Abstract Background Repetitive negative thinking (RNT) increases vulnerability to multiple anxiety and depressive disorders and, as a common risk factor, elevated RNT may account for the high levels ...of comorbidity observed between emotional disorders. The aims of this study were to (a) compare two common forms of RNT (worry and rumination) across individuals with non-comorbid anxiety or depressive disorders, and (b) to examine the relationship between RNT and comorbidity. Methods A structured diagnostic interview and measures of rumination, worry, anxiety, and depression were completed by a large clinical sample with an anxiety disorder or depression ( N =513) presenting at a community mental health clinic. Results Patients without ( n =212) and with ( n =301) comorbid diagnoses did not generally differ across the principal diagnosis groups (depression, generalised anxiety disorder, social anxiety disorder, panic disorder) on worry or rumination. As predicted, comorbidity was associated with a higher level of RNT. Limitations Cross-sectional design precluded causal conclusions and findings may not generalize to excluded anxiety disorders. Conclusions Consistent with the transdiagnostic hypothesis, RNT was associated with a range of anxiety disorders and depression and with comorbidity for those with a principal depressive disorder, supporting recent evidence that RNT is a transdiagnostic process. The presence of RNT, specifically worry and rumination, should be assessed and treated regardless of diagnostic profile. Future research may show that both pure and comorbid depressed or anxious patients receive incremental benefit from transdiagnostic protocols developed to treat core pathological processes of RNT traditionally associated with separate disorders.
Depression and anxiety are common, disabling and chronic. Self-guided internet-delivered treatments are popular, but few people complete them. New strategies are required to realise their potential.
...To evaluate the effect of automated emails on the effectiveness, safety, and acceptability of a new automated transdiagnostic self-guided internet-delivered treatment, the Wellbeing Course, for people with depression and anxiety.
A randomised controlled trial was conducted through the website: www.ecentreclinic.org. Two hundred and fifty seven people with elevated symptoms were randomly allocated to the 8 week course either with or without automated emails, or to a waitlist control group. Primary outcome measures were the Patient Health Questionnaire 9-Item (PHQ-9) and the Generalized Anxiety Disorder 7-Item (GAD-7).
Participants in the treatment groups had lower PHQ-9 and GAD-7 scores at post-treatment than controls. Automated emails increased rates of course completion (58% vs. 35%), and improved outcomes in a subsample with elevated symptoms.
The new self-guided course was beneficial, and automated emails facilitated outcomes. Further attention to strategies that facilitate adherence, learning, and safety will help realise the potential of self-guided interventions.
Australian and New Zealand Clinical Trials Registry ACTRN12610001058066.
Objective: The aims of this study were to report 12-month and lifetime prevalence for anxiety disorders in the Australian general population, identify sociodemographic and clinical correlates of ...anxiety disorders, and report the rates of comorbidity among anxiety, affective, and substance use disorders across the lifespan.
Method: The 2007 National Survey of Mental Health and Wellbeing was a nationally representative, face-to-face household survey of 8841 (60% response rate) community residents aged between 16 and 85 years. Diagnoses for anxiety, affective and substance use disorders were made according to the DSM-IV using the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview.
Results: 12-month and lifetime prevalence of anxiety disorders were 11.8% and 20.0%, respectively. Anxiety disorders had a similar median age of onset (19 years) compared to substance use disorders (20 years), but earlier than affective disorders (34 years). Social phobia was the earliest onset anxiety disorder (median 13 years), with generalized anxiety disorder the latest (median 33 years). Significant correlates of the presence of anxiety disorders included being female, single, not in the labour force, in the middle age groups, not having post-graduate qualifications, having a comorbid physical condition, and having a family history of mental disorders. Being in the oldest age ranges and being born in another non-English speaking country were associated with lower odds of having an anxiety disorder. Body mass index was not associated with the presence of an anxiety disorder. Anxiety disorders were highly comorbid, particularly with major depression, dysthymia, and alcohol dependence. Comorbidity with substance use disorders reduced with age. Comorbidity with affective disorders was high across the lifespan.
Conclusions: Anxiety disorders are common, can have an early onset, and are highly comorbid. Prevention, early detection, and treatment of anxiety disorders should be a priority.
Purpose of Review
This review describes (a) key features of the metacognitive model as they relate to anxiety and related disorders, (b) central components of metacognitive therapy (MCT), (c) the ...current empirical status of MCT, (d) recent developments, (e) controversies and (f) future research directions.
Recent Findings
Evidence is accumulating that MCT is effective for anxiety and related disorders. Emerging evidence suggests that MCT may be effective with children and adolescents and compares well to other evidence-supported treatments such as cognitive behaviour therapy and mindfulness-based approaches. Evidence for distinct mechanisms across therapies is mixed.
Summary
While MCT appears to be effective for anxiety and related disorders, more research is required to evaluate (a) efficacy and unique (vs. common) mechanisms of change compared to other therapies, (b) effectiveness for children and adolescents, (c) alternative delivery methods (e.g., via internet, group vs. individual), (d) transdiagnostic impacts and (e) applications to a broader array of disorders.
Highlights • Investigated intolerance of uncertainty (IU) across three disorders and treatments. • Associations were consistently found between changes in IU and repetitive thinking. • Change in IU ...was associated with change in social and generalized anxiety symptoms. • Change in IU was not associated with change in depression symptoms. • IU appears to be a transdiagnostic and ‘trans-therapy’ change process.
