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In this study, we combined the results of two controlled trials and examined the relationships between working alliance, telepresence, cognitive change, and treatment outcome. Sixty-five participants with a primary diagnosis of generalized anxiety disorder (GAD) or panic disorder with agoraphobia (PDA) received cognitive behavior therapy delivered via videoconference. Participants completed measures of working alliance and telepresence after three psychotherapy sessions. They also completed measures of treatment outcome and dysfunctional beliefs (cognitive change) specific to PDA and GAD at pretreatment and posttreatment. Results revealed that telepresence at the fifth session moderated the relationship between the working alliance at the first and fifth sessions. As telepresence increased, its impact on the working alliance diminished. Cognitive change mediated the relationship between the working alliance at the fifth session and treatment outcome.

Anxiety disorders are among the most prevalent psychopathologies in children and adolescents around the world. They affect their personal, family, school and social functioning. Although symptoms of generalized anxiety disorder (GAD) are among the most commonly observed symptoms in adolescence, relatively little is known about the most important risk factors. Objectives The purpose of the present study was therefore 1) to document the prevalence of the central feature of GAD, excessive worrying, in high school students aged 12 to 17 years, by identifying the percentage of students reporting low, medium, and high levels of symptoms, 2) to identify key sociodemographic characteristics associated with high symptom level, and 3) to identify individual and family risk factors associated with high symptom level and estimate their relative contribution. Method A total of 8689 Quebec high school students (55.9% girls) participated in the study. The average age of these students was 14.34 years (SD=1.52). A k-means cluster analysis was first performed to create three categories based on the symptoms of generalized anxiety presented by the participants (low, medium, high). Multinomial logistic regression analyzes were then performed to identify the variables that best predict membership in these different categories. Results The results showed that 35.1% of the students reported a low level of symptoms, 40.2% reported an average level of symptoms, while 24.7% reported a high level of symptoms. Girls and adolescents in higher grades were more likely to report high levels of symptoms. Several factors were also identified as increasing the risk of being in the high generalized anxiety symptoms category compared to the average generalized anxiety symptoms and low generalized anxiety symptoms categories. These include fear of negative evaluation by others, perfectionism, depressed feelings, negative problem orientation and cognitive avoidance. Conclusion This study supports previous research showing that girls are at greater risk of developing generalized anxiety disorder. It also highlights the multidimensional aspect of the problem, by identifying the most important risk factors. Ultimately, this better understanding of the factors involved will allow us to better identify the targets to prioritize in the prevention of generalized anxiety disorders in adolescence.

Objectives Assessing late-life anxiety using an instrument with sound psychometric properties including cross-cultural invariance is essential for cross-national aging research and clinical assessment. To date, no cross-national research studies have examined the psychometric properties of the frequently used Geriatric Anxiety Inventory (GAI) in depth. Method Using data from 3,731 older adults from 10 national samples (Australia, Brazil, Canada, The Netherlands, Norway, Portugal, Spain, Singapore, Thailand, and United States), this study used bifactor modeling to analyze the dimensionality of the GAI. We evaluated the “fitness” of individual items based on the explained common variance for each item across all nations. In addition, a multigroup confirmatory factor analysis was applied, testing for measurement invariance across the samples. Results Across samples, the presence of a strong G factor provides support that a general factor is of primary importance, rather than subfactors. That is, the data support a primarily unidimensional representation of the GAI, still acknowledging the presence of multidimensional factors. A GAI score in one of the countries would be directly comparable to a GAI score in any of the other countries tested, perhaps with the exception of Singapore. Discussion Although several items demonstrated relatively weak common variance with the general factor, the unidimensional structure remained strong even with these items retained. Thus, it is recommended that the GAI be administered using all items.

Telepsychotherapy represents a promising solution to problems pertaining to specialized mental health services accessibility, including when delivering psychotherapy to people who do not have access to care due to the COVID-19 pandemic. The quality of the working alliance established in such a therapeutic context remains often questioned. Moreover, no study has comparatively examined the evolution of the alliance over telepsychotherapy and conventional, face-to-face, psychotherapy. This study assesses the impact of cognitive- behavioral therapy administered via telepsychotherapy or face-to-face on the quality of the working alliance. One hundred and 15 participants suffering from generalized anxiety disorder (GAD) took part in this randomized controlled trial, 50 of whom were assigned to telepsychotherapy in videoconference and 65 of whom were assigned to conventional psychotherapy. Each client and their psychotherapist completed the Working Alliance Inventory every 2 sessions. In the current sample, telepsychotherapy did not interfere with the establishment of the working alliance over the course of the treatment for GAD. On the contrary, clients showed a stronger working alliance in telepsychotherapy delivered in videoconference than in conventional psychotherapy. Clients seemed to be more comfortable with telepsychotherapy than psychotherapists. The clinical implications of these findings are discussed.

