Search

The current study examined whether cannabis use frequency and cannabis-related problem severity (as per the Cannabis Use Disorder Identification Test-Revised) predicted outcomes of cognitive behavioural therapy (CBT) for anxiety and related disorders. It was predicted that greater frequency of cannabis use and greater cannabis-related problem severity would be associated with dampened treatment outcomes compared to less severe cannabis use presentations.Participants were 253 adults seeking treatment for anxiety and related disorders. Cannabis use was categorized as non-use (n = 135), infrequent use (using monthly to 4 times per month; n = 45), and frequent use (using 2 or more times per week; n = 73). Individuals who reported using cannabis completed cannabis use and cannabis-related problem measures before starting a CBT group. Participants also completed a weekly symptom-specific measure of anxiety symptoms throughout CBT.As hypothesized, frequent cannabis use was associated with poorer outcomes in CBT for anxiety and related disorders compared to non-use. Despite this, individuals who used cannabis frequently still experienced a statistically significant decrease in their anxiety symptoms from pre-to post-CBT, with a large effect size (d = -0.87). Cannabis-related problems was not a significant predictor of CBT outcomes.Cannabis use frequency was associated with poorer CBT outcomes for anxiety and related disorders, however these individuals still made notable treatment gains. The mechanism driving this relationship remains unclear. Future studies should attempt to replicate the current findings and examine possible mechanisms.

This study examined cannabis use motives in individuals with anxiety disorders and compared motives between infrequent and frequent cannabis users. It was hypothesised that coping motives would be endorsed at a significantly higher rate than other motives, and that frequent cannabis users would endorse coping motives significantly more than infrequent users. Participants were 144 adults seeking clinical services for anxiety disorders who reported using cannabis. Cannabis use was categorized by infrequent (n = 54) and frequent (n = 90) use. Anxiety symptoms were assessed and deemed clinically significant. Participants completed measures of cannabis use motives, cannabis use patterns, and cannabis use disorder symptoms, cross-sectionally. Cannabis use motives were examined for the entire sample and compared between frequent and infrequent users. In general, cannabis users endorsed coping (i.e., use for managing distress) and enhancement (i.e., use for fun, pleasant feeling, or the high) motives at equal rates (p = .265) and more than other motives (p < .001). Frequent users reported using cannabis for coping and expansion motives (i.e., use to change one's thinking) significantly more than infrequent users. These results indicate that individuals with anxiety disorders use cannabis for various reasons, some of which may not be directly related to their mental health symptoms. Future research is needed to compare motives for cannabis use in those with anxiety disorders, other mental health populations, and the general population, as well as examine motives for cannabis use within specific anxiety disorders.

Background:Many people with anxiety do not seek therapy due to negative views of treatment. Although close others (e.g. romantic partners, family members, close friends) are highly involved in treatment decisions, the role of specific relational behaviours in treatment ambivalence has yet to be studied.Aims:This study examines the relationship between social predictors (perceived criticism and accommodation of anxiety symptoms by close others) and treatment ambivalence.Method:Community members who met diagnostic criteria for an anxiety-related disorder (N = 65) and students who showed high levels of anxiety (N = 307) completed an online study. They were asked to imagine they were considering starting cognitive behavioural therapy (CBT) for their anxiety and complete a measure of treatment ambivalence accordingly. They then completed measures of perceived criticism and accommodation by close others. Linear regression was used to examine the predictive value of these variables while controlling for sample type (clinical/analogue) and therapy experience.Results:Greater reactivity to criticism from close others and greater accommodation of anxiety symptoms by close others were associated with greater treatment ambivalence in those with anxiety. These predictors remained significant even when controlling for therapy history and sample type.Conclusions:When it comes to treatment attitudes, relational context matters. Clients demonstrating ambivalence about starting therapy may benefit from discussion about the impact of their social environment on ambivalence.

Background: Post-event processing (PEP) is an important maintenance factor of social anxiety disorder (SAD). This study examined psychometric properties of the Positive Beliefs about Post-Event Processing Questionnaire (PB-PEPQ; Fisak & Hammond, 2013), which measures metacognitive beliefs about PEP. Method: Participants receiving treatment for SAD (n = 71) and other anxiety and related disorders (n = 266) completed self-report questionnaires at several timepoints. Results: Confirmatory factor analysis did not support the PB-PEPQ's proposed unidimensional model. Subsequent exploratory factor analysis yielded a three-factor structure consisting of engaging in PEP to (1) review negative events (Negative scale), (2) review positive events (Positive scale), and (3) better understand one's social anxiety (Understand scale). Within the SAD subsample, PB-PEPQ scales demonstrated good internal consistency (α = 0.83–0.85) and test–retest reliability (r = 0.65–0.78). Convergent and criterion validity of the PB-PEPQ Negative scale were supported. PB-PEPQ scale scores were significantly higher within the SAD group, as compared with the other groups (generalised anxiety disorder, panic disorder and agoraphobia, posttraumatic stress disorder, and obsessive-compulsive disorder), supporting the scales’ discriminative validity. Conclusion: Findings support the reliability and validity of the PB-PEPQ in a clinical sample and reveal the measure's multifactorial structure.

Executive functions (EF) deficits are hypothesized to be a core contributor to hoarding symptoms. EF have been studied in adult hoarding populations, but studies in youth are lacking. The current study compared multiple EF subdomains between youth with obsessive-compulsive disorder (OCD) and youth with OCD and hoarding symptoms. Forty youth (8–18 years old) with a primary diagnosis of OCD were recruited. Participants were divided by hoarding severity on the Child Saving Inventory (CSI) into either the “hoarding group” (upper 33.3%) or the “low-hoarding group” (lower 66.7%). Groups were compared on EF tasks of cognitive flexibility, decision-making, and inhibitory control. Youth in the hoarding group exhibited significantly higher cognitive flexibility and lowered perseveration than the low-hoarding group. Hoarding and low-hoarding groups did not differ in any other EF subdomain. Hoarding symptoms in youth with OCD were not associated with deficits in EF subdomains; instead, youth who hoard exhibited higher cognitive flexibility compared to youth with low hoarding symptoms.

