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Tools to assess worry among adolescents exist but do not capture the content of worries. This study reports on the development of a brief, psychometrically sound measure of worry for use with adolescents. Phase 1 involved identification of 27 potential items from existing instruments as well as item generation identified in interviews with students, teachers, school psychologists, and parents. In Phase 2, the candidate items were completed by 835 Australian adolescents (317 males, 508 females, 10 unspecified; Mean age = 13.55, SD = 1.31) from Grades 5 to 10. These data were randomly split in half, and an exploratory factor analysis on the first half identified a two-factor solution with 12 items: Peer Relationships (6 items) and Academic Success and the Future (6 items). On the second half of the data, confirmatory factor analyses supported the factor structure and supported strong invariance across age, socioeconomic status, and presence/absence of a diagnosed neurodevelopmental disorder. Weak invariance was evident across sex. Differences across groups are reported as are correlations with indicators of psychological wellbeing. In conclusion, the Perth Adolescent Worry Scale provides both applied professionals and researchers with a short, easy-to-administer, and psychometrically strong instrument to evaluate adolescents' everyday worries., (© 2021. The Author(s).)

Background: The Perinatal Anxiety Screening Scale (PASS; Somerville et al., 2014) reliably identifies perinatal women at risk of problematic anxiety when a clinical cut-off score of 26 is used. This study aimed to identify a severity continuum of anxiety symptoms with the PASS to enhance screening, treatment and research for perinatal anxiety., Methods: Antenatal and postnatal women (n=410) recruited from the antenatal clinics and mental health services at an obstetric hospital completed the Edinburgh Postnatal Depression Scale (EPDS), the Depression, Anxiety and Stress Scale (DASS-21), the Spielberg State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory II (BDI), and the PASS. The women referred to mental health services were assessed to determine anxiety diagnoses via a diagnostic interview conducted by an experienced mental health professional from the Department of Psychological Medicine - King Edward Memorial Hospital. Three normative groups for the PASS, namely minimal anxiety, mild-moderate anxiety, and severe anxiety, were identified based on the severity of anxiety indicated on the standardised scales and anxiety diagnoses., Results: Two cut-off points for the normative groups were calculated using the Jacobson-Truax method (Jacobson and Truax, 1991) resulting in three severity ranges: 'minimal anxiety'; 'mild-moderate anxiety'; and 'severe anxiety'., Limitations: The most frequent diagnoses in the study sample were adjustment disorder, mixed anxiety and depression, generalised anxiety, and post-traumatic stress disorder. This may limit the generalisability of the severity range results to other anxiety diagnoses including obsessive compulsive disorder and specific phobia., Conclusions: Severity ranges for the PASS add value to having a clinically validated cut-off score in the detection and monitoring of problematic perinatal anxiety. The PASS can now be used to identify risk of an anxiety disorder and the severity ranges can indicate developing risk for early referrals for further assessments, prioritisation of access to resources and tracking of clinically significant deterioration, improvement or stability in anxiety over time., (Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.)

Objectives: Integrative models of psychopathology suggest that quality of interpersonal relationships is a key determinant of psychological well-being. However, there is a relative paucity of research evaluating the association between interpersonal problems and psychopathology within cognitive behavioural therapy. Partly, this may be due to lack of brief, well-validated, and easily interpretable measures of interpersonal problems that can be used within clinical settings. The aim of the present study was to evaluate the psychometric properties, factor invariance, and external validity of the Inventory of Interpersonal Problems 32 (IIP-32) across anxiety, depression, and eating disorders., Methods: Two treatment-seeking samples with principal anxiety and depressive disorders (AD sample, n = 504) and eating disorders (ED sample, n = 339) completed the IIP-32 along with measures of anxiety, depression, and eating disorder symptoms, as well as quality of life (QoL)., Results: The previously established eight-factor structure of the IIP-32 provided the best fit for both the AD and ED groups, and was robustly invariant across the two samples. The IIP-32 also demonstrated excellent external validity against well-validated measures of anxiety, depression, and eating disorder symptoms, as well as QoL., Conclusion: The IIP-32 provides a clinically useful measure of interpersonal problems across emotional and ED., (© Commonwealth of Australia 2012.)

