Abstract
Introduction
Insomnia Disorder (ID) elevates risk of incident anxiety disorders and vice versa. We examined whether ID and poor sleep are associated with greater self-reported anxiety in ...persons with Generalized Anxiety Disorder (GAD).
Methods
Twenty-one participants with GAD and ID (GAD+/ID+) having Insomnia Severity Index (ISI) scores ≥ 13 (mean 17.8, SD 3.6) and 14 with GAD but not ID (GAD+/ID-) having ISI scores ≤ 12 (mean 6.4, SD 3.4) completed 14 days of actigraphy and sleep diaries as well as a night of ambulatory polysomnography (PSG) following an acclimation night. Participants completed the Pittsburgh Sleep Quality Index (PSQI), the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA-T/C, -T/S), the Ford Insomnia Response to Stress Test (FIRST), the Penn State Worry Questionnaire (PSWQ), and the Anxiety Sensitivity Index (ASI). Differences in self-reported anxiety (STICSA, ASI, PSWQ) between GAD+/ID+ and GAD+/ID- were analyzed using t-tests. Relationships of anxiety with retrospective (PSQI, FIRST, ISI), longitudinal (actigraphy, diaries) and physiological (PSG) sleep variables were analyzed using simple regression.
Results
GAD+/ID+ versus GAD+/ID- participants showed trends toward higher anxiety on the PSWQ (p=0.075), ASI (p=0.072) and STICSA-T/S (p=0.078). PSQI scores were positively associated with STICSA-T/S, (R=0.417, p=0.018, N=32). Greater insomnia reactivity (FIRST) was associated with increased worry on the PSWQ (R=0.352, p=0.044, N=33). STICSA-T/C was negatively associated with mean diary (R= -0.440, p=0.015, N=30) and actigraph (R= -0.517, p=0.01, N=24) total sleep time (TST). Actigraph mean TST trended toward lower PSWQ (R= -0.376, p=0.058, N=26) while actigraph mean sleep efficiency (SE) trended toward lesser STICSA-T/C (R= -0.397, p=0.058). Greater REM% was associated with greater STICSA-T/C (R=0.613, p=0.0005, N=28) and STICSA-T/S (R=0.516, p=0.005), a relationship also seen in GAD+/ID+ alone (p=0.03 and 0.015 respectively, N=16). Slow Wave Sleep% (SWS%) was not associated with lesser STICSA-T/S across both groups (p=0.14) but was so in GAD+/ID+ (R= -0.539, p=0.031, N=16).
Conclusion
GAD+/ID+ versus GAD+/ID-, show greater worry, anxiety sensitivity and somatic anxiety. In GAD, shorter and poorer quality sleep measured retrospectively or averaged longitudinally, as well as greater REM%, are associated with greater somatic and cognitive anxiety. Among those with ID, greater SWS% is associated with less somatic anxiety.
Support (if any)
R21MH115279, R01MH109638
Generalized Anxiety Disorder (GAD) is a mental disorder that affects people across the lifespan. The study of GAD has evolved over time, with advancements in research methodologies and treatments. ...This paper provides an examination of the current understanding of GAD, including etiological factors and evidence-based treatments. Advances in neuroimaging technologies have contributed to a greater understanding of the neurological underpinnings of GAD, while psychotherapeutic interventions have emerged as effective treatment strategies. Moreover, GAD is associated with traits such as avoidance of perceived harm, neuroticism levels, and introversion preference. Studies have also explored the etiology of GAD from a genetic perspective. Future research should focus on validating the efficacy of treatments and exploring novel therapeutic combinations. Additionally, investigating the role of early life events, societal stressors, and cognitive biases in the development of GAD may provide insights into improving management and treatment strategies. This study provides further insights into the etiology of GAD and its treatment.
Generalized Anxiety Disorder (GAD) is a prevalent and complex psychiatric condition that poses significant challenges to individuals' psychological health and societal functionality. This article ...endeavors to extend beyond a foundational understanding of GAD by intricately examining its multifaceted etiology, encompassing genetic predispositions, neurobiological abnormalities, psychological constructs, and the profound influence of environmental stressors. Through a meticulous synthesis of the current body of literature, this analysis unveils the intricate interplay between these diverse etiological factors and their contribution to the disorder's complexity. Acknowledging the broad-ranging consequences of GAD on individual well-being, this essay critically assesses the spectrum of current therapeutic approaches, from pharmacological treatments to Cognitive Behavioral Therapy, highlighting the variable effectiveness of these modalities and underscoring the indispensable need for personalized and multimodal treatment strategies. Additionally, it explores the promising yet under-researched realm of digital health interventions and the potential of emotion regulation strategies in enhancing treatment outcomes, suggesting a future direction towards more accessible and tailored care.This comprehensive analysis aims not only to enrich the understanding of GAD but also to advocate for the integration of these nuanced insights into clinical practice. By identifying significant research gaps and proposing innovative avenues for future investigation, the article aspires to contribute to the development of Etiology research and more effective, inclusive treatment modalities, thereby addressing the pressing challenges in the management of GAD. The ultimate goal is to improve outcomes for individuals with GAD, ensuring they receive the comprehensive support and care essential for leading fulfilling live.
Abstract
Introduction
Abnormal interoception is believed to contribute to anxiety disorders as well as possibly to Insomnia Disorder. We therefore hypothesized that interoceptive sensitivity in ...persons with Generalized Anxiety Disorder (GAD) would vary with sleep quality and would differ between GAD patients with and without insomnia.