Background:Safety behaviours are hypothesized to play a vital role in maintaining social anxiety disorder (SAD), in part by orienting socially anxious individuals to adopt an avoidance-based mindset focused on self-protection and self-concealment. Evidence suggests an association between safety behaviour use and negative social outcomes for individuals with SAD. However, research has largely focused on the broad group of safety behaviours, whereas specific subtypes have received less attention.Aim:The present study aimed to further our understanding of the negative interpersonal consequences of specific types of safety behaviours for individuals with SAD by examining whether active, inhibiting/restricting, or physical symptom management safety behaviour use affects perceived likeability and authenticity during a conversation with a stranger.Method:Individuals with SAD (n = 29; mean age 35.5 years) and healthy control (non-SAD) participants (n = 40; mean age 18.6 years) engaged in a semi-structured social interaction with trained confederates.Results:Participants with SAD were perceived as significantly less likeable and authentic by the confederates, and rated themselves as significantly less authentic compared with those without SAD. The association between group status and likeability was mediated by the use of inhibiting/restricting safety behaviours and the association between group status and participant-rated authenticity was mediated by the use of both inhibiting/restricting and active safety behaviours, but not physical symptom management strategies.Conclusions:These results contribute to a growing literature suggesting that some, but not all, safety behaviours may play an important role in creating the negative social outcomes that individuals with SAD experience.

Repugnant obsessions are a common theme of intrusions in obsessive-compulsive disorder and are typically ego-dystonic. Exposure and response prevention (ERP) is the first-line intervention and involves in vivo and/or imaginal exposures. Many therapists are however reluctant to conduct ERP and the reasons remain unclear. Similarly, little is known about therapist preference for in vivo versus imaginal exposure for repugnant obsessions. To address these gaps, 200 therapists read vignettes of an in vivo and imaginal exposure for each repugnant obsession subtype and indicated whether they would have clients complete it. If not, they selected their primary refusal reason. Therapists were more likely to refuse in vivo (versus imaginal) exposures related to intentional/accidental harm, religion, and sexual orientation. There were no differences in willingness for pedophilic obsessions, with both forms receiving more refusals than approvals. “Dangerous/harmful to client/others” and “not necessary for therapeutic success” were most frequently selected as refusal reasons.

Those close to people with mental health difficulties (e.g., family members, romantic partners and close friends) are often involved in their care decisions. Research shows that criticism by close others and accommodation of symptoms are associated with symptom severity and treatment response. Recent research has found that those close to someone with an anxiety disorder report a range of concerns about their loved one starting cognitive-behaviour therapy (e.g., that treatment will cause the person to change in undesirable ways). The purpose of this study was to examine the relationship between close others' criticism and symptom accommodation and their treatment concerns, hypothesizing that these relationships would be significant.Close others to those with notable anxiety (N = 287) completed self-report measures online. Multiple regression was used to test our hypothesis.Respondents who identified as being close to someone with notable anxiety completed measures of their accommodation of anxiety symptoms, feelings of criticism/hostility towards them, concerns about them starting treatment, perceived impairment due to anxiety, and their own and their loved ones' treatment history.Greater criticism and accommodation significantly predicted greater treatment concerns, with a medium effect size, controlling for degree of impairment due to anxiety and treatment history.Criticism and accommodation may reflect appraisal of the person with anxiety as weak or fragile, which may evoke concerns about treatment success. Implications for clinicians and anxiety treatment are discussed.

Background Individuals with hoarding report stressful and traumatic life events at an elevated rate compared with those with obsessive-compulsive disorder and healthy controls, but have not been compared with other clinical groups. This study compared rates of traumatic life events between those with clinically significant hoarding, anxiety disorders, or posttraumatic stress disorder (PTSD), hypothesizing that rates would be higher in the hoarding and PTSD groups than the anxiety group. Methods Rates of traumatic and stressful events were compared across groups. Results All comparisons across groups on types of events were significant (partial-eta squared 0.051-0.162). The hoarding group endorsed significantly more crime-related events but similar rates of other events as compared to the PTSD and anxiety disorder groups. Conclusion These findings suggest that many stressful and traumatic life events are not uniquely elevated in hoarding when compared with other clinical populations.

Introduction: Obsessive-compulsive disorder (OCD) is a heterogeneous disorder, with multiple symptom presentations. Delineating the neuropsychological characteristics associated with previously identified symptom clusters may therefore be useful in assisting to better define symptom subtypes of OCD.Areas covered: This review summarizes the existing literature on the assessment of neuropsychological performance in symptom-based dimensions of OCD. Results of 23 studies are described and the methodological issues and challenges present in this body of literature are discussed.Expert opinion: The current state of the literature precludes a meaningful meta-analysis of cognitive dysfunction across the breadth of symptom dimensions of OCD. This is due primarily to significant methodological differences observed between studies, both in terms of neuropsychological measures and symptom subtyping methods employed, and any resulting meta-analytic results would be biased by varying quality of evidence. Future studies addressing these limitations should include more consistent neuropsychology measures and methods of classifying OCD symptoms with the aim of reproducing the results of previous research to identify more concrete patterns of neuropsychological performance across dimensions; best practices and alternative approaches are discussed.

