Journal of Anxiety Disorders最新文献

{"title":"“To die, to sleep”: A systematic review and meta-analysis of the relationship between death anxiety and sleep","authors":"Rachel E. Menzies,&nbsp;Jessie Brown,&nbsp;Jye Marchant","doi":"10.1016/j.janxdis.2025.103001","DOIUrl":"10.1016/j.janxdis.2025.103001","url":null,"abstract":"<div><div>Poor sleep has long been established as both a symptom and cause of psychopathology. Similarly, death anxiety has attracted growing attention for its transdiagnostic role in mental illnesses, particularly anxiety-related disorders. However, the relationship between death anxiety and sleep has not been systematically explored. This systematic review and meta-analysis examined the relationship between sleep and death anxiety. In total, 15 studies were included in this review, representing a total sample size of 2786 participants. A review of these studies revealed that death anxiety was significantly associated with a number of sleep outcomes, particularly insomnia and poor sleep quality. Mixed results were found regarding the relationship between death anxiety and nightmare frequency. A meta-analysis of seven studies revealed a significant but small relationship between death anxiety and sleep problems (<em>r</em> = .225). Neither gender nor age emerged as a significant moderator of this relationship. These studies were generally of moderate quality, and there was limited evidence of publication bias. The current findings support the relationship between death anxiety and sleep. Further research is needed to clarify the direction of this effect, and whether targeting one in treatment may produce direct improvements in the other.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"112 ","pages":"Article 103001"},"PeriodicalIF":4.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143767923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Find your rhythm and regulate: Breath-synced vibration feedback during breath-focused mindfulness reduces respiration variability in trauma-exposed adults","authors":"Timothy J. McDermott ,&nbsp;Greg J. Siegle ,&nbsp;Alfonsina Guelfo ,&nbsp;Kayla Huynh ,&nbsp;Maya C. Karkare ,&nbsp;Rebecca Krawczak ,&nbsp;Amanda Johnston ,&nbsp;Aziz Elbasheir ,&nbsp;Travis M. Fulton ,&nbsp;Jacob Semerod ,&nbsp;Divya Jagadeesh ,&nbsp;Emma C. Lathan ,&nbsp;Robert T. Krafty ,&nbsp;Negar Fani","doi":"10.1016/j.janxdis.2025.103008","DOIUrl":"10.1016/j.janxdis.2025.103008","url":null,"abstract":"<div><div>Stress and anxiety are associated with increased autonomic arousal, including altered respiration. Breath-focused mindfulness meditation can reduce stress and anxiety, but trauma-exposed adults with dissociation have difficulty engaging in this practice. Our ongoing clinical trial examines if vibration-augmented breath-focused mindfulness (VABF) can improve outcomes and increase engagement. Here, we tested if VABF reduces respiration rate (RR) or respiration variability (RV), and examined associations between RR, RV, and emotion ratings. 128 trauma-exposed adults (mean age = 30.21 years) with elevated dissociation volunteered and completed at least 50 % of intervention visits. Participants were randomized to one of four mindfulness meditation interventions: VABF (<em>n</em> = 34); breath-focus only (<em>n</em> = 33); vibration only (<em>n</em> = 34); open awareness (no vibration or breath-focus, <em>n</em> = 27). Results from linear mixed-effects models showed that VABF decreased RV across visits while all the other interventions showed increased RV across visits (<em>p</em> = .008; <em>η</em>_<em>p</em>² = .014), and RV was positively associated with both anxiety and anger ratings (<em>p</em>s &lt; .001; <em>r</em>s &gt; .125). Findings suggest RV is a meaningful metric for examining regulatory processes in clinical populations with elevated autonomic arousal and negative emotionality. They also show that RV is modifiable through VABF, which holds significant promise as an intervention to improve regulatory processes in trauma-exposed populations.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"112 ","pages":"Article 103008"},"PeriodicalIF":4.8,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the internal structure of intolerance of uncertainty? A network analysis approach","authors":"Igor Marchetti ,&nbsp;Lavinia Miriam Pedretti ,&nbsp;Sara Iannattone ,&nbsp;Ilaria Colpizzi ,&nbsp;Alessandra Farina ,&nbsp;Lisa Di Blas ,&nbsp;Marta Ghisi ,&nbsp;Gioia Bottesi","doi":"10.1016/j.janxdis.2025.102999","DOIUrl":"10.1016/j.janxdis.2025.102999","url":null,"abstract":"<div><h3>Background</h3><div>Intolerance of uncertainty (IU) is a well-established risk factor for anxiety disorders, as higher levels of IU increase the likelihood of future maladaptive outcomes. However, the presence of low levels of IU does not imply that maladaptive outcomes will not occur, as other risk factors can still lead to the onset of anxiety symptoms. Currently, it is unknown whether IU also serves as a necessary cause for anxiety symptoms, meaning that its absence would ensure the absence of these symptoms.