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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.

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 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.

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.

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.

Concurrent panic disorder with agoraphobia (PDA) and generalized anxiety disorder (GAD) are the most common diagnostic occurrences among anxiety disorders. This particular comorbidity is associated with significant impairments in quality of life (QOL). The current study sought to investigate the efficacy of a combined cognitive-behavioral psychotherapy that addressed both conditions compared with a conventional psychotherapy, which attends solely to the primary disorder. The hypotheses postulated firstly, that both treatment conditions would lead to improvements in participants’ QOL and secondly, that the combined therapy would lead to greater QOL ameliorations. Twenty-five participants with comorbid PDA/GAD diagnoses were evaluated with a number of clinical interviews and self-report questionnaires, and were provided with either conventional or combined cognitive-behavioral psychotherapy, which consisted of 14 one-hour weekly sessions. Participants were once again evaluated in the same fashion 2-weeks after the completion of the psychotherapy. The results revealed that both conditions led to significant improvements in participants’ QOL, but that the two groups did not significantly differ in terms of the effect on QOL. The results also reveal that the two conditions did not significantly differ in terms of their effect on PDA and GAD symptomatology or psychiatric comorbidity. The results demonstrate that the combined psychotherapy, which addresses both conditions simultaneously, is similar to the conventional psychotherapy employed for the primary disorder in terms of QOL enhancement, symptom severity, and comorbidity reduction.

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.

Anxiety disorders are very prevalent among children and adolescents and increase risk for comorbid diagnoses, psychopathology in adulthood and lower adaptive functioning in the areas of academic performance, peer relations and family interactions. Even if anxiety disorders are the principal psychopathologies present among children, there are few valid questionnaires available to assess all DSM–IV-specific anxiety disorder symptoms. Available French measures assess mainly anxiety symptoms and present poor discriminant validity among specific disorders. The aim of the present study was to translate and verify the psychometric properties of a French version of the Screen for Child Anxiety Related Emotional Disorders–Revised (SCARED-R; Muris et al., 2004) among children from ages 8 to 15 years. French-Canadian children (N 380) participated. Factorial, convergent and criteria validity, as well as reliability indices (e.g., internal consistency), were evaluated. Results showed that the psychometric properties of the questionnaire were adequate and superior to those of the English version. Only the obsessive–compulsive symptom subscale presents poorer psychometric properties. Overall, this French version of the SCARED-R, which include 51 items, seems to be a valid tool to assess anxiety disorder symptoms among children and adolescents.

Intolerance of uncertainty (IU) is related to anxiety, depression, worry, and anxiety sensitivity. Precedent IU measures were criticized for psychometric instability and redundancy; alternative measures include the novel 45-item measure (Intolerance of Uncertainty Index; IUI). The IUI was developed in French with 2 parts, assessing general unacceptability of uncertainty (15 items, Part A) and manifestations of uncertainty approximating more common anxiety disorder symptoms (30 items, Part B). The psychometric stability of the back-translated English items of the IUI as well as the incremental variance of Parts A and B remain to be assessed. The current study involved 2 samples of English-speaking community participants (n = 437 and n = 309; 73% women and 27% men) who completed the IUI and several related measures. Exploratory and confirmatory factor analyses suggested a refinement of IUI items as well as a unitary structure for Part A and a 3-factor structure for Part B. Regression results suggested Parts A and B each provide incremental validity in measures of worry, generalized anxiety disorder symptoms, negative problem orientation, and depression. Comprehensive results, implications, and future research directions are discussed.

The aim of this study was to investigate the influence of drying methods and low range of degrees of substitution (DS) on the structural, physicochemical, and drug-release properties of carboxymethyl high-amylose starch (CMS). CMS with three DS of 0.03, 0.14, and 0.25 was synthesized and dried by either solvent precipitation (SP), spray drying (SD), or lyophilization (Ly). DS had an influence on the crystalline structure of CMS. It was found that a DS of 0.14 or higher induced a modification of polymorphism. The drying method and the DS had both an impact on the physical properties of the CMS powder which can further influence the formulation characteristics and drug-release properties from monolithic tablets. The CMS with DS of 0.14 and 0.25 dried by SP or SD presented good excipient properties in terms of compressibility. With acetaminophen (20%) as tracer, the monolithic CMS tablets showed controlled drug release over 17 h for DS of 0.14 and 10 h for DS of 0.25, almost independent of pH, suggesting interesting properties for sustained release applications.

Intolerance of uncertainty represents an important risk factor for development of anxiety disorders. However, few measures have been developed in order to evaluate this construct. Four studies were conducted in order to validate a new instrument evaluating intolerance of uncertainty: the Intolerance of Uncertainty Inventory (IUI). The first study described the questionnaire's development and evaluated the psychometric properties of its preliminary version. Study 2 examined the reliability and the factorial validity of the final version of the questionnaire, while Study 3 mainly addressed its convergent validity. Finally, Study 4 examined the questionnaire's temporal stability. Factorial analyses confirmed the IUI's validity. Results also supported the IUI's reliability, convergent validity, and temporal stability. The IUI is the first instrument that offers the possibility of measuring intolerance of uncertainty as a tendency to consider uncertainties to be unacceptable, as well as in terms of cognitive and behavioral manifestations.