The close others (e.g., family members, romantic partners) of people with anxiety and related disorders are typically involved in their treatment decisions. However, we know little about close others' attitudes towards and concerns about their loved one starting cognitive-behavioural therapy (CBT).Study one surveyed close others of those with anxiety and related disorders (n = 33) about their concerns about their loved one starting CBT. Thematic coding was completed, and items were developed to reflect these themes, comprising a measure of treatment concerns in close others. Study two involved the administration of the novel measure to a larger sample (n = 287) to evaluate its structure, reliability, and validity.Close others endorsed having treatment concerns of moderate intensity. The final 17-item measure, the Treatment Concerns QuestionnaireThe value of this measure for clinicians and future directions for research are discussed.The online version contains supplementary material available at 10.1007/s10608-022-10318-9.

Objective: Research conducted with young adults has consistently identified cannabis use motives as a predictor for cannabis use and problems, but comparatively few studies have examined cannabis motives in adult samples. Furthermore, although substantive evidence has identified links between cannabis use and psychiatric conditions, limited research has examined the intersection of cannabis use, motives, and psychopathology. The present study sought to characterize cannabis use motives in an adult sample and investigate whether those motives would link relationships between cannabis misuse and psychiatric symptoms. Method: Participants (N=395; M age=34.8; %F=47.6; % White = 81.3%) completed assessments related to cannabis misuse, cannabis use motives, and symptoms of depression, anxiety, PTSD, and somatic experiences. Bivariate correlations, hierarchical regressions, and subsequently, mediation analyses were performed to examine associations between motives and cannabis misuse, and to investigate whether particular motives would link the relationship between cannabis misuse and psychiatric symptoms. Results: Analyses revealed statistically significant, unique associations between cannabis misuse and Social (β = .13), Enhancement (β = .12) and, particularly, Coping motives (β = .48). Further, Coping fully linked the relationship between level of cannabis misuse and depressive, anxiety, PTSD, and somatic symptoms. Conclusion: These results lend support for a negative reinforcement motivational profile as the predominant pattern in adult cannabis users, especially with regard to concurrent symptoms of cannabis use disorder and psychopathology. These results suggest that targeting maladaptive coping with cannabis may prove an effective treatment target in addressing co-occurring cannabis misuse and psychopathology.

This article describes the initial validation of the Diagnostic Assessment Research Tool (DART), a modular semistructured interview to facilitate diagnosis of various disorders among adults corresponding with the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). In this study, the construct, convergent, and discriminant validity of DART modules for anxiety disorders, depressive disorders, obsessive-compulsive disorder, posttraumatic stress disorder, and substance-related and addictive disorders was assessed among a sample of 610 participants in a clinical outpatient setting. The data indicated excellent construct validity among DART modules assessed. Individuals with and without DSM-5 diagnoses identified via the DART had significant between-group differences on self-report measures corresponding to these diagnoses. Follow-up logistic regressions supported convergent validity for all diagnostic categories assessed. Discriminant validity was established for the majority of diagnostic categories assessed. High rates of interrater agreement in a small subsample (n = 15) were observed for the various diagnostic categories of the DART (88% average agreement). The results of the present study provide initial support for the DART as a useful tool to aid in the assessment of several major diagnostic categories corresponding with DSM-5 disorders. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Cognitive behavioural therapy (CBT) for Social Anxiety Disorder (SAD) is an effective intervention for SAD, however, many individuals with SAD remain symptomatic at the end of CBT. Therefore, it is important to understand variables that influence patients’ responses to treatment. The present study investigated temporal changes in SAD symptoms as related to fear of negative evaluation (FNE) in a clinical sample of individuals with SAD who completed CBT. Participants with SAD (N = 175) completed self-report measures of SAD symptoms and FNE weekly across 12 weeks of group CBT. We used latent difference score dynamic modelling to explore the relationship between SAD symptom scores and FNE during CBT. Reductions in FNE were associated with subsequent reductions in SAD symptoms for individuals who showed a rapid response to treatment. The coupling of FNE and subsequent reductions in SAD symptoms was not seen in individuals not showing a rapid response. This study provides further support for the phenomenon of rapid response in CBT for SAD and suggests that mechanisms of change may be different for rapid responders as compared to non-rapid responders. The results of the current study may have implications for understanding the mechanisms underlying treatment response during CBT for SAD and for whom particular mechanisms are relevant.

Cognitive behavioural therapy (CBT) for problematic hoarding is an effective treatment, but further research in diverse, naturalistic settings is needed to see whether this treatment is effective across settings and in smaller doses. The current study investigated the outcome of a 12-session group CBT for hoarding offered in an outpatient hospital setting. Sixty-four participants completed therapy, and 38 participants completed posttreatment assessments. Results demonstrated statistically significant improvements in hoarding symptom severity, saving cognitions, and self-reported distress tolerance. Effect sizes for changes in saving cognitions were generally large. However, effect sizes were modest for most other outcome variables, and only 4 of 38 participants achieved clinically significant change in hoarding symptom severity. These results suggest that 12 sessions of group CBT for hoarding is associated with significant change in saving cognitions, but less meaningful change in other indicators of symptom severity.

Objectives:The present study describes patterns of cannabis use, motives for use, and the relationship between cannabis use and problematic alcohol use in a large sample of individuals seeking treatment for anxiety and related disorders at a specialized outpatient clinic in a Canadian hospit

The Social Suspiciousness Scale (SSS) is a 24-item self-report questionnaire designed to assess suspiciousness, along with the associated constructs of anger and hostility, within a social context. The present research evaluated the psychometric properties of this newly developed scale. The sample consisted of outpatients with social anxiety disorder (SAD; n = 145), unselected undergraduate university students (n = 162), and healthy community controls (n = 46). A principal components analysis suggested a one-factor solution. Internal consistency of the scale was high, and interitem correlations indicated that items were nonredundant. Test-retest reliability was strong. SSS scores were moderately correlated with measures of social anxiety, paranoia, anger and hostility. Moreover, in the outpatient SAD sample, SSS scores decreased significantly following a 12-week cognitive-behavioral group treatment program for SAD. The SSS may be a useful tool for measuring suspiciousness, anger and hostility across a variety of social contexts, particularly in individuals with SAD. This research contributes more generally to a broader understanding of SAD, and supports the importance of considering the role of mistrust and suspiciousness in this disorder.