A growing body of research examines the COVID-19 pandemic's effects on well-being. Only few studies focus on older adults or explore the predictors of COVID-19-related anxiety. Intolerance of uncertainty (IU) and some behaviors (e.g., avoidance, procrastination) are linked to anxiety among older adults and could both be relevant to consider in a pandemic context. This study measured the occurrence and anxiety levels among older adults and verified the possible role of IU and behaviors in predicting anxiety symptoms, impairment and distress related to COVID-19 health standards. It also examined the indirect effect of IU on symptoms, impairment and distress through behaviors. Participants aged 60 and over (N = 356) were recruited and administered questionnaires. Anxiety levels and symptom impairment were high and appeared to have increased since the beginning of the pandemic. IU and behavioral manifestations of anxiety were associated with higher anxiety symptoms, impairment and distress related to COVID-19 health standards. The indirect effects of IU on the tendency to worry and COVID-19-related anxiety through behavioral manifestations of anxiety were confirmed. This study provides knowledge on the relationship between COVID-19 and anxiety in older adults and identifies predictors relevant to this population.

Background Several studies conducted since the beginning of the COVID-19 pandemic have shown its harmful effects on young people’s mental health. In Québec and Canada, few studies have focussed on adolescents, and even fewer of these studies have examined this subject using a methodology that involved comparisons of data obtained before and during the pandemic, which is the purpose of this study. Objective The objective of this study is to determine the impact of the COVID-19 pandemic on the anxiety of secondary 1 and 2 students in Québec, using data obtained before and during the pandemic. Method Participants were 2990 French Canadian students in secondary 1 (grade 7) and secondary 2 (grade 8) in Québec. Two independent samples completed the questionnaires, one sample before the pandemic (fall 2019) and one sample during the pandemic (fall 2020). Their answers were subjected to descriptive analysis and multivariate analysis of variance. Results Results show that the pandemic has had variable impacts on the student’s mental health, with some of them reporting negative effects on their lives, others reporting no effect, and some reporting positive effect. However, the students surveyed during the pandemic generally reported more symptoms of generalized anxiety, and higher levels of test anxiety, fear of judgment and perfectionism than the ones surveyed before the pandemic. Conclusions The discussion puts forward possible explanations for the results obtained, which contribute to a better understanding of young adolescents’ experience during the COVID-19 pandemic. It also discusses the importance of developing interventions for adolescents affected by this pandemic.

Introduction: Anxiety disorders are among the most common mental health disorders affecting youth [1]. Several programs have been developed to prevent these disorders, but few have been implemented systematically, with the intention to sustainability and scaling up to all schools. The HORS-PISTE Program was developed based on the Knowledge to Action framework [2] derived from implementation science. We chose this framework because it is recognized to be clear and easy to use, to foster stakeholder engagement, to consider the local context, and to propose a cyclical and iterative process [3]. Objectives and method: The objective of the presentation is to describe the Program and how this framework was used to design, implement, sustain, evaluate, and scale up this program. An example of a student's involvement in the design of the program will be highlighted. A multi-method (pre and post-test evaluation protocol, surveys, implementation review meetings, logbooks of facilitators) and multi-informant approach (students, parents, teachers, school stakeholders linked to the program logistics) was used.Results: The HORS-PISTE Program aims to prevent anxiety among high school students (aged 12 to 17 years). In the short term, the program seeks to develop and promote various life skills that are determinants of mental health and well-being. The program was developed by involving more than a hundred stakeholders including students. The program offers a continuum with its two components: Exploration (universal prevention component) which is implemented with all students and Expedition (early intervention component) for students who remain vulnerable despite their participation in the Exploration component. The program invites professionals from the education and health networks to join forces in the deployment of the program. The different development, implementation and evaluation cycles of the HORS-PISTE program will be presented through the phases of the Knowledge to Action framework, thus demonstrating how it is possible to maximize its sustainability and scaling up to all Quebec secondary schools. Conclusion: About 100 schools are currently implementing the program. The Quebec Ministry of Health and Social Services is funding a team in order to support schools to make the program accessible to all schools.Implications: Several strengths of the process held by the HORS-PISTE program shed light on how best practices can be capitalized to promote program sustainability and scale-up. The challenges of combining the scientific rigor associated with assessment with the reality in the reality of practice will also be raised.References:1. Dumas JE. Psychopathologie de l’enfant et de l’adolescent. 4th ed. De Boeck; 2013.2. Straus SE, Tetroe JM, Graham ID. Knowledge translation is the use of knowledge in health care decision making. J Clin Epidemiol. 2011 Jan;64(1):6-10. doi: 10.1016/j.jclinepi.2009.08.016. PMID: 19926445.3. Peters S, Bussières A, Depreitere B, et al. Facilitating Guideline Implementation in Primary Health Care Practices. J Prim Care Community Health. 2020 Jan; 11: 1-9. doi:10.1177/2150132720916263

