Journal of Anxiety Disorders最新文献

{"title":"Things You Do: A randomized controlled trial of an unguided ultra-brief intervention to reduce symptoms of depression and anxiety","authors":"Madelyne A. Bisby ,&nbsp;Victoria Barrett ,&nbsp;Lauren G. Staples ,&nbsp;Olav Nielssen ,&nbsp;Blake F. Dear ,&nbsp;Nickolai Titov","doi":"10.1016/j.janxdis.2024.102882","DOIUrl":"https://doi.org/10.1016/j.janxdis.2024.102882","url":null,"abstract":"<div><p>The ‘Things You Do’ encompass five types of actions that are strongly associated with good mental health: Healthy Thinking, Meaningful Activities, Goals and Plans, Healthy Habits, and Social Connections. Ultra-brief interventions which increase how often people perform these actions may decrease depression and anxiety. A two-arm randomized controlled trial (N = 349) compared an unguided ultra-brief intervention based on the ‘Things You Do’ against a waitlist control. The intervention included one online module, two practice guides, and four weeks of daily text messages. The primary timepoint was 5-weeks post-baseline. The intervention resulted in moderate reductions in depression (<em>d</em> = 0.51) and anxiety (<em>d</em> = 0.55) alongside moderate increases in the frequency of Things You Do actions (<em>d</em> = 0.54), compared to controls. No significant change in number of days out of role or life satisfaction were observed. Treatment completion was high (92 %), most participants reported being satisfied with the treatment (66 %), and improvements were maintained at 3-month follow-up. This study demonstrated that an automated ultra-brief ‘Things You Do’ intervention resulted in clinically significant reductions in depression and anxiety. Ultra-brief interventions may provide a scalable solution to support individuals who are unlikely to engage in longer forms of psychological treatment.</p></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"105 ","pages":"Article 102882"},"PeriodicalIF":10.3,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0887618524000586/pdfft?md5=3b3039af1d06393fde2a9265a79bb1e6&pid=1-s2.0-S0887618524000586-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141286095","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":"Anhedonia is associated with overgeneralization of conditioned fear during late adolescence and early adulthood","authors":"Benjamin M. Rosenberg ,&nbsp;Katherine S. Young ,&nbsp;Robin Nusslock ,&nbsp;Richard E. Zinbarg ,&nbsp;Michelle G. Craske","doi":"10.1016/j.janxdis.2024.102880","DOIUrl":"10.1016/j.janxdis.2024.102880","url":null,"abstract":"<div><h3>Background</h3><p>Pavlovian fear paradigms involve learning to associate cues with threat or safety. Aberrances in Pavlovian fear learning correlate with psychopathology, especially anxiety disorders. This study evaluated symptom dimensions of anxiety and depression in relation to Pavlovian fear acquisition and generalization.</p></div><div><h3>Methods</h3><p>256 participants (70.31 % female) completed a Pavlovian fear acquisition and generalization paradigm at ages 18–19 and 21–22 years. Analyses focused on indices of learning (self-reported US expectancy, skin conductance). Multilevel models tested associations with orthogonal symptom dimensions (Anhedonia-Apprehension, Fears, General Distress) at each timepoint.</p></div><div><h3>Results</h3><p>All dimensions were associated with weaker acquisition of US expectancies at each timepoint. Fears was associated with overgeneralization only at age 21–22. General Distress was associated with overgeneralization only at age 18–19. Anhedonia-Apprehension was associated with overgeneralization at ages 18–19 and 21–22.</p></div><div><h3>Conclusions</h3><p>Anhedonia-Apprehension disrupts Pavlovian fear acquisition and increases overgeneralization of fear. These effects may emerge during adolescence and remain into young adulthood. General Distress and Fears also contribute to overgeneralization of fear, but these effects may vary as prefrontal mechanisms of fear inhibition continue to develop during late adolescence. Targeting specific symptom dimensions, particularly Anhedonia-Apprehension, may decrease fear generalization and augment interventions built on Pavlovian principles, such as exposure therapy.