</div></div><div><h3>Methods</h3><div>A sample of 186 adolescents (58.6 % boys) between 14 and 18 years of age (M = 16.58 ± 1.01) was followed for six months, with evaluations every three months. Several self-reports were administered to measure IU and general anxiety problems, derived from the Youth Self Report 11–18, and anxiety-specific symptoms, derived from the Self-Administered Psychiatric Scales for Children and Adolescents. The Necessary Condition Analysis approach was applied to determine the extent to which IU is a necessary condition for anxiety.</div></div><div><h3>Findings</h3><div>The analyses revealed that IU is a necessary condition for anxiety problems (<em>d</em> =.23 −.24), generalized anxiety disorder symptoms (<em>d</em> =.18 −.19), social anxiety disorder symptoms (<em>d</em> =.19 −.29), and school-related anxiety symptoms (<em>d</em> =.19 −.23) after three and six months. However, IU was not a statistically significant necessary condition for separation anxiety disorder symptoms. At baseline, between 29 % and 70 % of the sample exhibited the necessary levels of IU to potentially experience subclinical anxiety symptoms at subsequent follow-ups.</div></div><div><h3>Discussion</h3><div>IU is a necessary condition for the potential development of anxiety symptoms during adolescence. Recognizing necessary conditions for anxiety symptoms and mental disorders, in general, could lead to substantial progress, given its impact on enhancing our theoretical understanding and improving prevention strategies and clinical treatments.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"112 ","pages":"Article 102999"},"PeriodicalIF":4.8,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"And then one day you find ten years have got behind you\": Reflections on a Decade as Editor-in-Chief.","authors":"Gordon J G Asmundson","doi":"10.1016/j.janxdis.2025.103007","DOIUrl":"https://doi.org/10.1016/j.janxdis.2025.103007","url":null,"abstract":"","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":" ","pages":"103007"},"PeriodicalIF":4.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing structural models for internalizing pathology: Latent dimensions, classes, or a mix of both?","authors":"Ana De la Rosa-Cáceres ,&nbsp;Leon P. Wendt ,&nbsp;Johannes Zimmermann ,&nbsp;Carmen Díaz-Batanero","doi":"10.1016/j.janxdis.2025.103006","DOIUrl":"10.1016/j.janxdis.2025.103006","url":null,"abstract":"<div><div>In recent decades, the conceptualization of internalizing problems has changed from categorical to dimensional and hybrid approaches. However, most studies have analyzed the structure of internalizing problems at the disorder level using categorical or dimensional approaches, with only a few studies examining the structure at the symptom level, or considering a hybrid approach. This study aimed to compare categorical (latent class analysis), dimensional (confirmatory factor analysis), and hybrid models (semi-parametric factor analysis) of internalizing constructs at the symptom level regarding model fit (structural validity) and prediction (concurrent validity) in four samples: community adults (<em>n</em> = 1072; <em>n</em> = 620), students (<em>n</em> = 378), and patients (<em>n</em> = 485). All participants completed the Inventory of Depression and Anxiety Symptoms-II to assess internalizing symptoms. In two samples, participants completed additional measures to test concurrent validity regarding disability, externalizing symptoms, personality traits, impairments in personality functioning, and quality of life. Dimensional models, particularly those allowing for non-normal distributions, outperformed categorical and hybrid models in terms of structural and concurrent validity (median _<em>adj</em><em>R</em>^<em>2</em> for dimensional models =.18–.16). Our results suggest that future studies should prefer dimensional models to better describe internalizing constructs and predict external variables. The consistent application of dimensional models of internalizing pathology would facilitate the integration of empirical findings in clinical science and enable a more valid and fine-grained assessment of individual mental health problems in clinical practice, thereby enhancing the potential to guide effective personalized interventions.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"111 ","pages":"Article 103006"},"PeriodicalIF":4.8,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does intolerance of uncertainty predict child generalised anxiety? A longitudinal study","authors":"Zoe J. Ryan ,&nbsp;Holly Rayson ,&nbsp;Jayne Morriss ,&nbsp;Helen F. Dodd","doi":"10.1016/j.janxdis.2025.103004","DOIUrl":"10.1016/j.janxdis.2025.103004","url":null,"abstract":"<div><div>Intolerance of uncertainty (IU) is the tendency to find uncertainty distressing. IU is related to anxiety in adults and youth but it is unclear whether IU plays a maintenance or causal role, particularly across childhood. Our research examined whether: (1) IU is associated with generalised anxiety in preschool-aged children; (2) IU in preschool-aged children is associated with the trajectory of generalised anxiety into middle childhood; and (3) IU is associated