Intolerance of uncertainty is a dispositional trait associated with a range of psychological disorders, but the influence of methodological factors on theses associations remains unknown. The first ...aim of this meta-analysis was to quantify the strengths of the association between IU and symptoms of generalised anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, obsessive compulsive disorder, depression, and eating disorders. The second aim was to assess the influence of methodological factors on these relationships, including clinical (vs. non-clinical) status, age group, sex, IU measure, and symptom measure. We extracted 181 studies (N participants = 52,402) reporting 335 independent effect sizes (Pearson's r). Overall, there was a moderate association between IU and symptoms (r = 0.51, 95% CI = 0.50–0.52), although heterogeneity was high (I2 = 83.50, p < .001). Some small but significant moderator effects emerged between and within disorders. Effect sizes were not impacted by sample size. The results indicate that IU has robust, moderate associations with a range of disorder symptoms, providing definitive evidence for the transdiagnostic nature of IU.
•Meta-analysed transdiagnostic associations with intolerance of uncertainty (IU)•Examined moderators including clinical status, age, sex, IU measure, and symptom measure.•Extracted 181 studies (N participants = 52,402) with 335 independent effects•Moderate associations between IU and symptoms were observed across all disorders.•Some moderating effects were observed, but these were not substantive.
Highlights • Synthesizes what is known and unknown about intolerance of uncertainty (IU). • Implications for research, theory, and clinical intervention are discussed. • Presents an agenda for future ...research. • Contextualizing IU in theoretical and therapeutic models appears warranted.
SNPs discovered by genome-wide association studies (GWASs) account for only a small fraction of the genetic variation of complex traits in human populations. Where is the remaining heritability? We ...estimated the proportion of variance for human height explained by 294,831 SNPs genotyped on 3,925 unrelated individuals using a linear model analysis, and validated the estimation method with simulations based on the observed genotype data. We show that 45% of variance can be explained by considering all SNPs simultaneously. Thus, most of the heritability is not missing but has not previously been detected because the individual effects are too small to pass stringent significance tests. We provide evidence that the remaining heritability is due to incomplete linkage disequilibrium between causal variants and genotyped SNPs, exacerbated by causal variants having lower minor allele frequency than the SNPs explored to date.
The theorized role that intolerance of uncertainty (IU) plays in the acquisition, maintenance, and treatment of multiple emotional disorders underscores the importance of valid assessment tools. ...Research using the Intolerance of Uncertainty Scale-Short form (IUS-12) has conceptualized IU along 2 dimensions, namely, prospective IU and inhibitory IU. However, recent research has cast doubt on the separability of these dimensions. The aim of the current study was to evaluate the fit of competing measurement models of the IUS-12 in separate undergraduate (N = 506) and clinical (N = 524) samples. Unidimensional, correlated 2-factor, and bifactor models were tested using confirmatory factor analysis. The results of both studies supported a bifactor model consisting of a strong general IU factor. The general IU factor explained the majority of unique variance in the IUS-12, and suggested that a total score is generally appropriate for assessing IU. The general IU factor was most strongly and consistently associated with symptoms of multiple disorders. The inhibitory IU group factor was more weakly associated with most symptom measures in the clinical sample, but only with social phobia symptoms in the undergraduate sample. The prospective IU group factor was only separable from the general IU factor in the undergraduate sample, and did not explain unique variance in disorder symptoms.
Public Significance Statement
The present study supports a bifactor model of the Intolerance of Uncertainty Scale-Short Form, and suggests that the total score is generally appropriate for assessing intolerance of uncertainty (IU) in undergraduate and clinical samples. Additionally, it highlights the relative contributions of general, prospective (cognitive), and inhibitory (behavioral) aspects of IU to symptoms of emotional disorders.
•Prospective psychological predictors of mental health among ESP were examined.•Few factors received sufficient empirical attention to draw definitive conclusions.•Peritraumatic reactions and ...interpersonal support were consistent predictors.•Personality predicted outcomes in studies of operational personnel.•More research is needed to inform policy and practice to improve ESP mental health.
Emergency services personnel have an elevated risk of developing mental health conditions. Most research in this area is cross-sectional, which precludes inferences about temporal and potentially causal relationships between risk and protective factors and mental health outcomes. The current study systematically reviewed prospective studies of risk and protective factors for mental health outcomes in civilian emergency services personnel (firefighters, paramedics, police) assessed at pre-operational and operational stages. Out of 66 eligible prospective studies identified, several core groups of risk and protective factors emerged: (1) cognitive abilities; (2) coping tendencies; (3) personality factors; (4) peritraumatic reactions and post-trauma symptoms; (5) workplace factors; (6) interpersonal factors; (7) events away from work. Although there was insufficient evidence for many associations, social support was consistently found to protect against the development of mental health conditions, and peritraumatic dissociation, prior mental health issues, and prior trauma exposure were risk factors for future mental health conditions. Among operational studies, neuroticism was significantly associated with future PTSD symptoms, burnout, and general poor mental health, and avoidance and intrusion symptoms of PTSD were associated with future PTSD and depression symptoms. The current review results provide important targets for future research and interventions designed to improve the mental health of emergency services personnel.
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