Pathological Worry
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2021 ◽  
Vol 12 ◽  
Andreas Dinkel ◽  
Birgitt Marten-Mittag ◽  
Katrin Kremsreiter

Background: Fear of progression (FoP), or fear of cancer recurrence (FCR), is characterized by worries or concerns about negative illness-related future events. Actually, to worry is a common cognitive process that, in its non-pathological form, belongs to daily life. However, worry can also become pathological appearing as a symptom of mental disorders. This study aimed at investigating the associations among daily worry, pathological worry, and FoP in patients with cancer.Methods: This is a cross-sectional study that includes 328 hospitalized patients with cancer. Patients filled out the FoP Questionnaire (FoP-Q), the Worry Domains Questionnaire (WDQ) for the assessment of daily worry, and the Penn State Worry Questionnaire (PSWQ) for the assessment of pathological worry. Depressive, anxiety, and somatic symptoms were measured with modules of the Patient Health Questionnaire [Patient Health Questionnaire-Depressive Symptoms (PHQ-2), Generalized Anxiety Disorder-2 (GAD-2), and Patient Health Questionnaire-Somatic Symptoms (PHQ-15)]. Furthermore, a structured clinical interview was conducted for the assessment of anxiety disorders. The hierarchical multiple linear regression analysis was used to identify factors independently associated with FoP.Results: Mean age of the participants was M = 58.5 years (SD = 12.8), and 64.6% were men. FoP and worry were significantly intercorrelated (r = 0.58–0.78). The level of FoP was most strongly associated with daily worry (β = 0.514, p < 0.001), followed by pathological worry (β = 0.221, p < 0.001). Further significant determinants were younger age and depressive and anxiety symptoms. Clinical variables were not independently associated with FoP. The final model explained 74% of the variance.Discussion: Fear of progression is strongly associated with daily worry and pathological worry. These results bring up the question of whether FoP is an expression of a general tendency to worry. Whether a general tendency to worry, in fact, represents an independent vulnerability factor for experiencing FCR/FoP needs to be investigated in a longitudinal research design.

2021 ◽  
Ville Ritola ◽  
Jari Lipsanen ◽  
Satu Pihlaja ◽  
Eero-Matti Gummerus ◽  
Jan-Henry Stenberg ◽  

BACKGROUND Internet-delivered, therapist-supported Cognitive Behavioral Therapy (iCBT) is efficacious for Generalized Anxiety Disorder (GAD), but few studies have as yet reported its effectiveness in routine care. OBJECTIVE To examine whether a new 12-session iCBT program for GAD is effective in nationwide routine care. METHODS The program was free-of-charge for patients and its completion time was unrestricted. A specialized iCBT clinic delivered iCBT to 1,099 physician-referred patients. We measured symptoms with online questionnaires. The primary measure of anxiety was the GAD-7; secondary measures were, for pathological worry, the Penn State Worry Questionnaire (PSWQ) and, for anxiety and impairment, the Overall Anxiety Severity and Impairment Scale (OASIS). RESULTS Patients completed a mean 7.8 (65.1%) of 12 sessions, and 44.1% of patients completed all sessions. Effect size in the whole sample for GAD-7 was large (d=0.96; 95%CI: 0.87-1.05). For completers, effect sizes were very large, d=1.34 (95%CI: 1.25-1.53) for GAD-7, d=1.14 (95%CI:1.00-1.27) for PSWQ, and 1.23 (95%CI:1.09-1.37) for OASIS. Patients who dropped out also benefited from the treatment. Greater symptomatic relief (GAD-7) was associated with more completed sessions, older age, and being referred from private or occupational care. Of 894 patients with baseline GAD-7 score ≥10, those achieving a reliable recovery amounted to 421 (47.1%). CONCLUSIONS This nationwide, free-of-charge, therapist-supported HUS-iCBT for GAD was effective in routine care, but further research must establish comparative effectiveness and optimize the design of iCBT for GAD for different patient groups and individual patients. CLINICALTRIAL Nationwide internet-delivered computer-assisted cognitive-behavioral therapy (iCBT) for psychiatric disorders.

Bart Verkuil ◽  
Briana N. Brownlow ◽  
Michael W. Vasey ◽  
Jos F. Brosschot ◽  
Julian F. Thayer

AbstractWorry is a central process in a wide range of psychopathological and somatic conditions. Three studies (N = 856) were used to test whether a subscale composed of five items of the most commonly used trait anxiety questionnaire, Spielberger’s State Trait Anxiety Inventory-Trait version (STAI-T), is appropriate to measure worry. Results showed that the subscale, named the Brief Worry Scale (BWS), had excellent internal consistency and temporal stability. Convergent and divergent validity were supported by correlation analyses using worry questionnaires and measures of anxious arousal and depression. The BWS was a particularly good predictor of the pathogenic aspects of worry, including worry perseveration in daily life (study 1), measures of clinical worry (study 2) and the uncontrollability of experimentally induced worry (study 3). Taken together, these studies demonstrate that the BWS might be a valuable scale for pathological worry, for which many researchers already have data.