</p></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"105 ","pages":"Article 102880"},"PeriodicalIF":10.3,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141130336","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":"Anxious youth and adults share threat-biased interpretations of linguistic and visual ambiguity: A proof of concept study","authors":"Michelle Rozenman ,&nbsp;Timothy D. Sweeny ,&nbsp;Delaney C. McDonagh,&nbsp;Emily L. Jones,&nbsp;Anni Subar","doi":"10.1016/j.janxdis.2024.102878","DOIUrl":"10.1016/j.janxdis.2024.102878","url":null,"abstract":"<div><p>Interpretation bias, or the threatening appraisal of ambiguous information, has been linked to anxiety disorder. Interpretation bias has been demonstrated for linguistic (e.g., evaluation of ambiguous sentences) and visual judgments (e.g., categorizing emotionally ambiguous facial expressions). It is unclear how these separate components of bias might be associated. We examined linguistic and visual interpretation biases in youth and emerging adults with (<em>n</em> = 44) and without (<em>n</em> = 40) anxiety disorder, and in youth-parent dyads (<em>n</em> = 40). Linguistic and visual biases were correlated with each other, and with anxiety. Compared to non-anxious participants, those with anxiety demonstrated stronger biases, and linguistic bias was especially predictive of anxiety symptoms and diagnosis. Age did not moderate these relationships. Parent linguistic bias was correlated with youth anxiety but not linguistic bias; parent and youth visual biases were correlated. Linguistic and visual interpretation biases are linked in clinically-anxious youth and emerging adults.</p></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"105 ","pages":"Article 102878"},"PeriodicalIF":10.3,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141138147","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":"Parent-coached exposure therapy versus cognitive behavior therapy for childhood anxiety disorders","authors":"Stephen P.H. Whiteside ,&nbsp;Bridget K. Biggs ,&nbsp;Jennifer R. Geske ,&nbsp;Lilianne M. Gloe ,&nbsp;Stephanie T. Reneson-Feeder ,&nbsp;Megan Cunningham ,&nbsp;Julie E. Dammann ,&nbsp;Elle Brennan ,&nbsp;Mian Li Ong ,&nbsp;Mark W. Olsen ,&nbsp;Deanna R. Hofschulte","doi":"10.1016/j.janxdis.2024.102877","DOIUrl":"https://doi.org/10.1016/j.janxdis.2024.102877","url":null,"abstract":"<div><p>Cognitive-behavioral therapy (CBT) is the strongest evidenced-based therapy for childhood anxiety disorders (CADs). However, CBT’s impact is limited by its lack of clear superiority over treatment as usual, excessive length, and greater than 50% of patients remaining symptomatic. Parent-coached exposure therapy (PCET) is designed to treat CADs more effectively and efficiently through a focus on exposure and working with parents and youth together. In a randomized controlled trial, 78 patients (78% female) aged 7 to 17 with CADs were assigned to PCET or the gold-standard CBT. The primary outcome was independent evaluator ratings of anxiety severity at mid- and post-treatment. Secondary outcomes were parent- and child-reported symptoms. Patients receiving PCET had significantly lower mean scores than those receiving CBT on the primary outcome measure at mid-treatment (3.03 ± 0.14, 95% CI, 2.75–3.32 vs. 3.77 ± 0.16 95% CI, 3.45–4.08, p = 0.0010) and post-treatment (2.79 ± 0.14, 95% CI, 2.50–3.07 vs. 3.33 ± 0.16, 95% CI, 2.02–3.64, p = 0.0153). Similar significant results were found with the secondary parent- and child-reported outcomes. These superior results were achieved in PCET with fewer sessions (6.62, SD = 2.8) than those in CBT (8.00, SD = 3.1), <em>p</em> = 0.041. The superior effectiveness and efficiency of PCET likely results from the greater focus on implementing exposure exercises compared to traditional CBT.</p></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"104 ","pages":"Article 102877"},"PeriodicalIF":10.3,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141084228","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":"Work-Related Cognitive Behavioral Therapy for racially and economically diverse unemployed persons with social anxiety: A randomized clinical trial","authors":"Joseph A. Himle ,&nbsp;Richard T. LeBeau ,&nbsp;Jennifer M. Jester ,&nbsp;Amy M. Kilbourne ,&nbsp;Addie Weaver ,&nbsp;Daphne M. Brydon ,&nbsp;Katherine M. Tucker ,&nbsp;Nicole Hamameh ,&nbsp;Natalie Castriotta ,&nbsp;Michelle G. Craske","doi":"10.1016/j.janxdis.2024.102875","DOIUrl":"10.1016/j.janxdis.2024.102875","url":null,"abstract":"<div><p>Individuals with Social Anxiety Disorder (SAD) are at risk for employment problems. This multi-site trial examined the efficacy of <u>W</u>ork-Related <u>C</u>ognitive <u>B</u>ehavioral <u>T</u>herapy provided alongside <u>v</u>ocational <u>s</u>ervices <u>a</u>s <u>u</u>sual (WCBT+VSAU), a group-based treatment designed to improve mental health and employment outcomes for individuals with SAD. Vocational service-seeking participants with SAD (N = 250) were randomized to either WCBT+VSAU or VSAU-alone. Hypotheses were that participants randomized to WCBT+VSAU would report less social anxiety, less depression, and more hours worked than participants randomized to VSAU-alone. WCBT+VSAU participants had significantly greater improvements on the Liebowitz Social Anxiety Scale (LSAS; <em>d</em>=−.25, CI=−0.49 to −0.02, p = .03) at post-assessment compared to VSAU-alone. The conditions did not differ on any variable at later time points or on secondary outcomes. Unexpectedly, participants randomized to VSAU-alone experienced LSAS improvements, similar to WCBT+VASU at later timepoints. Baseline psychological flexibility (beta=−.098 [−0.19–0.008]) and depression (beta=−0.18 [−0.34–0.009]) moderated change in social anxiety. Participants with lower psychological flexibility and higher depression responded more strongly to WCBT+VSAU than VSAU-alone over the duration of the study, suggesting that WCBT+VSAU may particularly benefit those with greater psychopathology. Results indicate that vocational centers are promising settings for treating SAD and employment-focused refinements are likely needed to improve work outcomes.</p></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"104 ","pages":"Article 102875"},"PeriodicalIF":10.3,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066634","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":"Distinct patterns of monocular advantage for facial emotions in social anxiety","authors":"Mengyuan Gong ,&nbsp;Chaoya Pan ,&nbsp;Ruibo Pan ,&nbsp;Xiaohua Wang ,&nbsp;Jiafeng Wang ,&nbsp;Han Xu ,&nbsp;Yuzheng Hu ,&nbsp;Jun Wang ,&nbsp;Ke Jia ,&nbsp;Qiaozhen Chen","doi":"10.1016/j.janxdis.2024.102871","DOIUrl":"https://doi.org/10.1016/j.janxdis.2024.102871","url":null,"abstract":"<div><p>Individuals with social anxiety often exhibit atypical processing of facial expressions. Previous research in social anxiety has primarily emphasized cognitive bias associated with face processing and the corresponding abnormalities in cortico-limbic circuitry, yet whether social anxiety influences early perceptual processing of emotional faces remains largely unknown. We used a psychophysical method to investigate the monocular advantage for face perception (i.e., face stimuli are better recognized when presented to the same eye compared to different eyes), an effect that is indicative of early, subcortical processing of face stimuli. We compared the monocular advantage for different emotional expressions (neutral, angry and sad) in three groups (N = 24 per group): individuals clinically diagnosed with social anxiety disorder (SAD), individuals with high social anxiety in subclinical populations (SSA), and a healthy control (HC) group of individuals matched for age and gender. Compared to SSA and HC groups, we found that individuals with SAD exhibited a greater monocular advantage when processing neutral and sad faces. While the magnitudes of monocular advantages were similar across three groups when processing angry faces, individuals with SAD performed better in this condition when the faces were presented to different eye. The former findings suggest that social anxiety leads to an enhanced role of subcortical structures in processing nonthreatening expressions. The latter findings, on the other hand, likely reflect an enhanced cortical processing of threatening expressions in SAD group. These distinct patterns of monocular advantage indicate that social anxiety altered representation of emotional faces at various stages of information processing, starting at an early stage of the visual system.</p></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"104 ","pages":"Article 102871"},"PeriodicalIF":10.3,"publicationDate":"2024-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140879914","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":"Metacognitive therapy versus exposure and response prevention for obsessive-compulsive disorder – A non-inferiority randomized controlled trial","authors":"Cornelia Exner ,&nbsp;Alexandra Kleiman ,&nbsp;Anke Haberkamp ,&nbsp;Jana Hansmeier ,&nbsp;Christopher Milde ,&nbsp;Julia Anna Glombiewski","doi":"10.1016/j.janxdis.2024.102873","DOIUrl":"https://doi.org/10.1016/j.janxdis.2024.102873","url":null,"abstract":"<div><h3>Objective</h3><p>Exposure with response prevention (ERP) is the first-line treatment for obsessive-compulsive disorder (OCD). However, refusals, dropouts and the required high time and logistic effort constitute barriers to the use of ERP. In a non-inferiority randomized controlled trial, we compared metacognitive therapy (MCT) to exposure with response prevention (ERP) as treatments for OCD.