Trait anxiety is an individual-difference variable reflecting variation in state-anxiety elevations resulting from exposure to a stressor. It is usually measured using questionnaire instruments, such as the Spielberger State-Trait Anxiety Inventory (STAI-T). The present research conceptually distinguishes, and independently assesses, two hypothetical dimensions of anxiety vulnerability which, it is argued, could plausibly make independent contributions to variance in trait-anxiety scores. These dimensions are anxiety reactivity, the probability of experiencing an anxiety reaction to a stressor, and anxiety perseveration, the persistence of anxiety symptoms once elicited. Participants were asked three questions about each STAI-T item. The traditional STAI-T question assessed how much of the time this symptom was experienced; the anxiety-reactivity question assessed the probability of experiencing the symptom in response to a stressor; and the anxiety-perseveration question assessed how long the symptom persisted, if elicited. Regression analysis determined that anxiety reactivity and anxiety perseveration scores both accounted for independent variance in trait-anxiety scores. It is argued that models of anxiety vulnerability should seek to differentiate both the causes and the consequences of elevated anxiety reactivity and increased anxiety perseveration.

Objective: This study extends Penfold and Page's (1999) finding that exposure plus distraction enhanced within-session fear reduction to a phobic stimulus by examining whether the within-session advantage could be replicated and translated into longer-term gains., Design: To test the effects of distraction, participants were assigned randomly to one of three experimental conditions; exposure plus focusing, exposure plus distraction, or exposure alone., Method: Blood-injection fearful participants (N = 48) were assigned randomly to receive 3 weekly sessions of 10-min exposure under one of the experimental conditions., Results: Consistent with the previous finding, exposure plus distraction showed the greatest within-session fear reduction. Participants in the exposure plus distraction condition also reported the greatest reduction in fear between sessions, at post-treatment, and at 1-month follow-up. Furthermore, participants in the exposure plus distraction condition reported continued increases in perceived control over their anxiety during the month following the exposure sessions., Conclusions: The data suggest that conversation is a distraction that can increase perceived control over anxiety and assists anxiety reduction.

Objectives: A key feature of blood‐injection‐injury (BII) phobia is activation of disgust responses, in addition to fear. Yet, standard treatments have largely neglected addressing disgust responses. The disorder is further complicated by fainting in 75% of sufferers. Moreover, treatments have been traditionally delivered in an individual format, which may not be as efficient as group treatment. The aim of this study was to develop a group‐based programme for BII phobia, with components targeting fear, disgust, and fainting, to determine feasibility and effectiveness of such an intervention. Methods: Participants took part in an 8‐session, group‐based Cognitive Behavioural Therapy (CBT) programme for BII phobia (N = 40). The key outcome measure was the Multidimensional Blood/Injury Phobia Inventory, which assesses a range of phobic stimuli and responses (including fear, disgust, and fainting). Results: There were significant improvements, with large effect sizes, across symptoms over the course of treatment. Participants with higher disgust sensitivity reported higher pre‐treatment symptom severity and greater life interference than those with lower disgust scores. Despite this, neither pre‐treatment disgust sensitivity nor fainting history impacted on treatment response. For the first time, however, we showed that greater reductions in disgust to BII stimuli were associated with greater overall symptom reductions, highlighting the importance of disgust in the treatment of this disorder, and potentially others. Conclusion: Despite the heterogeneous nature of BII phobia, this group‐based, modified CBT intervention was effective in reducing a variety of phobic responses, including fear, disgust, and fainting. Practitioner points: Disgust is a key maintaining factor in blood‐injection‐injury phobia, which clinicians should consider in their assessment and treatment of this disorder. There is little in the existing literature to guide clinicians in this regard.This study examined a novel group treatment for blood‐injection‐injury phobia which included strategies to target disgust, in addition to traditional CBT strategies to address fear and fainting.The treatment was feasible and acceptable. Symptoms of fear, disgust, and fainting reduced significantly over treatment.Changes in disgust symptoms were associated with overall symptom changes, however a control group is needed to determine the effects of individual treatment components and to make more robust conclusions about the benefits of this enhanced approach. [ABSTRACT FROM AUTHOR]

