmacologic treatment approaches. Decades of evidence have indicated that for anxiety disorders of mild to moderate severity, cognitive-behavioral therapy (CBT) should be first-line treatment. CBT interventions for anxiety, including psychoeducation, cognitive restructuring, exposure, applied relaxation/breathing retraining, and skills training, are presented with descriptions of how they may be adapted to particular diagnoses, along with data for their efficacy. Data suggest that selective serotonin and norepinephrine reuptake inhibitors are pharmacologic treatments of choice for anxiety and may be used in combination with CBT for moderate to severe symptoms. d-Cycloserine is an emerging treatment that may enhance outcomes in anxiety disorders by optimizing exposure therapy through the facilitation of fear extinction. This review contains 7 figures, 12 tables, and 105 references. Key words: agoraphobia, anxiety, generalized anxiety disorder, panic disorder, phobias, social anxiety disorder

The role of Anxiety Sensitivity in fear conditioning: a moderation effect

2019 ◽  
Author(s):  
Bianca Gerardo ◽  
Raquel Nunes R. M. Guiomar ◽  
Mariana Moura-Ramos ◽  
Ana Ganho-Ávila
Keyword(s):  
Anxiety Disorders ◽  
Fear Conditioning ◽  
Skin Conductance ◽  
Anxiety Sensitivity ◽  
Conditioned Fear ◽  
Moderation Effect ◽  
Skin Conductance Responses ◽  
The Relationship ◽  
Over Time

Anxiety sensitivity (AS; the degree of fear of experiencing or imagining experiencing anxiety symptoms and its possible consequences) is associated with expression of conditioned fear responses. However, findings regarding the relationship between AS and fear acquisition indexed by skin conductance responses are rather conflicting. Here we aim to clarify this interaction. We classified 144 women that underwent fear conditioning procedures as either high-AS or low-AS. We found that high-AS participants show one of two patterns maintained over time: poor stimuli discrimination or good stimuli discrimination. This suggests that different patterns of fear acquisition potentially support the distinction between anxiety disorders.

Clinical Management of Anxiety Disorders

2018 ◽  
Author(s):  
Shona Vas ◽  
Pooja N Dave
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Panic Disorder ◽  
Anxiety Disorders ◽  
Generalized Anxiety Disorder ◽  
Social Anxiety Disorder ◽  
Mood State ◽  
Behavioral Therapy ◽  
Skills Training ◽  
Generalized Anxiety

Anxiety disorders are characterized by excessive fear and anxiety accompanied by associated behavioral disturbances that cause significant impairment in social and occupational functioning. Anxiety is a complex mood state that involves physiologic, cognitive, and behavioral components. This review describes the five anxiety disorders most commonly diagnosed in adults: social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder, and specific phobia. Diagnostic criteria for these disorders are presented along with empirically supported psychological and pharmacologic treatment approaches. Decades of evidence have indicated that for anxiety disorders of mild to moderate severity, cognitive-behavioral therapy (CBT) should be first-line treatment. CBT interventions for anxiety, including psychoeducation, cognitive restructuring, exposure, applied relaxation/breathing retraining, and skills training, are presented with descriptions of how they may be adapted to particular diagnoses, along with data for their efficacy. Data suggest that selective serotonin and norepinephrine reuptake inhibitors are pharmacologic treatments of choice for anxiety and may be used in combination with CBT for moderate to severe symptoms. d-Cycloserine is an emerging treatment that may enhance outcomes in anxiety disorders by optimizing exposure therapy through the facilitation of fear extinction. This review contains 7 figures, 12 tables, and 105 references. Key words: agoraphobia, anxiety, generalized anxiety disorder, panic disorder, phobias, social anxiety disorder

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