Introduction The Intolerance of Uncertainty Model (IUM) is a well-tested model of generalized anxiety disorder (GAD). Objective To test an extension of the IUM that suggests that intolerance of uncertainty (IU) contributes to worry not only by leading to a negative problem orientation, but also by leading to a negative emotion orientation. Method A total of two hundred and four non-clinical participants completed self-report measures. A structural equation model, which integrates the double role of negative orientation, was tested. Results The proposed model represents well the relationships between IU, negative problem orientation, limited access to emotion regulation strategies, and worry. Conclusion These preliminary results support the importance to study the relationships between IU and emotion regulation, and the need to develop an integrative theory of worry and GAD.

Objectives To estimate the 6-month prevalence of generalized anxiety disorder (GAD) in primary care patients aged 70 years and above and to describe their clinical profile, including types of worries. Methods/design Participants (N = 1193) came from the Etude sur la Sante des Aines (ESA) services study conducted in Quebec, Canada. An in-person structured interview was used to identify GAD and other anxiety/depressive disorders as well as to identify types of worries. Three groups were created (ie, patients with GAD, patients with another anxiety disorder, and patients without anxiety disorders) and compared on several sociodemographic and clinical characteristics using multinomial logistic regression analyses. Results The 6-month prevalence of GAD was 2.7%. Findings also indicated that the most common types of worries were about health, being a burden for loved ones, and losing autonomy. Compared with respondents without anxiety disorders, older patients with GAD were more likely to be women, be more educated, suffer from depression, use antidepressants, be unsatisfied with their lives, and use health services. In comparison with respondents with another anxiety disorder, those with GAD were 4.5 times more likely to suffer from minor depression. Conclusions GAD has a high prevalence in primary care patients aged 70 years and above. Clinicians working in primary care settings should screen for GAD, since it remains underdiagnosed. In addition, it may be associated with depression and life dissatisfaction. Screening tools for late-life GAD should include worry themes that are specific to aging.

Background Only a small proportion of older patients with generalized anxiety disorder (GAD) seek professional help. Difficulties in accessing treatment may contribute to this problem. Guided self-help based on the principles of cognitive-behavioral therapy (GSH-CBT) is one way of promoting access to psychological treatment. Moreover, because the therapist’s role in GSH-CBT is limited to supporting the patient, this role could be assumed by trained and supervised lay providers (LPs) instead of licensed providers. The main goal of this study is to evaluate the efficacy of GSH-CBT guided by LPs for primary threshold or subthreshold GAD in older adults. Methods We will conduct a multisite randomized controlled trial comparing an experimental group receiving GSH-CBT guided by LPs (n = 45) to a wait-list control group (n = 45). Treatment will last 15 weeks and will be based on a participant’s manual. Weekly telephone sessions with LPs (30 min maximum) will be limited to providing support. Data will be obtained through clinician evaluations and self-assessment questionnaires. Primary outcomes will be the tendency to worry and severity of GAD symptoms. Secondary outcomes will be anxiety symptoms, sleep difficulties, functional deficit, diagnosis of GAD, and cognitive difficulties. For the experimental group, measurements will take place at pre- and post-treatment and at 6 and 12 months post-treatment. For the control group, three evaluations are planned: two pre-treatment evaluations (before and after the waiting period) and after receiving treatment (post-treatment). The efficacy of GSH-CBT will be established by comparing the change in the two groups on the primary outcomes. Discussion This project will provide evidence on the efficacy of a novel approach to treat GAD in older adults. If effective, it could be implemented on a larger scale and provide many older adults with much needed mental health treatment through an expanded workforce. Trial registration The trial was registered at ClinicalTrials.gov, number NCT03768544, on December 7, 2018.