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.

The goal of this study was to explore the specificity of the relationship between intolerance of uncertainty and worry in a nonclinical sample. Three hundred and forty-seven university students completed measures of worry, obsessions/compulsions, and panic sensations. They also completed measures of process variables known to be associated with worry (intolerance of uncertainty), obsessions/compulsions (responsibility), and panic sensations (anxiety sensitivity). The results show that intolerance of uncertainty was highly related to worry, moderately related to obsessions/compulsions, and weakly related to panic sensations. Further, the relationship between intolerance of uncertainty and worry remained strong after shared variance with other study variables was removed. The findings are discussed in terms of their implications for understanding worry and preventing generalized anxiety disorder.

Intolerance of uncertainty has been identified as an important variable related to worry and Generalized Anxiety Disorder (GAD) [Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: a preliminary test of a conceptual model. Behaviour Research and Therapy, 36, 215-226; Ladouceur, R., Dugas, M. J., Freeston, M. H., Rheaume, J., Blais, F., Boisvert, J.-M., Gagnon, F., & Thibodeau, N. (1999). Specificity of Generalized Anxiety Disorder symptoms and processes. Behavior Therapy, 30, 197-207]. The goal of the present study was to clarify the relationship between this cognitive process and worry by experimentally manipulating intolerance of uncertainty. A gambling procedure was used to increase intolerance of uncertainty in one group (N = 21) and to decrease intolerance of uncertainty in another group (N = 21). The results indicate that participants whose level of intolerance of uncertainty was increased showed a higher level of worry, compared to participants whose level of intolerance of uncertainty was decreased. These results provide some initial clarifications as to the causal nature of the link between intolerance of uncertainty and worry. These results are coherent with our theoretical model of worry and GAD (Dugas et al., 1998), which stipulates that intolerance of uncertainty plays a key role in the acquisition and maintenance of excessive worry.

The objective of this study was to evaluate the human NCI-N87 cell line as a model for gastric permeability drug studies under pH conditions of the stomach. The optimal conditions that led NCI-N87 cells to form a typical differentiated gastric epithelial barrier were a seeding density of 2.5 × 10⁵ cells/cm² on porous inserts and growth in serum-complemented RPMI-1640 medium until 18-27 days post-confluency. The resulting cell monolayers showed moderately high transepithelial electrical resistance (TEER) values of about 500 Ω cm², cells of polygonal morphology expressing E-cadherin and ZO-1 proteins at their contact surfaces, and production of mucus clusters. The monolayers withstood apical pH of 7.4 down to 3.0 with the basal pH fixed at 7.4. The apparent permeability coefficients (P(app)) of model compounds were evaluated in the apical-to-basolateral and basolateral-to-apical directions under different pH gradients. The monolayers were impermeable to the integrity marker Lucifer Yellow (low P(app) of 0.3-1.1 × 10⁻⁶ cm/s). The furosemide P(app) (0.4-1.5 × 10⁻⁵ cm/s) were slightly dependent on pH but remained moderate. The caffeine P(app) (4.2-5.0 × 10⁻⁵ cm/s) were higher and insensitive to pH changes. The NCI-N87 cell line provides a useful in vitro tool to assess gastric drug permeability and absorption under physiologic conditions prevailing in the human stomach.

Sodium carboxymethyl high amylose starch, CMHAS(Na), with a DS up to 1.74 were synthesized in non-aqueous medium (with yields as high as 72%) in order to investigate the influence of the degree of substitution (DS) on physical and drug release properties. The CMHAS(Na) was converted to protonated form, CMHAS(H), by acid treatment. The DS and conversion of CMHAS(Na) to CMHAS(H) had a major impact on the physical properties of CMHAS particles and resulting tablets. Dissolution tests performed in simulated gastric fluid (SGF, pH 1.2) and in simulated intestinal fluid (SIF, pH 6.8), with acetaminophen as drug model (20% loading) showed CMHAS as a pH sensitive hydrophilic matrix whereas CMHAS(Na) seems suitable as controlled release matrix. CMHAS(Na) with DS between 0.1 and 0.2 can be preferably used as sustained release excipient since in both dissolution media, the drug release was driven by diffusion over a period up to 12 h. CMHAS(Na) with high DS, between 0.9 and 1.2, can be used as delayed release excipient since drug release in SGF was driven by diffusion over a period up to 20 h and in SIF by fast erosion lowering to less than 3 h the complete release of the drug.

This study evaluated the specific effectiveness of cognitive-behavior therapy (CBT) combined with medication tapering for benzodiazepine discontinuation among generalized anxiety disorder (GAD) patients by using a nonspecific therapy control group. Sixty-one patients who had used benzodiazepines for more than 12 months were randomly assigned to the experimental conditions. Nearly 75% of patients in the CBT condition completely ceased benzodiazepine intake, as compared with 37% in the control condition. Results of the 3-, 6-, and 12-month follow-ups confirmed the maintenance of complete cessation. Discontinuation rates remained twice as high in the CBT condition. The number of patients who no longer met GAD criteria was also greater in the CBT condition. The addition of specific CBT components thus seemed to facilitate benzodiazepine tapering among patients with GAD.