Methods
29 subjects (86% female) who reported GAD-7 scores ≥ 10 underwent psychiatric and sleep-disorders interviews and met DSM-5 criteria for GAD. Participants were assigned into an insomnia group if the Insomnia Severity Index (ISI) score exceeded 12 (N=18) or a non-insomnia group if ISI score < 11 (N=11). Participants completed approximately 2 weeks of actigraphy and sleep diaries (mean=14.09 days; SD=4.85) as well as online surveys of sleep quality including the Pittsburg Sleep Quality Index (PSQI) and interoceptive sensitivity including the Multidimensional Assessment of Interoceptive Awareness, the somatic anxiety scale of the State-Trait Inventory for Cognitive and Somatic Anxiety-Trait (STICSA-T) and the Anxiety Sensitivity Index. In addition, 28 participants underwent the Schandry heartbeat-counting task, an objective measure of interoceptive sensitivity.
Results
GAD-7 scores did not differ between insomnia and non-insomnia groups (t(18.36)=0.074, p = 0.941). However, insomniacs reported significantly higher scores on the somatic anxiety scale of the STICSA than non-insomniacs (t(17.71)=2.094, p=0.051). STICSA-T somatic anxiety scores positively correlated with greater PSQI scores (R=0.588; p=0.002) and trended negatively with actigraphy sleep-efficiency (R = -0.384; p=0.085). Non-insomniacs outperformed insomniacs in the Schandry task (t(25.9)=2.21, p=0.036). Higher Schandry scores were positively correlated with greater total sleep time (R=0.515; p=0.014) and lower ISI scores (R= -0.387; p=0.042).
Conclusion
Results suggest that GAD patients with insomnia have lesser objective interoceptive sensitivity and more subjective somatic anxiety than those without insomnia. Greater somatic anxiety predicted poorer subjective and objective sleep quality. Hence interoceptive sensitivity may vary with sleep disturbance in GAD.
Support
R21MH115279
Anxiety Disorders and Cardiovascular Disease Celano, Christopher M.; Daunis, Daniel J.; Lokko, Hermioni N. ...
Current psychiatry reports,
11/2016, Volume:
18, Issue:
11
Journal Article
Abstract
Introduction
We examined associations of sleep quality with neural responses to fear conditioning and extinction in individuals with Generalized Anxiety Disorder (GAD) with (INS) and without ...(NOI) Insomnia Disorder (ID). We hypothesized fear-related regions would show greater, and emotion-regulatory regions lesser activity in INS versus NOI and across both groups with decreasing sleep quality.
Methods
Participants were assigned to either an INS group with Insomnia Severity Index (ISI) ≥ 13 (N=21) or NOI with ISI ≤ 12 (N=14). Two weeks of actigraphy and sleep diaries were followed by a 2-session protocol with fMRI. During Session 1, mild electric shock produced conditioned fear to 2 different colors (CS+s) but not a third (CS-) (Fear Conditioning). Immediately afterward, one CS+ (CS+E) but not the other (CS+U) was extinguished (Extinction Learning). All 3 stimuli were presented 24h later (Extinction Recall). An acclimation/diagnostic ambulatory polysomnography (PSG) night was followed by PSGs before Session 1 and between Sessions 1 and 2. Using SPM8, t-tests compared groups, and multiple regressions predicted anterior cerebral activations (as a whole and as ROIs) using ISI, actigraph and diary sleep efficiency (SE) and latency (SOL), and sleep architecture.
Results
Beginning Fear Conditioning, differential activation to the reinforced stimulus (CS+>CS-) in the right insula was greater in INS than NOI, and greater actigraph SE predicted greater prefrontal activation. Change in activation to the CS+ across Extinction Learning (late CS+>early CS+) did not differentiate groups or correlate with sleep measures. During Extinction Recall, NOI versus INS showed less activation in bilateral amygdala ROIs (CS+E>CS-) but more activation in prefrontal regulatory regions (CS+U>CS-) and bilateral insula ROIs (both contrasts). Greater activation of prefrontal emotion-regulatory areas was associated with greater REM% (CS+E>CS+U and CS+E>CS-), lesser ISI (CS+E>CS- and CS+U>CS-), and greater actigraph SE (CS+U>CS). However for CS+E>CS+U, lesser diary SE and greater ISI were associated with greater prefrontal activity.
Conclusion
Results, on balance, suggest that persons with GAD and ID activated more fear-related and less prefrontal emotion-regulatory regions during fear conditioning and extinction recall than those with GAD alone. Across groups, greater REM% and sleep quality were associated with greater activity of emotion-regulatory areas.
Support (if any)
Funding: R21MH115279, R01MH109638
The nine-item Patient Health Questionnaire (PHQ-9), seven-item Generalized Anxiety Disorder scale (GAD-7), and ten-item Kessler Psychological Distress Scale (K-10) are valid and reliable measures of ...depression, anxiety and general distress. However, the time required in their administration may limit their use in routine care. This study examines the utility of shorter versions (PHQ-2, GAD-2, and K-6) as screening instruments and measures of treatment response.
Data from research trial participants (n = 993) receiving internet-delivered cognitive behaviour therapy (iCBT) were analysed to establish discriminant validity of the short versions. Mini International Neuropsychiatric Interview (MINI) diagnoses were used as comparators. Criterion group validity, test–retest reliability, internal consistency, and responsiveness to treatment changes were examined. Analyses were replicated using data from patients receiving iCBT in routine care (n = 1389).
Discriminant validity was excellent for the PHQ-2, and acceptable for the GAD-2 and K-6. Acceptable sensitivity and specificity were identified at a threshold of ≥3 for the PHQ-2 and GAD-2, and ≥14 for the K-6. The short versions were sensitive to treatment change.
The PHQ-2, GAD-2 and K-6 are useful screeners and efficient measures of treatment progress and outcomes in routine clinical care.
PDF