Background Previous meta-analyses have shown a significant relationship between working alliance and treatment outcome in general. Some studies have examined the relationship between working alliance and treatment outcome during telepsychotherapy, but to the best of our knowledge, no study has examined the mediating role of individual components of the working alliance. Objective As part of a clinical trial of cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) delivered by videoconference (VC), the aim of this study is to examine the mediating role of intolerance of uncertainty on the relationship between the components of the working alliance and treatment outcome. Methods A sample of 46 adults with primary GAD received 15 sessions of CBT for GAD delivered over VC. Participants completed the measure of working alliance immediately after the fifth therapy session. The degree of change in intolerance of uncertainty (a key psychological process) was assessed from pre- to posttreatment. Treatment outcome was assessed via changes in GAD symptoms from pretreatment to the 6-month follow-up. Results The results revealed that the therapeutic bond did not predict treatment outcome (r=−0.23; P=.12). However, agreement on therapeutic goals and tasks did predict treatment outcome (r=−0.42; P=.004 and r=−0.37; P=.01, respectively). In addition, the relationship between consensus on therapeutic tasks and treatment outcome was completely mediated by changes in intolerance of uncertainty (unstandardized β=−0.03; r2=0.12), whereas consensus relative to treatment goals had a direct impact on treatment outcome. Conclusions These results provide a better understanding of the differential role of the components of the working alliance in telepsychotherapy as a facilitative factor for changes in key cognitive processes, leading to therapeutic change. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 12662027; http://www.isrctn.com/ISRCTN12662027.

BackgroundTransdiagnostic group cognitive-behavioral therapy (tCBT) is a delivery model that could help overcome barriers to large-scale implementation of evidence-based psychotherapy for anxiety disorders. The aim of this study was to assess the effectiveness of combining group tCBT with treatment-as-usual (TAU), compared to TAU, for the treatment of anxiety disorders in community-based mental health care.MethodsIn a multicenter single-blind, two-arm pragmatic superiority randomized trial, we recruited participants aged 18–65 who met DSM-5 criteria for principal diagnoses of generalized anxiety disorder, social anxiety disorder, panic disorder, or agoraphobia. Group tCBT consisted of 12 weekly 2 h sessions. There were no restrictions for TAU. The primary outcome measures were the Beck Anxiety Inventory (BAI) and clinician severity rating from the Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5) for the principal anxiety disorder at post-treatment, with intention-to-treat analysis.ResultsA total of 231 participants were randomized to either tCBT + TAU (117) or TAU (114), with outcome data available for, respectively, 95 and 106. Results of the mixed-effects regression models showed superior improvement at post-treatment for participants in tCBT + TAU, compared to TAU, for BAI [p < 0.001; unadjusted post-treatment mean (s.d.): 13.20 (9.13) v. 20.85 (10.96), Cohen's d = 0.76] and ADIS-5 [p < 0.001; 3.27 (2.19) v. 4.93 (2.00), Cohen's d = 0.79].ConclusionsOur findings suggest that the addition of group tCBT into usual care can reduce symptom severity in patients with anxiety disorders, and support tCBT dissemination in routine community-based care.