The application of Cognitive Behavioural Therapy (CBT) skills are believed to be a mechanism of therapeutic change in treatment. Research has shown that the application of CBT skills affects outcomes, however, the way these relationships may change during treatment has not been explored. In this study, a naturalistic observational approach is used to examine the relationships between patients' wellbeing, symptoms, and the application of CBT skills throughout treatment. It is hypothesized that the application of CBT skills would lead to an increase in patients reported wellbeing, and a decrease in symptoms. Additionally, it was hypothesized that the application of CBT skills affects wellbeing and symptoms at different points in therapy. A sample of 584 patients in a two-week CBT treatment completed session-to-session measures of wellbeing, symptoms, and their application of CBT skills. Results of an autoregressive cross-lagged path analysis indicated that in the early stages of treatment the application of CBT skills predicted patient wellbeing but not symptoms. At the later stages of therapy, the application of CBT skills predicted both patient wellbeing and symptoms. At no point in treatment did patient wellbeing or symptoms predict the later application of CBT skills. Implications and future directions for research are discussed. [ABSTRACT FROM AUTHOR]

Background: Reporting of the clinical significance of observed changes is recommended when publishing mental health treatment outcome studies and is increasingly used in routine outcomes monitoring systems. Since recovery rates vary with the method chosen, we investigated the validity of classifications of clinically significant change when the Jacobson-Truax method and the Hageman-Arrindell method were used. Methods: Of 718 inpatients who completed the Depression Anxiety Stress Scales (DASS-21) and Quality of Life Enjoyment and Satisfaction Questionnaire at admission and discharge to a psychiatric clinic, 355 were invited (and 119 agreed) to complete the questionnaires and the Recovery Assessment Scale six weeks post discharge. Results: Both the JT and HA methods showed comparably good validity when referenced against the other indices. Clinically significant change on the DASS-21 was related to a greater consumer-based sense of recovery, greater perceived quality of life, and fewer readmissions to hospital within 28 days of discharge. Conclusions: Since there was found to be no advantage to using one method over another when recovery is of interest, the simpler JT method is recommended for routine usage. [ABSTRACT FROM AUTHOR]

Abstract: The present study examined the effects of attentional focus on fear reduction during exposure. Participants were randomly assigned to experimental conditions: exposure plus internal focus, exposure plus external focus, exposure plus internal distraction, exposure plus external distraction or exposure alone. Fifty blood-injury-injection fearful participants received 3 weekly exposure sessions. Participants in the distraction group reported the greatest fear reduction, with most notable reductions occurring for the external distraction condition. The distraction group also achieved a greater number of steps on a behavioral avoidance task at post-treatment, with the external distraction condition displaying greater approach behavior at follow-up. At follow-up the distraction group also displayed a greater increase in perceived control than the focusing group. Thus, distraction reduces fear within and between sessions and increases approach behavior in the longer-term, with exposure plus external distraction further facilitating this effect. [Copyright &y& Elsevier]