Studies aiming to better understand worry have neglected children and adolescents. This constitutes an important limitation considering that excessive worry is frequent among adolescents and that patients suffering from excessive worries associate the beginning of their disorder with adolescence. This study evaluates the cognitive variables associated with worry in a sample of 777 adolescents. It attempts to determine whether cognitive avoidance and false beliefs about the usefulness of worries are present and associated with worries in adolescence. The results showed that participants with a high level of worry used more avoidance strategies and held more beliefs about worry. The results also revealed that avoidance of stimuli that trigger unpleasant thoughts and thought substitution were the major avoidance strategies related to worry among adolescents. The belief that worry helps to avoid future negative events was also related to worry. These findings may suggest that adolescents' worries are maintained by processes similar to those observed among adults.

Les benzodiazépines sont souvent prescrites pour le traitement à court terme du Trouble d’anxiété généralisée (TAG). La nature chronique du TAG entraîne une prise prolongée de ces psychotropes sur plusieurs mois et plusieurs années, entraînant ainsi une dépendance psychologique et physique. La présente étude vise à déterminer si la combinaison d’une thérapie comportementale et cognitive et d’un sevrage médicamenteux graduel facilite l’arrêt des benzodiazépines chez les patients souffrant d’un TAG. Au total, cinq participants ont reçu l’intervention combinée selon un protocole expérimental à cas uniques avec niveaux de base multiples. Quatre d’entre eux ont complété le plan de sevrage et ont démontré des améliorations cliniques importantes. Les données recueillies lors des suivis 3 et 6 mois indiquent un maintien des gains thérapeutiques. Ces résultats suggèrent que la thérapie comportementale et cognitive facilite l’arrêt des benzodiazépines chez les patients présentant un TAG tout en diminuant significativement les symptômes anxieux., Benzodiazepine medication is often prescribed for the short-term treatment of generalized anxiety disorder. The chronic nature of generalized anxiety disorder entails a prolonged use of these psychotropic medication on several months and several years, entailing also a psychological and physical addiction. The current study aims at determining if the combination of a behavioral and cognitive therapy and gradual withdrawal facilitate interrupting the use of benzodiazepine in patients with generalized anxiety disorder. In total, five participants have received the combined intervention according to an experimental protocol of unique case with multiple levels. Four among them have completed the withdrawal plan and have demonstrated important clinical improvements. Data collected during the 3rd and 6th month indicate the preservation of therapeutic gain. These results suggest that behavioral and cognitive therapy facilitates stopping the use of benzodiazepine medication in patients with generalized anxiety disorder by significantly reducing anxious symptoms., Las benzodiacepinas son con frecuencia prescritas para el tratamiento a corto plazo del Trastorno de ansiedad generalizada (TAG). La naturaleza crónica del TAG provoca la toma prolangada de estos psicotrópicos durante varios meses y varios años, ocasionando de esta manera una dependencia psicológica y física. El presente estudio busca determinar si la combinación de una terapia comportamental y cognitiva y una abstinencia gradual de medicamentos facilita la suspensión de las benzodiazepinas en los pacientes que sufren de un TAG. En total, cinco participantes recibieron la intervención combinada según un protocolo experimental de casos únicos con líneas de base múltiples. Cuatro de ellos completaron el plan de reducción y demostraron mejoras clínicas importantes. Los datos recopilados durante el seguimiento de 3 y 6 meses indican un mantenimiento de los beneficios terapéuticos. Estos resultados sugieren que la terapia comportamental y cognitiva facilita la suspensión de las benzodiacepinas en los pacientes que presentan un TAG al mismo tiempo que disminuyen significativamente los síntomas de ansiedad., As benzodiazepinas são freqüentemente prescritas para o tratamento a curto prazo do Transtorno de ansiedade generalizada (TAG). A natureza crônica do TAG leva a uma utilização prolongada dos psicotrópicos durante vários meses e anos, levando assim a uma dependência psicológica e física. O presente estudo visa determinar se a combinação de uma terapia comportamental e cognitiva e uma desabituação médica gradual facilita a interrupção no uso das benzodiazepinas nos pacientes que sofrem de um TAG. No total, cinco participantes receberam a intervenção combinada segundo um protocolo experimental em casos únicos com níveis de base múltiplas. Quatro dentre eles completaram o plano de desabituação e demonstraram melhorias clínicas importantes. Os dados recolhidos após três e seis meses, indicam uma manutenção dos ganhos terapêuticos. Estes resultados sugerem que a terapia cognitivo-comportamental facilita a interrupção no uso de benzodiazepinas em pacientes que apresentam um TAG e ao mesmo tempo diminuem em muito os sintomas de ansiedade.