Objective: Telehealth is being increasingly incorporated into the delivery of mental health care and has received widespread attention during the COVID-19 pandemic for its ability to facilitate care during physical distancing restrictions. Videoconferencing is a common telehealth modality for delivering psychotherapy and has demonstrated similar outcomes to those of face-to-face therapy. Cognitive behavioural therapy (CBT) is the most common psychotherapy evaluated across various telehealth modalities; however, studies on CBT delivered via videoconference, particularly in a group therapy format, are lacking. Further, little research exists on videoconference group CBT for anxiety disorders. Accordingly, the present study compared the outcomes of group CBT for anxiety and related disorders delivered via videoconference versus face-to-face. Method: Using a non-randomized design, data on attendance, dropout, clinical outcomes, and functional impairment were collected from 413 adult outpatients of a tertiary care anxiety disorders clinic who attended a CBT group for panic disorder/agoraphobia, social anxiety disorder, generalized anxiety disorder (GAD), or obsessive-compulsive disorder delivered either face-to-face (pre-COVID-19 pandemic) or via videoconference (since the onset of COVID-19 pandemic). Outcomes were assessed using well-validated self-report measures. Data were collected pre-treatment, across 12 weekly sessions, and post-treatment. Intent-to-treat analyses were applied to symptom outcome measures. Results: Face-to-face CBT conferred only a slight benefit over videoconference CBT for symptom outcomes across all groups, but when assessed individually, only the GAD group showed greater symptom improvement in the face-to-face format. Effect sizes for significant differences between the delivery formats were small. Participants in videoconference groups tended to have slightly higher attendance rates in some instances, whereas functional improvement and treatment dropout were comparable across the delivery formats. Conclusions: Results provide preliminary evidence that videoconference group CBT for anxiety and related disorders may be a promising and effective alternative to face-to-face CBT. Additional research is needed to establish equivalence between these delivery formats.

Background Recent meta-analyses point towards cognitive impairments in obsessive-compulsive disorder (OCD), particularly in such executive function subdomains as planning and organization. Scant attention has focused on cognitive remediation strategies that may reduce cognitive dysfunction, with a possible corresponding decrease in symptoms of OCD. Objective The aim of this study was to assess the implementation of a standardized cognitive remediation program, Goal Management Training (GMT), in a pilot sample of individuals with OCD. Method Nineteen individuals with a primary DSM-5 diagnosis of OCD were randomized to receive either the 9-week GMT program (active group; n = 10) or to complete a 9-week waiting period (waitlist control; n = 9). Groups were assessed at baseline, post-treatment, and 3-month follow-up. The assessment comprised neuropsychological tasks assessing a variety of cognitive domains, and subjective measures of functioning and of symptom severity. Results The active condition showed significant improvements from baseline to post-treatment on measures of inattention, impulsivity, problem-solving, and organization compared to controls. Moreover, whereas the active group reported a significant improvement in subjective cognition over the course of treatment, no such improvement emerged in the waitlist group over this same period. Neither group showed improvement on indices of depressive, anxiety, or OCD-related symptom severity. Discussion The results of this small pilot investigation indicate that, although promising, this protocol requires several modifications to be best suited for this population. Replication of these findings is awaited, with current results potentially limited by sample characteristics including motivation to seek and complete treatment, and high attrition at 3-month follow-up (n = 6 completers). Trial Registration NCT02502604. (December 7, 2018)

The literature on transdiagnostic psychotherapy among youths is limited. Group transdiagnostic behavior therapy (TBT) has been shown to be effective for adults with affective disorders and may contain beneficial features for youths (e.g., behavioral focus, group format, ease of dissemination, and diversity of targeted diagnoses). This study aimed to investigate group TBT among youths in Canada to determine its feasibility and efficacy.Twenty participants (ages 16-19) diagnosed as having a principal anxiety disorder completed 12 sessions of group TBT. Symptoms of anxiety, depression, and transdiagnostic impairment were assessed pre- and posttreatment.Participants demonstrated significant improvements on measures of anxiety (general, cognitive, and somatic) and stress, with moderate effect sizes. Findings for symptoms of depression and transdiagnostic impairment were unreliable, with small effect sizes.These findings provide preliminary support for the use of group TBT among youths with anxiety disorders. Future research should incorporate comparison groups and larger samples.

Adults’ recollections of how often they were teased as children are positively associated with their social anxiety symptoms. It has therefore been suggested that childhood teasing may play a role in the development of social anxiety disorder (SAD). However, existing studies have not determined whether adults with SAD were actually teased more as children or whether their current symptoms have distorted their memories of childhood events. This study examined reports of childhood teasing in adults with SAD before and after cognitive behavioral therapy (CBT). If recollections of childhood teasing are colored by SAD symptoms, then reported frequency of teasing might be more likely to decrease as symptoms improve after CBT. However, if individuals’ memories of teasing are unbiased, they should not substantially change with the reduction of symptoms after CBT. Ninety-one participants with SAD completed the Teasing Questionnaire-Revised (TQ-R) before and after 12 sessions of group CBT. CBT was effective in reducing SAD symptoms, whereas recollections of the frequency of childhood teasing did not change significantly after treatment. These results are consistent with the possibility that recollections of childhood teasing are not substantially biased by symptoms of SAD, and they lend support to previous studies which suggest that adults with SAD endured higher frequencies of teasing as children compared to controls.