BACKGROUND Previous meta-analyses have shown a significant relationship between working alliance and treatment outcome in general. Some studies have examined the relationship between working alliance and treatment outcome during telepsychotherapy, but to the best of our knowledge, no study has examined the mediating role of individual components of the working alliance. OBJECTIVE As part of a clinical trial of cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) delivered by videoconference (VC), the aim of this study is to examine the mediating role of intolerance of uncertainty on the relationship between the components of the working alliance and treatment outcome. METHODS A sample of 46 adults with primary GAD received 15 sessions of CBT for GAD delivered over VC. Participants completed the measure of working alliance immediately after the fifth therapy session. The degree of change in intolerance of uncertainty (a key psychological process) was assessed from pre- to posttreatment. Treatment outcome was assessed via changes in GAD symptoms from pretreatment to the 6-month follow-up. RESULTS The results revealed that the therapeutic bond did not predict treatment outcome (r=−0.23; P=.12). However, agreement on therapeutic goals and tasks did predict treatment outcome (r=−0.42; P=.004 and r=−0.37; P=.01, respectively). In addition, the relationship between consensus on therapeutic tasks and treatment outcome was completely mediated by changes in intolerance of uncertainty (unstandardized β=−0.03; r2=0.12), whereas consensus relative to treatment goals had a direct impact on treatment outcome. CONCLUSIONS These results provide a better understanding of the differential role of the components of the working alliance in telepsychotherapy as a facilitative factor for changes in key cognitive processes, leading to therapeutic change. CLINICALTRIAL International Standard Randomized Controlled Trial Number (ISRCTN): 12662027; http://www.isrctn.com/ISRCTN12662027.

This study aims to examine two explanatory factors of relationship satisfaction and parental alliance among both parents of a new child, namely romantic attachment and perfectionism. A sample of 80 couples completed individual online questionnaires. Path analyses based on the Actor-Partner Interdependence Model were carried out to explore the actor and partner effects of each explanatory variable (attachment, perfectionism) on both partners' postnatal relationship satisfaction and parental alliance. Results revealed that attachment avoidance is negatively related to each partner's own relationship satisfaction and parental alliance, whereas attachment anxiety is related to their own lower parental alliance. Maladaptive perfectionism is negatively related to each partner's own relationship satisfaction, whereas adaptive perfectionism is positively related to each partner's own relationship satisfaction. These results extend the understanding of the factors contributing to parental and couple adaptation in the postnatal period. They highlight the role of attachment and perfectionism for improving postnatal professionals' interventions.

A cognitive-behavioral guided self-help conducted by lay providers (CBT-GSH-LP) had been shown to be effective in treating anxiety and may help facilitate access to treatment. The first objective of this study was to assess the acceptability the CBT-GSH-LP for the Generalised Anxiety Disorder in adults aged 60 and over. Its acceptability was compared to that of the same treatment conducted by a psychotherapist (CBT- GSH-PSY) and to that of a face-to-face cognitive behavioral therapy with a psychotherapist (CBT- PSY). The second objective was to assess the preference of the participants for these treatment modalities. As a secondary objective, variables potentially associated with acceptability or preference were explored, as well as reported reasons for treatment preference. Participants were recruited in community centers and private residences. They had to complete a sociodemographic questionnaire, read descriptions of the three treatments, and complete the Treatment Evaluation Inventory for each one, then to place those treatment in order of preference as well as indicating the reason for their preferred treatment. ANOVAs were performed to identify differences in acceptability scores between the three treatment modalities and proportions were calculated for preferred treatment and reasons associated. CBT-GSH-LP was considered moderately acceptable by participants (N = 116; mean age = 70.5 years), although significantly less acceptable than the other two treatment modalities. In addition, the proportion of participants who found CBT-GSH-LP to be at least moderately acceptable was high (59,3%), although lower than that of the other two treatment modalities (CBT-GSH-PSY: 85,8%; CBT-PSY: 91,2%). Consequently, the preferred treatment of participants was CBT-PSY followed by CBT-GSH-PSY, then CBT-GSH-LP. Among participants preferring CBT-GSH-LP, its long-lasting effect, ease of access, training of the therapist, required patient involvement, and autonomy afforded by treatment were the top reasons. Regarding characteristics, the results show that single and widowed older adults considered CBT-GSH-LP more acceptable than married, divorced, or separated people. Thus, although it is not the preferred treatment modality for older adults, CBT-GSH-LP is acceptable and would benefit from being better known and used for generalized anxiety disorder.