Abstract: The effects on blood–injury fear and fainting of scripts concerning pain, nausea, and anger and individual differences in trait anxiety and disgust sensitivity were investigated. Eighteen participants were high in disgust sensitivity and trait anxiety, 11 were low in disgust sensitivity but high in trait anxiety, 10 were high in disgust sensitivity but low in trait anxiety, and 16 were low in disgust sensitivity and trait anxiety. Participants were exposed to pain, nausea, and anger scripts during presentation of blood–injury slides. The ability of the scripts to increase symptoms of fear and faintness, on a state version of the Blood–Injection Symptom Scale (BISS; Page, A. C., Bennett, K. S., Carter, O., Smith, J., & Woodmore, K. (1997). Blood–Injection Symptom Scale (BISS): Assessing the structure of phobic symptomatology elicited by blood and injections. Behaviour Research and Therapy, 35, 457–464) were examined. Analyses indicated that individual differences in trait anxiety and disgust sensitivity interact to generate symptoms of faintness when the pain script was read. That is, disgust sensitive and trait anxious participants reported greater faintness relative to other conditions. The implications for theory and treatment of blood–injury–injection phobia are discussed. [Copyright &y& Elsevier]

Members of an anxiety disorders self-help group were surveyed to provide a better understanding of the members of these organisations in Australia and thereby assist psychologists providing for their needs. Thirty-four members of the West Australian Anxiety Self-Help Association (ASHA) completed an open-ended survey asking about the type of professionals from which help was sought, the length of time before a diagnosis was made, the type of treatment received and the type of treatment that was preferred. Responses were then classified into categories for analysis. The membership of the Australian group was comparable to U.S. studies. Most members (88%) initially consulted a general practitioner about their anxiety disorder. It took 4.7 visits to health professionals over 3 years before a diagnosis of an anxiety disorder was made. The most commonly provided treatment was medication, with 91% being prescribed medication at some point, and one third were not happy with their current medication. Nearly all of the participants had tried "alternative" therapies, yet only 44% had tried cognitive behaviour therapies. In conclusion, understanding the needs and experiences of members of self-help organisations will permit greater integration with other mental health services. [ABSTRACT FROM AUTHOR]

To replicate and extend the finding that distraction facilitates between session anxiety reduction (), 27 spider phobics underwent three 10-min sessions of in vivo exposure followed by one 10-min exposure session at a 4-week follow-up, while having either stimulus-relevant focused conversation or stimulus-irrelevant distracting conversation with the experimenter. Physiological arousal and subjective anxiety were measured during exposure, and self-efficacy, perceived control and performance on a behavioural task were measured at pre-treatment, post session-3, and follow-up. Monitoring and blunting coping styles were also measured at pre-treatment to assess their impact on treatment outcome. Despite equal physiological activation between the groups, those who underwent distracted exposure showed greater reductions in subjective fear within and between sessions, and showed greater increases in self-efficacy ratings, internal perceived control and performance on a behavioural task. Coping style did not interact with the effect of distraction or focusing during exposure, however blunters had less subjective anxiety reduction overall, particularly when they underwent focused exposure. Results are discussed in terms of the emotional processing model and self-efficacy theory. [Copyright &y& Elsevier]

We present evidence that dysphoric rumination involves a working memory (WM) updating deficit. Sixty-one undergraduates—pre-screened with rumination and depression scales—completed a novel task providing a specific measure of WM updating. This task involved the substitution of emotionally-valenced words, and provided an online measure of the time taken to remove outdated items from WM. Results showed that dysphoric ruminators spent less time removing outdated words from WM when the new to-be-remembered word was negative. This effect was (1) associated with impaired subsequent recall of negative words, arguably caused by interference from the insufficiently removed outdated words; and (2) correlated with participants’ rumination scores. This is the first study to use the novel removal task to investigate the nature of WM-updating impairments in rumination. The findings are consistent with a negative attentional bias in rumination, and provide preliminary evidence that rumination is associated with a valence-generic removal deficit during WM updating. Reducing the attentional bias could thus be an intervention target in the treatment of dysphoric rumination. [ABSTRACT FROM AUTHOR]