Despite an abundance of self-report measures that screen for the presence of specific phobias, there is a lack of comprehensive, well-validated screening tools for identifying a wide range of fears based on DSM-5 specific phobia types. The current paper reports on the psychometric properties and clinical utility of the Specific Phobia Questionnaire (SPQ), a new screening tool for assessing fear of a broad range of phobic stimuli, and the extent to which fear interferes with daily life. An exploratory factor analysis revealed five factors with internal consistency (Cronbach’s α) ranging from .64–.92. The SPQ also demonstrated good convergent and discriminant validity with measures of worry, depression, and other specific phobias, and good test-retest reliability. Results also suggest that SPQ scores are useful for discriminating individuals with specific phobias from those without specific phobias, and for identifying specific phobia types. Overall, preliminary results suggest that the SPQ can serve as a useful tool in both research and clinical settings, and inform intervention and prevention efforts.

The Children's Saving Inventory (CSI) was introduced in 2011 and is the first parent-rated questionnaire specifically designed to measure the severity of hoarding symptoms in youth. To date, however, no replication studies of the CSI have been published. Additionally, the total CSI score includes several items measuring acquisition, a behavioural dimension that has since been excluded from DSM-5's hoarding disorder criteria. Given these limitations, the primary goal of the present study was to test a modified, DSM-5-consistent, total score of the CSI. Because a confirmatory factor analysis did not support the 2011 four-factor model of the CSI, we reviewed the original CSI and excluded all acquisition items. An exploratory factor analysis yielded a strong three-factor solution (difficulty discarding, Clutter, and distress/impairment) with good reliability and validity for a 15-item version of the CSI. Overall, our results support the use of the 15-item CSI in youth with OCD.

In one of the few studies examining working memory processes in social anxiety disorder (SAD), Amir and Bomyea (2011) recruited participants with and without SAD to complete a working memory span task with neutral and social threat words. Those with SAD showed better working memory performance for social threat words compared to neutral words, suggesting an enhancement in processing efficiency for socially threatening information in SAD. The current study sought to replicate and extend these findings. In this study, 25 participants with a principal diagnosis of SAD, 24 anxious control (AC) participants with anxiety disorders other than SAD, and 27 healthy control (HC) participants with no anxiety disorder completed a working memory task with social threat, general threat, and neutral stimuli. The groups in the current study demonstrated similar working memory performance within each of the word type conditions, thus failing to replicate the principal findings of Amir and Bomyea (2011). Post hoc analyses revealed a significant association between higher levels of anxiety symptomatology and poorer overall WM performance. These results inform our understanding of working memory in the anxiety disorders and support the importance of replication in psychological research. (PsycINFO Database Record

The present study examined the moderating role of extraversion in explaining the relation between shyness and anxiety in a non-clinical early adolescent sample (N = 119, nfemale = 75; Mage = 12.93 years, SDage = 2.23 years) and a clinical adult sample from an outpatient anxiety disorders clinic (N = 100, nfemale = 77; Mage = 34.97 years, SDage = 12.66 years). We found evidence for the protective role of relatively high levels of extraversion in both samples, such that shyness was positively associated with anxiety in the context of relatively low levels of extraversion. Our results provide support for the protective role of extraversion in the presence of high levels of shyness.

Recurrent sexual thoughts characterize several different psychological disorders, most notably obsessive-compulsive disorder (OCD), paraphilias, and nonparaphilic sexual disorders (NPSDs). Many clinicians are aware of the rule of thumb that sexual thoughts in OCD are personally distressing, whereas sexual thoughts in paraphilias and NPSDs are not distressing to the individual experiencing these thoughts, and they rely on this heuristic to inform diagnosis. This is problematic because distress alone is not a reliable diagnostic differentiator; as a result, misdiagnosis is common. Given the negative consequences of misdiagnosis, including worsening of symptoms, treatment dropout, and potential harm to individuals experiencing these thoughts or those who are targets of these thoughts, the purpose of this paper is to help clinicians identify and differentiate repetitive sexual obsessions in OCD from repetitive sexual thoughts in paraphilias and NPSDs. A clinical case example is provided along with pivotal areas of questioning to aid in differential diagnosis.

Obsessive-compulsive disorder (OCD) related contamination concerns are often associated with excessive handwashing. Less is known about other hygiene-related behaviors (HRBs) in OCD. In contrast, extensive public health research has examined the frequency and duration of personal (e.g., handwashing) and household (e.g., scrubbing tub/shower) HRBs in community members. The present study connected these literatures by examining self-reported HRB frequency and duration in 25 patients with OCD with predominant contamination-related symptoms, 95 patients with social anxiety disorder, 36 patients with panic disorder with agoraphobia, and 31 nonclinical community members. Participants reported the frequency or duration of common HRBs. Patients with OCD reported greater frequency of daily handwashing, but the groups did not differ with respect to the frequency/duration of other HRBs or the overall frequency/duration of HRBs. A minority of participants in all groups had high levels of engagement in at least one hygiene-related activity, and within each group, different psychological factors were associated with high hygiene engagement. These findings suggest that for many patients with OCD and contamination concerns, the frequency of handwashing is heightened, whereas frequencies/durations of other HRBs are similar to those for people without OCD. More research is needed on the mechanisms associated with high hygiene engagement.