Resume La peur de l’accouchement est tres frequente chez les femmes enceintes d’un premier enfant. Elle semble liee a des consequences specifiques a l’accouchement et en post-partum, dont l’apparition de symptomes post-traumatiques (SPT), de meme que le blues ou la depression post-partum (DPP). Or, la plupart des etudes realisees reposent sur des echantillons tres restreints, montrent des resultats contradictoires ou tiennent peu compte des interactions entre les facteurs impliques. Objectif Cette etude vise a verifier si la peur de l’accouchement de femmes enceintes nullipares est liee au deroulement de l’accouchement et a la presence de consequences post-partum (c’est-a-dire symptomes de DPP et de SPT). Methode Au total, 176 femmes ont repondu a deux temps de mesure (pre- et post-partum). Resultats La peur de l’accouchement est liee a la douleur percue a la naissance chez les femmes accouchant par voie vaginale, en l’absence d’anesthesie. Elle est aussi liee aux symptomes de DPP et de SPT, independamment du recours ou non a l’anesthesie. La peur apparait aussi liee fortement aux symptomes de SPT chez les femmes ayant vecu une cesarienne non planifiee. Les symptomes de SPT post-partum pourraient jouer un role mediateur dans le lien unissant la peur d’accoucher et la depression post-partum. Conclusions Ces resultats supportent la pertinence de tenir compte de la peur de l’accouchement et de la douleur percue en lien avec les symptomes de SPT et de DPP aupres de nullipares. La peur de l’accouchement pourrait rendre l’experience de la naissance plus negative et predisposer au SPT et a la DPP post-partum. D’autres etudes sont necessaires pour preciser ces relations.

Carboxymethyl starch microspheres (CMS-MS) were produced from carboxymethyl starch powder (CMS-P) with a degree of substitution (DS) from 0.1 to 1.5 in order to investigate the influence of DS on physicochemical, drug release and mucoadhesion properties as well as interactions with gastrointestinal tract (GIT) epithelial barrier models. Placebo and furosemide loaded CMS-MS were obtained by emulsion-crosslinking with sodium trimetaphosphate (STMP). DS had an impact on increasing equilibrium water uptake and modulating drug release properties of the CMS-MS according to the surrounding pH. The transepithelial electrical resistance (TEER) of NCI-N87 gastric cell monolayers was not influenced in presence of CMS-MS, whereas that of Caco-2 intestinal cell monolayers decreased with increasing DS but recovered initial values at about 15h post-treatment. CMS-MS with increasing DS also enhanced furosemide permeability across both NCI-N87 and Caco-2 monolayers at pH gradients from 3.0 to 7.4. Mucoadhesion of CMS-MS on gastric mucosa (acidic condition) increased with the DS up to 55% for a DS of 1.0 but decreased on neutral intestinal mucosa to less than 10% with DS of 0.1. The drug release, permeability enhancement and mucoadhesive properties of the CMS-MS suggest CMS-MS with DS between 0.6 and 1.0 as suitable excipient for gastroretentive oral delivery dosage forms.

Background.The Geriatric Anxiety Inventory (GAI) is a widely used self-report measure of anxiety symptoms in older adults. Much research has been conducted on the psychometric properties of the GAI in various populations and using different language versions. Previous reviews of this literature have examined only a small proportion of studies in light of the body of research currently available and have not evaluated the methodological quality of this research. We conducted a systematic review of the psychometric properties of the GAI.Method.Relevant studies (N = 30) were retrieved through a search of electronic databases (Pubmed, PsycINFO, CINAHL, EMBASE and Google Scholar) and a hand search. The methodological quality of the included studies was assessed by two independent reviewers using the ‘‘COnsensusbased Standards for the selection of health status Measurement INstruments’’ (COSMIN) checklist.Results.Based on the COSMIN checklist, internal consistency and test reliability were mostly rated as poorly assessed (62.1% and 70% of studies, respectively) and quality of studies examining structural validity was mostly fair (60% of studies). The GAI showed adequate internal consistency and test-retest reliability. Convergent validity indices were highest with measures of generalized anxiety and lowest with instruments that include somatic symptoms. A substantial overlap with measures of depression was reported. While there was no consensus on the factorial structure of the GAI, several studies found it to be unidimensional.Conclusions.The GAI presents satisfactory psychometric properties. However, future efforts should aim to achieve a higher degree of methodological quality.