</p></div><div><h3>Method</h3><p>74 outpatients received 12 weekly sessions of either manualized MCT or ERP, with primary outcomes assessed by blinded assessors using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at pre-treatment, mid-treatment, post-treatment, and 6-month follow-up. Secondary outcomes included measures of depression and anxiety. Non-inferiority margin was specified at no less than <em>d</em> = 0.38 below the improvement reached by ERP, corresponding to a difference of about 3 points on the Y-BOCS.</p></div><div><h3>Results</h3><p>Drop-out rates were low (&lt;14%) and similar in both groups. Linear models indicated non-inferiority of MCT to ERP at post-treatment, but not at 6-month follow-up. While both groups showed comparable Y-BOCS improvements, the MCT group demonstrated a significantly greater reduction in state anxiety scores at post-treatment and follow-up.</p></div><div><h3>Conclusions</h3><p>Overall, MCT was not inferior to ERP, especially at post-treatment, suggesting it could be a treatment alternative. However, further research is needed to explore differential treatment indications.</p></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"104 ","pages":"Article 102873"},"PeriodicalIF":10.3,"publicationDate":"2024-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0887618524000495/pdfft?md5=caef3d97c88fe64eb485ebf0e8c8e2b1&pid=1-s2.0-S0887618524000495-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140901353","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":"Intensive longitudinal assessment following index trauma to predict development of PTSD using machine learning","authors":"Adam Horwitz ,&nbsp;Kaitlyn McCarthy ,&nbsp;Stacey L. House ,&nbsp;Francesca L. Beaudoin ,&nbsp;Xinming An ,&nbsp;Thomas C. Neylan ,&nbsp;Gari D. Clifford ,&nbsp;Sarah D. Linnstaedt ,&nbsp;Laura T. Germine ,&nbsp;Scott L. Rauch ,&nbsp;John P. Haran ,&nbsp;Alan B. Storrow ,&nbsp;Christopher Lewandowski ,&nbsp;Paul I. Musey Jr. ,&nbsp;Phyllis L. Hendry ,&nbsp;Sophia Sheikh ,&nbsp;Christopher W. Jones ,&nbsp;Brittany E. Punches ,&nbsp;Robert A. Swor ,&nbsp;Lauren A. Hudak ,&nbsp;Srijan Sen","doi":"10.1016/j.janxdis.2024.102876","DOIUrl":"https://doi.org/10.1016/j.janxdis.2024.102876","url":null,"abstract":"<div><p>There are significant challenges to identifying which individuals require intervention following exposure to trauma, and a need for strategies to identify and provide individuals at risk for developing PTSD with timely interventions. The present study seeks to identify a minimal set of trauma-related symptoms, assessed during the weeks following traumatic exposure, that can accurately predict PTSD. Participants were 2185 adults (Mean age=36.4 years; 64% women; 50% Black) presenting for emergency care following traumatic exposure. Participants received a ‘flash survey’ with 6–8 varying symptoms (from a pool of 26 trauma symptoms) several times per week for eight weeks following the trauma exposure (each symptom assessed ∼6 times). Features (mean, sd, last, worst, peak-end scores) from the repeatedly assessed symptoms were included as candidate variables in a CART machine learning analysis to develop a pragmatic predictive algorithm. PTSD (PCL-5 ≥38) was present for 669 (31%) participants at the 8-week follow-up. A classification tree with three splits, based on mean scores of nervousness, rehashing, and fatigue, predicted PTSD with an Area Under the Curve of 0.836. Findings suggest feasibility for a 3-item assessment protocol, delivered once per week, following traumatic exposure to assess and potentially facilitate follow-up care for those at risk.