Many individuals with obsessive-compulsive disorder (OCD) have residual symptoms after undergoing cognitive behavioral therapy (CBT). Mindfulness meditation techniques may help alleviate these residual symptoms. This study qualitatively evaluates the acceptability and perceived benefit of a Mindfulness-Based Cognitive Therapy (MBCT) intervention tailored to individuals with OCD who continue to suffer symptoms following CBT. A sample of 32 participants (which included seven pilot phase participants) with a principal diagnosis of OCD completed an 8-week MCBT intervention and were interviewed approximately 2 weeks post-intervention. The satisfaction interviews consisted of 21 questions that assessed treatment outcomes and treatment acceptability. An inductive thematic approach was used to identify, analyze, and describe overall patterns and themes (i.e., codes) within the participant responses. We identified 64 (+6 miscellaneous) data-generated codes and a total of eight (+1 miscealleous) key themes that encompassed participants’ reported treatment outcomes. Participants verbally reported a decrease in perceived OCD symptoms, an increase in mindfulness and coping skills, high treatment acceptability, and overall quality of life improvement after undergoing the MBCT intervention. Our results provide a detailed description of participants’ perspectives regarding the efficacy and acceptability of MBCT for OCD and support for the perceived benefit of MBCT as an augmentative strategy following CBT to optimize treatment outcomes for individuals with OCD.

Many studies attest to the efficacy of exposure-based cognitive-behavioral therapy for obsessive-compulsive disorder (OCD), yet there is little research assessing varying patterns of change throughout the course of this treatment. Given recent research showing that change patterns during cognitive-behavioral treatment predict long-term maintenance of gains, identifying different patterns of OCD symptom change is important. In the present investigation, we conducted a cluster analysis on session-by-session measures of OCD symptom severity from 54 clients who completed group exposure-based cognitive-behavioral therapy. Four distinct change patterns emerged that showed noticeable differences in both the pace of symptom reduction and the extent of overall treatment response. Among two clusters with relatively higher initial severity, one cluster experienced more noticeable early symptom reduction as well as superior response by post-treatment. We found this same pattern among the other two clusters with initially lower OCD severity. We also saw differential treatment response in relation to depressive severity. Similar cluster patterns emerged across symptom types; however, obsessions appeared to benefit least from exposure-based CBT. The present findings offer possible explanations for previous inconsistencies in the literature on the effect of OCD and depression severity on treatment outcomes for OCD.

Aims Post-event processing (PEP) in social anxiety disorder (SAD) involves ruminating about social encounters after the fact. There is a clear relationship between PEP and SAD, but less is known about the negative effects of PEP. The goal of the current study was to investigate these negative effects in a sample of people with SAD. We hypothesized that PEP would contribute to decreased willingness to try a similar task again and to increased anxiety about engaging in a similar task. We also hypothesized that the degree of PEP would mediate the relationship between initial self-evaluation of performance and follow-up self-evaluation. Methods Forty-one individuals with a principal diagnosis of SAD completed the study. Participants completed baseline measures of symptom severity and state affect and then completed an impromptu speech task. After completing the speech, they completed a self-evaluation of their performance. Five days later, they rated the degree to which they engaged in PEP about their speech performance, indicated their willingness and anxiety about completing a similar speech task in the future, and completed a second self-evaluation of their performance. Results PEP contributed unique and significant variance to willingness (R2 change = .12, p < .05) but not to anxiety ratings (R2 change = .027, p = .13) once symptom severity, depressive symptoms, and state anxiety were controlled for. Using bias-corrected bootstrapping, PEP mediated the relationship between initial and follow-up performance ratings. Conclusions The more people engage in PEP, the less willing they appear to be to re-enter difficult social situations, likely perpetuating a cycle of avoidance. PEP also appears to be one factor that keeps negative self-perceptions “alive” after a challenging social situation. The current study provides unique evidence of the negative consequences of PEP for individuals with SAD.

Emotional distress tolerance (EDT) has increasingly been recognized as a transdiagnostic vulnerability factor. However, research assessing EDT in anxiety disorder populations is lacking. The current study addressed this gap in the literature by examining EDT in a sample of outpatients with panic, social anxiety, generalized anxiety, or obsessive compulsive disorders (n=674), and by assessing its relationship to symptom severity and impairment. Results showed that poor EDT was common across diagnostic groups. However, correlation and regression analyses suggested that although EDT was associated with symptom severity and impairment, it did not account for unique variance in scores beyond the effect of negative affect, stress, intolerance of uncertainty (IU) and anxiety sensitivity (AS). IU and AS had a stronger relationship with overall symptom severity and impairment in the regression models. Together, findings suggest that although EDT may be transdiagnostic, IU and AS are more relevant to our understanding of anxiety disorders.