Evan J. White ◽  
DeMont M. Grant ◽  
Jacob D. Kraft ◽  
Danielle L. Taylor ◽  
Danielle E. Deros ◽  

Abstract. Recent theoretical research posits that a key factor in the development and maintenance of pathological worry is the avoidance of sudden emotional shifts. Recently two self-report instruments were developed to index this phenomenon (Contrast Avoidance Questionnaire – Worry [CAQ-W] and Contrast Avoidance Questionnaire – General Emotion [CAQ-GE]). This work employed a multi-study design to provide an independent evaluation of the latent structure of these measures; additionally, the validity and longitudinal predictive ability of the measures was examined. Findings of the factor analytic work support a two-factor solution for each of the questionnaires. These were defined as the following subscales: CAQ-W: Emotional Contrast; Negative Affect, and for the CAQ-GE: Avoidance; Discomfort. Test-retest reliability of the measure was strong and the identified subscales demonstrated differential predictive ability regarding future worry and depression. Results indicate that subscales related to the experience of negative affect rather than avoidance, display predictive utility of future symptoms. These findings are somewhat discrepant with extant literature on ecological momentary assessment (EMA) assessment of contrast avoidance indicating the need for refinement in the self-report measurement of this construct.

Bonifacio Sandín ◽  
Julia García-Escalera ◽  
Rosa M. Valiente ◽  
Victoria Espinosa ◽  
Paloma Chorot

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) has been shown to be effective for reducing symptoms of anxiety and depression in adolescents with emotional disorders. Internet-delivered psychological treatments have great potential to improve access to evidence-based psychological therapy since they are associated with reduced human and economic costs and less social stigma. Recently, our group developed an online version of the UP-A (the iUP-A) for the treatment of emotional disorders in adolescents. The aim of this pilot trial was to test the clinical utility of the iUP-A in a small sample (n = 12) of adolescents with elevated anxiety and/or depressive symptoms. Intention-to-treat and completer analyses revealed pre- to post-intervention self-reported decreases of anxiety and depressive symptoms, anxiety sensitivity, emotional avoidance, panic disorder symptoms, panic disorder severity, generalized anxiety disorder symptoms, pathological worry, and major depressive disorder symptoms. We found high feasibility and acceptability of the program with all participants and responsible parents reporting an improvement in the adolescents’ ability to cope with emotions. Results suggest that the iUP-A may provide a new approach to improve access to treatment for anxious and depressive adolescents in Spain; however, further research must be conducted before firm conclusions can be drawn.

2020 ◽  
pp. 1-11 ◽  
Nur Hani Zainal ◽  
Michelle G. Newman

Abstract Background Affective neuroscience and scar theories propose that increased excessive worry, the hallmark symptom of generalized anxiety disorder (GAD), predicts future declines in executive functioning (EF). However, the preponderance of cross-sectional designs used to examine between-person chronic worry–EF relationships has blocked progress on understanding their potentially causal within-person associations. Accordingly, this study used bivariate dual latent change score (LCS) models to test whether within-person increased GAD severity might relate to future reduced EF. Methods Community-dwelling adults (N = 2581, 46 years on average, s.d. = 11.40, 54.71% female) were assessed for GAD symptom severity (Composite International Diagnostic Interview-Short Form) across three waves, spaced about 9 years apart. Three aspects of EF [inhibition, set-shifting, and mixing costs (MCs; a measure related to common EF)], were assessed with stop-and-go switch tasks. Participants responded to 20 normal and 20 reverse single-task block trials and 32 mixed-task switch block trials. EF tests were administered at time 2 (T2) and time 3 (T3), but not at time 1 (T1). Results After controlling for T1 depression, LCS models revealed that within-person increased T1 − T2 GAD severity substantially predicted future reduced T2 − T3 inhibition and set-shifting (both indexed by accuracy and latency), and MC (indexed by latency) with moderate-to-large effect sizes (|d| = 0.51–0.96). Conclusions Results largely support scar theories by offering preliminary within-person, naturalistic evidence that heightened excessive worry can negatively predict future distinct aspects of cognitive flexibility. Effectively targeting pathological worry might prevent difficulties arising from executive dysfunction.

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