Background: Depression and anxiety disorders exhibit comorbidity, and the same relationships have been observed in postpartum samples. The tripartite model posits that anxiety and depression overlap due to shared and unique symptom components. The present study tested whether a one-factor model, or a three-factor model consistent with the tripartite model, provided a better fit to anxiety and depression symptoms in a postpartum sample.Methods: The sample consisted of 663 postpartum psychiatric inpatients who completed self-reported questionnaires assessing symptoms of anxiety and depression.Results: Confirmatory factor analysis revealed that a three-factor model consistent with the tripartite model provided a good fit to anxiety/depression data. This model consisted of three factors: positive affect, negative affect, and autonomic arousal. Positive affect was related to depressive diagnoses and negatively related to anxiety diagnoses; autonomic arousal was related to anxiety diagnoses; and negative affect was uniquely related to mixed anxiety-depressive diagnoses.Limitations: The sample consisted of postpartum psychiatric inpatients and the generalisability of results to other postpartum samples is not known.Conclusions: Postpartum anxiety and depression appear to be characterised by three differentiable symptom clusters. Postpartum anxiety, depression, and mixed anxiety-depressive diagnoses are differentially associated with these symptom clusters. These findings suggest that the tripartite model may be useful in guiding assessment, differentiation, and treatment of postpartum emotional disorders. [ABSTRACT FROM AUTHOR]

Abstract: Background: To date, the monitoring of patient progress using standardized assessments has been neglected in hospital-based psychiatric care. Findings in outpatient psychotherapy have demonstrated clinically significant benefits for providing feedback to the sizeable minority of patients who were otherwise unlikely to experience positive outcome (Lambert, 2007). However, a similar system for presenting feedback on patient progress has not yet been assessed for group therapy within psychiatric inpatient settings. The current study aimed to develop and evaluate the effectiveness of a feedback system suitable for use in psychiatric services. Methods: In a nonrandomized trial, 1308 consecutive inpatients and day patients, whose diagnoses were primarily depressive and anxiety disorders, completed the World Health Organization''s Wellbeing Index (WHO-5) routinely during a ten-day cognitive behavioral therapy group. The first cohort (n =461) received treatment as usual. The second cohort (n =439) completed monitoring measures without feedback, and for patients in the third cohort (n =408), feedback on progress was provided to both clinicians and patients midway through the treatment period. Results: Feedback was effective in reducing depressive symptoms (F(1,649)=6.29, p <.05) for those patients at risk of poor outcome, but not effective in improving wellbeing (F(1,569)=1.14, p >.05). Limitations: The current findings may be generalized to patient samples that exhibit largely depressive disorders, however rigorous follow-up is warranted. Conclusions: Similar to outpatient settings, feedback appears to be beneficial for improving symptom outcomes but further time may be required for wellbeing to be affected. [Copyright &y& Elsevier]

Standard clinical significance classifications are based on movement between the "dysfunctional" and "functional" distributions; however, this dichotomy ignores heterogeneity within the "dysfunctional" population. Based on the methodology described by Tingey, Lambert, Burlingame, and Hansen (1996), the present study sought to present a 3-distribution clinical significance model for the 21-item version of the Depression Anxiety Stress Scales (DASS-21; P. F. Lovibond & Lovibond, 1995) using data from a normative sample (n = 2,914), an outpatient sample (n = 1,000), and an inpatient sample (n = 3,964). DASS-21 scores were collected at pre- and post-treatment for both clinical samples, and patients were classified into 1 of 5 categories based on whether they had made a reliable change and whether they had moved into a different functional range. Evidence supported the validity of the 3-distribution model for the DASS-21, since inpatients who were classified as making a clinically significant change showed lower symptom severity, higher perceived quality of life, and higher clinician-rated functioning than those who did not make a clinically significant change. Importantly, results suggest that the new category of recovering is an intermediate point between recovered and making no clinically significant change. Inpatients and outpatients have different treatment goals and therefore use of the concept of clinical significance needs to acknowledge differences in what constitutes a meaningful change. [ABSTRACT FROM AUTHOR]