Biological models for psychiatric disorders, such as anxiety and depression, emphasize the role of neurochemical changes in the development and maintenance of the disorders. The past decade, however, has shown increased evidence for the role of the microbiota-gut-brain axis in psychiatric disorders. Although much of this research is still in its preclinical stages and has largely been based on animal models, the findings in this area have potential implications for the conceptualization and treatment of psychiatric disorders. A number of excellent in-depth systematic and narrative reviews have been published on the topic of the microbiota-gutbrain axis and psychopathology recently (Collins, Surette & Bercik, 2012; De Angelis et al., 2015; Foster & Neufeld, 2013; Montiel-Castro et al., 2013; Wang & Kasper, 2014), many of which have been written by our research group at McMaster University. However, one of the limitations of these reviews is that they are published in basic science journals and tend to provide a very in-depth, detailed, and technical review of the basic science literature as it relates to the microbiota-gut-brain axis with limited focus on clinical implications. Therefore, the goal of the current article is to increase the visibility and accessibility of this research by providing an introduction to the topic with a strong focus on theoretical and clinical implications. Moreover, this article brings together ideas on the topic from a multidisciplinary team, including clinical psychologists, psychiatrists, gastroenterologists, and primary researchers, which highlights an interdisciplinary perspective on the topic with ideas for future research.The Gut MicrobiomeThe human body consists of a number of microbial environments that are predominantly made up of bacteria but also includes archaea, fungi, protists, and viruses. The intestinal or gut microbiome is the largest with approximately 100 trillion bacteria, most of which are located in the distal gut (Gill et al., 2006; Qin et al., 2010). The gut microbiome consists of over 1,000 distinct bacterial species (Qin et al., 2010) and its genetic material outnumbers human DNA by 10-fold. Although a core microbiome is shared by all humans, there is variability and fluctuation in the microbiota throughout the life span. This variability and fluctuation is influenced by factors such as diet, stress, infections, and antibiotic use (Cryan & O'Mahony, 2011; Forsythe, Sudo, Dinan, Taylor, & Bienenstock, 2010; Turnbaugh, Ridaura, Faith, Rey, Knight, & Gordon, 2009; Wu & Hui, 2011). The gut microbiome changes rapidly during the first 2 years of life and is influenced by a number of factors including genetics, method of birth delivery, maternal characteristics, nutrition, infections, use of antibiotics, and stress (Collado et al., 2010; Dominguez-Bello et al., 2010; Harmsen et al., 2000; Palmer et al., 2007; Penders et al., 2006).The Microbiota-Gut-Brain AxisThe microbiota-gut-brain axis is defined by the bidirectional communication between the digestive system and the central nervous system. The microbiota-gut-brain axis involves the central nervous system, the autonomic nervous system, and the enteric nervous system. The enteric nervous system consists of approximately 100 million neurons that line the gastrointestinal tract and is often referred to as the "second brain" because it can function autonomously (Pocock & Richards, 2006). Early research focused on the role of the gut-brain axis in digestion, metabolism, and immune functioning (Konturek, Konturek, Pawlik, & Brzozowski, 2004; Tache, Vale, Rivier, & Brown, 1980), with a strong focus on the role of the central nervous system in regulating these functions (i.e., a top-down model). More recently, there is growing appreciation for the bidirectional communication between the central nervous and digestive systems. The gut is not only influenced by the brain, but also influences the brain. …

A growing body of literature suggests that obsessive-compulsive disorder (OCD) is a heterogeneous condition. The studies investigating symptom dimensions have been limited by numerous methodological differences and sample characteristics. The purpose of this study was to compare the two most commonly applied statistical techniques used in addressing this question in the same large cohort of individuals with OCD. Both cluster analysis and factor analysis were used to examine OCD symptom data as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Symptom Checklist for 355 individuals with a primary diagnosis of OCD. The factor analysis revealed a three-factor model best described as symmetry obsessions/ordering compulsions, contamination obsessions/cleaning compulsions and aggressive obsessions/checking compulsions. In contrast, the cluster analysis yielded a stable four-cluster solution best described as symmetry obsessions/ordering compulsions, contamination obsessions/cleaning compulsions, aggressive-somatic-religious obsessions/checking compulsions and a mixed symptom profile. Although there was overlap in the models resulting from these two statistical approaches, cluster analysis better captured the dimensional nature of OCD by demonstrating the prevalence of symptom categories in each subgroup. Though both analyses are capable of providing similar outputs, the validity of these results is limited given the input of a priori symptom categories from the Y-BOCS.

Background The study of seasonal patterns of public interest in psychiatric disorders has important theoretical and practical implications for service planning and delivery. The recent explosion of internet searches suggests that mining search databases yields unique information on public interest in mental health disorders, which is a significantly more affordable approach than population health studies. Objective This study aimed to investigate seasonal patterns of internet mental health queries in Ontario, Canada. Methods Weekly data on health queries in Ontario from Google Trends were downloaded for a 5-year period (2012-2017) for the terms “schizophrenia,” “autism,” “bipolar,” “depression,” “anxiety,” “OCD” (obsessive-compulsive disorder), and “suicide.” Control terms were overall search results for the terms “health” and “how.” Time-series analyses using a continuous wavelet transform were performed to isolate seasonal components in the search volume for each term. Results All mental health queries showed significant seasonal patterns with peak periodicity occurring over the winter months and troughs occurring during summer, except for “suicide.” The comparison term “health” also exhibited seasonal periodicity, while the term “how” did not, indicating that general information seeking may not follow a seasonal trend in the way that mental health information seeking does. Conclusions Seasonal patterns of internet search volume in a wide range of mental health terms were observed, with the exception of “suicide.” Our study demonstrates that monitoring internet search trends is an affordable, instantaneous, and naturalistic method to sample public interest in large populations and inform health policy planners.

BACKGROUND The study of seasonal patterns of public interest in psychiatric disorders has important theoretical and practical implications for service planning and delivery. The recent explosion of internet searches suggests that mining search databases yields unique information on public interest in mental health disorders, which is a significantly more affordable approach than population health studies. OBJECTIVE This study aimed to investigate seasonal patterns of internet mental health queries in Ontario, Canada. METHODS Weekly data on health queries in Ontario from Google Trends were downloaded for a 5-year period (2012-2017) for the terms “schizophrenia,” “autism,” “bipolar,” “depression,” “anxiety,” “OCD” (obsessive-compulsive disorder), and “suicide.” Control terms were overall search results for the terms “health” and “how.” Time-series analyses using a continuous wavelet transform were performed to isolate seasonal components in the search volume for each term. RESULTS All mental health queries showed significant seasonal patterns with peak periodicity occurring over the winter months and troughs occurring during summer, except for “suicide.” The comparison term “health” also exhibited seasonal periodicity, while the term “how” did not, indicating that general information seeking may not follow a seasonal trend in the way that mental health information seeking does. CONCLUSIONS Seasonal patterns of internet search volume in a wide range of mental health terms were observed, with the exception of “suicide.” Our study demonstrates that monitoring internet search trends is an affordable, instantaneous, and naturalistic method to sample public interest in large populations and inform health policy planners.