with the trajectory of internalising symptoms and externalising symptoms over time. Parents completed questionnaires (child anxiety, IU, internalising and externalising symptoms) about their children at three timepoints when their child was: 3–4 years old (<em>n</em> = 180); 5–7 years old (<em>n</em> = 162); and 8–10 years old (<em>n</em> = 148). Those with higher IU had higher concurrent generalised anxiety, internalising and externalising symptoms at each measurement point. Preschoolers with higher IU, relative to lower IU, had, on average, higher generalised anxiety across childhood. Unexpectedly though, children who were higher in IU as preschoolers were more likely to show a decrease in generalised anxiety over time. These findings indicate that IU is a consistent correlate of generalised anxiety, internalising and externalising symptoms, but that it may not play a causal role in the onset of generalised anxiety in children.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"112 ","pages":"Article 103004"},"PeriodicalIF":4.8,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143681595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emotion regulation difficulties in children and adolescents with obsessive-compulsive disorder: A multi-informant and multi-method study","authors":"Christine Lykke Thoustrup ,&nbsp;Robert James Blair ,&nbsp;Sofie Heidenheim Christensen ,&nbsp;Valdemar Uhre ,&nbsp;Linea Pretzmann ,&nbsp;Nicoline Løcke Jepsen Korsbjerg ,&nbsp;Camilla Uhre ,&nbsp;Anna-Rosa Cecilie Mora-Jensen ,&nbsp;Melanie Ritter ,&nbsp;Nicole Nadine Lønfeldt ,&nbsp;Emilie Damløv Thorsen ,&nbsp;Daniel S. Quintana ,&nbsp;Ahmad Sajadieh ,&nbsp;Jakob Hartvig Thomsen ,&nbsp;Kerstin Jessica Plessen ,&nbsp;Signe Vangkilde ,&nbsp;Anne Katrine Pagsberg ,&nbsp;Julie Hagstrøm","doi":"10.1016/j.janxdis.2025.103002","DOIUrl":"10.1016/j.janxdis.2025.103002","url":null,"abstract":"<div><div>Pediatric obsessive-compulsive disorder (OCD) is associated with emotion regulation (ER) difficulties. Most studies are based on self-reports, while few have examined how these difficulties are expressed across modalities, which may hold important diagnostic and therapeutic information. We applied a multi-informant and multi-method approach to examine ER difficulties in 211 children aged 8–17 years: 121 with OCD and 90 non-clinical controls. Child ER difficulties were assessed with The Difficulties in Emotion Regulation Scale (self-report and parent-report) and a Tangram frustration task with investigator-rated behavior, self-rated frustration, and heart rate variability (HRV). Children with OCD differed significantly from non-clinical controls in showing: (i) elevated child ER difficulties on self-report (partial eta squared =.068–.165) and parent-report (partial eta squared =.207–.369); (ii) more investigator-rated ER difficulties during the task (Cohen’s <em>d</em> = −.33); (iii) increased levels of self-rated frustration before and after the task (partial eta squared =.089); notably, the magnitude of this increase did not differ between children with and without OCD. Finally, (iv) all children, regardless of group, demonstrated significant HRV changes during the frustration task, with no discernible group differences in the magnitude of these changes. Results suggest the OCD-related experience of ER difficulties may not impact autonomic functioning.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"111 ","pages":"Article 103002"},"PeriodicalIF":4.8,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using machine learning methods to predict the outcome of psychological therapies for post-traumatic stress disorder: A systematic review","authors":"James Tait ,&nbsp;Stephen Kellett ,&nbsp;Jaime Delgadillo","doi":"10.1016/j.janxdis.2025.103003","DOIUrl":"10.1016/j.janxdis.2025.103003","url":null,"abstract":"<div><h3>Background</h3><div>A number of treatments are available for post-traumatic stress disorder (PTSD), however, there is currently a lack of data-driven treatment selection and adaptation methods for this condition. Machine learning (ML) could potentially help to improve the prediction of treatment outcomes and enable precision mental healthcare in practice.</div></div><div><h3>Objectives</h3><div>To systematically review studies that applied ML methods to predict outcomes of psychological therapy for PTSD in adults (e.g., change in symptoms, dropout rate), and evaluate their methodological rigour.</div></div><div><h3>Methods</h3><div>This was a pre-registered systematic review (CRD42022325021), which synthesised eligible clinical prediction studies found across four research databases. Risk of bias was assessed using the PROBAST tool. Study methods and findings were narratively synthesised, and adherence to ML best practice evaluated.</div></div><div><h3>Results</h3><div>Seventeen studies met the inclusion criteria, including samples derived from experimental and observational study designs. All studies were assessed as having a high risk of bias, notably due to inadequately powered samples and a lack of sample size calculations. Training sample size ranged from <em>N</em> &lt; 36–397. The studies applied a diverse range of ML methods such as decision trees, ensembling and boosting techniques. Five studies used unsupervised ML methods, while others used supervised ML. There was an inconsistency in the reporting of hyperparameter tuning and cross-validation methods. Only one study performed external validation.