Background Anxiety disorders are the most common mental disorders in community settings, and they are associated with significant psychological distress, functional and social impairment. While cognitive behaviour therapy (CBT) is the most consistently efficacious psychological treatment for anxiety disorders, barriers preclude widespread implementation of CBT in primary care. Transdiagnostic group CBT (tCBT) focuses on cognitive and behavioural processes and intervention strategies common to different anxiety disorders, and could be a promising alternative to conventional CBT. This study aims to examine the effectiveness of a transdiagnostic group CBT for anxiety disorders program as a complement to treatment-as-usual (TAU) in primary mental health care. Methods/Design The trial is a multicentre pragmatic randomized controlled trial with a pre-treatment, post-treatment, and follow-up at 4, 8 and 12-months design. Treatment and control groups . a) tCBT (12 weekly 2-h group sessions following a manualized treatment protocol); b) TAU for anxiety disorders. Inclusion criteria comprise meeting DSM-5 criteria for primary Panic Disorder, Agoraphobia, Social Anxiety Disorder and/or Generalized Anxiety Disorder. Patients are recruited in three regions in the province of Quebec, Canada. The primary outcome measures are the self-reported Beck Anxiety Inventory and the clinician-administered Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5); secondary outcome measures include treatment responder status based on the ADIS-5, and self-reported instruments for specific anxiety and depression symptoms, quality of life, functioning, and service utilisation. Statistical analysis: Intention-to-treat analysis. A mixed effects regression model will be used to account for between- and within-subject variations in the analysis of the longitudinal effects of the intervention. Discussion This rigorous evaluation of tCBT in the real world will provide invaluable information to decision makers, health care managers, clinicians and patients regarding the effectiveness of the intervention. Widespread implementation of tCBT protocols in primary care could lead to better effectiveness, efficiency, access and equity for the large number of patients suffering from anxiety disorders that are currently not obtaining evidence-based psychotherapy. Trial registration ClinicalTrials.gov: NCT02811458.

Bioavailability of oral drugs can be limited by an intestinal excretion process mediated by P-glycoprotein (P-gp). Polyethylene glycol (PEG) is a known P-gp inhibitor. Dispersion of Famotidine (a P-gp substrate) within PEGylated nanoparticles (NPs) was used to improve its oral bioavailability. In this work, we evaluated the potential impact of NPs prepared from a grafted copolymer of polylactic acid and PEG on P-gp function by studying in vitro permeability of Famotidine across Caco-2 cells. Copolymers of PEG grafted on polylactic acid (PLA) backbone (PLA-g-PEG) were synthesised with 1 mol% and 5 mol% PEG vs. lactic acid monomer using PEG 750 and 2000 Da. The polymers were used to prepare Famotidine-loaded NPs and tested in vitro on Caco-2 cells. Significant decrease in basolateral-to-apical transport of Famotidine was observed when Famotidine was encapsulated in NPs prepared from PLA-g-PEG5%. NPs prepared from PLA-g-PEG5% are promising to improve oral bioavailability of P-gp substrates.

Individuals with pathological worry, a common symptom of Generalized Anxiety Disorder (GAD), make threatening interpretations of ambiguous information related to various life domains (e.g., finances, relationships). A word-sentence association paradigm (WSAP) computer task, originally designed for social anxiety, was adapted to assess two threat-related interpretation biases common among individuals with generalized anxiety and pathological worry. The two biases, which have yet to be investigated simultaneously, include: accepting threatening interpretations and rejecting benign interpretations of ambiguous information (for the original WSAP, see Beard & Amir, 2009). It was hypothesized that endorsing threat interpretations on the WSAP would be associated with greater bias for threat on a validated self-report measure of bias, and would predict GAD symptoms and worry after trait anxiety and depression were statistically controlled. Results from a non-clinical sample (N = 148) provided support for the convergent validity of the WSAP. After controlling for trait anxiety and depression, a bias to accept threat interpretations predicted a unique and significant proportion of variance in measures of GAD symptoms and worry. A bias away from non-threat (i.e., rejecting benign interpretations) was unrelated. The WSAP shows evidence of sensitivity and specificity to GAD symptoms and worry, and appears to be a unique and specific measure of two types of threat bias making it theoretically informative and clinically useful.

The Geriatric Anxiety Inventory (GAI) and a short form of this instrument (GAI-SF) were developed to assess the severity of anxiety symptoms in older adults in order to compensate for the lack of validated screening tools adapted to the elderly population. This study examined the psychometric properties of the French Canadian version of the GAI, in its complete (GAI-FC) and short form (GAI-FC-SF).A total of 331 community-dwelling seniors between 65 and 92 years old participated in this study.Both the GAI-FC and the GAI-FC-SF have sound psychometric properties with, respectively, a high internal consistency (α = .94 and .83), an adequate convergent validity (r = .50 to .86 with instruments known to evaluate constructs similar to the GAI or related to anxiety), a good test-retest reliability (r = .89 and .85), in addition to a single-factor structure.The results support the use of both the GAI-FC and the GAI-FC-SF. The GAI-FC-SF seems to be an interesting alternative to the GAI-FC as a screening tool when time available for assessment is limited.