Background:Transdiagnostic psychotherapies are designed to apply the same underlying treatment principles across a set of psychiatric disorders, without significant tailoring to specific diagnoses. Several transdiagnostic psychotherapy protocols have been developed recently, each of which has its own strengths and weaknesses. One promising treatment is Transdiagnostic Behaviour Therapy (TBT), in that it is one of the few transdiagnostic treatments to date shown to be effective in patients with depressive and anxiety disorders. However, TBT has only been investigated via individual psychotherapy.Aims:The present study investigated the effectiveness of a group protocol for TBT, compared with disorder-specific group psychotherapies, in a naturalistic setting.Method:109 participants with various diagnoses of affective disorders completed either group TBT (n= 37) or a disorder-specific group psychotherapy (n= 72). Measures included assessments of psychiatric symptomatology and transdiagnostic impairment at baseline and post-treatment.Results:Overall, participants in the TBT group demonstrated significant improvements across all measures. When compared with disorder-specific groups, no statistical differences were observed between groups across symptoms; however, participants in the TBT group demonstrated roughly twice the treatment effect sizes in transdiagnostic impairment compared with participants in the disorder-specific groups. In addition, when participants from the most well-represented diagnosis and disorder-specific treatment (social anxiety disorder) were investigated separately, participants in the TBT group demonstrated significantly larger improvements in comorbid depressive symptoms than participants in the disorder-specific treatment.Conclusions:Pending replication and additional comparison studies, group TBT may provide an effective group treatment option for patients with affective disorders.

Specific phobia and social anxiety disorder (SAD) share a number of features, but the focus of fear distinguishes between these anxiety disorders. In specific phobia, the excessive fear is focused on a particular situation or object, whereas in SAD, it is focused on one or more social and performance situations in which the individual fears acting in a way that will be embarrassing or lead to negative evaluation by others or revealing unbecoming personal attributes. The chapter focuses on the assessment of specific phobia and SAD in adults. It begins with a review of the nature of the disorders, which is followed by a review of clinical assessment instruments designed for the assessment purposes of (a) diagnosis, (b) case conceptualization and treatment planning, and (c) treatment monitoring and evaluation. Recommendations are included for instruments with the greatest scientific support and for assessing these anxiety disorders in a clinically sensitive manner.

The current study examined changes in anxiety sensitivity following cognitive behavior therapy as a predictor of treatment outcome in patients with social anxiety disorder (SAD) and patients with panic disorder (PD). One-hundred ninety-seven patients with a principal diagnosis of SAD (n = 108) or PD (n = 89) completed the Anxiety Sensitivity Index (ASI; Reiss et al in Behav Res Ther 24:1–8, 1986), Depression Anxiety Stress Scales (DASS-21; Lovibond and Lovibond in Behav Res Ther 33:335–343, 1995), Social Phobia Inventory (SPIN; Connor et al in Br J Psychiatry 176:379–386, 2000) and Panic Disorder Severity Scale-Self Report (PDSS-SR; Houck et al in Depress Anxiety 15:183–185, 2002; Shear et al in Am J Psychiatry 154:1571–1575, 1997) pre and post disorder specific treatment. For the SAD group, changes on ASI Physical and ASI Social subscales made significant contributions to the prediction of posttreatment social anxiety symptoms over and above pretreatment social anxiety symptoms and changes in depression scores. For the PD group, changes on the ASI Physical subscale made a significant contribution to the prediction of posttreatment panic symptoms over and above pretreatment panic symptoms and changes in depression scores. The present study provides further support that, while the global construct of anxiety sensitivity is a transdiagnostic factor across the anxiety disorders, the lower-order dimensions of anxiety sensitivity have specificity for particular anxiety disorders.

Background: Post-event processing (PEP) occurs when individuals engage in cognitive rumination following an event or interaction. Although the relation between PEP and social anxiety has been clearly demonstrated, it remains unclear whether PEP is limited to individuals with elevated social anxiety, or if it is also problematic among people with other anxiety presentations. Aims: The present study assessed PEP after the first session of group cognitive behavioural therapy (CBT) in individuals with a variety of anxiety presentations. Method: Participants with a principal diagnosis of SAD (N = 25), those diagnosed with a principal other anxiety disorder with comorbid SAD (N = 18), and those with principal other anxiety diagnoses with no SAD (N = 43) completed baseline measures of social anxiety severity and state anxiety at their first session of CBT and measures of PEP one week later. Results: Participants with a principal diagnosis of SAD experienced the most PEP in the week following the first CBT session, while those with no comorbid SAD experienced the least. Those with comorbid SAD experienced intermediate levels of PEP. The strongest predictor of PEP was state anxiety during the first session. Conclusions: Results suggest that PEP is more problematic for clients with SAD as part of their clinical presentation. Clinical and theoretical implications are discussed.

Problem hoarding is associated with significant family dysfunction and burden on family members. Currently, little is known about the effect that family members have on individuals' hoarding symptoms and functioning, and vice versa. The present study examined the nature and frequency of accommodation in hoarding. Fifty-two individuals with self-reported hoarding problems and their close significant others (CSOs) completed the Family Accommodation Interview for Hoarding (FAI-H), which was adapted from a previously validated measure for this study, and a series of self-report questionnaires. The FAI-H was found to be a reliable and valid measure of accommodation in problem hoarding. CSOs who lived with the individual with the hoarding problem reported engaging in accommodating behaviors more frequently than those who did not live with the individual. Accommodation was positively associated with hoarding symptom severity, relationship functioning, and CSOs' rejecting attitudes toward the individual with hoarding problems, and it partially mediated the association between hoarding symptom severity and relationship conflict. These results inform our understanding of accommodation and interpersonal processes in hoarding, and suggest that accommodation may play an important role in problem hoarding.