</p></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"104 ","pages":"Article 102876"},"PeriodicalIF":10.3,"publicationDate":"2024-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140894180","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":"No harmful effect of propranolol administered prior to fear memory extinction in rats and humans","authors":"Laura Luyten ,&nbsp;Anastasia Chalkia ,&nbsp;Anna Elisabeth Schnell ,&nbsp;Burcu Özcan ,&nbsp;Lu Leng ,&nbsp;Natalie Schroyens ,&nbsp;Lukas Van Oudenhove ,&nbsp;Wolf Vanpaemel ,&nbsp;Tom Beckers","doi":"10.1016/j.janxdis.2024.102870","DOIUrl":"https://doi.org/10.1016/j.janxdis.2024.102870","url":null,"abstract":"<div><p>Exposure therapy is an evidence-based treatment option for anxiety-related disorders. Many patients also take medication that could, in principle, affect exposure therapy efficacy. Clinical and laboratory evidence indeed suggests that benzodiazepines may have detrimental effects. Large clinical trials with propranolol, a common beta-blocker, are currently lacking, but several preclinical studies do indicate impaired establishment of safety memories. Here, we investigated the effects of propranolol given prior to extinction training in 9 rat studies (N = 215) and one human study (N = 72). A Bayesian meta-analysis of our rat studies provided strong evidence against propranolol-induced extinction memory impairment during a drug-free test, and the human study found no significant difference with placebo. Two of the rat studies actually suggested a small beneficial effect of propranolol. Lastly, two rat studies with a benzodiazepine (midazolam) group provided some evidence for a harmful effect on extinction memory, i.e., impaired extinction retention. In conclusion, our midazolam findings are in line with prior literature (i.e., an extinction retention impairment), but this is not the case for the 10 studies with propranolol. Our data thus support caution regarding the use of benzodiazepines during exposure therapy, but argue against a harmful effect of propranolol on extinction learning.</p></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"104 ","pages":"Article 102870"},"PeriodicalIF":10.3,"publicationDate":"2024-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140905985","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":"Fear of negative and positive evaluation as mediators and moderators of treatment outcome in social anxiety disorder","authors":"Amanda S. Morrison ,&nbsp;Philippe R. Goldin ,&nbsp;James J. Gross","doi":"10.1016/j.janxdis.2024.102874","DOIUrl":"https://doi.org/10.1016/j.janxdis.2024.102874","url":null,"abstract":"<div><h3>Introduction</h3><p>Elevated fear of negative evaluation (FNE) and fear of positive evaluation (FPE) are thought to play key roles in the maintenance of social anxiety disorder (SAD). Although efficacious therapies exist for SAD, the potential mediating and moderating effects of FNE and FPE on social anxiety treatment outcome have not been examined.</p></div><div><h3>Methods</h3><p>This sample comprised a secondary analysis of 210 individuals who participated in one of three randomized controlled trials for the treatment of SAD. Participants were randomized to: individual cognitive behavioral therapy (CBT), group CBT, community mindfulness-based stress reduction (MBSR), group MBSR, or they were randomized to waitlist and offered treatment after waitlist. Assessments were completed pre- and post-treatment/waitlist and, for the treatment groups, at three-month follow-up.</p></div><div><h3>Results</h3><p>CBT and MBSR led to greater reductions in FNE and FPE than waitlist, with CBT more efficacious in reducing FPE than MBSR. For both CBT (vs. waitlist) and MBSR (vs. waitlist), there were significant indirect effects on post-treatment social anxiety through both FNE and FPE, and the indirect effect through FPE was greater for CBT than MBSR. However, in the fully longitudinal model testing mediation, CBT and MBSR were not differentially mediated by FPE. Baseline FNE and FPE each moderated CBT treatment outcome compared to waitlist – higher baseline FNE and FPE were associated with higher baseline social anxiety and greater reductions in social anxiety during CBT.</p></div><div><h3>Discussion</h3><p>FNE and FPE contributed in sometimes similar and sometimes distinct ways to the mediation and moderation of psychosocial approaches for treating SAD. This supports the importance of distinguishing between fears of negative and positive evaluation in the assessment and treatment of SAD.</p></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"104 ","pages":"Article 102874"},"PeriodicalIF":10.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0887618524000501/pdfft?md5=5580ab63d135da502baf04bcac5e0b5f&pid=1-s2.0-S0887618524000501-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140948708","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}