</div></div><div><h3>Conclusions</h3><div>ML has the potential to advance precision psychotherapy for PTSD, but to enable this, ML methods must be applied with greater adherence to best practice guidelines.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"112 ","pages":"Article 103003"},"PeriodicalIF":4.8,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143681596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal dynamics of costly avoidance in anxiety disorders: Faster threat and weaker reward impact during approach-avoidance decisions in patients","authors":"Juliane M. Boschet-Lange ,&nbsp;Valentina M. Glück ,&nbsp;Roxana Pittig ,&nbsp;Stefan Scherbaum ,&nbsp;Andre Pittig","doi":"10.1016/j.janxdis.2025.103005","DOIUrl":"10.1016/j.janxdis.2025.103005","url":null,"abstract":"<div><div>In anxiety disorders, approach-avoidance behavior is typically biased towards excessive, maladaptive avoidance despite costs and impairments (i.e., costly avoidance). Yet, little is known about the underlying decision dynamics that may contribute to such imbalanced behavior. The current study tested for altered temporal decision dynamics in patients with anxiety disorders compared to matched healthy controls in a task where avoiding an aversive stimulus conflicted with obtaining rewards. Participants chose repeatedly between a fixed safe/low reward and a threat/high reward option with varying threat (probability of an aversive stimulus presentation) and reward information (reward magnitude). Structured computer mouse movements required for choosing between options were tracked to capture the temporal dynamics of the decision process (i.e., when and how strongly threat and reward information influenced decision preference). The current study replicated elevated costly threat avoidance in patients with anxiety disorders compared to matched controls. Importantly, time-continuous multiple regression of mouse movements revealed altered temporal dynamics: patients showed a faster (but not stronger) impact of threat and a weaker impact of competing rewards. These findings highlight that not only biases in threat processes but also competing rewards may guide excessive avoidance and could be important treatment targets in anxiety disorders. Future research may support the external validity of these findings in real-life decisions and try to identify therapeutic strategies that allow to specifically target the attenuated impact of rewards and the accelerated impact of threat in patients.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"111 ","pages":"Article 103005"},"PeriodicalIF":4.8,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A randomized clinical trial investigating the clinical impact of a game-based digital therapeutic for social anxiety disorder","authors":"Jennifer de Rutte ,&nbsp;Sarah Myruski ,&nbsp;Elizabeth Davis ,&nbsp;Abigail Findley ,&nbsp;Tracy A. Dennis-Tiwary","doi":"10.1016/j.janxdis.2025.103000","DOIUrl":"10.1016/j.janxdis.2025.103000","url":null,"abstract":"<div><div>The objective of this study was to determine if a novel game-based digital therapeutic intervention reduced anxiety symptom severity in adults with clinically elevated symptoms of social anxiety disorder (SAD). Participants were randomly allocated (1:1) to receive four weeks of either the active intervention, a game-based form of attention bias modification (Active ABM) for anxiety, or the sham control training (Control). Between June 2022 to June 2023, 104 participants were enrolled with 93 completing the trial per-protocol and 104 included in the final intention-to-treat analysis (54 intervention, 50 control); mean age was 38.08 (10.56) years and 79 were female. The dependent variable was reduction in SAD symptoms, measured via the Liebowitz SAD Scale (LSAS). Participants were classified as having clinically elevated SAD symptoms only, or both SAD and Generalized Anxiety Disorder (GAD) symptoms (comorbid). The Active condition induced significantly greater reductions in SAD symptoms compared to the Control condition between Baseline and Post-Treatment [Active: <em>M</em> = -29.71, <em>SD</em> = 23.68; Control: <em>M</em> = -14.59, <em>SD</em> = 21.52, <em>d</em> = .67, <em>t</em>(102) = -3.40, <em>p</em> &lt; .001] across the four-week study period. While no significant between-groups differences emerged at each timepoint individually, the Active condition induced significantly greater change over time in SAD symptoms compared to the Control condition. Use of this game-based digital ABM intervention showed benefits in the reduction of anxiety symptoms.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"111 ","pages":"Article 103000"},"PeriodicalIF":4.8,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143592502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}