Patients with panic disorder with agoraphobia (PDA) or generalized anxiety disorder (GAD) frequently also suffer from insomnia. However, the impact of cognitive-behavioral therapy (CBT) for anxiety disorders on insomnia has been understudied. Furthermore, comorbidity between anxiety disorders is common. Our main objective was to assess the impact of CBT for PDA or GAD on insomnia. In a quasi-experimental design, 86 participants with PDA and GAD received conventional CBT for their primary disorder or combined CBT for both disorders. Overall, CBTs had a significant impact on reducing insomnia symptoms (η = 0.58). However, among people with insomnia at pretest (67%), 33% still had an insomnia diagnosis, and the majority (63%) had clinically significant residual insomnia following treatment. In conclusion, the CBTs had a positive effect on the reduction of insomnia, but a significant proportion of participants still had insomnia problems following treatment. Clinicians should address insomnia during CBT for PDA and GAD.

Panic disorder with agoraphobia (PDA) and generalized anxiety disorder (GAD) are impairing and costly disorders that are often misdiagnosed and left untreated despite multiple consultations. These disorders frequently co-occur, but little is known about the costs associated with their comorbidity and the impact of cognitive-behavioral therapy (CBT) on cost reduction.The first objective of this study was to assess the mental health-related costs associated with the specific concomitance of PDA and GAD. The second aim was to determine whether there is a reduction in direct and indirect mental health-related costs following conventional CBT for the primary disorder only (PDA or GAD) or combined CBT adapted to the comorbidity (PDA and GAD).A total of 123 participants with a double diagnosis of PDA and GAD participated in this study. Direct and indirect mental health-related costs were assessed and calculated from a societal perspective at the pre-test, the post-test, and the three-month, six-month and one-year follow-ups.At the pre-test, PDA-GAD comorbidity was found to generate a mean total cost of CADUSD 2,000.48 (SD = USD 2,069.62) per participant over a three-month period. The indirect costs were much higher than the direct costs. Both treatment modalities led to significant and similar decreases in all cost categories from the pre-test to the post-test. This reduction was maintained until the one-year follow-up.Methodological choices may have underestimated cost evaluations. Nonetheless, this study supports the cost offset effects of both conventional CBT for primary PDA or GAD and combined CBT for PDA-GAD comorbidity.Treatment of comorbid and costly disorders with evidence-based treatments such as CBT may lead to considerable economic benefits for society.Considering the limited resources of healthcare systems, it is important to make choices that will lead to better accessibility of quality services. The application of CBT for PDA, GAD or both disorders and training mental health professionals in this therapeutic approach should be encouraged. Additionally, it would be favorable for insurance plans to reimburse employees for expenses associated with psychological treatment for anxiety disorders.In addition to symptom reduction, it would be of great pertinence to explore which factors can contribute to reducing direct and indirect mental health-related costs.

The main objective of this study was to examine the efficacy of a guided self-help treatment based on cognitive behavioral principles (CBT-GSH) for generalized anxiety disorder (GAD) in older adults.Three older adults aged from 66 to 70 and diagnosed with GAD were included in a single-case experimental multiple-baseline protocol. Data were collected using daily self-monitoring, standardized clinician ratings, and self-report questionnaires at pretest, posttest, and 6-month and 12-month follow-ups. Treatment consisted of awareness training, worry interventions, relaxation training, pleasant activities scheduling, and relapse prevention. Participants used a manual presenting weekly readings and at-home practice exercises. They also received weekly supportive phone calls from a therapist.At posttest, participants showed improvement on worries and GAD severity, on psychological process variables targeted by treatment (intolerance of uncertainty, negative problem orientation, cognitive avoidance, and perceived usefulness of worry), and on secondary variables associated with GAD (anxiety, depression, sleep difficulties, cognitive functioning, and disability). These results were generally maintained at 12 months after the end of treatment. Participants had favorable opinions toward the treatment.The results of this study suggest that CBT-GSH is both feasible and effective for the treatment of GAD in older adults.